What Is “Manic Depression”? Bipolar Disorder Symptoms And Treatment Options
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At the dawn of psychiatry and psychology, many knew bipolar disorder as a different term—known as “manic depression”.
However, due to stigmatization, possible inaccuracy, and misdiagnoses, the name was formally clinically changed to “bipolar disorder” in the 1980 edition of the DSM (DSM-III). In keeping with current best practices, this article will use the term bipolar disorder (abbreviated as BD).
There are approximately seven types of bipolar disorder recognized in the DSM-5 at the time of this publication, which can generally be characterized by large shifts in mood, activity level, and energy that can disrupt daily functions.
While bipolar disorder cannot generally be “cured,” many people can effectively address their symptoms with a combination of therapy, medications, and lifestyle adjustments.
What are the symptoms of bipolar disorder?
Bipolar disorder is generally classified as a mood disorder. The mood swings that characterize bipolar disorder can be referred to as episodes, possibly indicating their transient and dynamic nature for many.
There are three subtypes of bipolar disorder—bipolar I disorder, bipolar II disorder, and cyclothymic disorder. Depending on the type of bipolar disorder one has, one might experience some combination of hypomanic, manic, and depressive episodes—which can vary in duration or co-occur.
For example, some episodes may last a few days, whereas others may last several weeks or longer. Episodes can include symptoms from all (or just one) of the groups above. Everyone can experience episodes differently. Additionally, between episodes, people who live with BD may experience some symptoms, or they may experience none. The following are common symptoms of bipolar disorder, broken down by general common episode type.
The following are common symptoms of bipolar disorder, broken down by general common episode type:
Mania and hypomania
Although mania and hypomania can be considered separate types of episodes, they can have the same symptoms. Manic episodes generally differ from hypomanic episodes; however, they may vary in severity and cause a more impactful disruption to daily life. Additionally, mania can incite psychosis, which may require intensive in-person care. During a manic or hypomanic episode, some of the following symptoms may be present:
During a manic or hypomanic episode, some of the following symptoms may be present:
Feeling extremely happy or upbeat
Speaking rapidly
Experiencing a sense of self-importance and invincibility
Experiencing an abnormally high energy level
Becoming easily agitated or irritated
Behaving impulsively, such as spending an excessive amount of money or driving erratically
Being easily distracted
Having a sense that you do not need to sleep
Making potentially harmful choices that you wouldn’t normally make
Delusions, hallucinations, and illogical thoughts (such as one might experience psychosis)
Manic episodes can be misunderstood by people who do not have bipolar disorder. Some might think that, for example, mania or hypomania may be characterized only by feeling happy and being productive.
However, mania and hypomania can feel confusing and frustrating for people with bipolar disorder. Manic symptoms of this mental health condition can also be challenging for family members. Additionally, these episodes can disrupt daily life, cause harm to relationships, and drive risky behaviors. Therapeutic intervention and supportive strategies can be helpful to many as they learn to manage the condition.
Depression
Major depressive episodes can disrupt daily functioning, and may include some of the following symptoms:
Feeling sad or hopeless, low mood
Experiencing a lack of interest in activities you used to enjoy
Experiencing weight or appetite change
Experiencing changes in sleeping habits (sleeping too much or not enough)
Feeling a sense of fatigue or inability to accomplish tasks
Experiencing restlessness
Feeling guilty or worthless without a known cause, such as you might feel when negative self-talk occurs
Experiencing general difficulty concentrating or making decisions
Suicidal thoughts
Types of bipolar disorders: How many are there?
Several types of mental health conditions can fall within the umbrella of bipolar disorder, and each of these disorders may include episodes or symptoms of mania, hypomania, and depression. Below are the current types of bipolar disorder that are clinically recognized:
Below, we’ve summarized the current types of bipolar disorder that are clinically recognized:
- Bipolar I disorder: Bipolar I disorder can be characterized by experiencing at least one manic episode, which can precede or follow a major depressive episode (though depressive episodes do not necessarily need to be present for a diagnosis to be made). Many people diagnosed with Bipolar I might also experience depressive episodes, which can last for two weeks or longer.
Bipolar II disorder: Bipolar II can be characterized by experiencing both hypomanic episodes (which do not meet the criteria for a manic episode and last under five days) and depressive episodes.
Cyclothymic disorder: Cyclothymic disorder can be characterized by chronic periods of depressive symptoms (which may not meet the criteria for major depressive disorder) and hypomania symptoms—which can last for two or more years. Periods between episodes can be short in duration.
Substance/medication-induced bipolar and related disorder: These terms generally define major depressive, manic, or hypomanic episodes that might have developed during exposure or shortly after exposure to a medication or substance. Common substances that may cause this disorder can include alcohol, hallucinogens, amphetamines, and phencyclidine.
