Beyond Depression: Recognizing the Signs and Symptoms of Bipolar Disorder
Depression is a complex disorder, a condition triggered by biochemical, environmental, and psychological influences. People living with depression often express persistent feelings of pessimism, loneliness, and isolation. Although patients diagnosed with bipolar disorder often experience bouts of depression, their condition is far more complex.
Bipolar disorder can cause thought processes, emotional responses, and energy levels to shift dramatically from one extreme to another. The emotional highs rival the depths of the emotional lows. Many people living with bipolar disorder report feeling conflicting emotional extremes simultaneously (mixed bipolar). Yet far too many are misdiagnosed. Overlooking bipolar symptoms can have devastating consequences for patients and their families.
Understanding the Origins of Bipolar Disorder
Bipolar disorder, once called manic depression, can run in families. Current research suggests that 80-90 percent of patients treated for the condition have a relative or family member also diagnosed with bipolar I, bipolar II, mixed bipolar, cyclothymia, or major depression. Although researchers don't fully understand every potential cause, many believe that stress, sleep cycle disruptions, or drug and alcohol use can trigger bipolar symptoms in those who are genetically vulnerable.
Some people living with bipolar disorder are also diagnosed with post-traumatic stress, anxiety, or attention-deficit hyperactivity disorder (ADHD). Having a secondary condition can make the signs of bipolar disorder more difficult to recognize. That's why NIMH (The National Institute of Mental Health) urges health care providers to consider a person's family and medical history during patient evaluations. Paying close attention to symptoms between bouts of depression helps ensure everyone living with the condition receives an accurate diagnosis and appropriate care.
Recognizing the Signs of Bipolar Disorder
The signs and symptoms of bipolar disorder tend to emerge during the late teen years and early adulthood. However, researchers suspect this serious mental health condition also affects between 1 and 5 percent of adolescents and children. Children, adolescents, and young adults living with bipolar disorder tend to experience extreme, intense emotional states and behavioral changes. To better understand the condition, consider the potential impact of the following emotional extremes.
Major Depressive Episodes
A major depressive episode is most often described as depression symptoms that occur almost daily for two weeks or more. During a depressive episode, those living with bipolar disorder often experience feelings of hopelessness, despair, worthlessness, or guilt. Many lose interest in activities and experiences they once found enjoyable. Some withdraw or self-isolate as their struggles intensify.
As with others who experience major depressive episodes, some people living with bipolar disorder have troubling thoughts of suicide or death. Major depressive episodes can also cause any number of the following symptoms:
- Tearfulness or irritability
- Changes in sleep patterns
- Slow movements or restless behavior
- Indecisiveness or inability to concentrate
- Fatigue or loss of energy
- Changes in weight or appetite
A manic episode causes an uncharacteristic boost in energy levels. During a manic episode, many people sleep less without feeling tired, experience intense feelings of extreme wellbeing, or display an inflated sense of self-esteem. While feeling euphoric, some experience racing thoughts or engage in risky or irresponsible behaviors.
But everyone is different. Manic episodes are also known to cause irritability, restlessness, aggression, or any combination of the following symptoms and behaviors:
- Feeling wired or high
- Talking at a faster pace
- Increased sensitivity to touch, taste, or smell
- Hearing or seeing things that aren't there
- Delusional or paranoid thoughts
Hypomanic episodes are not as intense as manic episodes, but the symptoms are generally similar. Since symptoms are less extreme, many patients and their families overlook their significance. However, the signs of hypomania are just as crucial to proper diagnosis as the symptoms of mania.
The intensity of the manic state helps mental health providers differentiate between a bipolar I (manic) and bipolar II (hypomanic) diagnosis. A person experiencing a hypomanic episode may not realize that the following behaviors could suggest a complex mental health condition:
- Feelings of extreme wellbeing or euphoria
- Decreased inhibitions or impulsive behavior
- Starting multiple projects but completing none
- Decreased need for sleep
- Erratic spending, gambling, or other risky behaviors
The Mental Health Complications Associated with Manic and Hypomanic Episodes
To the casual observer, the symptoms of mania or hypomania may initially appear quite positive, an indication that a friend or family member has escaped the icy clutches of a depressive episode. However, it's important to understand that the extreme shifts in mood and behavior are not any more desirable than the symptoms of depression.
During a depressive or manic episode, a person living with bipolar disorder can experience irrational thoughts or a significant break with reality. During a manic episode, there's also an increased risk of experiencing hallucinations or psychosis. Grandiose delusions may result in a person believing they have special powers or dangerous enemies.
Left untreated, hypomanic episodes can quickly evolve into mania or severe depression. Although many people living with bipolar disorder experience relatively few manic or hypomanic episodes throughout their lifetime, some cycle through emotional extremes several times a year (rapid cycling bipolar disorder).
Treatment Helps Stabilize Moods and Manage Symptoms
While the unpredictability of bipolar disorder can have devastating consequences, more than 30 percent of patients are mistakenly treated for depression alone. Many experts believe it's easy for health care providers to miss the characteristic symptoms because patients are far more likely to seek treatment during a period of prolonged depression, not while experiencing symptoms of the manic or hypomanic episodes that suggest a more complex mood disorder.
Once diagnosed, many patients and their providers find the condition can be initially challenging because the medications often prescribed to offset one emotional extreme can trigger the other. However, balance is possible. For severe episodes, doctors sometimes recommend short-term hospitalization or outpatient care to help stabilize moods more efficiently. But prescriptions alone may not be enough for long-term symptom management.
Most children, teens, and adults diagnosed with bipolar disorder respond well to individualized treatment plans that include daily medication, lifestyle modifications, and psychotherapy or counseling. Since treatments for depression can make bipolar symptoms worse, anyone with a history of depression could benefit from knowing the moods and behaviors that could suggest manic or hypomanic episodes. Accurate diagnosis and appropriate treatment help patients living with this complex mental health disorder live stable, fulfilling, productive lives.