What is being manic
Bipolar disorder - Symptoms and causes
Overview
Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression).
When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts to mania or hypomania (less extreme than mania), you may feel euphoric, full of energy or unusually irritable. These mood swings can affect sleep, energy, activity, judgment, behavior and the ability to think clearly.
Episodes of mood swings may occur rarely or multiple times a year. While most people will experience some emotional symptoms between episodes, some may not experience any.
Although bipolar disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan. In most cases, bipolar disorder is treated with medications and psychological counseling (psychotherapy).
Bipolar disorder care at Mayo Clinic
Products & Services
- Book: Mayo Clinic Family Health Book, 5th Edition
- Newsletter: Mayo Clinic Health Letter — Digital Edition
Symptoms
There are several types of bipolar and related disorders. They may include mania or hypomania and depression. Symptoms can cause unpredictable changes in mood and behavior, resulting in significant distress and difficulty in life.
- Bipolar I disorder. You've had at least one manic episode that may be preceded or followed by hypomanic or major depressive episodes. In some cases, mania may trigger a break from reality (psychosis).
- Bipolar II disorder. You've had at least one major depressive episode and at least one hypomanic episode, but you've never had a manic episode.
- Cyclothymic disorder. You've had at least two years — or one year in children and teenagers — of many periods of hypomania symptoms and periods of depressive symptoms (though less severe than major depression).
- Other types. These include, for example, bipolar and related disorders induced by certain drugs or alcohol or due to a medical condition, such as Cushing's disease, multiple sclerosis or stroke.
Bipolar II disorder is not a milder form of bipolar I disorder, but a separate diagnosis. While the manic episodes of bipolar I disorder can be severe and dangerous, individuals with bipolar II disorder can be depressed for longer periods, which can cause significant impairment.
Although bipolar disorder can occur at any age, typically it's diagnosed in the teenage years or early 20s. Symptoms can vary from person to person, and symptoms may vary over time.
Mania and hypomania
Mania and hypomania are two distinct types of episodes, but they have the same symptoms. Mania is more severe than hypomania and causes more noticeable problems at work, school and social activities, as well as relationship difficulties. Mania may also trigger a break from reality (psychosis) and require hospitalization.
Both a manic and a hypomanic episode include three or more of these symptoms:
- Abnormally upbeat, jumpy or wired
- Increased activity, energy or agitation
- Exaggerated sense of well-being and self-confidence (euphoria)
- Decreased need for sleep
- Unusual talkativeness
- Racing thoughts
- Distractibility
- Poor decision-making — for example, going on buying sprees, taking sexual risks or making foolish investments
Major depressive episode
A major depressive episode includes symptoms that are severe enough to cause noticeable difficulty in day-to-day activities, such as work, school, social activities or relationships. An episode includes five or more of these symptoms:
- Depressed mood, such as feeling sad, empty, hopeless or tearful (in children and teens, depressed mood can appear as irritability)
- Marked loss of interest or feeling no pleasure in all — or almost all — activities
- Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in children, failure to gain weight as expected can be a sign of depression)
- Either insomnia or sleeping too much
- Either restlessness or slowed behavior
- Fatigue or loss of energy
- Feelings of worthlessness or excessive or inappropriate guilt
- Decreased ability to think or concentrate, or indecisiveness
- Thinking about, planning or attempting suicide
Other features of bipolar disorder
Signs and symptoms of bipolar I and bipolar II disorders may include other features, such as anxious distress, melancholy, psychosis or others.
The timing of symptoms may include diagnostic labels such as mixed or rapid cycling. In addition, bipolar symptoms may occur during pregnancy or change with the seasons.
Symptoms in children and teens
Symptoms of bipolar disorder can be difficult to identify in children and teens. It's often hard to tell whether these are normal ups and downs, the results of stress or trauma, or signs of a mental health problem other than bipolar disorder.
Children and teens may have distinct major depressive or manic or hypomanic episodes, but the pattern can vary from that of adults with bipolar disorder. And moods can rapidly shift during episodes. Some children may have periods without mood symptoms between episodes.
