Bipolar Disorder


Bipolar Disorder was formerly known as Manic-Depressive Disorder. The term means that a person has had episodes of both extremely low and extremely high or speedy mood. These lows and highs are extreme "poles", hence the name Bi (meaning two) polar (meaning extremes).

Almost everyone has times when they feel low and other times when we feel quite "high" or energetic. Does this mean that we all have Bipolar Disorder?

No. In order to receive this diagnosis, a person must be diagnosed by a health professional as meeting the criteria for both Major Depressive Episode (the low) and either Manic Episode or Hypomanic Episode (the high) at some point in his or her life.

There are two types of Bipolar Disorder. If a person has had episodes of full Mania (see below), the problem is called Bipolar I Disorder. If the highs are not so extreme and only meet criteria for Hypomania (described below), then Bipolar II Disorder is diagnosed.

Some people with Bipolar Disorder experience episodes more frequently than do others. Those who experience more than four episodes (of any sort) per year may be described as having the "rapid cycling" form of the disorder.

So what are the descriptions of these different types of episodes? Read below.

Major Depressive Episode


A Major Depressive Episode is a period of at least two weeks of severe mood disruption accompanied by a variety of other symptoms.

Briefly, the person must have a severely depressed mood most of the day nearly every day, or a marked lack of interest or pleasure in almost all activities, or both.

To count as a true episode, at least four of the following must also be present:

• Significant change in appetite (decrease or increase; or significant change in weight that isn't the result of a deliberate dieting attempt).
• Insomnia or excessive sleep.
• A speeding up or slowing down of movements nearly every day.
• Fatigue or loss of energy.
• Feelings of worthlessness or excessive guilt.
• Impaired concentration or decision-making ability
• Recurrent thoughts of death (such as suicidal thoughts or a wish for death - not just a fear of dying).

To count as a Major Depressive Episode, the symptoms have to cause significant distress or impairment. As well, the symptoms cannot be due to medication, recreational drugs (such as alcohol), a medical condition, or recent bereavement.

Manic Episode


A Manic Episode is a period of at least a week of unusually high or irritable mood. In addition, at least three of the following must be present (four if the mood is mainly irritable):
• Excessively or unusually high self-esteem, or grandiose ideas (for example "Tonight I'll stay up late and write the Great Canadian Novel in one sitting").
• Decreased need for sleep, relative to usual.
• Being much more talkative than usual.
• Racing thoughts.
• Unusual distractibility.
• A sharp increase in activity that is directed toward life goals (such as a period of unusually intense work, or socializing, or household organization).
• Pleasure-oriented behavior with a high probability of danger or negative consequences (such as spending sprees, impulsive investments, or sexual adventures).

None of these symptoms, on its own, is necessarily a sign of a psychological problem. But if enough of them are present at the same time, if they are intense enough to cause significant work or social problems, and if they are not the result of medication, other drugs, or another medical condition, then they may add up to a manic episode.

Manic episodes are typically so extreme that they are easily diagnosed by a trained professional, and easily recognized as unusual by the person's family or friends.

Hypomanic Episode


A high may not always be so extreme as a manic episode. These milder highs are called Hypomanic Episodes, where "hypo" means "below."

Whereas manic episodes can be extremely easy to spot, hypomanic episodes are often more difficult. Diagnosis requires an unusually elevated or irritable mood lasting at least four days, plus additional symptoms similar to those listed for manic episode. But the episode need not be so severe that it causes a marked decline in functioning. Indeed, as author Kaye Redfield Jamison has pointed out in her book Touched with Fire (1993), many noted writers and artists have produced significant works during hypomanic episodes.

Mixed Episode


Sometimes a person displays characteristics of both mania and depression. A mixed episode is diagnosed when the person meets the criteria for both manic and depressed episodes at the same time, for at least one week.

Overall...


If, based on these descriptions, you believe that you may have Bipolar Disorder, tell your physician. Effective treatments are available for this problem.

Note: Information on these pages is provided for educational purposes only. It should not be taken as a substitute for care from a qualified healthcare provider.

Online Course: What Is Depression?

In this course, Dr Paterson discusses the nature, experience, and diagnosis of bipolar disorder as well as other mood-related issues. The focus is on the symptoms, rather than the causes or treatments, which are topics planned for other courses. Registrants receive an extensive set of course notes. For 40% off the regular fee of $20, use coupon code “what40off” when you visit our host site,
here.