An Introduction to Bipolar Disorder

By Steve Bressert, Ph.D.

Table of Contents:

Bipolar disorder, also known by its older name “manic depression,” is a mental disorder that is characterized by constantly changing moods. A person with bipolar disorder experiences alternating “highs” (what clinicians call “mania“) and “lows” (also known as depression). Both the manic and depressive periods can be brief, from just a few hours to a few days, or longer, lasting up to several weeks or even months. The periods of mania and depression range from person to person — many people may only experience very brief periods of these intense moods, and may not even be aware that they have bipolar disorder.

A manic episode is characterized by extreme happiness, hyperactivity, little need for sleep and racing thoughts, which may lead to rapid speech. A depressive episode is characterized by extreme sadness, a lack of energy or interest in things, an inability to enjoy normally pleasurable activities and feelings of helplessness and hopelessness. On average, someone with bipolar disorder may have up to three years of normal mood between episodes of mania or depression.

Bipolar disorder is recurrent, meaning that more than 90% of the individuals who have a single manic episode will go on to experience future episodes. Roughly 70% of manic episodes in bipolar disorder occur immediately before or after a depressive episode. Treatment seeks to reduce the feelings of mania and depression associated with the disorder, and restore balance to the person’s mood.

Types of Bipolar Disorder

Those with bipolar disorder often describe their experience as being on an emotional roller coaster. Cycling up and down between strong emotions can keep a person from having anything approaching a “normal” life. The emotions, thoughts and behavior of a person with bipolar disorder are often experienced as beyond one’s control. Friends, co-workers and family may sometimes intervene to try and help protect their interests and health. This makes the condition exhausting not only for the sufferer, but for those in contact with her or him as well.

Bipolar cycling can either be rapid, or more slowly over time. Those who experience rapid cycling can go between depression and mania as often as a few times a week (some even cycle within the same day). Most people with bipolar disorder are of the slow cycling type — they experience long periods of being up (“high” or manic phase) and of being down (“low” or depressive phase). Researchers do not yet understand why some people cycle more quickly than others.

Bipolar Cycling

Living with bipolar disorder can be challenging in maintaining a regular lifestyle. Manic episodes can lead to family conflict or financial problems, especially when the person with bipolar disorder appears to behave erratically and irresponsibly without reason. During the manic phase, people often become impulsive and act aggressively. This can result in high-risk behavior, such as repeated intoxication, extravagant spending and risky sexual behavior.

During severe manic or depressed episodes, some people with bipolar disorder may have symptoms that overwhelm their ability to deal with everyday life, and even reality. This inability to distinguish reality from unreality results in psychotic symptoms such as hearing voices, paranoia, visual hallucinations, and false beliefs of special powers or identity. They may have distressing periods of great sadness alternating with euphoric optimism (a “natural high”) and/or rage that is not typical of the person during periods of wellness. These abrupt shifts of mood interfere with reason, logic and perception to such a drastic degree that those affected may be unaware of the need for help. However, if left untreated, bipolar disorder can seriously affect nearly every aspect of a person’s life.

Identifying the first episode of mania or depression and receiving early treatment is essential to managing bipolar disorder. In most cases, a depressive episode occurs before a manic episode, and many patients are treated initially as if they have major depression. Usually, the first recognized episode of bipolar disorder is a manic episode. Once a manic episode occurs, it becomes clearer that the person is suffering from an illness characterized by alternating moods. Because of this difficulty with diagnosis, family history of similar illness or episodes is particularly important. People who first seek treatment as a result of a depressed episode may continue to be treated as someone with unipolar depression until a manic episode develops. Ironically, treatment of depressed bipolar patients with antidepressants can trigger a manic episode in some patients.

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APA Reference
Bressert, S. (2007). An Introduction to Bipolar Disorder. Psych Central. Retrieved on November 23, 2014, from http://psychcentral.com/lib/an-introduction-to-bipolar-disorder/000914
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    Last reviewed: By John M. Grohol, Psy.D. on 30 Jan 2013
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