Bipolar Disorder Symptoms

Bipolar disorder symptoms vary depending on which phase of the disorder you are experiencing, the manic phase (or its milder version, hypomania), the depressed phase, or the mixed state, which combines symptoms of both the high energy manic phase and the low or irritable mood of the depressed phase. Thus, to know whether you have a bipolar disorder, you must look at symptoms over as long a period of time as possible. You might have depression right now, but perhaps you had hypomanic symptoms a year ago, and have forgotten about them. People who know you reasonably well can help you to make that determination with the help of a psychiatrist.

Symptoms of the depressed phase, are the same as those for depression itself (also called Unipolar depression, since the person has never experienced the manic pole). These include a depressed, sad, blue mood, as well as changes in sleep (oversleeping, or difficulty falling and staying asleep), appetite (overeating, or loss of appetite), energy (loss of energy manifesting as sluggishness, or a seeming excess of energy leading to agitation), diminished or lost ability to experience pleasure (anhedonia), reduced sexual drive, reduced concentration and or memory (short term memory), a sense of helplessness, hopelessness or being trapped, frequent thoughts about death, and often a change in the depression with the time of the day (either worse in the morning, or worse in the evening), and social withdrawal.

Symptoms of the manic phase include a loss of contact with reality that is so severe that it often results in hospitalization, or causes devastating effects in the life of the person and those around him or her. Criteria include elevated and expansive mood, such as euphoria (feeling of extreme happiness), decreased need for sleep (less than 6 hours or so, usually either no need for sleep, or 2-3 hours at most) for at least several days with out feeling tired the next day, increased rate of speech, rapid thoughts, increased creativity, increased goal-oriented activities, excessive involvement in pleasurable activities, impairment of judgment, and unusual and inappropriate social activity. Symptoms of hypomania, the milder form of mania, involve the same systems (cognitive, vegetative, psychomotor, social), but to a milder degree.

There is some evidence that the depression experienced by a person with bipolar disorder is different than the depression experienced by a person with Unipolar disorder (see table).

Rapid Cycling

In the Whole Psychiatry model it has become clear that rapid cycling (at least four episodes per year of alternating mood cycles, although in severe cases it can be hourly) is often due to nutritional/dietary/immune and hormonal factors, which when corrected, alleviate the cycling and stabilize the mood.

Table: Differences between bipolar and depressive mood disorders

Criteria Depressive Bipolar
Age at onset Older Younger, often in adolescence
Sleep pattern (Depressed phase) Middle (1-2 a.m.) and terminal (4-5 a.m.) insomnia Hypersomnia (> 8-10 hours of sleep)
Appetite Decreased (classic) or increased, craving sweets, chocolate (atypical) Bipolar I: decreased, craving salts;
Bipolar II: often increased as in atypical depression, but may be decreased in more severe classic depressive episodes
Female / Male ratio 2:1 1:1
Lifetime risk of developing the disorder 5-15% of population will experience at some time; different frequency across cultures 1% of population will experience; stable frequency across cultures
Frequency of substance abuse More than general population but less than in bipolar Greater than depressive mood disorder
Impulsivity Low High
Novelty seeking Low High
Frequency of personality disorders when assessed in normal mood state High Low
Extroversion in well state Low High
Genetic component Less More
Each episode increases risk for subsequent episodes Yes Yes
Frequency of episodes Lower Greater
Duration of episodes Longer Shorter
Divorce rate Lower Higher

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