Bipolar and related disorder due to another medical condition: To meet the diagnostic criteria, a person must generally experience a persistently altered mood or energy level that generally cannot be explained by another mental disorder and is caused by a medical condition.
Other specified bipolar and related disorder: Symptoms might not meet the criteria for bipolar disorder, but can cause distress and contain features of short-term bipolar episodes.
Unspecified bipolar and related disorder: This diagnosis might be given when the reasons for why symptoms do not meet the criteria for bipolar disorders are not specified.
The DSM-5 also generally includes specifiers to define other features that may be present, such as rapid cycling, seasonality, atypical features, or mixed features.
Diagnosis and treatment
The average age of bipolar disorder onset is 25 years—however, episodes can begin in early childhood or during mid-life. According to a 2012 study by Youngstrom et al., several red flags can indicate the benefit of bipolar disorder assessment for young people. These flags might include family history, early onset of depression, manic symptoms that occur during antidepressant use, mood fluctuations, episodes of high energy or aggression, symptoms of psychosis, and sleeping difficulty.
A medical practitioner can use several tools to conduct a thorough evaluation and rule out other conditions. These tools may include a physical exam, medical history evaluation, and blood tests. Your doctor may conduct a mental health evaluation themselves or refer you to an in-person mental health professional to determine whether you meet the diagnostic criteria for a bipolar disorder or another mental health condition.
After making a diagnosis, your providers can work with you to establish a treatment plan. Many treatment plans might involve a combination of psychotherapy, medication, and education. Talk therapy can help people with bipolar disorder seek emotional support, identify the sources of their symptoms, and address potential comorbid mental health conditions. Common medications for bipolar disorder are mood stabilizers and antipsychotics.
Consult with a healthcare professional prior to starting or stopping any medication for depression. Using a notebook to track symptoms and patterns (a process that is sometimes called mood charting) may be helpful for people going through the diagnostic process.
The BetterHelp platform is not intended to provide any information regarding which drugs, medication, or medical treatment may be appropriate for you. The content provides generalized information that is not specific to one individual. You should not take any action (including starting, stopping, or changing medications) without consulting a qualified medical professional.
Diagnostic challenges
Diagnosis in teenage years may be delayed due to parents or doctors mistakenly identifying episodes as age-related emotional fluctuations. Additionally, bipolar disorder can be misdiagnosed as attention-deficit hyperactivity disorder (ADHD), depressive disorders, schizophrenia, substance use disorders, or borderline personality disorder (BPD). However, misdiagnosis can delay effective treatment and research, so remaining receptive and open to diagnostic possibilities throughout treatment can be crucial.
Treatment options
There are many treatment options for bipolar disorder, including but not limited to the following.
Medication
Many people diagnosed with bipolar disorder might be prescribed medications by their in-person medical practitioner, which may include mood stabilizers, antidepressants, anti-anxiety medications, and antipsychotics. Even between episodes, many people might be prescribed medications to reduce the frequency and intensity of episodes. If you are prescribed psychiatric medications, take them as directed and discuss side effects with your doctor.
Lifestyle modifications
Consistent routines and structure, reduced caffeine consumption, moderate physical activity, journaling, avoiding alcohol and substance use, managing stress (with activities such as meditation, tai chi, or mindfulness), and maintaining support networks with loved ones can help many people manage their symptoms. You might consider speaking with a healthcare professional to determine the best options for your specific needs.
Psychotherapy: How can online therapy help?
Several types of psychotherapy can be effective, in this case, including interpersonal and social rhythm therapy (IPSRT), family-focused therapy, and cognitive behavioral therapy (CBT). With CBT, therapists can help clients evaluate negative thoughts and reframe them to improve emotions and behaviors. A study on CBT found that it can effectively reduce mania and depressive symptoms, improve daily functioning, and reduce the overall relapse rate.
Some people with bipolar disorder may prefer attending sessions from home or having the ability to message their therapist when symptoms come up. Online therapy platforms, like BetterHelp, can connect you with a therapist by allowing you to use in-app messaging to get in touch whenever you want to talk. In addition, online therapy may be more cost-effective.
Studies have found information that suggests that online CBT can be effective in addressing symptoms of many psychiatric disorders, including bipolar disorder. The study does acknowledge, however, that some people may need in-person care—such as those experiencing an immediate crisis or psychosis. The study concludes that online therapy can be similarly effective to in-person therapy in many use cases throughout a person’s treatment experience and may offer more convenience compared to other methods.
Takeaway
Manic depressive disorder is considered by many to be an outdated term for bipolar disorder. Bipolar disorder can be subdivided into seven separate disorders, which may include episodes or symptoms of hypomania, mania, and major depression.
Bipolar disorder can be a lifelong mental illness—however, symptoms can often be effectively managed with medications, lifestyle adaptations, and psychotherapy. For many people, online cognitive-behavioral therapy can effectively reduce relapse rates, improve symptoms, and improve the ability to accomplish day-to-day tasks. Consider reaching out to a therapist online or in your area.
