Trigger Warning: This post contains discussions of suicide. If you or someone you know is at risk of suicide, please:
- Call the U.S. National Suicide Prevention Lifeline at 800-273-8255
- Text TALK to 741741
- Or go to SpeakingOfSuicide.com/resources for additional resources.
For a post with a list of domestic crisis lines, click here.
With 45 million people worldwide living with this illness and abundant, harmful stereotypes presented in the media, you may have heard of or experienced this illness in your own life.
But what is bipolar disorder, really? What do “mania” and “depression” really mean?
First, we must clinically define bipolar disorder. bipolar disorder. Bipolar disorder, formerly known as manic depression, is a mood disorder characterized by swings between depression, grandiose moods called mania, and precious periods of stability.
Over five million people worldwide live with the illness, which often runs in families. The mood disorder affects men and women equally and often appears in early adulthood, though children may also develop the mental illness.
But what does all that gobbledygook mean? How does this affect you, the diagnosed person or the person with a loved one who has a diagnosis?
Here’s a crash course in what bipolar disorder is and what it means from The Bipolar Parent.
What is Mania?
The bipolar sufferer is a creature of extremes, and nowhere is that made more clear than during manic episodes. Often depicted as the default bipolar state in popular culture, mania is a psychiatric state defined by symptoms of:
- euphoric mood
- insomnia or sleep disturbances
- massively increased energy
- rapid and/or pressured speech
- a flood of ideas
- an inability to think things through or control impulses
- increased risk-taking, including extreme spending and dangerous sex.
When I’m manic, I can flip from overjoyed and impervious in one second to angry and snappish in the next. I cannot control my impulses and am totally distractable.
I often speak too quickly and become frustrated with everyone around me, whom I perceive as moving too slow. My friends and family, however, cannot understand me.
Inability to concentrate due to the flood of ideas in my mind means I start projects and then drop them before they’re even half-done (eg: I have document after document of unfinished fanfictions). And I spend loads of money on craft materials, and the purchases are rarely thought through.
I also have an inflated sense of their own mortality; most of the time, it feels good to be a god, so I am easily convinced by my own ego that I don’t need medication or sleep.
It’s difficult to recognize that I’m manic when I’m in the middle of it, because I feel great. I usually have to be told by a concerned friend or family member that I’m spinning out into a mood episode, if the uber-productivity doesn’t tip me off.
A diagnosis of mania is also the primary difference between Bipolar I and Bipolar II: the former requires an extreme manic episode lasting at least one week, possibly with psychotic features such as hallucinations or delusions of godhood. Sufferers of Bipolar II deal with depression and hypomania, a lower form of mania, only.
What is Hypomania?
In Latin, “hypo” means below, so the definition of hypomanic as, “appears less intense than manic” follows logically.
People in a hypomanic episode usually have feelings of euphoria, irritability, increased sexuality, and competitiveness–but less than someone with full-blown mania.
Whereas inability to focus permeates mania, my experience with hypomania has been completely different. Increased focus and feelings of contentment means that I am incredibly productive while hypomanic, and I don’t doubt that this drive and ability applies to other people in such a state as well.
Hypomania is a very pleasurable episode to be in; I have often felt as if I am coasting along in my day, accomplishing anything I set out to do with my super-human energy.
This is part of the reason bipolar people (including me) often grieve for the hypomanic episode while depressed or normal. Similarly, taking my meds is difficult while in this state of ecstasy, because I think I can do whatever I want.
Unfortunately for me and everyone else who has enjoyed a hypomanic episode, any manic episode, no matter how intense, is typically followed by a crash.
What is Depression?
Even the neurotypical layperson, who may have never experienced mental illness, knows what depression is–at least on an intellectual level.
Depression is often described as being miserable, down in the dumps, or–my favorite–trapped in a black, sucking hole of apathy.
According to the Kübler-Ross model, also known as the five stages of grief, depression is one of the normal responses to a traumatic life event.
Clinical or bipolar depression, however, rears its ugly head due to chemical imbalances in the brain, medication, or genes–meaning that it can strike at any time not connected to stress or winter blues.
So what are depression’s signs and symptoms, and how are they treated?
When I’m depressed, I often feel most or all of these:
- Persistent feelings of hopelessness
- Poor concentration
- Memory loss
- Lack of energy
- Isolating self
- Inability to sleep
- Missed showers, meals
- Suicidal tendencies
When I want to remember the times I was deep in the midst of a depression episode, all I have to do is look over my old blog entries.
This one in particular hit home:
Over the past year I’ve isolated myself and my five-year-old, confining us both to the house due to both anxiety and depression.
I’ve only just begun to emerge from the fugue, armed with new medications and new coping strategies, as well as an attempt to shuck off old habits.
Due to the advice of a dear friend, I found that doing things makes me want to do more things.
It’s counter-intuitive, but making sure that I do the dishes and pick up the living room every day has worked as the best anti-depressant I’ve ever had.
Staying in bed until I have to pick up my kid from kindergarten is a sure-fire way of destroying the rest of the day.
Getting up and getting dressed is that first, difficult step, but I am better off when it’s done.– Cassandra Stout
I suffered massive depressive episode for years and years, crippling me emotionally and causing me to miss out on “normal” things for me and my son, like planning birthday parties or making new friends after a move.