The most prominent signs of bipolar disorder in children and teenagers may include severe mood swings that are different from their usual mood swings.
When to see a doctor
Despite the mood extremes, people with bipolar disorder often don't recognize how much their emotional instability disrupts their lives and the lives of their loved ones and don't get the treatment they need.
And if you're like some people with bipolar disorder, you may enjoy the feelings of euphoria and cycles of being more productive. However, this euphoria is always followed by an emotional crash that can leave you depressed, worn out — and perhaps in financial, legal or relationship trouble.
If you have any symptoms of depression or mania, see your doctor or mental health professional. Bipolar disorder doesn't get better on its own. Getting treatment from a mental health professional with experience in bipolar disorder can help you get your symptoms under control.
When to get emergency help
Suicidal thoughts and behavior are common among people with bipolar disorder. If you have thoughts of hurting yourself, call 911 or your local emergency number immediately, go to an emergency room, or confide in a trusted relative or friend. Or call a suicide hotline number — in the United States, call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255).
If you have a loved one who is in danger of suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.
Request an Appointment at Mayo Clinic
From Mayo Clinic to your inbox
Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health.
To provide you with the most relevant and helpful information, and understand which
information is beneficial, we may combine your email and website usage information with
other information we have about you. If you are a Mayo Clinic patient, this could
include protected health information. If we combine this information with your protected
health information, we will treat all of that information as protected health
information and will only use or disclose that information as set forth in our notice of
privacy practices.
You may opt-out of email communications at any time by clicking on
the unsubscribe link in the e-mail.
Causes
The exact cause of bipolar disorder is unknown, but several factors may be involved, such as:
- Biological differences. People with bipolar disorder appear to have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes.
- Genetics. Bipolar disorder is more common in people who have a first-degree relative, such as a sibling or parent, with the condition. Researchers are trying to find genes that may be involved in causing bipolar disorder.
Risk factors
Factors that may increase the risk of developing bipolar disorder or act as a trigger for the first episode include:
- Having a first-degree relative, such as a parent or sibling, with bipolar disorder
- Periods of high stress, such as the death of a loved one or other traumatic event
- Drug or alcohol abuse
Complications
Left untreated, bipolar disorder can result in serious problems that affect every area of your life, such as:
- Problems related to drug and alcohol use
- Suicide or suicide attempts
- Legal or financial problems
- Damaged relationships
- Poor work or school performance
Co-occurring conditions
If you have bipolar disorder, you may also have another health condition that needs to be treated along with bipolar disorder.
Some conditions can worsen bipolar disorder symptoms or make treatment less successful. Examples include:
- Anxiety disorders
- Eating disorders
- Attention-deficit/hyperactivity disorder (ADHD)
- Alcohol or drug problems
- Physical health problems, such as heart disease, thyroid problems, headaches or obesity
More Information
- Bipolar disorder care at Mayo Clinic
- Bipolar disorder and alcoholism: Are they related?
Prevention
There's no sure way to prevent bipolar disorder. However, getting treatment at the earliest sign of a mental health disorder can help prevent bipolar disorder or other mental health conditions from worsening.
If you've been diagnosed with bipolar disorder, some strategies can help prevent minor symptoms from becoming full-blown episodes of mania or depression:
- Pay attention to warning signs. Addressing symptoms early on can prevent episodes from getting worse.
You may have identified a pattern to your bipolar episodes and what triggers them. Call your doctor if you feel you're falling into an episode of depression or mania. Involve family members or friends in watching for warning signs. - Avoid drugs and alcohol. Using alcohol or recreational drugs can worsen your symptoms and make them more likely to come back.
- Take your medications exactly as directed. You may be tempted to stop treatment — but don't. Stopping your medication or reducing your dose on your own may cause withdrawal effects or your symptoms may worsen or return.
By Mayo Clinic Staff
Related
Associated Procedures
Products & Services
What Is It, Causes, Triggers, Symptoms & Treatment
Overview
What is mania?
