Bipolar disorder is a class of mood disorders that is marked by dramatic changes in mood, energy and behaviour. The key characteristic is that people with bipolar disorder alternate between episodes of mania (extreme elevated mood) and depression (extreme sadness). These episodes can last from hours to months. The mood disturbances are severe enough to cause marked impairment in the person’s functioning.The experience of mania is not pleasant and can be very frightening to the person. It can lead to impulsive behaviour that has serious consequences for the person and their family. A depressive episode makes it difficult or impossible for a person to function in their daily life.
People with bipolar disorder vary in how often they experience an episode of either mania or depression. Mood changes with bipolar disorder typically occur gradually. For some individuals there may be periods of wellness between the different mood episodes. Some people may also experience multiple episodes within a 12 month period, a week, or even a single day (referred to as “rapid cycling”). The severity of the mood can also range from mild to severe.
Establishing the particular type of bipolar disorder can greatly aid in determining the best type of treatment to manage the symptoms.
The Diagnostic Statistical Manual (DSM-IV-TR) is a manual used by doctors to determine the specific type of bipolar disorder. The diagnosis is based on the severity of symptoms and length of time that the symptoms are evident.
The different types of bipolar disorder are based on the severity and duration of the altered mood.
Bipolar I disorder is characterized by at least one manic episodes or mixed episodes and one or more major depressive episodes. These episodes last for at least one week but may continue for months. Bipolar I disorder is the most severe form of the illness.
Bipolar II disorder is characterized by predominantly depressive episodes accompanied by occasional hypomanic episodes. Hypomanic episodes are milder than manic episodes but can still impair functioning. Between episodes, there may be periods of normal functioning. The risk of suicide is high for this type of bipolar disorder.
Cyclothymic disorder is characterized by chronic fluctuating moods involving periods of hypomania and depression. The periods of both depressive and hypomanic symptoms are shorter, less severe, and are separated by periods of normal mood. However, these mood swings can impair a person’s life and create chaos as they can be feeling on top of the world one day and feeling down and depressed the next day. Some people with cyclothymia develop a more severe form of bipolar illness while for others, it continues as a chronic (ongoing) condition.
Bipolar Disorder Not Otherwise Specified: Some people will experience the symptoms of a manic episode and a major depressive episode, but their symptoms do not fit into the above mentioned types of bipolar disorder. This is known as Bipolar Disorder Not Otherwise Specified. For example,a person who experiences rapid cycling between manic and depressive episodes would be diagnosed with this type of bipolar disorder. Just like the other types of bipolar disorder,Bipolar Disorder Not Otherwise Specified is a treatable disorder.
Mixed episodes are ones in which a person simultaneously experiences characteristics of both mania and depression. For example, a person may experience excitability and agitation of mania coupled with depression and irritability. This combination of energy, agitation and depression makes a mixed episode the most dangerous for risk of suicide.
People with bipolar disorder can lead healthy and fulfilling lives when the illness is effectively treated and managed.
Without treatment, the illness tends to worsen. Over time a person may suffer more frequent and more intense episodes. Treatment can help to reduce frequency and severity of episodes and help to maintain a good quality of life.