MANIC DEPRESSION

5 Facts About Bipolar Disorder You Didn’t Know

“I was actually manic a lot of the times that I would take on workloads, and I would say, ‘Yes, I can do this, I can do this, I can do this.’ I was conquering the world, but then it would all come crashing down and I would be more depressed than ever.” — Demi Lovato

Bipolar disorder, also known as manic depression, is a mental disorder that causes unusual shifts in someone’s mood, energy, activity levels, and concentration, which can make it difficult to carry out day-to-day tasks. I was diagnosed a few years back and I was actually shocked to receive the diagnosis at first as I had never thought I might have Bipolar Disorder. Once I did a bit more research, I realised the disorder was more complex than I thought. Below are some lesser-known facts about the disorder.

1. Even though Bipolar Disorder is also known as manic depression, not everyone with the disorder has depressive episodes.

Bipolar Disorder is characterized by mood swings between manic/hypomanic and depressive episodes. That said, there are different types and not all require the existence of both for a diagnosis. Bipolar I requires at least one manic episode that has lasted for a week or any duration if hospitalization was deemed necessary¹ and therefore can be diagnosed without the existence of depressive episodes.

I am diagnosed with Bipolar I and I only experience manic episodes. They usually involve an increase in goal-directed activity, where I take on a lot of commitments and spend most of the day either studying or working.

During one episode I was working full time while studying for my master's as well as volunteering on top of that. I also managed to find time to do additional reading and research around a subject I was interested in and I was putting in at least 2 hours a day on that in addition to everything else. Within 2 months of this, I crashed so badly that I ended up missing a deadline at uni and had to get an extension.

During an episode, I feel like I have unlimited energy and no one can stop me but I always end up taking on more than I can manage and crash. When I do crash, it’s just a decrease in activity levels for me — I don’t become depressed or suicidal, although I do experience fatigue and loss of energy.

2. There are multiple types of Bipolar Disorder

The two main types are called Bipolar I and Bipolar II. The first one, as I explained above, requires at least one manic episode to be diagnosed, however, individuals diagnosed with it often experience depressive episodes as well. Bipolar II only involves hypomanic episodes, which are not as severe as manic episodes and do not last as long (only 4 days). To get diagnosed with Bipolar II, one major depressive episode lasting about 2 weeks is also required.¹

There is a milder form of Bipolar Disorder which is called Cyclothymic Disorder. It is diagnosed when someone experiences chronic mood disturbances with periods of hypomania and mild depression, yet they are not severe enough for a diagnosis of Bipolar Disorder.

3. Not everyone with Bipolar Disorder has psychotic symptoms arising from a manic episode.

Psychotic episodes can be a feature of manic episodes in Bipolar I, where the person experiences delusions; false beliefs that are incorrect interpretations of information, and hallucinations, meaning you see, hear or feel things that aren’t really there, such as hearing voices of someone talking to them when they’re not actually there.

A manic psychotic episode involves the common symptoms of mania in addition to hallucinations and delusions. As hypomania is not as severe as a manic episode, symptoms of psychosis won’t be present. However, one can also have depressive psychotic episodes where they experience hallucinations and delusions often related to themes of guilt, worthlessness and personal inadequacy, in addition to feeling depressed, hopeless and in despair, which means people who are diagnosed with Bipolar II can also experience symptoms of psychosis.

4. There are major differences between mania and hypomania

A manic episode lasts for at least one week, causes severe impact on social work/school functioning, may require hospitalization and psychotic symptoms may be present. It involves:

• High levels of euphoria
• High levels of irritability
• Increased energy and activity levels
• Increased goal-directed activity (either socially, at work or school), taking on too many things at once, being obsessed with and completely absorbed in an activity and working on several projects at once
• Impulsivity and poor judgment
• Decreased need for sleep
• Racing thoughts and rapid speech
• Grandiose beliefs or delusions of grandeur
• Increased engagement in risky behaviours, such as excessive spending, reckless driving, or risky sexual encounters

Hypomania, on the other hand, lasts for at least four consecutive days, is not severe enough to significantly affect social or work/school functioning, does not require hospitalisation and doesn’t feature psychotic episodes. It involves:

• Elevated mood, but not as extreme as mania
• Increased sociability and extroversion
• Greater talkativeness and increased creativity
• Mild impulsivity
• Increased energy and productivity
• Reduced need for sleep

5. Psychomotor agitation can be a symptom of Bipolar Disorder

It is a common feature of manic and hypomanic episodes and includes uncontrollable mental and physical activity that is excessive and often without a purpose. For instance, rapid speech, racing thoughts and an inability to sit still are some of the hallmark symptoms of a manic episode. You might also notice aimless pacing, picking at skin and fidgeting.

These symptoms can also indicate other mental health conditions such as ADHD so it is important to be able to differentiate. Bipolar disorder is a mood disorder whilst ADHD affects attention and behaviour; it causes symptoms of inattention, hyperactivity, and impulsivity that are chronic and ongoing. On the other hand, bipolar disorder tends to be episodic, with periods of normal mood interspersed with depression, mania, or hypomania.

References:

[1]: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

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