Mania is a condition in which you have a period of abnormally elevated, extreme changes in your mood or emotions, energy level or activity level.
This highly energized level of physical and mental activity and behavior must be a change from your usual self and be noticeable by others.
What's considered an “abnormal,” extreme change in behavior and what does it look like?
Abnormal manic behavior is behavior that stands out. It’s over-the-top behavior that other people can notice. The behavior could reflect an extreme level of happiness or irritation. For example, you could be extremely excited about an idea for a new healthy snack bar. You believe the snack could make you an instant millionaire but you’ve never cooked a single meal in your life, don’t know a thing about how to develop a business plan and have no money to start a business. Another example might be that you strongly disagree with a website “influencer” and not only write a 2,000 word post but do an exhaustive search to find all the websites connected to the influencer so you can post your letter there too.
Although these examples may sound like they could be normal behavior, a person with mania will expend a great deal of time and energy including many sleepless nights working on projects such as these.
What is a manic episode?
A manic episode is a period of time in which you experience one or more symptoms of mania and meet the criteria for manic episode (see “symptoms” and “diagnosis” sections). In some cases, you may need to be hospitalized.
Can I have a manic episode as its own condition or is it always part of another mental health condition?
Technically if you have a manic episode, you have a mental health condition. Mania can be a part of several mental health conditions including:
- Bipolar I disorder (most common condition for mania to occur).
- Seasonal affective disorder.
- Postpartum psychosis.
- Schizoaffective disorder.
- Cyclothymia.
What is bipolar I disorder?
Bipolar I disorder is a mental health illness in which a person has major high and low swings in mood, activity, energy and ability to think clearly. To be diagnosed with bipolar I disorder, you have to have at least one episode of mania that lasts for at least seven days or have an episode that is so severe that it requires hospitalization.
Most people have both episodes of both mania and depression, but you don’t have to have depression to be diagnosed with mania. Many people with a bipolar I disorder diagnosis have recurring, back-to-back manic episodes with very few episodes of depression.
What are the triggers of manic episodes?
Manic episode triggers are unique to each person. You’ll have to become a bit of a detective and monitor your mood (even keeping a “mood diary”) and start to track how you feel before an episode and when it occurs. Ask family and close friends who you trust and have close contact with to help identify your triggers. As outside observers, they may notice changes from your usual behavior more easily than you do.
Knowing your triggers can help you prepare for an episode, lessen the effect of an episode or prevent it from happening at all.
Common triggers to be aware of include:
- A highly stimulating situation or environment (for example, lots of noise, bright lights or large crowds).
- A major life change (such as divorce, marriage or job loss).
- Lack of sleep.
- Substance use, such as recreational drugs or alcohol.
What happens after a manic episode?
After a manic episode you may:
- Feel happy or embarrassed about your behavior.
- Feel overwhelmed by all the activities you’ve agreed to take on.
- Have only a few or unclear memories of what happened during your manic episode.
- Feel very tired and need sleep.
- Feel depressed (if your mania is part of bipolar disorder).
Symptoms and Causes
What are the symptoms of mania?
Symptoms of a manic episode
- Having an abnormally high level of activity or energy.
- Feeling extremely happy or excited — even euphoric.
- Not sleeping or only getting a few hours of sleep but still feeling rested.
- Having an inflated self-esteem, thinking you’re invincible.
- Being more talkative than usual.
Talking so much and so fast that others can’t interrupt. - Having racing thoughts — having lots of thoughts on lots of topics at the same time (called a “flight of ideas”).
- Being easily distracted by unimportant or unrelated things.
- Being obsessed with and completely absorbed in an activity.
- Displaying purposeless movements, such as pacing around your home or office or fidgeting when you’re sitting.
- Showing impulsive behavior that can lead to poor choices, such as buying sprees, reckless sex or foolish business investments.
Psychotic symptoms of a manic episode
- Delusions. Delusions are false beliefs or ideas that are incorrect interpretations of information. An example is a person thinking that everyone they see is following them.
