The symptoms of bipolar disorder

Bipolar Disorder: An Information Guide

On this page:

• Mania
• Hypomania
• Mixed State
• Depression
• Other Symptoms of a Bipolar Episode
• “Comorbidity” and Its Importance

Mania

Sometimes, a person may seem abnormally and continuously high, irritable or expansive for at least one week. If this change in mood is accompanied by other symptoms (see below) the person may be in a manic phase of the bipolar illness. Not everybody who enters a manic phase feels happy or euphoric. Instead, a person may feel very irritable, or may be terribly angry, disruptive and aggressive.

People in a manic phase do not just have mood symptoms. They must have at least three of the following symptoms to an important degree:

Exaggerated self-esteem or feeling of grandeur

People feel invincible or all powerful; they believe they understand “how the world works” or how to save it. They may feel they have a special mission in life (that is, God has sent them or given them special powers).

Less need for sleep

People feel rested after just a few hours of sleep. Sometimes they may not sleep at all for a few days or even weeks.

Increased talking

People may talk very quickly, too loudly and much more than usual. They may like to tell jokes or rhyme words and may become angry when interrupted. They may keep switching topics and cannot converse properly with others.

Flight of ideas or racing thoughts

People easily lose their train of thought, and have trouble interacting because they are easily distracted. They may be impatient with others who cannot follow their fast thinking and changing plans and ideas.

Speeded-up activity

People may socialize more than usual at work or school, or may be much more active, with seemingly boundless energy. In the early manic phase, they may be productive, but as symptoms worsen, people are more frantic in their activities and start but do not finish many projects.

Poor judgment

People may not be able to control or plan how they act. They may take part in unusual and risky activities without realizing harmful consequences (e.g., shopping sprees, bad business choices and bad decisions). They may feel more sexual, become more sexually active and take less care in choosing their sexual partners. This increased sexual activity may lead to unwanted pregnancies, sexually transmitted diseases, guilt and disrupted relationships.

Psychotic symptoms

People may experience delusions, or beliefs that are not based in reality. They may hallucinate - most often, they hear voices.

Hypomania

The symptoms of hypomania are less severe than those of mania, but may still be disruptive. People may feel happy and have lots of energy, but do not usually get into serious trouble. Hypomania may progress to a full-blown manic episode or a severe depression, and therefore needs treatment.

Mixed State

Some patients do not always have “pure” manic or depressive episodes. Instead, they may experience episodes in which manic and depressive symptoms occur at the same time. This is called a “mixed state.” For example, someone in a mixed state can think and speak very rapidly. At the same time, the person may be very anxious and have suicidal thoughts. Mixed states are hard to diagnose and are very painful for the individual.

Depression

Depression can take many forms, and it often comes out of nowhere. The symptoms must last for at least two weeks, and must be present most days and last most of the day. Symptoms of depression in bipolar disorder include at least five of the following:

Depressed Mood

The mood state in depression differs substantially from normal sadness. In fact, many depressed people say they cannot feel sadness, and many people cannot cry when depressed. Being able to cry again often means the depression is improving.

Marked Loss of Interest or Pleasure in Activities That Used to Be Fun

When people have just begun to feel depressed or are mildly depressed, they can still enjoy things, and may also be distracted by pleasurable activities. When people are severely depressed, they lose these abilities.

Weight Loss or Weight Gain

Many people lose weight when depressed, partly because they lose their appetite. However, one subgroup of patients feels hungrier, and may develop a craving for carbohydrate-rich and fatty foods. This results in weight gain. Metabolism may also increase or slow down, depending on the type of depression; such changes in metabolism can cause either weight loss or weight gain.

Sleep Problems

Sleep disturbance is common in depression. Many people suffer from insomnia: they have trouble falling asleep, wake up often during the night or wake very early in the morning. People do not see sleep as being restful, and they may wake up feeling exhausted. Other people oversleep, especially during the day; they are said to have “hypersomnia.”

Apathy or Agitation

Many people with depression develop slowed-down movement, speech or thinking. In severe cases, depressed people may be unable to move, speak and respond to their environment. In some people, the opposite happens, and they are very agitated. They are tormented by a severe inner restlessness - they cannot sit still, they pace, they may wring their hands. They may also show in other ways that they are agitated. Patients who feel agitated often feel very anxious, too.

Loss of Energy

Depressed individuals find it hard to complete everyday chores. It takes them longer to perform at work or at home because they lack energy and drive.

Worthlessness and Guilt

When depressed, individuals may lack self-confidence. They may not assert themselves, and they may be overwhelmed by feelings of worthlessness. Many people cannot stop thinking about past events. They obsess about having let others down or having said the wrong things - and they feel very guilty. In severe cases, the guilt may cause delusions; that is, people feel sure that they have sinned and need to be punished for their wrong-doings. Or they may believe that God is punishing them for their past mistakes.

Inability to Concentrate or Decide

These symptoms may be so bad that people cannot do simple tasks. They may have trouble deciding on very small matters.

Suicidal Thoughts

Depressed people often think that life is not worth living or that they would be better off dead. The risk of acting upon these thoughts is high, and many people do try to commit suicide when depressed.

Psychotic Symptoms

These may include false beliefs about poverty or punishment for past sins. People may believe that they have a deadly disease, such as cancer. They may also hear voices (auditory hallucinations) or may see things that do not exist (visual hallucinations).

Depressive symptoms also often include:

• severe anxiety
• worries about small matters
• complaints about physical symptoms, including pain
• many visits to the family doctor for various physical symptoms.

Other Symptoms of a Bipolar Episode

Some patients with bipolar disorder may have problems with movement during their episodes. These disturbances of movement (motor symptoms) occur in up to 25 per cent of depressed patients and up to 28 per cent of patients with mixed or pure manic episodes. These motor problems are called “catatonic symptoms.” Such symptoms vary and may include extreme physical agitation or slowness and odd movements or postures. Patients can’t be slowed down or, on the other hand, they may move so little that they even refuse to open their mouth to eat, drink or speak. This is a serious risk to their physical health. In most cases, patients become free of catatonic symptoms after specific treatment.

There is a risk that people who exhibit catatonic symptoms may be misdiagnosed, because catatonic symptoms have been traditionally associated with schizophrenia, rather than bipolar disorder.

“Comorbidity” and Its Importance

A “comorbid disorder” is an illness or medical condition that occurs together with another illness or medical condition. Comorbid conditions can occur with bipolar disorder - they can start either before a bipolar illness or at the same time. Experts do not know why some disorders co-occur frequently with bipolar disorder and others do not. The severity of the comorbid condition may change over a lifetime, and its symptoms may also vary as the bipolar disorder changes.

For example, one of the most common comorbid conditions is drug or alcohol abuse. People with an alcohol problem may drink too much during mania, or they may experiment with drugs, because they feel free and they are impulsive. They may also drink or do drugs during depressive phases, because alcohol or drugs help them to feel less depressed. The same people may not abuse alcohol or drugs during their well phase.

Other Psychiatric Conditions that often Co-occur with Bipolar Disorder

• panic disorder
• obsessive-compulsive disorder
• binge eating disorder
• drug/alcohol abuse

It is important to diagnose comorbidity in bipolar disorder. Comorbid conditions may cloud the clinical picture and complicate treatment of bipolar disorder. Also, the comorbid conditions are often so severe that they too need treating.

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