Bipolar Disorder: Not As Simple As Just Having Manic Depression.
- Megon Champion
- Jul 29
- 10 min read
Over the years, Bipolar Disorder type 1 (formerly known as manic depression) has become a very popular mental health condition to show in TV shows and movies. These shows tend to misrepresent the condition, mainly in the case of how they show the severity of the manic episodes. This leads to many actual sufferers of Bipolar Disorder, especially those who have the other types, having their symptoms downplayed or ignored as they are not as severe as what is portrayed in the media. Hopefully, this article can clear up some of these misconceptions and show that there is more to Bipolar Disorder than mania.
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What Is Bipolar Disorder?
Bipolar Disorder is a mental health condition and mood disorder. It is a lifelong condition and it causes shifts in mood, energy levels, thinking patterns and behaviour. These shifts can last anywhere from an hour to months and affect the ability of a person to carry out day-to-day tasks.
There are seven types of Bipolar Disorder, which include episodes of significant mood fluctuations known as hypomania/mania and depression. However, these episodes are not continuous, and Bipolar Disorder patients can have periods of normal moods known as euthymia.
What Are Manic And Depressive Episodes?
What Is A Manic Episode?
Mania is a condition where a person experiences a period of abnormal levels of irritability and elevated mood. They can also experience extreme changes in emotions, thoughts, energy, talkativeness and activity levels. These changes are noticeable from your usual self, and others will notice the change.
People in a manic state have lowered inhibitions and so may take part in activities that cause financial, physical or social harm. This could include driving recklessly, spending a lot of money or engaging in gambling.
In some extreme cases, people in a manic state can experience psychotic symptoms, such as delusions and hallucinations. This sometimes means that Bipolar Disorder can be difficult to distinguish from other disorders, such as schizophrenia or schizoaffective disorder.
What Is A Depressive Episode?
In a depressive episode, a person will experience a low or depressed mood. They may also find that they have a lack of interest in normal activities.
Bipolar Disorder sufferers during a depressive episode will also have the usual symptoms of depression, including:
Tiredness.
Changes in appetite.
Feelings of worthlessness and hopelessness.
The Types Of Bipolar Disorder.
There are seven types of Bipolar Disorder and co-classifications. Unfortunately, not all professionals agree on how to diagnose or classify the different types of Bipolar Disorder. A lot more research is needed in this area to help patients feel that they are being heard and that they are getting the right diagnosis for their symptoms.
Bipolar Type 1:
Have both mania and depression, although depression is not required for diagnosis.
Must have an episode of mania of at least a week long, or the episode of mania required hospitalisation.
Depressive episodes usually last two weeks.
Bipolar Type 2:
Have both hypomania and depression.
Have at least one depressive episode and a hypomanic episode of four days to get a diagnosis.
Hypomania is a less impairing form of mania.
Why Is Bipolar Type 2 Seen As More Debilitating?
Contrary to popular belief and media representation, Bipolar Type 2 is seen by medical professionals as the more debilitating of the two types. This is due to the chronic depression that is more common in Bipolar Type 2.
Cyclothymia:
Have experienced hypomania and depressive mood episodes over the last two years.
Have periods of normal mood (euthymia) that last less than eight weeks.
Symptoms are not severe enough to meet a Bipolar Type 1 or 2 diagnosis.
Cyclothymia can be a difficult diagnosis to receive. People feel as if their symptoms are not “severe” enough; however, cyclothymia can impact their day-to-day life in the same way as any other Bipolar diagnosis.
Rapid Cycling Bipolar:
This is linked with Types 1 and 2. It is not a stand-alone diagnosis.
Have experienced four or more depressive, manic, hypomanic or mixed episodes within a year.
This might mean:
You experience episodes that last months, weeks or days.
You experience episodes of mania or hypomania, followed by episodes of depression.
You feel stable for a few weeks between episodes.
People may experience Rapid Cycling at some periods of their lives but not at others.
Bipolar With Mixed Features:
This is linked with Types 1 and 2. It is not a stand-alone diagnosis.
When a person experiences hypomania/mania and depression at the same time or very close together.
Bipolar With Seasonal Pattern:
This is linked with Types 1 and 2. It is not a stand-alone diagnosis.
The time of year or the season affects the symptoms of the person.
Unspecified Bipolar:
The person’s symptoms don't quite fit into the diagnostic categories for other types of bipolar disorder.
However, this doesn’t mean:
Their symptoms are any less difficult.
They don’t need treatment or support.
Who Does Bipolar Disorder Affect?
Bipolar Disorder affects men and women equally, although differently. Women tend to have Bipolar Disorder with Rapid Cycling. This could be because of sex and thyroid hormones, and the higher tendency for women to be prescribed antidepressants.
Bipolar Disorder’s usual onset is at age 25, but it can show up as late as the 40s or 50s or as young as childhood.