- Hallucinations. Having a hallucination means you see, hear, taste, smell or feel things that aren’t really there. An example is a person hearing the voice of someone and talking to them when they’re not really there.
How long does a manic episode last?
Early signs (called “prodromal symptoms”) that you’re getting ready to have a manic episode can last weeks to months. If you’re not already receiving treatment, episodes of bipolar-related mania can last between three and six months. With effective treatment, a manic episode usually improves within about three months.
What causes mania?
Scientists aren’t completely sure what causes mania. However, there are several factors that are thought to contribute. Causes differ from person to person.
Causes may include:
- Family history. If you have a family member with bipolar illness, you have an increased chance of developing mania. This isn't definite though. You may never develop mania even if other family members have.
- A chemical imbalance in the brain.
- A side effect of a medication (such as some antidepressants), alcohol or recreational drugs.
- A significant change in your life, such as a divorce, house move or death of a loved one.
- Difficult life situations, such as trauma or abuse, or problems with housing, money or loneliness.
- A high level of stress and an inability to manage it.
- A lack of sleep or changes in sleep pattern.
- As a side effect of mental health problems including seasonal affective disorder, postpartum psychosis, schizoaffective disorder or other physical or neurologic condition such as brain injury, brain tumors, stroke, dementia, lupus or encephalitis.
Diagnosis and Tests
How is mania diagnosed?
Your healthcare provider will ask about your medical history, family medical history, current prescriptions and non-prescription medications and any herbal products or supplements you take. Your provider may order blood tests and body scans to rule out other conditions that may mimic mania. One such condition is hyperthyroidism. If other diseases and conditions are ruled out, your provider may refer you to a mental health specialist
To be diagnosed with mania, your mental health specialist may follow the criteria of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, DSM-5.
Their criteria for manic episode is:
- You have an abnormal, long-lasting elevated expression of emotion along with a high degree of energy and activity that lasts for at least one week and is present most of the day, nearly every day.
- You have three or more symptoms to a degree that they’re a noticeable change from your usual behavior (four symptoms if mood is only irritable). (See the symptoms section of this article for a list of the symptoms used as criteria.)
- The mood disturbance is severe enough to cause significant harm to your social, work or school functioning or there’s a need to hospitalize you to prevent you from harming yourself or others, or you have psychotic features, such as hallucinations or delusions.
- The manic episode can’t be caused by the effects of a substance (medications or drug abuse) or another medical condition.
Management and Treatment
How is mania treated?
Mania is treated with medications, talk therapy, self-management and family and friends support.
Medications
If you have mania only, your healthcare provider may prescribe an antipsychotic medication, such as ariprazole (Abilify®), lurasidone (Latuda®), olanzapine (Zyprexa®), quetiapine (Seroquel®) or risperridone (Risperdal®).
If you have mania as part of a mood disorder, your provider may add a mood stabilizer. Some examples include lithium, valproate (Depakote®) and carbamazepine (Tegretol®). (If you’re pregnant or plan to become pregnant, let your provider know. Valproate can increase the chance of birth defects and learning disabilities and shouldn’t be prescribed to individuals who are able to become pregnant.)
Sometimes antidepressants are also prescribed.
Talk therapy (psychotherapy)
- Psychotherapy involves a variety of techniques. During psychotherapy, you’ll talk with a mental health professional who'll help you identify and work through factors that may be triggering your mania and/or depression (if you’re diagnosed with bipolar I disorder).
- Cognitive behavioral therapy can be useful in helping you change inaccurate perceptions that you have about yourself and the world around you.
- Family therapy is important since it’s very helpful for your family members to understand your behavior and what they can do to help.
Ask your provider for contact information for local support groups. You might find it helpful to talk with other people who have similar medical experiences and share problems, ideas for coping and strategies for living and caring for yourself.
Other treatments
Electroconvulsant therapy (ECT) may be considered in rare cases in individuals who have severe mania or depression (if bipolar). ECT involves applying brief periods of electric current to your brain.
Prevention
What steps can I take to better cope with or manage my mania?
