Bipolar disorder, or bipolar and manic depression

When hearing about bipolar disorder, many people think of extreme mood swings. However, the illness is much more complex than that. Along with mood, energy levels, activity, sleep, thinking, and behavior can also change significantly. The previously common name “manic depression” also refers to this condition.

This article is about how to recognize bipolar disorder, its forms and symptoms, and how it is treated. The most important thing you should know is that we are not talking about simple mood swings, but a mental disorder that requires treatment. At the same time, with the right help, symptoms can be managed well and you can live a full and happy life.

Main takeaways:

• During bipolar disorder, manic or hypomanic and depressive periods can occur.

• For a diagnosis, we look at the pattern and timing of symptoms rather than individual mood swings.

• Treatment is usually based on a combination of medication and psychotherapy methods.

What is bipolar disorder?

Bipolar disorder is a mental health condition where you experience mood episodes that are very different from each other. Alongside manic or hypomanic periods, depressive episodes can also occur. Between individual episodes, there can even be longer, more balanced periods.

It is important to make a distinction between everyday mood swings and bipolar episodes. All our moods are affected by successes, failures, conflicts, or even a lack of sleep. However, in bipolar disorder, the change is more intense, lasts longer, and can affect how you function in everyday life.

How does bipolar disorder affect mood and behavior?

During a manic period, a person can feel unusually energetic, enthusiastic, or self-confident. In others, irritability and restlessness are more prominent. A decreased need for sleep, rapid speech and thoughts, and impulsive behavior are common.

During a depressive period, on the other hand, you can experience a significant lack of energy, a loss of joy, and feelings of hopelessness. Even tasks that were previously easy to do can become overwhelming.

Types of bipolar disorder

Bipolar disorder does not look the same for everyone. The diagnostic system distinguishes between several forms.

Bipolar I disorder: The defining feature of bipolar I disorder is that the person experiences at least one full manic episode in their lifetime. This state lasts for at least one week, or is severe enough to require hospital care (in which case it doesn't need to last a week for a diagnosis).

During mania, energy levels, thinking, and behavior can change significantly. Common signs can include:

• unusually high energy levels while the need for sleep drops significantly;

• grand ideas, even feeling a kind of "special mission";

• uncontrolled spending or risky sexual behavior;

• increased irritability, which can even turn into aggressive behavior.

In severe manic episodes, psychotic symptoms can also appear, such as delusions or hallucinations.

During bipolar I disorder, depressive episodes can also occur, but these are not required for a diagnosis. 

For a diagnosis of bipolar I disorder, a single full manic episode is enough.

Bipolar II disorder: In bipolar II disorder, a full manic episode does not occur. Instead, hypomanic periods appear. 

Hypomania is a milder form of mania, which brings a noticeable change from the person's usual way of functioning.

A hypomanic episode:

• lasts for at least four consecutive days;

• is clearly different from the person's usual behavior;

• does not involve psychotic symptoms – if psychosis appears, the episode is classified as manic;

• is not severe enough to require hospital care.

During a hypomanic period, the person might seem more energetic and productive than usual. Because of this, they or those around them might initially view the change as a positive thing.

An important part of bipolar II disorder are the often deep depressive episodes. These often last longer and cause more distress than the hypomanic periods.

To make a diagnosis, two basic conditions must be met:

• at least one hypomanic episode;

• at least one major depressive episode.

Cyclothymia: characterized by chronically fluctuating hypomanic and depressive symptoms that do not meet the full criteria for an episode in every case. Even so, the mood swings can be persistent and significantly affect your quality of life.

There are also other specified and unspecified bipolar and related disorders. In these, bipolar-like symptoms are present, but the pattern does not fully fit into the main diagnostic categories.

Symptoms of bipolar disorder

The symptoms of bipolar disorder can vary greatly depending on what kind of mood episode you are currently experiencing. Manic, depressive, and mixed states can show completely different symptoms, so it is worth looking at them separately.

Symptoms of manic depression

As mentioned above, “manic depression” is the older name for bipolar disorder. During a manic episode, you might notice:

• a strikingly elevated or irritable mood;

• significantly increased energy levels;

• decreased need for sleep;

• fast talking and racing thoughts;

• boosted self-confidence or grandiosity;

• being easily distracted;

• impulsive spending or risk-taking;

• unusually intense social or sexual activity.

In severe mania, psychotic symptoms can appear. In these cases, the person might attribute special abilities or significance to themselves that do not match reality.

Symptoms of a depressive episode

During a depressive episode, persistent sadness or a loss of interest can appear. Fatigue, changes in sleep and appetite, and poor concentration are also common.

You might also experience feelings of worthlessness, excessive guilt, and hopelessness. In severe cases, thoughts of death or suicide can also occur. 

Characteristics of mixed episodes

Manic and depressive symptoms do not always stay clearly separated. Sometimes, features of both poles can appear during the same period.

For example, someone might feel extremely energetic and restless, while at the same time experiencing hopelessness or strong negative emotions. 

