This article discusses the various forms of Bipolar disorder. For information on specific symptoms of Bipolar disorder, please check out: Bipolar Depression Symptoms: Signs You Should Watch Out For Before They Get Too Bad.
The term manic depression is an older term that has been replaced by Bipolar disorder or simply Bipolar. It refers to the cycling between periods of depression and periods of high mood, known as mania.
On TV and in the movies, Bipolar disorder is shown as extreme, with those suffering from a manic episode going out and doing life endangering activities, leaving their families for weeks, and living in a total dreamworld, out of touch with reality.
While the basic concepts are the same, the reality of Bipolar isn’t so clear cut. Bipolar is diagnosed when an individual does have periods of an elevated mood, higher than you would see in normal happiness. The other side of Bipolar is depression. The cycling is random and can be very sudden. However, there are some individuals who won’t seem to be acting manic except to those around them who know their mood is exceptionally elevated. There are also some manifestations of depression that are believed to actually be a milder form of Bipolar, not simply depression.
The idea of a disorder referred to first as manic depression, and then later as Bipolar, has been around for at least a century, dating back to the beginning of psychiatry. However, it’s only been since the 1970s or so that the idea of a Bipolar spectrum has been gaining widespread approval. Although not all psychiatrists believe that a Bipolar spectrum is needed, there are distinct reasons to have one.
The Bipolar spectrum is a way of defining the range of severity of Bipolar symptoms that patients experience. Those with clear manic episodes that cycle with depression, those closest to what you see in the movies and on TV, would be at one end of the spectrum. Those who have mild periods of mania, which may be mistaken for times of normal happiness, would fall on the other end of the spectrum.
The bipolar spectrum is divided into four segments:
Bipolar I is the new name for what was typically thought of as manic depression. Those with Bipolar I have a manic episode that lasts for at least one week, alternating with periods of depression. The cycles are random and can’t be anticipated. The periods of depression occur more often than the mania, at about 3 to 1.
Bipolar II is used to describe those with Bipolar who don’t show symptoms as severe. The periods of mania are much milder, and can last several days, though not necessarily as long as those with Bipolar I. The periods of mania are referred to as hypomania and can often be mistaken for periods of normal happiness. Also, because the episodes of depression outnumber the periods of hypomania, usually at least 30 to 1, many patients are thought to simply be depressed, and the cycling that comes with Bipolar II can be missed.
The other two categories of Bipolar aren’t typically thought of when someone thinks of depression or manic depression.
Bipolar III refers to those who may have seemed to be simply depressed, yet end up with hypomanic episodes when they are put on antidepressant medications. In these cases, the antidepressant medications have made symptoms worse, but a good psychiatrist will be watching for these reactions and carefully working with the patient to find the best treatment for them.
Bipolar IV is used for those who have a rapid cycling between the extremes of mania and depression. This type of bipolar disorder is described as at least 4 episodes of either mania or depression in a year. In rare cases, the cycling may be even more rapid, up to those severe cases where the cycling occurs throughout a single day.
The DSM-IV, the “bible” of mental disorders, refers to part of the Bipolar spectrum called Cyclothymia. This is alternative Bipolar III, characterized by a history of episodes of hypomania and depression. The depression can certainly be recognized, but may not be as severe as other depressive episodes. Remember that because hypomania can be seen as normal happiness, depending on the diagnosing physician, they may be seen as having recurrent depression.
Although, if the return of the depression appears to have a distinct cycle, the diagnosis may be changed from depression to part of the Bipolar spectrum. A doctor may also treat recurrent depression as if it is on the Bipolar spectrum, even if he doesn’t suspect episodes of hypomania; mood stabilizers in combination with anti depressants are helpful for some people.
Cyclothymia also describes those whose hypomania or depressive episodes appear as a personality trait. Since the cycling may be gradual and the symptoms very mild, others may not recognize the individual as having a mental illness. None the less, these patients can also be helped, and their mood stabilized so that their life is not affected.
One of the reasons this spectrum of bipolar isn’t widely accepted is because there are some who feel many different manifestations of mental illness are really subsets of bipolar disorder. Diseases such as substance abuse, eating disorders, or personality disorders have been proposed to fit on the scale, sometimes in between the categories stated above, as fractions, like Bipolar I 1/2.
If you hear of someone who has been diagnosed, or have been diagnosed yourself, with manic depression, or Bipolar disorder, it is unlikely to be as dramatic as depicted in fiction. Although symptoms of the disease are along the same lines as those seen in the movies, they are usually not as severe.
Also remember that Bipolar may refer to a much milder form of cycling that mostly involves depression, rather than distinct periods of mania. And, as hypomania may seem, even to the person experiencing them, as what normal feels like, a diagnosis of Bipolar may seem much scarier than it really is.
It’s important for anyone who suspects they may have depression or Bipolar disorder to see a trained professional to help distinguish exactly what is going on. This will ensure a method of treatment that is best suited to each individual. If they don’t feel comfortable with their physician, they should see someone else.
Since mental illness can be very slippery, unlike an infection, treatment will probably need to be adjusted as some medications may not work as well, or even as the seasons change. A good relationship with a doctor allows the doctor to sense changes in mood that may indicate the need for a change in medication.
Whether a diagnosis of Bipolar I, or Bipolar II, or even a diagnosis of only depression, sometimes called unipolar depression, there is help available. A balanced mood helps people live a normal life without ruining relationships, turning to substance abuse, or engaging in even more extreme behaviors – including suicide. Mental illness is an illness, and a good doctor will treat it as such.
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