Bipolar Disorder

Bipolar Disorder (once called ‘manic depression‘)  tends to be associated with alternating low, depressive moods and high or ‘manic’ moods separated by periods of ‘normal’ moods.

However, it is not uncommon for these depressive moods to be accompanied by manic moods at the same time. These two extremes of bipolar disorder can also rapidly change from day to day or even from hour to hour.

We all have mood swings from time to time, and this is healthy when our mood reflects what is happening in our lives.  It is only when these mood swings – either highs or lows – interfere with, or cause problems within, our daily life and are not related to external events or situations that they may be due to the clinical condition called Bipolar Disorder and need professional treatment.

There are 2 forms of bipolar disorder: Bipolar 1 disorder and Bipolar 2 disorder (not very creative names!)  Bipolar 1 disorder tends to involve extended high periods and also may include psychotic episodes, whereas Bipolar 2 disorder does not involve psychotic episodes and the periods of mania tend to be shorter, ie from a few hours to a few days at a time.

A note on Bipolar Disorder

Bipolar Disorder is one of the most mis-diagnosed / undiagnosed mental illnesses. It is important to talk to your doctor about this if you think that you may have bipolar disorder rather than depression.

There is a very interesting research article regarding the importance of checking for bipolar disorder.

Below we have more information on Bipolar 1, Bipolar 2, manic & depressive episodes, as well as Our Stories from people living with Bipolar Disorder.
The Black Dog Institute in NSW has some excellent detailed information about Bipolar Disorder on their website at: www.blackdoginstitute.org.au   They also provide very useful information for GPs  on bipolar disorder including how to best treat / manage this condition.  With new research being done all the time, and bipolar disorder often missed in diagnosis, it can’t hurt to let your GP know and suggest they have a look!


Bipolar 1 Disorder

Bipolar 1 Disorder is also known as Bipolar 1 or Bipolar Type 1.

This is considered to be the most severe form of bipolar disorder and is characterised by one or more Manic or Mixed Episodes, usually accompanied by Major Depressive Episodes.

In a major manic episode of Bipolar 1 Disorder a person may become delusional and even suffer from hallucinations, which are both symptoms of psychosis.  If this occurs, the condition is called bipolar I with psychotic features. Only bipolar I disorder, by definition, can include psychotic features. Bipolar I can seriously impair day-to-day functioning.

Other symptoms and characteristics of mania may include:

  • Feelings of grandiosity
  • Decreased need for sleep
  • Pressured speech
  • Racing thoughts
  • Distractibility
  • Tendency to engage in behavior that could have serious consequences, such as spending recklessly or inappropriate sexual behaviours
  • Excess energy

Symptoms and characteristics of major depression in Bipolar 1 Disorder are the same as those for major depression and may include:

  • Decreased energy
  • Severe withdrawal from normal activities
  • Weight loss or gain
  • Despair
  • Irritability
  • Uncontrollable crying
  • Thoughts of or attempts at suicide

For a very clinical definition, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) clinical diagnostic criteria states that the essential feature of bipolar I disorder is a clinical course that is characterised by the occurrence of one or more manic episodes or mixed episodes. Often individuals have also had one or more major depressive episodes.

Episodes of substance-induced mood disorder due to the direct effects of a medication, or other somatic treatments for depression, drug abuse, or toxin exposure, or of mood disorder due to a general medical condition need to be excluded before a diagnosis of bipolar I disorder can be made. In addition, the episodes must not be better accounted for by any other disorder.

Bipolar 2 Disorder

Bipolar 2 Disorder is also known as Bipolar 2 or Bipolar Type 2.

This is a bipolar disorder that is characterised by at least one hypomanic episode and at least one major depressive episode and with this disorder the depressive episodes are more frequent and more intense than the manic episodes.
Bipolar 2 disorder is believed to be under-diagnosed because hypomanic behavior often presents as incredibly high-functioning behavior.  Sometimes even mental health professionals specialising in mood disorders may view, highly confident ambition to be symptomatic of hypomania only if they consider that person’s goals are unrealistic.

There is an interesting article on the incidence of undiagnosed or misdiagnosed Bipolar Disorder written by Professor Gordon Parker of the Black Dog Institute in NSW.
The key difference between bipolar 1 and bipolar 2 disorders is that bipolar 2 has hypomanicbut not manic episodes, meaning the symptoms of mania are generally less severe in type 2.

Also, while those with bipolar 1 disorder may experience additional psychotic symptoms such as delusions and hallucinations, bipolar 2 by definition cannot have psychotic features.

The signs which would lead to a diagnosis of bipolar 2 disorder are:

  • One or more major depressive episodes
  • At least one hypomanic episode
  • There has never been a manic or mixed episode
  • Another disorder is not responsible for symptoms
  • Symptoms cause distress or impair functioning


Manic Episode

The manic stage of bipolar disorder shares the underlying common characteristics of an elevated mood, and is characterised by an increase in the quantity and speed of physical and mental activity.

The person experiencing hypomania may also become more sociable, talkative, overfriendly, have an increased sexual energy and a decrease in the amount of sleep needed. Even though these are present they do not necessarily lead to a disruption in working or in a disruption in social activity. The opposite of this elevated feeling may also take place leaving the sufferer irritable, conceited and boring.

Their concentration and attention may be impaired, thus leading to work, leisure and relation difficulties. Whether on a slightly elevated or slightly lower hypomania the sufferer may have a new interest in adventures, activities or mild over-spending.

Hypomanic Episode

Hypomania is a lesser degree of mania. The distinctiveness of mania is no longer present and a more consistent mood is prevalent. Hypomania does not include hallucinations or delusions, but is a mild elevation in mood that can last several days on end. It is usually recognised by the distinct increase in energy and activity, as well as feelings of well-being and both physical and mental efficiency.

Depressive Episode

Depressive episodes can be classed as either one of the following; mild, moderate or severe.

When the sufferer is in the depressive episode they may suffer loss of interest and enjoyment, reduced energy, fatigue, lethargy, apathy, depressed mood, lowered concentration and attention, reduced self-esteem and self-confidence, guilt, unworthiness, become pessimistic, diminished sleep and appetite and ideas or acts of self-harm or suicide.

Depressive episodes can often be masked by irritability, excessive consumption of alcohol, obsessional symptoms and hypochondria. The most typical symptoms are: loss of interest or pleasure in activities that are normally enjoyable, lack of emotional reactivity, waking in the early morning hours, loss of appetite and weight loss or gain and loss of libido.