Recognizing mixed symptoms is very important because this state can put a lot of strain on a person.

What causes bipolar disorder?

There is no single, clear cause of bipolar disorder. Based on what we know today, genetic, biological, psychological, and environmental factors all play a role together in its development.

Genetic predisposition is a significant factor, so having it in the family can increase the risk. However, this does not mean the illness will definitely develop just because a family member has it.

Certain life situations can also trigger or worsen symptoms. This could be a major loss, a relationship crisis, or long-term stress. Alcohol and certain psychoactive substances can also affect how the illness develops.

Sleep plays an especially important role. A disruption of the sleep-wake cycle can be linked to mood episodes, which is why a stable daily routine is an important part of managing the condition.

How is bipolar disorder diagnosed?

Diagnosing bipolar disorder requires a detailed assessment. There is no simple lab test or psychological test that can prove the illness on its own. A specialist will review your current symptoms and previous mood periods. 

The duration and severity of the episodes, and their impact on daily life, are key details. 

Family history can also provide valuable clues.

During diagnosis, other possible causes must be ruled out. Certain physical illnesses, medications, and psychoactive substances can cause states similar to bipolar symptoms.

Recognizing bipolar II disorder can be especially tricky. People often seek help during a depressive period, while not seeing past hypomania as a problem. Because of this, it might first be suspected as major depression.

Treating bipolar disorder

Treating bipolar disorder is usually a long-term journey. 

The goal is to treat the current episode, prevent new ones, and support you in your daily life.

Medication plays a central role. Mood stabilizers and certain antipsychotics are often used. All medication requires careful attention, so therapy should always be set up and monitored by a psychiatrist.

Psychotherapy support can complement your medication. Cognitive behavioral therapy, psychoeducation, and family-focused methods can all be very helpful. It is really important to be mindful and make the right decision when deciding whether to seek help from a psychologist or a psychiatrist first. 

Your lifestyle is also a key part of treatment. Regular sleep, a predictable daily routine, suitable physical activity, and reducing stress can all help you stay balanced. Keeping track of your mood and sleep is also a handy tool.

How to live with bipolar disorder

A diagnosis does not mean you cannot live a full, active life. 

With the right treatment, many people are able to manage their symptoms well in the long run and keep up their relationships, work, and the activities they love.

It helps a lot to learn to recognize your own early warning signs. These might include a noticeable drop in your need for sleep, unusual activity, or a lasting change in your mood.

Involving close family and friends can be wonderful too. They often notice changes early on, especially when a hypomanic or manic period is starting.

When should you seek professional help if you suspect bipolar disorder?

It is wise to seek help if you regularly experience extreme mood periods. Getting checked out is especially important if these are accompanied by significant changes in sleep, energy, or behavior.

A psychiatric assessment is also a good idea if these mood changes are putting your work, relationships, or safety at risk. 

If you experience thoughts of suicide, severe psychotic symptoms, or dangerous behavior, immediate help is needed. In this case, please visit your nearest psychiatric emergency service right away, or call 112 for guidance!

Common myths about bipolar disorder

“A person with bipolar is happy one minute and sad the next.” 

Bipolar episodes are not just quick, everyday mood swings that last a few minutes. They involve lasting changes in mood, energy levels, and behavior.

“Mania is just being in a really great mood.” 

Mania can bring euphoria, but it can also bring irritability, impulsivity, and risky decisions. In severe cases, psychotic symptoms can appear.

“Bipolar II is less serious.” 

While hypomania is indeed milder than mania, the depressive episodes of bipolar II disorder can cause significant suffering and make daily life very difficult.

“If you take medication, you do not need psychological support.” 

Treatment is a whole puzzle. Along with medication, psychotherapy and psychosocial methods play a big part in helping you feel your best, and we highly recommend a combined approach.

Frequently asked questions about bipolar disorder

What is the difference between bipolar disorder and depression?

In major depression, there are no manic or hypomanic episodes. In bipolar disorder, you experience depressive periods alongside periods of mania or hypomania.

What is the difference between bipolar I and II?

Bipolar I is characterized by manic episodes. In bipolar II, you experience hypomanic and major depressive episodes (at least one of each), without full mania.

Can bipolar disorder be cured?

Bipolar disorder is typically a condition that requires long-term management. However, with the right therapy, symptoms and the risk of relapse can be significantly reduced, helping you live a happier, smoother life.

Can I live a normal life with bipolar disorder?

Yes, absolutely. With the right treatment, regular check-ins, and understanding your own symptoms, many people live a balanced and fulfilling life with bipolar disorder.

How is bipolar disorder treated?

Treatment usually consists of medication, psychological or psychotherapeutic support, and lifestyle changes. The specific plan is always tailored to fit the individual.

In summary, bipolar disorder can show up in many ways, so it is not a good idea to self-diagnose based on a few symptoms. If you recognize these patterns in yourself or someone close to you, the next step is to chat with a specialist. An accurate diagnosis and the right support can make a wonderful difference in the long run.