Manic and Depressive Episodes in Bipolar Disorder

There are different types of episodes that most people with bipolar disorder can experience from one pole to another. The most common type of bipolar disorder is one where the individual cycles back and forth between a state of mania or hypomania, a milder form of mania and depression.

During the manic episode, people have an elevated mood, commonly called a high, which includes feelings of increased self-esteem and being special in some way. They often feel that they can accomplish much more than they can do and the quality of their ideas. Their judgment becomes impaired and a feeling of being powerful with painful consequences. They may have many ideas and the energy to carry them out.

These rapid thoughts may be difficult to follow; this type of thinking thoughts is called racing thoughts or with pressured speech. People in manic episode may feel such an extreme pressure to talk and are unable to stop or slow down so that others do not have the opportunity to interrupt. Manic people’s minds are working so fast that they can speak with rhymes or singsong phrases. They may start singing or start dancing spontaneously. Their behavior can become disorganized or dangerous to the point that they require hospitalization.

Manic episodes can also have psychotic symptoms present.  A psychosis is a state in which a person is unable to tell the difference from reality and unreality. Psychosis symptoms include hallucinations, false beliefs about having special powers or identity. Psychotic symptoms indicate a severe mood episode that requires immediate treatment.

People experiencing mania often start several activities at once, without the insight to know if they can complete all of them. They have so much energy that they function on two or three hours of sleep a day.

During depression people with bipolar disorder may stay in bed all day with the feeling that they cannot get the day started. They their thoughts move slowly, and they take little pleasure in any activity.  People with bipolar disorder in a depressed phase often feel as if they are worthless and their life is meaningless. They may begin to overeat and, with a slowed down activity level, gain weight. They may speak or think of suicide. Psychotic symptoms may also occur during severe depressive episodes, the same as in a manic episode.

A Mixed episode is a mood episode during which the symptoms of depression and mania are present at the same time. This can lead to irritability, hostility and physical aggression.  Often hospitalization for their safety and the safety of those around them is necessary. They may need a longer hospital stay or a combination of medications to get well.

In Rapid cycling there are 4 or more manic or hypomanic episodes in the course of the illness with depressive or mixed episodes in a 12-month period. Rapid cycling bipolar disorder is not as easily treated and often is less responsive to medication. Treatment usually requires a combination of medications. It is seen more commonly in women.

Seasonal Disorders or SAD are mood disorders that seem to be triggered by the seasons of the year. A person who becomes depressed during the late fall and winter and then returns to a regular mood during the spring and summer has a seasonal form of mood disorder. In bipolar disorder, a seasonal disorder person has manic or hypomanic episodes during a certain seasons of the year. During the other seasons, their mood normal or depressed or neither manic nor depressed. The fall/winter depression is more common than the spring/summer episodes. Suicide is found to be more common in March, April and May this is thought to be due to changes in light.