Although episodes of mania can’t always be prevented, you can make a plan to better manage your symptoms and prevent them from getting worse when you feel a manic episode may be starting.
Some ideas to try during this time include:
- Avoid stimulating activities and environment – such as loud or busy places or bright places. Instead choose calm and relaxing activities and environments.
- Stick to routines. Go to bed at a set time, even if you’re not tired. Also, stick to the same times for eating meals, taking medications and exercising.
- Limit the number of social contacts to keep you from getting too stimulated and excited.
- Postpone making any major life decisions and big purchases.
- Avoid people and situations that might tempt you to make poor or risky choices, such as taking recreational drugs or drinking alcohol.
- Consider selecting someone to manage your finances during a manic episode.
If you ever have thoughts of harming yourself, tell family or friends, call you healthcare provider or contact the National Suicide Prevention Lifeline at 800-273-(TALK) (1-800-273-8255). Counselors are available 24/7.
Outlook / Prognosis
What outcome can I expect if I’ve been diagnosed with mania?
If your mania is related to a diagnosis of bipolar I disorder, this is a lifelong disease. Although there’s no cure for mania, medication and talk therapy (psychotherapy) can manage your condition in most cases.
Living With
How can I involve family and friends in understanding my mania?
It’s important to have an honest conversation with your family and closest friends.
- Let your family and friends know what you do and don’t find helpful. For example, if you’d appreciate a friendly reminder about taking your daily medications or a question about if you are getting enough sleep, let them know. On the other hand, if you don’t like always being asked if your current state of happiness is a sign you’re having a manic episode, discuss this.
- Ask your family and friends if they can help identify your triggers if you can’t. They may be able to spot triggers that you can’t spot yourself.
Ask what they’ve noticed or any patterns they may see around the times of your episodes. As soon as you recognize an early sign, make an appointment to see your healthcare provider. You may or may not need a medication adjustment. However, it’s good to be on the alert since your symptoms could rapidly change. - Describe how your symptoms feel to you. Your family and friends will have a better understanding of your condition.
- Let family and friends know what type of help you’d like from them and when you’d like it. There may be times when you feel you can cope on your own. Knowing the difference will be helpful for everyone.
Frequently Asked Questions
What is acute mania?
Acute mania is the manic phase of bipolar I disorder. It is defined as an extremely unstable euphoric or irritable mood along with excess activity or energy level, excessively rapid thought and speech, reckless behavior and feeling of invincibility.
What is unipolar mania?
Unipolar mania is a disorder in which only excitement, excess activity or energy level and euphoric symptoms are seen. This is a rare condition.
What’s the difference between mania and hypomania?
Hypomania is a less severe form of mania. The criteria that healthcare professionals use to make the diagnosis of either hypomania or mania is what sets them apart. The differences between these two conditions is as follows:
| Mania | Hypomania | |
|---|---|---|
| How long the episode lasts. | At least one week. | At least four consecutive days. |
| Severity of episode. | Causes severe impact on social or work/school functioning. | Not severe enough to significantly affect social or work/school functioning. |
| Need for hospitalization. | Possibly. | No. |
| Psychotic symptoms present (delusions or hallucinations). | Is among possible symptoms. | Can’t be present for a diagnosis of hypomania. |
Can my diagnosis change between bipolar I disorder and bipolar II disorder?
No. Once you have a diagnosis of bipolar I disorder — even if you never have another manic episode or a psychotic event (delusions or hallucinations) — your diagnosis can never be changed to bipolar II disorder. You’ll always have a bipolar I disorder diagnosis.
A note from Cleveland Clinic
Problems can develop in your social life, work/school functioning and home life when you have symptoms of mania, which include mood swings and an abnormal level of energy and activity. You may require hospitalization if you have severe hallucinations or delusions, or to prevent you from harming yourself or others. It’s important to have a good understanding of mania, mania symptoms, your particular triggers and ways to better manage your manic episodes. Medications, talk therapy and support groups as well as support from your family and friends can help manage your mania.
