The clinical features of bipolar disorder

Bipolar Disorder: An Information Guide

The Episodes of Bipolar Disorder

Bipolar disorder is an episodic (that is, recurrent) disorder. It typically consists of three states:

a high state, called “mania”
a low state, called “depression”
a well state, during which many people feel normal and function well.

The manias and depressions may be either “pure” episodes (they have only typical manic or depressive symptoms) or they may be “mixed” episodes (they may consist of a mixture of manic and depressive symptoms at the same time). Traditionally, mixed episodes have been associated with the manic phase of the illness, so terms such as “mixed mania” or “dysphoric mania” are often used to describe mixed states.

Types of Bipolar Disorder

Some people experience manic or mixed, depressed and well phases during their illness. Such people are said to have “Bipolar-I” disorder. A milder form of mania is called “hypomania.” People who have hypomania, depression and intervals without symptoms, but no full manic phases, are said to have “Bipolar-II” disorder.

Order and Frequency of the Various States

The manic/hypomanic, mixed and depressive states usually do not occur in a certain order, and their frequency cannot be predicted. For many people there are years between each episode, whereas others suffer more frequent episodes. Over a lifetime, the average person with bipolar illness experiences about 10 episodes of depression and mania/hypomania or mixed states. As the person ages, the episodes of illness come closer together. Untreated manias often last for two to three months. Untreated depressions usually last longer, between four and six months.

Rapid Cycling

In about 20 per cent of cases, patients have four or more (sometimes many more) episodes a year, and have short phases without symptoms. Patients with four or more episodes a year are said to be having rapid cycling, which is a subtype of bipolar disorder that needs specific treatment. We don’t know for certain what causes rapid cycling. Sometimes, its course may be triggered by certain antidepressants, but how the antidepressant causes rapid cycling is not clear. Sometimes stopping the antidepressant may help the patient to return to a “normal” cycling pattern.