There are a number of common types of phases that most people with bipolar disorder experience to one degree or another. The most commonly experienced type of bipolar disorder is one where the individual cycles back and forth between a state of mania (or hypomania, a lesser form of mania) and depression.
During this phase, people have an elevated mood, or “high,” which includes feelings of increased self-esteem and uniqueness. They often overestimate how much they can do and the quality of their ideas. Judgment becomes impaired and patients feel powerful over painful consequences. They feel “bulletproof” and have little regret or concern for their actions. They may have many ideas and lots of energy to carry them out.
The abundance of thoughts may be difficult to follow; such thoughts are called racing thoughts or pressured speech. People in manic episode may feel such an extreme pressure to keep talking that others do not have the opportunity to interrupt them. Manic patients’ minds are working so fast that they come up with rhymes or sing-song phrases, burst out in song or start dancing spontaneously. Their daily behavior can become disorganized or even dangerous to the point that they require hospitalization.
Manic episodes can also have psychotic symptoms present. Psychosis is a state in which a person is unable to tell the difference from reality and unreality. Psychosis symptoms include hallucinations, false beliefs about having special powers or identity (such as superhuman strength or X-ray vision). Psychotic symptoms indicate a severe mood episode that requires immediate medical attention and treatment.
People experiencing mania might begin several activities at once, never doubting that they can complete all of them. They may have so much energy that they operate on two or three hours of sleep each day. All of this energy can exhaust the family, friends and co-workers of a person with bipolar disorder.
During this phase, people with bipolar disorder may stay in bed all day, often feeling that they cannot get going. They may feel that their thoughts move slowly, and they take little pleasure in any activity. Bipolar patients in a depressed phase often feel as if they are worthless and as if their life is meaningless. They may begin to overeat and, given their low activity level, gain weight. They may speak or think of suicide, making emergency care crucial for their safety. Just as in a manic episode, psychotic symptoms may also occur during severe depressive episodes.
This is a mood episode during which the symptoms of depression and mania are experienced at the same time. This can lead to irritability, hostility and physical aggression. Patients often are hospitalized for their safety and the safety of those around them. They may need a longer hospital stay or a combination of more than one medication to get well.
This term describes the overall course of the illness over a period of 12 months. A patient with rapid cycling bipolar disorder has four or more manic, hypomanic, depressive or mixed episodes in a 12-month period. Rapid cycling bipolar disorder is difficult to treat and often is less responsive to medication. Treatment usually requires a combination of medications. This condition is more common in women, especially women who have a problem with the thyroid gland, which can involve a hormonal imbalance that mimics mania or depression. An estimated 15 to 20 percent of bipolar patients will develop rapid cycling.
This term describes mood disorders that seem to be triggered by a particular season of the year. For example, someone who tends to become depressed during the late fall and winter and then returns to a regular mood during the spring and summer has a seasonal pattern of depression. In bipolar disorder, a seasonal-pattern patient would tend to have manic or hypomanic episodes during a specific season of the year. During the other seasons, their mood would tend to be normal neither manic nor depressed. The fall/winter depression pattern is more common than the spring/summer pattern. Suicide is far more common in March, April and May, probably due to changes in light.