Stay in close contact with all your healthcare providers, especially during times of manic episodes. Your provider will want to see you and may need changes to your medications or dose.
Manic disorders
Classification of manic episodes by severity includes hypomania, mania without psychotic episodes, and mania with psychotic episodes.
Under hypomania understand a mild degree of mania, in which changes in mood and behavior are long-term and pronounced, not accompanied by delusions and hallucinations. An elated mood manifests itself in the sphere of emotions as a joyful cloudlessness, irritability, in the sphere of speech - as increased talkativeness with ease and superficial judgments, increased contact. In the field of behavior, there is an increase in appetite, sexuality, distractibility, a decrease in the need for sleep, and individual actions that go beyond morality. Ease of associations, increase in working capacity and creative productivity are subjectively felt.
Objectively, the number of social contacts and success increase. At the same time, there are episodes of reckless or irresponsible behavior, increased sociability or familiarity.
The main criterion for diagnosis is an elevated or irritable mood that is abnormal for the individual, persists for at least several days, and is accompanied by the above symptoms.
It should be noted that hypomanic episodes are possible in some somatic and psychiatric disorders. For example, with hyperthyroidism, anorexia or therapeutic starvation in the phase of food arousal; with intoxication with certain psychoactive substances - PAS (amphetamines, alcohol, marijuana, cocaine), however, there are other manifestations of somatic and mental pathology and PAS intoxication.
In its typical form , an extended manic state is manifested by the so-called manic triad: a painfully elevated mood, an accelerated flow of thoughts, and motor excitation. The leading sign of a manic state is a manic affect, manifested in an elevated mood, a feeling of happiness, contentment, well-being, an influx of pleasant memories and associations.
It is characterized by an aggravation of sensations and perceptions, an increase in mechanical and some weakening of logical memory, superficial thinking, lightness and unproductiveness of judgments and conclusions, ideas of reassessment of one's own personality , up to delusional ideas of greatness, disinhibition of drives and weakening of higher feelings, instability, ease of switching attention.
Mania without psychotic symptoms. The main difference from hypomania is that elevated mood affects the change in the norms of social functioning, manifests itself in inadequate actions that are not controlled by the patient. The pace of the passage of time accelerates and the need for sleep is significantly reduced. Tolerance and need for alcohol increase, sexual energy and appetite increase, there is a craving for travel and adventure. Thanks to the leap of ideas, many plans arise, the implementation of which is not carried out. The patient strives for bright and flashy clothes, speaks in a loud voice, incurs a lot of debt and gives money to people he hardly knows.
He easily falls in love and is sure of the love of the whole world for himself. Gathering a lot of random people, he arranges holidays on credit. There is reckless driving, a marked increase in sexual energy, or sexual promiscuity. There are no hallucinations or delusions, although there may be perceptual disturbances (eg, subjective hyperacusis, vivid color perception).
The main symptom is an elevated, expansive, irritable (angry) or suspicious mood, which is not characteristic of this individual. The change in mood should be distinct and persist throughout the week.
Mania with psychotic symptoms. It is a pronounced mania with a bright jump of ideas and manic excitement, to which secondary crazy ideas of greatness, high origin, hypereroticity, value join. There may be hallucinatory hails confirming the significance of the person, or "voices" telling the patient about emotionally neutral things, or delusions of meaning and persecution. The greatest difficulty lies in the differential diagnosis with schizoaffective disorders, however, with these disorders, there should be symptoms characteristic of schizophrenia, and delusions with them are less consistent with mood.
However, the diagnosis can be considered as the starting point for the assessment of schizoaffective disorder (first episode).
Mental disorder formerly referred to as manic-depressive psychosis (MDP). It is characterized by repeated (at least two) manic, depressive and mixed episodes that alternate without a definite sequence. A feature of this psychosis is the presence of light interphase gaps (intermissions), in which all signs of the disease disappear, a complete restoration of a critical attitude to the transferred painful condition is observed, premorbid characterological and personal properties, professional knowledge and skills are preserved. Its non-psychotic form (cyclothymia) in clinical terms is a reduced (weakened, outpatient) variant of the disease.
