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The Recognition Page - The symptoms of Bipolar Disorder

Bipolar disorder involves cycles of mania and depression. Over the course of the illness, the person experiences periods of elevated mood, periods of depressed mood, and times when mood is normal. There are four different kinds of mood episodes that occur in bipolar disorder. Manic-depressive illness is often not recognized by the patient, relatives, friends, or even by physicians.

Mania (manic episode)
Hypomania (hypomanic episode)
Depression (major depressive episode)

Mixed Episode

Mania (manic episode)

Mania often begins with a pleasurable sense of heightened energy, creativity, and social ease. However, these feelings quickly progress to full-blown euphoria (extremely elevated mood) or severe irritability. People with mania typically lack insight, deny that anything is wrong, and angrily blame anyone who points out a problem. In a manic episode, the following symptoms are present for at least one week and make it very difficult for the person to function. These include discrete periods of:

  • Increased energy, activity, restlessness, racing thoughts, and rapid talking
  • Excessive "high" or euphoric feelings
  • Extreme irritability and distractibility
  • Decreased need for sleep
  • Unrealistic beliefs in one's abilities and powers
  • Uncharacteristically poor judgment
  • A sustained period of behaviour that is different from usual
  • Increased sexual drive
  • Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
  • Provocative, intrusive, or aggressive behaviour

Hypomania (hypomanic episode)

Hypomania is a milder form of mania that has similar but less severe symptoms and causes less impairment. During a hypomanic episode, the person may have an elevated mood, feel better than usual, and be more productive. These episodes often feel good and the quest for hypomania may even cause some individuals with bipolar disorder to stop their medication. Thus, even when friends and family learn to recognize the mood swings, the individual will often deny that anything is wrong. However, hypomania can rarely be maintained indefinitely, and is often followed by an escalation to mania or a crash to depression.

Depression (major depressive episode)

In a major depressive episode, the following symptoms are present for at least two weeks and make it difficult for the person to function. Signs and symptoms include:

  • Persistent sad, anxious, or empty mood
  • Feelings of hopelessness or pessimism
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in ordinary activities, including sex
  • Decreased energy, a feeling of fatigue or being "slowed down"
  • Difficulty concentrating, remembering, making decisions
  • Restlessness or irritability
  • Sleep disturbances
  • Loss of appetite and weight, or weight gain
  • Chronic pain or other persisting bodily symptoms that are not caused by physical disease
  • Thoughts of death or suicide; suicide attempt

Mixed Episode

Perhaps the most disabling episodes are those that involve symptoms of both mania and depression occurring at the same time or alternating frequently during the day. Individuals are excitable or agitated as in mania but also feel irritable and depressed. Owing to the combination of high energy and depression, mixed episodes present the greatest risk of suicide.

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© Mark Hannant
Published 2nd May 2001