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Mood Episodes In Bipolar Disorder: Differences Between Manic, Hypomanic, And Depressive Episodes

by — Last updated: 2019-12-23 in Mental Health

It can be hard to differentiate between the main episodes of bipolar disorder, so this article will try to provide more information about each of the three — manic, hypomanic, and depressive episodes.

What is Bipolar Disorder?

When a person suffers from extreme mood disturbances that come and go in episodes that last a minimum of four consecutive days, a person might well have bipolar disorder. These mood switches vary from extreme depression to overwhelming manic states, and it’s not easy to cope with them all alone without professional help and changing your lifestyle.

Bipolar disorder is relatively hard to diagnose, and studies have shown that a significant amount of time tends to pass between the onset of the disease and starting the appropriate treatment, but it’s still unknown why – whether it’s because of the complexity of the illness, or due to uninformed physicians.

It’s important to learn more about this serious mental disease, especially for clinicians, because it comes with major dysfunctions in all life fields, from personal to professional relationships.

Types of Bipolar Disorder

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), bipolar disorder has two main types: Bipolar I and Bipolar II. They both include depressive periods, but differ when it comes to the other, exhilarating state.

  • Bipolar Disorder Type I mostly comes with severe mood switches, from depression to full-blown mania. Some people may experience only mania, without the depressive phase.
  • Bipolar Disorder type II is milder and has less intense episodes of mania called hypomania. If you have significant mood fluctuations but you’ve never reached manic state, you probably suffer from bipolar type II. 

Besides these two “main” types, you can also get diagnosed with cyclothymic disorder – this is when a person experiences mood fluctuations including both hypomanic and depressive states for at least two years, but neither episode is as intense or extensive as it would be if they had bipolar I or II. There are testimonies from patients with this type of disorder being told by health professionals that it’s all in their head, because the symptoms weren’t as extreme as in the first two types.

Bipolar disorder with “mixed features” is a messed up state where a person might feel all things at once – including characteristics of mania and hypomania, as well as a depressive state. A person might be all over the place, with racing thoughts and high energy, but at the same time feel irritable, angry, and suicidal. Obviously, this one is the hardest to diagnose.

There are a few subtypes that can occur with any type of Bipolar Disorder. Rapid cycling is when a person goes through four or more episodes of hypomania, mania or depression within a year. Ultra-rapid cycling occurs within a few days, and ultra-ultra rapid (also called ultradian cycling) comes with mood switches that occur within a 24 hour period.

Key differences between mania and hypomania

Maybe you’re wondering how to differentiate between less intense or hypomanic states and severe mania? What is the line between them?

Hypomania is indeed a milder manic state. For example, in hypomania, your energy levels will often be higher than normal, and you’ll feel that, but it’s never going to be as high as in the manic state. People will spot that you’re different, but you probably won’t cause trouble for yourself or others. Because of this, hypomania often goes unnoticed for years. It’s a lot sneakier than mania, especially if the episodes are infrequent. Hypomanic people will be talkative, outgoing, more active, flirtatious, and in a good mood in general. Decision-making becomes a lot more relaxed.

Mania, on the other hand, turns people into incontrollable beasts. If a hypomanic person flirts with strangers, a manic person has sex with them. If a hypomanic person goes out and talks to strangers, a manic person will disappear for days and come back home tired, ashamed, and with bruises that they know nothing about.

Bipolar: The main characteristics of depressive periods

If hypomanic and manic episodes make you go for days without sleep, depression tends to make you unable to leave the bed. When a person is in their depressive phase, they may completely lose interest and pleasure in activities that they once liked and enjoyed.

In severe cases of depression, a person may even develop delusions and hallucinations – a state known as bipolar disorder with psychotic features. Major depressive periods last at least two weeks, and can end tragically if they are left untreated for too long.

A depressive state is easy to spot, but unfortunately, bipolar depression often gets misdiagnosed as unipolar or “regular” depression, especially if the (hypo)manic episodes are infrequent.

Do You Need to See a Doctor?

If you notice mood changes that are unusual and don’t appear normal in yourself or someone you love, visiting a doctor is the right course of action. Bipolar disorder is a serious mental illness that can be difficult to diagnose, but with a physical exam and an extensive talk about your health history, your physician can learn enough to send you to see a specialist, someone skilled in diagnosing mental disorders.

The sooner you seek help, the less chance bipolar disorder has to ruin your life.

If you’re already diagnosed with bipolar disorder, it’s good to have a support network – a group of people who understand the disease and will tell you when you’re getting out of control so you can pick yourself up again.

  • Photo courtesy of SteadyHealth

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