Manic episodes usually start suddenly and last from two weeks to 4-5 months (mean episode duration about 4 months). Depression tends to last longer (average duration about 6 months), although rarely more than a year (excluding elderly patients).
Both episodes often follow stressful situations or trauma, although their presence is not required for a diagnosis. The first episode can occur at any age. The frequency of episodes and the pattern of remissions and exacerbations are highly variable, but remissions tend to shorten with age, and depressions become more frequent and prolonged after middle age.
Although the earlier concept of manic-depressive disorder included patients who suffered only from depression, the term MDP is now used mainly as a synonym for bipolar disorder.
ATTENTION!!! Self-medication is not allowed in any cases, a psychotherapist is needed
Bipolar disorder | Symptoms, complications, diagnosis and treatment
Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). Episodes of mood swings may occur infrequently or several times a year.
When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When the mood shifts to mania or hypomania (less extreme than mania), you may feel euphoric, full of energy or unusually irritable. These mood swings can affect sleep, energy, alertness, judgment, behavior, and the ability to think clearly.
Although bipolar disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan. In most cases, bipolar disorder is treated with medication and psychological counseling (psychotherapy).
Symptoms
There are several types of bipolar and related disorders. They may include mania, hypomania, and depression. The symptoms can lead to unpredictable changes in mood and behavior, leading to significant stress and difficulty in life.
- Bipolar I. You have had at least one manic episode, which may be preceded or accompanied by hypomanic or major depressive episodes.
In some cases, mania can cause a break with reality (psychosis). - Bipolar disorder II. You have had at least one major depressive episode and at least one hypomanic episode, but never had a manic episode.
- Cyclothymic disorder. You have had at least two years - or one year in children and adolescents - many periods of hypomanic symptoms and periods of depressive symptoms (though less severe than major depression).
- Other types. These include, for example, bipolar and related disorders caused by certain drugs or alcohol or due to health conditions such as Cushing's disease, multiple sclerosis or stroke.
Bipolar II is not a milder form of Bipolar I but is a separate diagnosis. Although bipolar I manic episodes can be severe and dangerous, people with bipolar II can be depressed for longer periods of time, which can cause significant impairment.
Although bipolar disorder can occur at any age, it is usually diagnosed in adolescence or early twenties.
Symptoms can vary from person to person, and symptoms can change over time.
Mania and hypomania
Mania and hypomania are two different types of episodes, but they share the same symptoms. Mania is more pronounced than hypomania and causes more noticeable problems at work, school, and social activities, as well as relationship difficulties. Mania can also cause a break with reality (psychosis) and require hospitalization.
Both a manic and a hypomanic episode include three or more of these symptoms:
- Abnormally optimistic or nervous
- Increased activity, energy or excitement
- Exaggerated sense of well-being and self-confidence (euphoria)
- Reduced need for sleep
- Unusual talkativeness
- Distractibility
- Poor decision-making - for example, in speculation, in sexual encounters, or in irrational investments
Major depressive episode
Major depressive episode includes symptoms that are severe enough to cause noticeable difficulty in daily activities such as work, school, social activities, or relationships.
Episode includes five or more of these symptoms:
- Depressed mood, such as feeling sad, empty, hopeless, or tearful (in children and adolescents, depressed mood may manifest as irritability)
- Marked loss of interest or feeling of displeasure in all (or nearly all) activities
- Significant weight loss with no diet, weight gain, or decreased or increased appetite (in children, failure to gain weight as expected may be a sign of depression)
- Either insomnia or sleeping too much
- Either anxiety or slow behavior
- Fatigue or loss of energy
- Feelings of worthlessness or excessive or inappropriate guilt
- Decreased ability to think or concentrate, or indecisiveness
- Thinking, planning or attempting suicide
Other features of bipolar disorder
Signs and symptoms of bipolar I and bipolar II disorder may include other signs such as anxiety disorder, melancholia, psychosis, or others.
