Manic episodes may not be as obvious as advertised.
One cliched image of bipolar disorder shows the two Greek theater masks: one making the joyful grin beside the other with a sorrowful frown. The two masks serve to show the clear-cut extreme moods that define bipolar disorder.
“Bipolar disorder is a mental illness that involves both having had experience of a manic episode, as well as experience of depressive episodes,” says Susan Samuels, MD, psychiatrist at New York-Presbyterian Hospital, Weill Cornell Medicine.
But contrary to the opposing mask symbolism, bipolar disorder might be more nuanced in real life. Manic episodes may be few and far between, and states of hypomania may fly under the radar. But catching manic symptoms is crucial because it’s arguably the most vital piece for diagnosing someone with bipolar disorder.
How to Spot a Manic Episode in Bipolar Disorder
Symptoms of bipolar disorder typically appear first during late adolescence and early adulthood, according to Dr. Samuels. This mood disorder may last a lifetime, but treatment for bipolar disorder may lessen symptoms.
The signature symptom of bipolar disorder is the presence of manic or hypomanic episodes. A true manic episodes lasts at least one week and may be severe enough to result in hospitalization, according to the National Alliance for Mental Illness.
During a manic episode, you might notice the following symptoms, according to Ben Michaelis, PhD, psychologist in New York City.
Feeling special and grandiose
Needing less sleep
Having racing thoughts
Talking more than usual
Engaging in risky behaviors, such as gambling, impulsive spending, reckless sex, or misusing drugs and alcohol
If someone has bipolar I disorder, their manic episodes may include psychosis, meaning they hear and see things that aren’t there. Someone with bipolar II disorder may not have true mania, but will often experience a more subtle form: hypomania. Learn more about the difference between bipolar I and bipolar II here.
Symptoms of a Depressive Episode in Bipolar Disorder
Although manic episodes distinguish bipolar disorder from other mental health problems, most patients tend to notice depressive symptoms first. Sometimes, people with bipolar disorder may have a hypomanic episode but not realize it—or not care because it actually feels great.
“Depression in bipolar disorder looks like major depression,” says Gail Saltz, MD, psychiatrist at New York-Presbyterian Hospital, Weill Cornell Medicine. Just like with unipolar depression, a depressive episode of bipolar disorder may exhibit these symptoms:
Sleeping more or less than usual
Eating more or less than usual
Extended feelings of sadness, hopelessness, and worthlessness
Losing interest in things you once loved
Thinking about self-harm, death, or suicide
When Depression Becomes Bipolar Disorder
Here’s the truth: Most people with bipolar disorder feel depressed more than they feel manic. The feelings of sadness and worthlessness may seem constant and acute. For many days, their symptoms are indistinguishable from someone with major depressive disorder.
“To qualify for the diagnosis [of bipolar disorder], you only need to have ever had one manic episode in your entire life,” says Dr. Samuels. That’s important because bipolar disorder is treated differently than depression, since medications for depression may actually trigger a manic episode.
It might seem like manic episodes don’t need treatment, but severe mania can have serious consequences and be exhausting to deal with. Even hypomania, which is sometimes considered a “high-functioning” form of mania, needs treatment.
“The problem is that untreated hypomania doesn’t stay that way,” says Dr. Saltz. “It dips quickly into either severe depression or mania with psychosis—both of which are dangerous states.” Learn more about how bipolar disorder is treated.
If you’re having thoughts of self-harm or suicide, call 911, go to the nearest emergency room, or call the National Suicide Prevention Lifeline: 1-800-273-8255.
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So in bipolar disorder,
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really what defines it is to some
degree the hypomania or mania.
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Because otherwise if they're
just having depressions,
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then we say you have
recurrent major depression.
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We most often see the first
signs of bipolar disorder in late
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more commonly in early adulthood.
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So, some time around 20 years old
we'll tend to see signs and symptoms.
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Bipolar disorder is a mental illness
that involves both having had
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an experience of a manic episode, as well
as experiencing depressive episodes.
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Pneumatic episode is an experience
lasting at least one week,
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where a person feels really great
about themselves, grandiose,
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even to great about
themselves if you will.
00:00:52,710 --> 00:00:56,670
They tend to need less sleep,
they experience racing thoughts,
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they're more talkative than usual,
they seem to be more outgoing than usual.
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And they tend to engage in a variety
of different activities that have
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potentially painful consequences.
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So more activities involving drugs,
or alcohol, or spending, or
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sex, or sort of frivolous purchases.
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All of these things are a part
of a manic episode.
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The difference between more severe and
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less severe bipolar disorder is determined
by the severity of the manic episode.
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So a severely manic
episode would qualify for
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bipolar I versus a hypomanic episode
would qualify for bipolar II.
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So depression in bipolar disorder
looks like major depression,
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unipolar major depression.
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Which is, usually, a disturbance of sleep,
an appetite, either too little or
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too much, feelings of sadness for
most of the day, every day,
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with feelings of hopelessness,
worthlessness, difficulty concentrating.
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Something called anhedonia, the loss
of pleasure in anything that you used
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to find pleasurable, and a lot of thoughts
potentially about death or even suicide.
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So what's really important to
know about the diagnosis of bipolar
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disorder is to qualify for the diagnosis,
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you only need to have ever had one
manic episode in your entire life.
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The problem is that untreated
hypomania doesn't stay that way.
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It dips quickly into either
severe depression or
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mania with psychosis,
both of which are dangerous states.
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00:02:26,435 --> 00:02:30,463
If you ever feel like you might want
to harm yourself or somebody else,
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please call 911 immediately or
proceed to your nearest emergency room.
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It's also good to have on hand
the National Suicide Prevention Lifeline
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which is 1-800-273-8255.
Bipolar disorder. Arlington, VA: National Alliance for Mental Illness. (Accessed on July 31, 2018 at https://www.nami.org/learn-more/mental-health-conditions/bipolar-disorder.)
Bipolar disorder. Bethesda, MD: National Institute of Mental Health. (Accessed on July 31, 2018 at https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml.)
Bipolar disorder. Washington, DC: U.S. National Library of Medicine. (Accessed on July 31, 2018 at https://medlineplus.gov/bipolardisorder.html.)