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(12) Bipolar Disorder

What are the symptoms of bipolar disorder?

When speaking of symptoms of bipolar disorder, the symptoms of concern are those of mania, specifically because bipolar disorder can be diagnosed only after a manic episode has occurred.

Signs and symptoms of mania include:

• Extremely happy, euphoric, or irritable mood

• Engagement in risk-taking behaviors

• High energy levels

• Difficulty concentrating, high distractibility

• Decreased need for sleep

• Racing thoughts or increased rate of speech

• Increased sex drive

• Inflated self-esteem or grandiose ideas

• Auditory or visual hallucinations

• Paranoia or delusional ideation

If the symptoms noted here persist for at least one week, a manic episode may be present. The greater the number of symptoms present, particularly if associated with euphoria, the more likely mania is present. Hypomania has the same symptoms, but they are judged to be less severe, need only last for four days, and are not associated with psychotic symptoms. It is also possible to have symptoms noted above in addition to such depressive symptoms as suicidal thinking, which may occur in a mixed episode, which is a combination of symptoms of mania and symptoms of major depression.

Suicidal ideation warrants an immediate evaluation, as manic individuals can be extremely impulsive. Although mania is typically characterized by euphoria, severe anger and rageful mood are common as well.

The decreased need for sleep is exactly a decreased need, which differs from insomnia, a condition of not being able to sleep when it is needed.

Signs and symptoms of depression occurring in a bipolar person are the same as that for major (or unipolar) depression and include:

• Sadness or irritability

• Loss of enjoyment of once-pleasurable activities

• Loss of energy

• Difficulty concentrating

• Insomnia or excessive sleep

• Fatigue

• Unexplained physical complaints (e.g., headache, backache, stomach upset)

• Decreased sex drive

• Change in appetite (increased or reduced)

• Feelings of hopelessness, helplessness, and/or worthlessness

• Suicidal thoughts or attempts

If the symptoms noted here persist for more than two weeks, a major depressive episode may be present, and it is more likely the greater the number of symptoms present, particularly if associated with sadness or irritability.

Again, suicidal thinking warrants an immediate evaluation, especially if associated with hopelessness. Because of the multitude of physical symptoms of depression, many patients seen by a primary care health provider for certain physical complaints actually have depression. Certainly a physical evaluation to rule out any other medical conditions is warranted, but depression needs to be considered as a possible condition. If there is a history of mania or hypomania, a diagnosis of bipolar depression should be considered in the presence of such symptoms.

Leslie’s comments:

My symptoms began as a teenager but, unfortunately, I went undiagnosed (and therefore untreated) until my early 30s. I think because my symptoms appeared during the teen years they were easily mistaken or overlooked because they were assumed to be part of the “normal” growing pains associated with that period of one’s life. I experienced severe depression for extended periods of time along with times of great energy and motivation, as if I could do(and wanted to do)anything. I would swing between these feelings fairly rapidly and felt at the mercy of something outside of myself.

I now find that I can go from low to high to low within extremely short periods of time and have been diagnosed as a “rapid, rapid” cycler or “ultradian” cycler. These constant mood fluctuations are very tiring and distressing and take a real toll on me emotionally.

Terms:

Racing thoughts - the subjective feeling of having thoughts in one’s mind move quickly from one topic to the next, often difficult to follow and make sense of, typically associated with rapid, uninterruptible speech.

Insomnia - the inability to fall asleep, middle-of the-night awakening, or early morning awakening.

Unipolar - in contrast to manic-depressive illness, known as bipolar, or two poles of mood states, the description of major depression, or the presence of one pole of mood state.

Bipolar depression - an episode of depression that occurs in the course of bipolar disorder.

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