Bipolar Disorder (AKA 'Manic Depression'): What Is Typical and What Isn't?

Bipolar disorder is a brain disease that causes shifts in mood, activity, as well as energy levels. The condition is also known as manic-depressive disorder or bipolar depression, and it affects a person’s ability to perform day-to-day tasks.

Bipolar disorder was once referred to as "manic depression" because of the extreme mood shifts from emotional highs or mania, to emotional lows, when a person might feel helpless and lose interest in a lot of activities they once loved.

What is the bipolar spectrum?

The bipolar spectrum is an expression commonly used to describe disorders that include not only standard bipolar disorder with clear episodes of (hypo)mania and depressive states, but also several other types of mental problems that can involve mood fluctuations and depressive episodes – issues such as anxiety, personality disorders, and impulse control disorders, as well as substance abuse. 

What causes bipolar disorder?

Scientists are still researching the possible causes of bipolar disorder and the majority of them agree that there is no single cause but rather many factors that more or less contribute to or increase a person's risk of developing the condition.

After a long-term study that lasted over a decade and included more than a thousand people of whom 730 had bipolar disorder, researchers from the University of Michigan uncovered some of the most common reasons someone gets bipolar disorder.

They analyzed genetics, life experiences, feelings, health histories, nutritional habits, sleep patterns, thought processes, and motivation. The lead scientist on this study, doctor Melvin McInnis, concluded that all of these elements as well as other biological mechanisms influence the disease and how a person will face it.

What is typical for manic episodes?

Hypomanic/manic episodes differ from depressive periods. Some of the typical signs and symptoms of a manic episode include:

• Feeling ecstatic or "high"
• Having bursts of energy
• Being more active than usual
• Being more attentive
• Impaired judgment
• Increased activity levels
• Racing thoughts
• A false belief that nothing is wrong
• A false belief that they can do anything
• Being easily distracted
• Over-the-top confidence
• Sense of self-importance
• Nervousness
• Fast, sometimes unintelligible speaking
• Difficulties falling asleep (also a lack of desire to sleep)
• A tendency to engage in risky and reckless behaviors (alcohol, recreational drugs, promiscuous sex, spending too much money)

What is typical for depressive episodes?

Unlike manic episodes where a person feels "good", the depressive portion of bipolar disorder is all about hopelessness and doom. The most common feelings during a depressive episode include:

• Feeling sad and empty
• Lack of energy
• Decreased activity levels
• Anxiety about everyday things
• Forgetfulness
• Sleeping problems (sleeping too much or not at all)
• Eating more or less (which results in weight problems)
• Inability to enjoy activities that they usually find interesting
• Sensitivity to light, smells, noises (anything that is usually tolerated)
• Difficulties concentrating
• Suicidal thoughts are not uncommon

Conditions that often come with bipolar disorder

Attention-Deficit/Hyperactivity Disorder (ADHD) often overlaps with symptoms of bipolar disorder. Studies have shown that bipolar children and teenagers are more likely than adults to be diagnosed with ADHD as well. Research suggests that 70 percent of people with bipolar disorder have ADHD, which brings additional burden to an already serious disease.

Psychotic symptoms such as hallucinations and delusions often come with severe forms of bipolar disorder. During the manic episode, a person might believe he or she is important or extremely wealthy. Depressive episodes come with psychoses such as belief that someone is trying to hurt them, or that they did something bad. This is why bipolar disorder has been often wrongly identified as schizophrenia in the past.

Anxiety disorders are also commonly diagnosed in combination with bipolar disorder.

How to diagnose and treat bipolar disorder?

According to the Diagnostic and Statistical Manual, fifth edition (DSM-5), the holy grail of psychiatry, to be diagnosed with bipolar disorder you must meet certain criteria for both mania and depression including irritable mood, and increased energy levels lasting longer than a week. If the symptoms are severe, a person might even need hospitalization.

Physicians usually perform standard blood and urine tests to rule out other possible diseases that may cause similar symptoms. People with this condition are more likely to seek help during a depressed episode than while being manic or hypomanic. Some even report that they like the confidence and euphoria that manic episodes typically come with.

To prevent misdiagnosis and mismanagement of bipolar disorder, the National Institute of Mental Health (NIMH) advises physicians to search for signs of mania in a person's medical history.

Besides mood stabilizers, successful treatment typically involves a few other techniques such as therapy, healthy lifestyle, and other self-coping strategies. Even though the condition isn’t curable, it is successfully treated across the world, with a remarkable 80 percent success rate.