What Causes Bipolar Disorder?
Unfortunately, scientists don’t know what causes Bipolar Disorder. They do, however, believe that there is a genetic component to the condition. In fact, Bipolar is one of the most heritable psychiatric conditions, with two-thirds of all Bipolar patients having at least one biological relative with the condition.
Other factors that may contribute to Bipolar Disorder:
Environmental factors like trauma and stress: A stressful event, such as the death of a loved one, a serious illness, divorce or financial problems, can trigger a manic or depressive episode. Because of this, stress and trauma may also play a role in the development of bipolar disorder.
Changes in your brain: Researchers have identified subtle differences in the average size or activation of some brain structures in people with bipolar disorder. However, brain scans can’t diagnose the condition.
Symptoms Of Bipolar Disorder.
People with Bipolar Disorder experience both mania/hypomania and depressive episodes. However, the mood states do not follow any set pattern, and a depressive state does not always follow a manic/hypomanic episode. Some people may experience the same mood state several times with periods of euthymia in between before experiencing the opposite mood state.
The important aspect of Bipolar Disorder is that these mood changes are a major change from the person’s normal self and that they last for a sustained period.
It is also important to remember that the severity of symptoms varies from person to person and can change within the same person over time.
Symptoms Of A Manic Episode.
Signs and symptoms of a manic episode include:
Psychosis: experiencing hallucinations and delusions. (only in severe cases)
Excessive happiness, hopefulness and excitement.
Feeling like you’re unusually important, talented or powerful.
Sudden and severe changes in mood.
Reckless and risk-taking behaviour.
Restlessness.
Making grand and unattainable plans.
Rapid speech and racing thoughts.
Increased impulsivity and poor judgment, such as suddenly quitting your job.
Increased energy and less need for sleep.
Most of the time, people having a manic episode are unaware of the negative effects of their actions. They may need to be hospitalised to prevent them from harming themselves or others.
Symptoms Of A Hypomanic Episode.
This is a milder form of a manic episode. However, most people feel good and believe they can accomplish a lot of work. They tend to function well in both society and the work environment.
This may seem like a good thing, but friends and family will notice a shift in the person's mood. A hypomanic episode is followed by a severe depressive episode.
Symptoms Of A Depressive Episode.
The symptoms of depressive episodes in bipolar disorder are the same as those of major depression. They include:
Thoughts of death or suicide (suicidal ideation). Click here for resources.
Overwhelming sadness.
A change in appetite, causing weight loss or gain.
Low energy and fatigue.
Insomnia or excessive sleep.
Lack of motivation.
Feelings of hopelessness or worthlessness.
Increased need for sleep.
Loss of enjoyment of things that were once pleasurable for you.
Irritability.
Difficulty concentrating and making decisions.
Uncontrollable crying.
Symptoms Of A Mixed Episode.
The symptoms include both those of a manic/hypomanic episode and a depressive episode. So a person will have the negative feelings and thoughts that come from the depressive episode, but also feel agitated, restless and have high energy.
Getting A Bipolar Diagnosis.
We have gone over the diagnosis criteria for each type of Bipolar Disorder earlier in the article, but here are the tools that a healthcare provider may use to reach a diagnosis:
A physical exam.
A mental health evaluation. Your healthcare provider may perform the evaluation, or they may refer you to a mental health specialist, such as a psychologist or psychiatrist.
A thorough medical history, which will include asking about your symptoms, lifetime history, experiences and family history.
Medical tests, such as blood tests, are used to rule out other conditions that could be causing your symptoms.
People with Bipolar Disorder can also have the following conditions:
Substance use disorders/dual diagnosis.
Post-traumatic stress disorder (PTSD).
Anxiety.
Attention-deficit /hyperactivity disorder (ADHD).
The fact that people have these extra conditions, plus the fact that they often can’t remember their manic/hypomanic episodes correctly, does make diagnosing Bipolar Disorder difficult. As with any mental health diagnosis, be honest with your care team and patient during the process.
Bipolar Disorder Treatment.
There are five main types of treatment used for Bipolar Disorder. They are often used in combination with each other.
Types Of Psychotherapy Used For Bipolar Disorder.
Psychotherapy, otherwise known as talk therapy, is a variety of treatment techniques that aim to help a person identify and change troubling emotions, thoughts and behaviours.
The following psychotherapies are used for Bipolar Disorder:
Cognitive behavioural therapy (CBT): This is a structured, goal-oriented type of therapy. A therapist or psychologist will help a person take a close look at their thoughts and emotions. They will come to understand how these thoughts affect different actions. Through CBT, a person can unlearn negative thoughts and behaviours and learn to adopt healthier thinking patterns and habits.