For eight years, I lacked a solid community. I rarely took my child out on playdates and as a consequence, he finds making friends difficult.
I did very little around the home, including cleaning the house and showering myself.
Thankfully, I’ve found a combination of medication that worked, attended therapy, and worked on my own self-care. I now have a community of friends that support me, and I am helping to undo the damage that was done to my son.
What is a Mixed Episode?
To make bipolar disorder even worse, what happens if you felt symptoms of depression and symptoms of mania at the same time?
This awful set of feelings is colloquially called a mixed episode or a mixed mood state, and they are common in people with bipolar disorder. Half or more of people with bipolar disorder deal with mixed episodes, and I am one of them.
Mixed episodes are terrible. People suffering a mixed mood state have a high chance to die by suicide because they have the awful, soul-destroying symptoms of depression with the ability to carry out plans.
Medications typically used to treat depression or mania usually don’t work well on mixed episodes.
Bipolar I vs. Bipolar II: What’s the Difference?
To be diagnosed with bipolar I, which I have, requires an intense manic episode with symptoms lasting longer than seven days or severe enough to require immediate hospitalization. Depressive episodes often last two weeks or more.
Both states prevent normal function, and require treatment in order for the individual to fully live their life. It is extremely difficult to reason with the bipolar I sufferer when they’re in the midst of a mood episode.
Four times more common than Bipolar I, bipolar II is characterized by both depression and hypomanic (“below mania”) episodes, but not full-blown mania. Often productive, persons with Bipolar II are rarely hospitalized.
What Makes Bipolar I so Dangerous?
Bipolar I disorder sufferers experience the most intense manic episodes.
Immediately after giving birth to my first child, I suffered a postpartum psychotic break and an intense manic episode, committing myself to a local mental hospital. I earned a diagnosis of bipolar I.
During my committal, I was literally crazy. I suffered all the symptoms listed above as well as delusions and a hallucination. I was deemed dangerous to my infant and myself.
After stabilizing the manic episode with medication, I suffered a debilitating depressive episode for the next four years. I clawed my way back to stability through pursuing medication that worked and regularly taking it, faithfully attending therapy, and focusing on self-care.
That manic episode changed my entire life. Bipolar I disorder is dangerous because the manic episodes are so powerful, the person behind the mental illness ceases to recognize their own limits.
What is Cyclothymia?
Cyclothymia is a tricky diagnosis with manic symptoms less severe than bipolar I and depressive symptoms less severe than bipolar II.
Impact on productivity varies; some individuals may be hyper-productive with little impairment, whereas others are manic or severely depressed for most of their lives.
Cyclothymic people may have periods of stability, but those last less than eight weeks.
Risk Factors of Bipolar Disorder
There are several risk factors under consideration.
Genetics may play a part, though studies of identical twins have found that one twin may develop the disorder while the other twin does not.
Brain scans show that the structure of the brains of sufferers of bipolar disorder have differently sized portions of the brain compared to healthy people.
Family history seems to contribute as well, as those who have a family history of the disorder tend to develop it more often than those who do not.
Childhood trauma is also a huge factor; one 2016 review in the International Journal of Bipolar Disorder showed that multiple traumas are more frequent in patients with BD than in controls (63 versus 33 %).
Whatever the reasons behind the development of the disorder, over five million people worldwide live with it, and a great deal of people remain untreated.
What about Treatments?
Several illnesses are comorbid with bipolar disorder, such as Attention Deficit Hyperactivity Disorder (ADHD) or anxiety-related illnesses. These related conditions make it difficult to treat the underlying bipolar disorder, as stimulants used to treat ADHD can sometimes trigger a manic episode.
Drugs are not without their side effects. I gained 45 pounds on mine, and topped out over 200. I’ve also tried medications that knocked me out for weeks. But I persisted until I found a cocktail that worked for me.
Attending therapy also helps the person with bipolar disorder live a fulfilling life. Therapy has no side effects.
Performing self-care is also crucial for anyone to be happy, but doubly so for people with mental illnesses.
With treatment, people with bipolar disorder can lead productive, healthy lives, managing their illness as it comes.
Bipolar disorder is a mental illness that can devastate families, but it’s also one of the most treatable disorders.
With treatment, I have stabilized after suffering terrible mood episodes, and you can, too. Mania, depression, and mixed episodes can be survived.
What a bipolar diagnosis really means is different for everyone. But what it means to me is that I have an extra layer of work on top of my normal affairs to manage my moods.
I have to make sure I take my meds on time twice a day, monitor my moods so that I’m sure that the meds are working, monitor my actions to make sure they’re not wildly off base and within the range of societal norms, get enough sleep (this is especially important to avoid manic episodes), monitor my spending, avoid alcohol, and so on and so forth.
It sounds like a lot, and it is, but it’s just part and parcel with living with a mental illness. If I don’t put the work in, I become miserable and a danger to myself and others. Thankfully, the work gets easier as you get used to it.
Bipolar disorder doesn’t have to control your life. Whether you have bipolar I, bipolar II, or cyclothymia, you can live stably.
I wish you well on your journey.
- 11 Lessons I Learned from 11 Years of Managing Bipolar Disorder
- 5 Things I Wish Someone had Told Me When I was Diagnosed with Bipolar Disorder
- My Advice to a Relative Facing a Bipolar Disorder Diagnosis — And What This Diagnosis Really Means