Understanding and Living with the Many Shades of Bipolar Disorder

An overview of Bipolar Disorder

/ Author:  / Reviewed by: Joseph V. Madia, MD

Catherine Zeta-Jones deciding to seek treatment for Bipolar II sheds light on a mental illness that affects millions of Americans.

Bipolar disorder, sometimes called manic-depressive illness, is a complex spectrum of mental illness that can destroy lives. Literally.

But this illness that takes its sufferers on a wild ride of mood changes can be controlled with effective medical treatments. And ongoing research continues to find new answers and hope.

What is bipolar disorder?

People with bipolar disorder live with and express a kaleidoscope of moods, ranging from the highest of highs (mania) to the lowest of lows (depression). These sometimes violent and always noticeable mood shifts can occur several times a day or just a few times over a lifetime.

The disorder is seen in the marked transitions between mania on the one end of the spectrum and depression on the other end. The name of the condition reflects the fact that these moods are polar opposites.

The key to identifying symptoms of the disease in yourself or others is clearly understanding what happens during the different moods - how a person feels and behaves.

What is mania?

People living with some forms of bipolar disorder don't recognize that there's anything wrong with their elevated, high-energy moods, which are actually manic episodes. These are their good, on-the-go days - the sunny days that are lighter and brighter than the dark, gloomy days of depression that are so common, feel so bad and are sure to follow.

Symptoms of mania or manic episodes include three or more of the following feelings and behaviors:

  • Periods of elevated, expansive or irritable mood
  • Feeling overly happy, outgoing or "high"
  • Being or feeling wound up, agitated, jumpy, irritable or "wired"
  • Having racing thoughts, jumping from one topic to another
  • Talking fast or being more talkative that usual
  • Starting or thinking about new projects and activities
  • Being easily distracted - getting off track with unimportant things
  • Decreased need for sleep
  • Being restless and fidgety; needing to be on the go
  • Having unrealistic thoughts and beliefs about one's abilities - inflated self-esteem
  • Behaving impulsively and engaging in pleasurable but risky activities such as spending sprees, unsafe sex or impulsive investments

What is hypomania?

People with less severe forms of bipolar disorder experience hypomania, a less intense high than mania that lasts at least four days and includes:

  • Feeling unusually social or self-confident
  • Feeling "hyper" - very energetic but easily irritated or angered; may need less sleep
  • Thinking faster, possibly more creatively
  • Being more productive at home, school, work; very active and goal-oriented
  • Being unusually talkative
  • Having trouble concentrating; easily distracted
  • More involved in pleasurable activities - spending or sex

What is depression?

The polar opposite of mania is depression, periods marked by at least three of the following:

  • Feelings of sadness, worry, emptiness
  • Less interest in things and activities usually enjoyed
  • Low energy and fatigue
  • Sleep problems
  • Overwhelming feelings of guilt, worthlessness, low self-esteem
  • Trouble concentrating and making decisions
  • Thoughts of death or suicide
  • Planning or attempting suicide

What are the different types of bipolar disorder?

There are five types of bipolar disorder:

Bipolar I

  • Most severe form of the illness that's seen for at least one week
  • Extreme manic episodes, i.e., going without sleep for days
  • Major depression, i.e., suicidal thoughts or attempts

Bipolar II

  • Milder form of the illness
  • Patients experience hypomania, a less intense elevated mood than mania
  • Sometimes misdiagnosed as major depression because hypomanic episodes are not recognized or reported

Bipolar Not Otherwise Specified (NOS)

  • Mood swings don't follow a pattern
  • May include very rapid swings between some symptoms of hypomania and depression
  • May include hypomania with less depression


  • Milder form of bipolar disorder
  • Several alternating hypomanic and less severe depressive cycles during past two years
  • Illness may become more severe over time

Rapid Cycling

  • Four or more manic, hypomanic or depressive episodes in any 12-month period
  • Can occur with any type of bipolar disorder
  • May be only a temporary condition

What causes bipolar disorder?

Most scientists agree there is no single cause of bipolar disease. Instead, a number of factors act together. Because the disease runs in families, there is a genetic link.

According to researchers at Stanford University School of Medicine, "Genes may have an impact on many different functions that can all feed into depression or bipolar disorder—for example, by affecting how our brains respond to stress, modulate mood, or maintain cognitive performance."

Bipolar disorder difficult to diagnose

Diagnosing bipolar disorder is tricky. Studies show that it's misdiagnosed in seven of every 10 people with the illness. Correct diagnosis usually doesn't occur for at least 10 years after it first appears.

Most people seek help when they're depressed and not when they're feeling the good effects of mania or hypomania. Therefore, they may be prescribed antidepressants, which treat only one part of the disease. But in fact, antidepressants alone may actually increase the mania side of the disease.

How is bipolar disorder diagnosed?

Unfortunately, this condition can't be diagnosed with a blood test or a brain scan. However, these tests can be used to eliminate other possibilities for symptoms, such as a brain tumor or stroke.

You will want to seek the care of a trained mental health professional, such as a psychologist or psychiatrist. This professional specializes in analyzing symptoms and patterns that identify the disease. A complete medical history will be taken and you'll be given a mental health evaluation.

It's essential that all symptoms be discussed, including those that aren't currently a problem. You will want to talk about:

  • Feelings or behaviors you experience that seem out of the ordinary for you
  • How you feel and what you do during times you're in a particularly good mood
  • How you feel when you're depressed
  • Patterns you notice - are good moods typically followed by down cycles, for example?
  • Feedback you've received from family or friends regarding your moods or mood changes

What's the difference between normal mood swings and bipolar disorder?

Three things distinguish bipolar mood shifts from normal emotional changes

  • Mood swings are more severe - going from feeling really good one day to feeling really bad the next
  • Bipolar symptoms can last weeks or months whereas bad moods usually disappear in a few days
  • Bipolar extremes can interfere with and disrupt  many areas of a person's life, including work and relationships

How many people live with bipolar disorder?

Bipolar disorder is a serious medical condition that affects women, men, children and adolescents:

  • 2.2 million Americans
  • 80 percent of patients have a number of manic episodes
  • 15 percent of sufferers end their own life
  • Illness usually begins in adolescence or early adulthood and lasts a lifetime

How to get help

If you suspect that you, a friend or loved one may have bipolar disease, help and treatment are available. Talk to your family physician and be honest about how you're feeling. Ask to be referred to a mental health specialist to get the help you need.

What types of treatments are available for bipolar disorder?

Bipolar disorder is a very serious lifelong and recurrent illness that needs consistent, long-term treatment. Treatment options include one or more of the following:

  • Medications
  • Talk therapy
  • Electroconvulsive therapy in the most serious cases

What kinds of the medications are prescribed for bipolar disorder?

Doctors have a number of medicines that can be used alone or in combination to treat bipolar disorder.

Mood stabilizing medications are usually the first line of treatment. Mood stabilizers approved to treat bipolar disorder include:

Equetro, Tegretol

Antidepressants may prescribed to work with the mood stabilizers, however a large study showed that the combination is no more effective than using a mood stabilizer alone.

Bipolar medications must be monitored on an ongoing basis to ensure ongoing effectiveness.

Get help

Bipolar disorder should not be ignored. In its most serious forms, it can cause violence, directed toward self or others.

Talk to you health professional about how you can live successfully with the many shades of bipolar disorder.


Review Date: 
April 14, 2011
Bipolar Disorder