These episodes alternate with periods of normal mood, as well as periods of depression. During depressive episodes, there is typically a lack of energy and motivation, irritability, sadness, and a feeling of hopelessness. In between manias and depressions, there can be periods where the patient seems normal, balanced, and in control. A small percentage of bipolar patients do, however, experience chronic residual symptoms.
The early designation for this condition was “manic depression.” Now, it is called bipolar disorder to indicate polar opposites, or shifts in mood and perception.
The defining symptom of bipolar disorder is alternating cycles of mania and depression.
In the manic phase, behaviors include:
- Dramatic increase in energy with a decreased need for sleep
- Racing thoughts that are sometimes expressed during rapid-fire conversation
- Feelings of being “high” or euphoric — as if they could do almost anything
- Easy distractibility and sometimes irritability
- Poor judgment — for example, purchasing things one can’t afford or use
- An increased need for sex and reckless sexual behaviors
- Alcohol or drug abuse, particularly cocaine and sleeping pills
- Aggressive behavior, sometimes provocative
- Denial that anything is wrong or different
In the depressive phase, behaviors include:
- Persistent sadness, anxiety, or a feeling of despair
- Pessimism or hopelessness that is not justified by circumstances
- Feelings of guilt, worthlessness, or helplessness
- Extreme fatigue, loss of interest in pleasurable activities
- Decreased interest in sexSleep disturbances
- Food issues, loss of appetite and weight or increased appetite and weight gain
- Suicidal thoughts or attempts
A true manic episode is diagnosed if an elevated mood occurs with three or more of the symptoms related to sleep, energy, thinking, and behavior most of the day, nearly every day, for at least one week, and the symptoms interfere with someone’s ability to function. If irritability is present, then four or more symptoms are required for diagnosis.
A depressive episode is said to exist if five or more depressive symptoms exist for most of the day, every day, for two weeks or more.
A psychiatrist is usually the type of doctor who makes the determination of bipolar disorder. Frequently blood and urine tests are done to rule out drug use as the cause of symptoms, or certain illnesses such as thyroid disorder.
Bipolar II disorder defines those who never experience severe mania; instead the high periods (called hypomania) are milder, do not impair functioning, and more often involve extensive time spent with depression.
A subtype of both forms of bipolar disorder is rapid cycling, which defines patients with bipolar I or II disorder who experience four or more bipolar episodes within 12 months. Some researchers believe that “mini” episodes can occur as frequently as within one week or even within one day, although the meaning and classification of such frequent mood shifts is controversial and not well-understood. A pattern of rapid cycling can come and go at any point in the course of bipolar I or II disorder, and appears to be more common among women.
For mania, common treatments include mood stabilizers such as lithium, Depakote, and Tegretol, as well as antipsychotic medications and/or the tranquilizers like benzodiazepines. While hospitalization was once considered necessary during this phase, more patients are being treated with outpatient care.
Treatment for depressive episodes can include lithium and/or certain anticonvulsive drugs, as well as the atypical antipsychotics Latuda (lurasidone), Seroquel (quetiapine), and Symbyax (olanzapine-fluoxetine combination). Sometimes, the combination of lithium or an anticonvulsant drug plus an antidepressant can be helpful, although antidepressants in general have not been proven to be effective for the treatment of bipolar depression.
In addition to medication, psychosocial treatment like cognitive therapy can be helpful for support education and guidance.
When medications and psychotherapy are not effective, electroconvulsive therapy (ECT) or “shock treatments” is said to help 75% of patients who try it.
The hormonal changes of perimenopause and menopause can sometimes worsen symptoms of bipolar disorder, although hormone therapy is not a proven treatment for mood symptoms of bipolar disorder. Additionally, changes in medication regimens may become necessary during this time to offset the effects of changing hormones.