Bipolar DisorderPage 2 of 5
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Signs and symptoms of depression (or a depressive episode) include:
- Lasting sad, anxious, or empty mood
- Feelings of hopelessness or pessimism
- Feelings of guilt, worthlessness, or helplessness
- Loss of interest or pleasure in activities once enjoyed,
- Decreased energy, a feeling of fatigue or of being "slowed down"
- Difficulty concentrating, remembering, making decisions
- Restlessness or irritability
- Sleeping too much, or can't sleep
- Change in appetite and/or unintended weight loss or gain
- Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury
- Thoughts of death or suicide, or suicide attempts
A depressive episode is diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer.
A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person who experiences it and may even
be associated with good functioning and enhanced productivity. Thus even when family and friends learn to recognize the mood swings as possible
bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some
people or can switch into depression.
Sometimes, severe episodes of mania or depression include symptoms of psychosis (or psychotic symptoms). Common psychotic
symptoms are hallucinations (hearing, seeing, or otherwise sensing the presence of things not actually there) and delusions (false, strongly
held beliefs not influenced by logical reasoning or explained by a person's usual cultural concepts). Psychotic symptoms in bipolar disorder
tend to reflect the extreme mood state at the time. For example, delusions of grandiosity, such as believing one is the President or has
special powers or wealth, may occur during mania; delusions of guilt or worthlessness, such as believing that one is ruined and penniless
or has committed some terrible crime, may appear during depression. People with bipolar disorder who have these symptoms are sometimes
incorrectly diagnosed as having schizophrenia, another severe mental illness.
It may be helpful to think of the various mood states in bipolar disorder as a spectrum or continuous range. At one end is severe depression,
above which is moderate depression and then mild low mood, which many people call "the blues" when it is short-lived but is termed "dysthymia"
when it is chronic. Then there is normal or balanced mood, above which comes hypomania (mild to moderate mania), and then severe mania.
In some people, however, symptoms of mania and depression may occur together in what is called a mixed bipolar state.
Symptoms of a mixed state often include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking.
A person may have a very sad, hopeless mood while at the same time feeling extremely energized.
Bipolar disorder may appear to be a problem other than mental illness—for instance, alcohol or drug abuse, poor school or work
performance, or strained interpersonal relationships. Such problems in fact may be signs of an underlying mood disorder.
Diagnosis of Bipolar Disorder
Like other mental illnesses, bipolar disorder cannot yet be identified physiologically—for example, through a blood test or a brain scan.
Therefore, a diagnosis of bipolar disorder is made on the basis of symptoms, course of illness, and, when available, family history. The
diagnostic criteria for bipolar disorder are described in the Diagnostic and Statistical Manual for Mental Disorders, fourth edition
- Descriptions offered by people with bipolar disorder give valuable insights into the various mood states associated with the illness:
Depression: I doubt completely my ability to do anything well.
It seems as though my mind has slowed down and burned out to the point of being virtually useless…. [I am] haunt[ed]… with the total, the
desperate hopelessness of it all…. Others say, "It's only temporary, it will pass, you will get over it," but of course they haven't any
idea of how I feel, although they are certain they do. If I can't feel, move, think or care, then what on earth is the point?
Hypomania: At first when I'm high, it's tremendous…
ideas are fast… like shooting stars you follow until brighter ones appear…. All shyness disappears, the right words and gestures are
suddenly there… uninteresting people, things become intensely interesting. Sensuality is pervasive, the desire to seduce and be seduced
is irresistible. Your marrow is infused with unbelievable feelings of ease, power, well-being, omnipotence, euphoria… you can do anything… but,
somewhere this changes.
Mania: The fast ideas become too fast and there are far too
many… overwhelming confusion replaces clarity… you stop keeping up with it—memory goes. Infectious humor ceases to amuse. Your friends
become frightened…. everything is now against the grain… you are irritable, angry, frightened, uncontrollable, and trapped.
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