Interpersonal and social rhythm therapy (IPSRT): This therapy is designed to help a person improve their moods by understanding and working with their biological and social rhythms. IPSRT is an effective therapy for people with mood disorders, including bipolar disorder. It emphasises techniques to improve medication adherence (taking medication regularly), manage stressful life events and reduce disruptions in social rhythms (day-to-day differences in habitual behaviours). IPSRT teaches patients the skills that let them protect themselves against the development of future manic or depressive episodes.
Family-focused therapy: This therapy is for adults and children with bipolar disorder and their caregivers. During this treatment, their loved ones will join them in therapy sessions of psychoeducation regarding bipolar disorder, communication improvement training and problem-solving skills training.
Medication Used To Treat Bipolar Disorder.
Medications can be used to manage some of the symptoms of Bipolar Disorder. Some people will have to use more than one medication or try a few medications first to find what works best for them. This is all done with the guidance of the healthcare team.
The most commonly prescribed medications for Bipolar Disorder are:
Mood stabilisers.
Second-generation (“atypical”) neuroleptics (also called antipsychotics).
Antidepressants.
Always remember when taking medication for Bipolar Disorder:
Remember that medication for bipolar disorder must be taken consistently, as prescribed.
Talk with a healthcare provider to understand the risks, side effects and benefits of the medication.
Tell a healthcare provider right away if there are any concerning side effects. They may need to change the dose or try a different medication.
Tell a healthcare provider about any prescription drugs, over-the-counter medications or supplements that have already been taken.
Other Medical Treatments Used For Bipolar Disorder.
These treatments can be used if more traditional methods are not successful:
Hospitalisation: This is considered an emergency option in bipolar disorder care. It becomes necessary when someone is experiencing a severe depressive or manic episode and they’re an immediate threat to themselves or others.
Electroconvulsive therapy (ECT): This is a procedure in which a brief electric current is applied to a patient's brain through the scalp, inducing a seizure. It’s most often used to treat people with severe depression. ECT is very safe and highly effective for medication-resistant depression or acute life-threatening mania. It’s the best treatment for mania if the patient is pregnant. ECT is done under general anaesthesia, so the person is asleep during the procedure and won’t feel any pain.
Transcranial magnetic stimulation (TMS): This therapy involves a short electromagnetic coil that passes an electric current into your brain. Healthcare providers sometimes use it to treat medication-resistant depression. It’s an alternative to ECT. TMS isn’t painful and doesn’t require general anaesthesia.
Ketamine treatment: Ketamine, an anaesthetic, given at low doses through an IV, has been proven to provide short-term antidepressant and antisuicidal effects for people with bipolar disorder.
Thyroid medications: These medications can sometimes act as mood stabilisers. Studies have shown positive results in reducing symptoms in females with hard-to-treat, rapid-cycling bipolar disorder.
Healthy Lifestyle Changes That Help With Bipolar Disorder.
Simple changes can help with managing Bipolar Disorder symptoms. These can include:
Manage stress and maintain healthy relationships: Stress and anxiety can worsen mood symptoms in many people with bipolar disorder. It’s important to manage stress in a healthy way. A big part of this is maintaining healthy relationships with friends and family who are supportive, and letting go of toxic relationships with people who add stress.
Quit drinking alcohol and/or using recreational drugs and tobacco: It’s essential to quit drinking and using drugs, including tobacco, since they can interfere with prescription medications. They can also worsen bipolar disorder and trigger mood episodes.
Meditation: Meditation has been shown to be effective in improving the depression that’s part of bipolar disorder.
Keep a daily diary or mood chart: Keeping track of daily thoughts, feelings, and behaviours can help a person be aware of how well treatment is working and/or help identify potential triggers of manic or depressive episodes.
Exercise: Exercise has been proven to improve mood and mental health in general, so it may help manage symptoms related to bipolar disorder. Since weight gain is a common side effect of bipolar disorder medications, exercise may also help with weight management.
Maintain a healthy sleep schedule: Bipolar disorder can greatly affect a person’s sleep patterns, and changes in sleep frequency can even trigger an episode. Prioritise a routine sleeping schedule, including going to sleep and getting up at the same time every day.
Self-Management Strategies For Bipolar Disorder.
Much like keeping a daily diary or mood tracker from above, self-management strategies can help someone who has Bipolar Disorder become more aware of their condition.
These strategies can include:
Tracking symptoms.
Getting together a family history.
Keeping a detailed medical history.
Monitoring side effects or successes of medication.
Tracking lengths and severity of mood episodes.
Tracking the successes or failures of other treatment options.
Doing all of these things, a patient can work closely with their care team to achieve the best possible outcomes.
Conclusion.
As this article shows, there is far more to Bipolar Disorder than just having a manic episode. And while it is a lifelong illness with some harsh outcomes (1 in 5 Bipolar patients commit suicide, and Bipolar Disorder patients have their life expectancy shortened by nine years), with the right support and treatment, a Bipolar Patient can live life to the full.
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