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The Basics

Bipolar disorder (also known as manic depression) is a treatable illness marked by extreme changes in mood, thought, energy and behavior. It is not a character flaw or a sign of personal weakness. Bipolar disorder is also known as manic depression because a person’s mood can alternate between the "poles" mania (highs) and depression (lows). This change in mood or "mood swing" can last for hours, days weeks or months.

Bipolar disorder affects more than two million adult Americans. It usually begins in late adolescence (often appearing as depression during teen years) although it can start in early childhood or later in life. An equal number of men and women develop this illness (men tend to begin with a manic episode, women with a depressive episode) and it is found among all ages, races, ethnic groups and social classes. The illness tends to run in families and appears to have a genetic link. Like depression and other serious illnesses, bipolar disorder can also negatively affect spouses and partners, family members, friends and coworkers.

Symptoms of Bipolar Disorder

Bipolar disorder differs significantly from clinical depression, although the symptoms for the depressive phase of the illness are similar. Most people who have bipolar disorder talk about experiencing "highs" and "lows" – the highs are periods of mania, the lows periods of depression. These swings can be severe, ranging from extreme energy to deep despair. The severity of the mood swings and the way they disrupt normal life activities distinguish bipolar mood episodes from ordinary mood changes.

Symptoms of mania - the "highs" of bipolar disorder

  • Increased physical and mental activity and energy
  • Heightened mood, exaggerated optimism and self-confidence
  • Excessive irritability, aggressive behavior
  • Decreased need for sleep without experiencing fatigue
  • Grandiose delusions, inflated sense of self-importance
  • Racing speech, racing thoughts, flight of ideas
  • Impulsiveness, poor judgment, distractibility
  • Reckless behavior
  • In the most severe cases, delusions and hallucinations

Symptoms of depression - the "lows" of bipolar disorder

  • Prolonged sadness or unexplained crying spells
  • Significant changes in appetite and sleep patterns
  • Irritability, anger, worry, agitation, anxiety
  • Pessimism, indifference
  • Loss of energy, persistent lethargy
  • Feelings of guilt, worthlessness
  • Inability to concentrate, indecisiveness
  • Inability to take pleasure in former interests, social withdrawal
  • Unexplained aches and pains
  • Recurring thoughts of death or suicide


If you or someone you know has thoughts of death or suicide, contact a medical professional, clergy member, loved one, friend or hospital emergency room or call 911 immediately.

You cannot diagnose yourself. Only a properly trained health professional can determine if you have bipolar disorder. Our online self-assessment can help you communicate your symptoms to your health care professional.

Many people do not seek medical attention during periods of mania because they feel manic symptoms (increased energy, heightened mood, increased sexual drive, etc.) have a positive impact on them. However, left unchecked, these behaviors can have harmful results.

When symptoms of mania are left untreated, they can lead to illegal or life-threatening situations because mania often involves impaired judgment and reckless behavior. Manic behaviors vary from person to person. All symptoms should be discussed with your doctor. (top)

Types of Bipolar Disorder
Patterns and severity of symptoms, or episodes, of highs and lows, determine different types of bipolar disorder.

Bipolar I disorder is characterized by one or more manic episodes or mixed episodes (symptoms of both a mania and a depression occurring nearly every day for at least 1 week) and one or more major depressive episodes. Bipolar I disorder is the most severe form of the illness marked by extreme manic episodes.

Bipolar II disorder is characterized by one or more depressive episodes accompanied by at least one hypomanic episode. Hypomanic episodes have symptoms similar to manic episodes but are less severe, but must be clearly different from a person’s non-depressed mood. For some, hypomanic episodes are not severe enough to cause notable problems in social activities or work. However, for others, they can be troublesome.

Bipolar II disorder may be misdiagnosed as depression if you and your doctor don’t notice the signs of hypomania. In a recent DBSA survey, nearly seven out of ten people with bipolar disorder had been misdiagnosed at least once. Sixty percent of those people had been diagnosed with depression.

How can I spot hypomania? Talk to your doctor about the possibility of hypomania if you’ve had periods of several days when your mood is especially energetic or irritable, and/or

  • You feel unusually confident
  • You need less sleep *You are unusually talkative
  • Your thoughts come and go faster than usual
  • You are more easily distracted or have trouble concentrating
  • You are more goal-directed at work, school or home
  • You are more involved in pleasurable or high-risk activities, such as spending or sex
  • You feel like you’re doing or saying things that are unlike your usual self
  • Other people say you’re acting strangely or you’re not yourself

Cyclothymic disorder is characterized by chronic fluctuating moods involving periods of hypomania and depression. The periods of both depressive and hypomanic symptoms are shorter, less severe, and do not occur with regularity as experienced with bipolar II or I. However, these mood swings can impair social interactions and work. Many, but not all, people with cyclothymia develop a more severe form of bipolar illness.

There is also a form of the illness called bipolar disorder not otherwise specified (NOS) that does not fit in to one of the above definitions.

Because bipolar disorder is complex and can be difficult to diagnose, you should share all of your symptoms with your health care provider. If you feel your symptoms are not getting better with your current treatment and your doctor does not want to try something new, do not hesitate to see another doctor to get a second opinion.

Treatments for Bipolar Disorder
Several therapies exist for bipolar disorder and promising new treatments are currently under investigation. Because bipolar disorder can be difficult treat, it is highly recommended that you consult a psychiatrist or a general practitioner with experience in treating this illness. Your treatment may include medications and talk therapy.

Be sure to tell your health care providers all of the symptoms you are having. Report all of the symptoms you have had in the past, even if you don’t have them at the time of your appointment. Since these illnesses can run in families, look at your family history. Tell your health care provider if any of your family members experienced severe mood swings, were diagnosed with a mood disorder, had “nervous breakdowns” or were treated for alcohol or drug abuse. With the right diagnosis, you and your doctor have a better chance of finding a treatment that is right for you.

Helping a Friend
One of the most important thing family and friends can do for a person with bipolar disorder is learn about the illness. Often people who are depressed or experiencing mania or mood swings do not recognize the symptoms in themselves. If you are concerned about a friend or family member, help him or her get an appropriate diagnosis and treatment. This may involve helping the person to find a doctor or therapist and make their first appointment. You may also want to offer go with the person to their first appointment for support. Encourage the individual to stay with treatment. Keep reassuring the person that, with time and help, he or she will feel better.

It is also important to offer emotional support. This involves understanding, patience, affection, and encouragement. Engage the person in conversation and listen carefully. Resist the urge to function as a therapist or try to come up with answers to the person’s concerns. Often times we just want someone to listen. Do not put down feelings expressed, but point out realities and offer hope. Invite the depressed person for walks, outings, to the movies, and other activities. Be gently insistent if your first invitation is refused.

It is often a good idea for the person with bipolar disorder to develop a plan should he or she experience severe manic or depressive symptoms. Such a plan might include contacting the person’s doctor, taking control of credit cards and car keys or increasing contact with the person until the severe episode has passed. Your plan should be shared with a trusted family member and/or friend. Keep in mind, however, that people with bipolar disorder, like all people, have good and bad days. Being in a bad mood one day is not necessarily a sign of an upcoming severe episode.

Never ignore remarks about suicide. Report them to the person's therapist. Do not promise confidentiality if you believe someone is close to suicide. If you think immediate self-harm is possible, contact their doctor or dial 911 immediately. Make sure the person discusses these feelings with his or her doctor.

© 2004 Depression and Bipolar Support Alliance. All rights reserved.


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