Bipolar Disorder
(Mania)

Introduction to bipolar disorder

Bipolar disorder, otherwise known as manic depression or bipolar depression, is a relatively common mood disorder that affects about 5.7 million Americans. Characterized by episodes of depression alternating with euphoric (manic) states, the symptoms of bipolar disorder are varied and often affect an individual's daily functioning and interpersonal relationships.

Bipolar disorder symptoms include depression and feelings of hopelessness during the depressive phase of the condition. Other depressive symptoms include thoughts of suicide, alterations in sleep patterns, and loss of interest in activities that once were a source of pleasure. What differentiates bipolar disorder from major depression is the occurrence of manic episodes, often described as emotional "highs," between the episodes of depression. Symptoms of manic states are varied and include restlessness, increased energy, euphoric mood, racing thoughts, poor judgment, intrusive or provocative behavior, difficulty concentrating, and a decreased need for sleep. People experiencing manic episodes often speak very rapidly, seem overly irritable, and may have unrealistic beliefs about their own power and capability.

Fortunately, bipolar disorder is a treatable condition. With appropriate treatment, most people suffering from bipolar disorder can achieve substantial stabilization of their mood swings and are able to lead a normal life. Treatment of bipolar disorder often involves medications known as "mood stabilizers." Lithium (Eskalith, Lithobid) is the most commonly prescribed mood stabilizer for people with bipolar disorder, but some anticonvulsant medications, including valproate (Depakote) or carbamazepine (Tegretol), also can have mood-stabilizing effects and may be used in the treatment of bipolar disorder.

MedicineNet Medical Author: Melissa Conrad Stöppler, MD
MedicineNet Medical Editor: William C. Shiel Jr., MD, FACP, FACR


The following information is provided by the National Institutes of Health.

What is bipolar disorder?

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. Symptoms of bipolar disorder are severe. They are different from the normal ups and downs that everyone goes through from time to time. Bipolar disorder symptoms can result in damaged relationships, poor job or school performance, and even suicide. But bipolar disorder can be treated, and people with this illness can lead full and productive lives.

Bipolar disorder often develops in a person's late teens or early adult years. At least half of all cases start before age 25. Some people have their first symptoms during childhood, while others may develop symptoms late in life.

Bipolar disorder is not easy to spot when it starts. The symptoms may seem like separate problems, not recognized as parts of a larger problem. Some people suffer for years before they are properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person's life.

What are bipolar disorder symptoms and signs?

People with bipolar disorder experience unusually intense emotional states that occur in distinct periods called "mood episodes." An overly joyful or overexcited state is called a manic episode, and an extremely sad or hopeless state is called a depressive episode. Sometimes, a mood episode includes symptoms of both mania and depression. This is called a mixed state. People with bipolar disorder also may be explosive and irritable during a mood episode.

Extreme changes in energy, activity, sleep, and behavior go along with these changes in mood. It is possible for someone with bipolar disorder to experience a long-lasting period of unstable moods rather than discrete episodes of depression or mania.

A person may be having an episode of bipolar disorder if he or she has a number of manic or depressive symptoms for most of the day, nearly every day, for at least one or two weeks. Sometimes symptoms are so severe that the person cannot function normally at work, school, or home.

Symptoms of bipolar disorder are described below.

Symptoms of mania or a manic episode include: Symptoms of depression or a depressive episode include:

Mood Changes

  • A long period of feeling "high," or an overly happy or outgoing mood
  • Extremely irritable mood, agitation, feeling "jumpy" or "wired."

Behavioral Changes

  • Talking very fast, jumping from one idea to another, having racing thoughts
  • Being easily distracted
  • Increasing goal-directed activities, such as taking on new projects
  • Being restless
  • Sleeping little
  • Having an unrealistic belief in one's abilities
  • Behaving impulsively and taking part in a lot of pleasurable, high-risk behaviors, such as spending sprees, impulsive sex, and impulsive business investments.

Mood Changes

  • A long period of feeling worried or empty
  • Loss of interest in activities once enjoyed, including sex.

Behavioral Changes

  • Feeling tired or "slowed down"
  • Having problems concentrating, remembering, and making decisions
  • Being restless or irritable
  • Changing eating, sleeping, or other habits
  • Thinking of death or suicide, or attempting suicide.

In addition to mania and depression, bipolar disorder can cause a range of moods, as shown on the scale.

Picture of scale of severe depression, moderate depression, and mild low mood

One side of the scale includes severe depression, moderate depression, and mild low mood. Moderate depression may cause less extreme symptoms, and mild low mood is called dysthymia when it is chronic or long-term. In the middle of the scale is normal or balanced mood.

At the other end of the scale are hypomania and severe mania. Some people with bipolar disorder experience hypomania. During hypomanic episodes, a person may have increased energy and activity levels that are not as severe as typical mania, or he or she may have episodes that last less than a week and do not require emergency care. A person having a hypomanic episode may feel very good, be highly productive, and function well. This person may not feel that anything is wrong even as family and friends recognize the mood swings as possible bipolar disorder. Without proper treatment, however, people with hypomania may develop severe mania or depression.

During a mixed state, symptoms often include agitation, trouble sleeping, major changes in appetite, and suicidal thinking. People in a mixed state may feel very sad or hopeless while feeling extremely energized.

Sometimes, a person with severe episodes of mania or depression has psychotic symptoms too, such as hallucinations or delusions. The psychotic symptoms tend to reflect the person's extreme mood. For example, psychotic symptoms for a person having a manic episode may include believing he or she is famous, has a lot of money, or has special powers. In the same way, a person having a depressive episode may believe he or she is ruined and penniless, or has committed a crime. As a result, people with bipolar disorder who have psychotic symptoms are sometimes wrongly diagnosed as having schizophrenia, another severe mental illness that is linked with hallucinations and delusions.

People with bipolar disorder may also have behavioral problems. They may abuse alcohol or substances, have relationship problems, or perform poorly in school or at work. At first, it's not easy to recognize these problems as signs of a major mental illness.




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