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learn: bipolar basics

Types of Bipolar

Bipolar disorder used to be called ‘manic depression’. As the older name suggests, someone with bipolar disorder will have severe mood swings. Most people have emotional ups and downs from time to time. If you have bipolar disorder, your mood can reach very high or low levels.

Bipolar disorder can be a life-long mental health problem that mainly affects your mood. It affects how you feel, and your mood can change massively.

You can experience episodes of mania, and depression. These usually last several weeks or months and are far beyond what most of us consider ‘normal’. Sometimes, you may feel immensely excited or energetic. Other times, you may find yourself sinking into depression. In any case, when your mood changes, you will see changes in your energy levels or how you act. You may feel well inbetween these.

Symptoms of bipolar disorder can be severe. They can affect areas of life, such as work, school or relationships.

You usually develop bipolar disorder before you are 20. It can develop in later life, but it rarely develops after the age of 40.

You could have symptoms of bipolar disorder for some time before a doctor diagnoses you. A doctor might say you have something else such as depression before you get a bipolar disorder diagnosis. This is because diagnosing mental illnesses can be sometimes difficult for doctors. They usually can’t do things like blood tests and scans to help them.

Bipolar I Disorder

This involves manic episodes that last at least 7 days straight.

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Bipolar Type I

A person with bipolar I disorder may or may not have a major depressive episode. The symptoms of a manic episode may require hospital care.

A diagnosis of bipolar I disorder means you will have had at least 1 episode of mania that lasts longer than 7 days. You may also have periods of depression.

Manic episodes will generally last 3-6 months if left untreated. Depressive episodes will generally last 6-12 months without treatment.

Bipolar II Disorder

Involving less severe episodes of mania known as Hypomania.

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Bipolar Type II

Bipolar II disorder involves a major depressive episode lasting at least 2 weeks and at least one hypomanic episode. People with bipolar II disorder typically don’t experience manic episodes intense enough to require hospitalisation.

A diagnosis of bipolar II disorder means it is common to have symptoms of depression. You will have had at least 1 period of major depression and at least 1 period of hypomania instead of mania.

Doctors sometimes misdiagnose bipolar II disorder as depression since depressive symptoms may be the primary symptom when the person seeks medical attention. When there are no manic episodes to suggest bipolar disorder, the depressive symptoms become the focus.

Cyclothymic Disorder

Chronic mood instability without extreme mood episodes.

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Cyclothymia

Cyclothymia is not actually a type of bipolar disorder. This is a common misconception.

People with cyclothymia experience both high and low moods; though they are not often as severe, they can last longer. A diagnosis of cyclothymic disorder means you will have experienced regular episodes of hypomania and depression for at least 2 years, but the severity of such episodes does not meet the criteria for a full hypomanic or depressive episode.

Cyclothymia can develop into bipolar disorder.

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Other Variants

Understandably this just makes treatment and management even harder. It goes without saying that everyone is different and finding a category to classify your illness in order to best manage it; is just not that simple…

Just when this was starting to make sense, yes there are even more variations of bipolar disorder. As well as a base diagnosis of Type I or Type II you could also have a more specific diagnosis categorised as one of these variants:

Now this is getting very complicated...

Bipolar Type I or II + Mixed Features

You will experience symptoms of mania or hypomania and depression at the same time. You may hear this being called ‘mixed bipolar state’. You may feel very sad and hopeless at the same time as feeling restlessness and being overactive.

Bipolar Type I or II + Rapid Cycling

Rapid cycling means you have had 4 or more depressive, manic or hypomanic episodes in a 12-month period.

Bipolar Type I or II + Seasonal Pattern

Seasonal pattern means that either your depression, mania or hypomania is regularly affected in the same way by the seasons. For example, you may find that each winter you have a depressive episode, but your mania doesn’t regularly follow a pattern.

There can be some similarities between bipolar I or II with seasonal pattern and another conditional called seasonal affective disorder.

How do the symptoms of type I and type II differ?

As mentioned above, bipolar I disorder involves episodes of mania and may involve depression, while bipolar II disorder is mostly depression but also includes hypomania periods.

All symptoms of bipolar disorder irrespective of type, can make day-to-day life difficult to deal with. All types of bipolar can have an adverse effect on your relationships and work.

Which is more serious?

Most people think of bipolar I as the more severe condition since manic episodes can be more intense and require hospitalisation. Bipolar I may often be more challenging to treat, too.

However, research suggests that depressive episodes in bipolar II may be more frequent and longer than in bipolar I and persist longer through life.

What is Mania?

A manic episode is more than just a feeling of elation, high energy, or distraction. During a manic episode, mania can interfere with daily activities.

People having an episode of mania may make some “irrational” decisions, such as spending large amounts of money they can’t afford. They may also engage in behaviours that could have harmful consequences.

