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What is bipolar disorder?

Individuals with bipolar disorder[1] classically have cycles of depression alternating with euphoric/irritable mood states (called mania[2]). Several disorders of mood in addition to the depressive disorders listed in Question 13 involve depression as well as manic or hypo-manic mood states:

• Bipolar I disorder

• Bipolar II disorder

• Cyclothymia

• Mood disorder not otherwise specified

A manic episode is defined as a period of euphoric and/or irritable mood that lasts at least 4 days; it is characterized by a decreased need for sleep, racing thoughts, the need to keep speaking, inflated self-esteem or grandiose thinking, and excess goal-directed activities. The same group of symptoms also defines a hypomanic episode, but the severity is judged to be less. Individuals in the midst of a manic episode can become psychotic and require hospitalization.

In bipolar I disorder the person must have a history of at least one manic episode. The number of depressive episodes can be as few as none to any amount. Classically, an afflicted person alternates between episodes with normal mood in between. However, cycles can consist of any frequency of mood states in any order. Bipolar II disorder comprises depressive episodes alternating with hypomanic episodes only (no mania). In cyclothymia no major depressive episode has occurred, but mild depressive episodes alternate with hypomanic states. Mood disorder not otherwise specified is also a condition of exclusion in that a mood disorder is considered present, but the criteria have not been met for the other conditions in the DSM-IV-TR. In someone presenting with depression, these conditions can only be excluded by a thorough history of symptoms and episodes in the past. Sometimes the patient does not recall such episodes, however, such that a bipolar condition is not learned of until the treatment for depression is initiated.

20. My husband is depressed and has mood swings. Is he a manic-depressive?

Mood swings are often thought to be synonymous with having manic depression. The presence of "mood swings," however, is not enough to determine that a person is manic-depressive. Many depressed persons can have ups and downs in their mood. The distinction is important because manic depression is another name for a condition called bipolar disorder (see Question 19), and depression in bipolar disorder is treated differently from major depression. Bipolar disorder is less frequent than major depressive disorder, occurring in approximately 3% of the population. It is also more closely associated with family history and, in general, is a more severe illness. Bipolar depression differs from major depression in that the individual has to have experienced at least one manic or hypomanic episode in his or her lifetime. Although experiencing mania or hypomania is often referred to as having mood swings, specific criteria define these mood states. Mood swings can mean many things to many people—from constant crying to episodes of irritability or anger. Recent research has also determined that the symptoms accompanying major depressive disorder may vary dramatically over time. Such variability can be misinterpreted as mood swings. Manic or hypomanic episodes are strictly characterized by a decreased need for sleep (not the same as insomnia), inflated self-esteem (grandiosity[3]), rapid and pressured speech[4] (the need to keep talking), euphoric or irritable mood, and increased activity level. Duration criteria are required to make the diagnosis as well. It is important that the strict criteria are used because depression alone can be a cause for irritability and anger management problems, both of which can look like mood swings. Once it is determined that a manic or hypomanic episode has occurred in the past, then the diagnosis must reflect that, because the treatment approach may be different and different risks are associated with taking antidepressants.

  • [1] a mental illness defined by episodes of mania or hypomania, classically alternating with episodes of depression. However, the condition can take various forms, such as repeated episodes of mania only or a lack of alternating episodes.
  • [2] a condition characterized by elevation of mood (extreme euphoria or irritability) associated with racing thoughts, decreased need for sleep, hyperactivity, and poor impulse control. One episode of mania (in the absence of an ingested substance) is needed to diagnose bipolar disorder.
  • [3] the tendency to consider the self or one's ideas better or more superior to what is reality.
  • [4] characterized by the need to keep speaking; it is difficult to interrupt someone with this type of speech. This is commonly seen in manic or hypomanic mood states.
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