What are the symptoms of a manic-depressive person?
“Manic depressive” is a now outdated term that was formerly used to describe people with bipolar disorder. The condition is no longer called “manic depression” in an attempt to decrease the stigma around the illness.
Key bipolar disorder symptoms include the experience of manic or hypomanic episodes (which tend to manifest as euphoria, restlessness, high energy levels, a decreased need for sleep, a decreased appetite, and others) and depressive episodes (marked by depression symptoms such as a lack of interest in activities once enjoyed, low mood, a significant change in eating and sleeping habits, and feelings of sadness, guilt, helplessness, or hopelessness, among others).
To diagnose bipolar disorder, clinicians may ask if the individual has experienced at least one hypomanic or manic episode. If not, the individual may have depression or other clinical mental disorders that do not qualify as bipolar disorder. Treating bipolar disorder and related disorders usually involves some combination of medication and therapy.
What happens in a manic-depressive episode?
“Manic depressive episodes” and “manic or depressive episodes” are outdated terms for what is now referred to as, separately, manic or hypomanic episodes and depressive episodes. An individual living with bipolar disorder may experience these, though the severity and frequency can vary depending on the disorder subtype. They’re sometimes referred to as “mood episodes” because they tend to affect a person’s mood and behavior significantly.
A manic or hypomanic episode can manifest as euphoria, restlessness, high energy levels, a decreased desire for sleep, a decreased appetite, and similar symptoms. In severe cases, a manic episode may manifest as psychotic symptoms that could require temporary hospitalization.
A depressive episode can manifest as symptoms of depression, such as a lack of interest in activities once enjoyed, low mood, a significant change in eating and sleeping habits, and feelings of sadness, guilt, helplessness, or hopelessness, among others.
What are the three types of manic depression?
“Manic depression,” “manic depressive illness,” “bipolar depression,” and similar are outdated terms that refer to the mental illness now known as bipolar disorder. According to the American Psychiatric Association, there are three primary types of bipolar disorder:
Bipolar I
Bipolar II
Cyclothymic disorder
What incites a manic depressive episode?
“Manic depressive episode” is an outdated term that refers to characteristics of what is now referred to as bipolar disorder. An individual with this illness may experience manic or hypomanic episodes (generally characterized by mood symptoms like unusually high energy, restlessness, and euphoric mood) and depressive episodes (generally characterized by a lack of interest in activities once enjoyed, hopelessness, and sadness).
What may cause a person to develop bipolar disorder is not fully understood, but it seems to be a combination of factors like genetics and life circumstances. An individual who already has bipolar disorder can then be more likely to experience a manic/hypomanic or depressive episode as a result of factors like the following:
Lack of sleep
Stress
Hormonal changes
Pregnancy
Certain medications
Alcohol or substance use
Individuals who are looking to prevent manic or depressive episodes may speak with their doctor or mental health care provider about ways to practice healthy lifestyle habits and positive coping mechanisms and to seek the support of friends and family.
What are the red flags of bipolar disorder?
Warning signs of bipolar disorder—formerly called “manic depressive illness”—could include the experience of manic or hypomanic and depressive episodes. Signs of a possible manic episode could include the temporary, often cyclical experience of unusually high energy, restlessness, racing thoughts, exaggerated self-confidence, and engagement in risky behaviors. Signs of a possible depressive episode could include trouble sleeping or sleeping too much, persistent sadness, guilt, worthlessness, hopelessness, and a loss of interest in activities once enjoyed.
The frequency and severity of these episodes can vary depending on the type of bipolar disorder and other elements of the individual’s health, well-being, and circumstances. Understanding the warning signs of and risk factors for developing bipolar disorder can help you seek help if you ever notice them in yourself or a loved one.
What does a manic episode look like?
A manic episode is typically characterized by a significant and temporary increase in energy and confidence. During a manic episode, a person may feel restless and have racing thoughts. They might have a decreased desire for sleep, speak a lot and very quickly, and be prone to risky behaviors.
What does a bipolar crash feel like?
A “crash” associated with bipolar disorder is an unofficial term that some people with this disorder may use to refer to how they feel after a manic episode ends. These feelings can vary but may include difficulty remembering details of what happened during that time, being able to think more clearly than during the episode, being lethargic, less impulsive, and feeling embarrassed or anxious about what may have happened.
At what age does bipolar show up?
According to the National Alliance on Mental Illness, signs of bipolar disorder will usually appear in an individual by age 25. That said, it’s also possible for teenagers to develop the condition or, more rarely, children or older adults.
How do you act when manic?
Symptoms of a manic episode that may be noticeable by others can include being especially talkative or talking very quickly, having high energy, being restless or fidgety, having an elevated mood, feeling an exaggerated sense of self-confidence, and engaging in reckless behaviors.
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