An episode is not considered manic if caused by outside influences such as alcohol, drugs, or another health condition. Symptoms of mania can include:

  • feeling happy or excited, even if things aren’t going well for you,
  • being full of new and exciting ideas,
  • moving quickly from one idea to another,
  • racing thoughts,
  • talking very quickly,
  • hearing voices that other people can’t hear,
  • being more irritable than normal,
  • feeling much better about yourself than usual,
  • being easily distracted and struggle to focus on one topic,
  • not being able to sleep, or feel that you don’t want to sleep, and
  • thinking you can do much more than you actually can.

Suffering from an episode of Mania can lead you to make unusual, or big decisions without thinking them through, and doing things you normally wouldn’t do which can cause problems. Things such as:

  • spending a lot of money,
  • having casual sex with different people,
  • using drugs or alcohol,
  • gambling, or
  • making unwise decisions.

What about Hypomania?

A hypomanic episode is a period of mania less severe than a manic episode. However, in a hypomanic episode, behaviours still differ from your usual state. The differences will be extreme enough that people around you may notice.

Officially, an episode isn’t considered hypomania if it’s influenced by drugs or alcohol.

What is Depression?

Depressive symptoms in someone with bipolar disorder are like those of someone with major depressive disorder. They may include extended periods of sadness and hopelessness.

You may also experience a loss of interest in people you once enjoyed spending time with and activities you used to like.

Other symptoms include:

Why do people keep asking me if I feel ok?
...I don't 'feel' anything!
Why do people keep asking me if I feel ok?
...I don't 'feel' anything!
  • low mood, having less energy and feeling tired,
  • feeling hopeless or negative,
  • feeling guilty, worthless or helpless,
  • being less interested in things you normally like doing,
  • difficulty concentrating, remembering or making decisions,
  • feeling restless or irritable,
  • sleeping too much or not being able to sleep,
  • eating less or over eating,
  • losing or gaining weight, when you don’t mean to, and
  • thoughts of death or suicide, or suicide attempts.

What is Psychosis?

Sometimes you can have psychotic symptoms during a severe episode of mania or depression.

Symptoms of psychosis can be:

  • hallucinations. This means that you may hear, see, or feel things that are not there.
  • delusions. This means you may believe things that aren’t true.

Other people will usually find your beliefs unusual. Psychotic symptoms found in bipolar can reflect your mood. For example:

If you have a manic episode you may believe that you have special powers or are being monitored by the government.

If you have depressive episode, you may feel very guilty about something you think you have done. You may feel that you are worse than anybody else or feel that you don’t exist.

Walking takes far too long, I'll just fly there!
learn: stats and figures

Bipolar Statistics

How common is bipolar?

  • Globally, 46 million people around the world have bipolar disorder. (Our World in Data, 2018)
  • One survey of 11 countries found the lifetime prevalence of bipolar disorder was 2.4%. The U.S. had a 1% prevalence of bipolar type I, which was notably higher than many other countries in this survey. (Therapeutic Advances in Psychopharmacology, 2018)
  • Annually, an estimated 2.8% of U.S. adults have a bipolar disorder diagnosis (Harvard Medical School, 2007).
  • Of all mood disorders, those with a diagnosis of bipolar disorder were found to have the highest likelihood of being classified with “severe” impairment (82.9%). (Archives of General Psychiatry, 2005)
  • The past-year prevalence of bipolar disorder is similar in females and males (2.8% and 2.9%, respectively). (National Institute of Mental Health, 2017)

Bipolar statistics by age

  • The average age of onset is 25 years old. (National Alliance on Mental Illness, 2017)
    People ages 18 to 29 years old had the highest rates of bipolar disorder (4.7%) followed by 30- to 44-year-olds (3.5%) as of 2001-2003. (Harvard Medical School, 2007)
  • People 60 and older had the lowest rates of bipolar disorder (0.7%) as of 2001-2003. (Harvard Medical School, 2007)
  • Only 2.9% of adolescents had bipolar disorder as of 2001-2004, the majority of which had severe impairment. (Archives of General Psychiatry, 2005)

Bipolar and overall health

  • On average, bipolar disorder results in 9.2 years reduction in expected life span (National Institute of Mental Health, 2017).
  • The risk of suicide is high in people with bipolar disorder with 15% to 17% committing suicide. (Treatment Advocacy Center)
  • Up to 60% of people with any mental health disorder, including bipolar disorder, develop substance use disorders. (WebMD, 2006)
  • Of those with bipolar disorder, many report co-occurring health conditions, which are most commonly migraine, asthma, and high cholesterol. High blood pressure, thyroid disease, and osteoarthritis were also identified as high probability co-occurring health problems. (The British Journal of Psychiatry, 2014)