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Never Know If You're Up or Down?

Updated: Apr 8


By Dr. Lawrence Hutchison, MD


You may be suffering from a mood disorder called Bipolar Disorder, or more commonly referred to as Bipolar Depression.

In fact there are three commonly recognized manifestations of Bipolar disorder- bipolar I, bipolar II and cyclothymic disorder. Many experts believe there may a fourth, but more on that later. The Bipolar disorders are a type of mental illness that causes sudden and profound changes in a person’s mood, energy and ability to function. People suffering with Bipolar disorder will have periods of relatively normal mood, punctuated by periods of intense mania, hypomania, and major depression.

To better understand the differences in the three or four types of Bipolar. We need to understand what the different periods look like.

When a person is in a period or Mania or having a manic episode they may feel extremely excited, anxious, keyed up or even irritable. They often seem to have more energy than usual and experience at least three of the following: Highly exaggerated self-esteem or grandiosity, little need for sleep, excessive loud and rapid talking, distractibility, trying to accomplish more in a day than can realistically be done, risky behavior (e.g., sexual promiscuity, reckless driving, spending sprees), racing thoughts and rapidly changing ideas or topics of conversation. The symptoms are severe enough to cause dysfunction and problems with work, family or social activities and responsibilities, and may not be apparent to the person, but are easily recognizable by family and coworkers, and must last at least 7 days.

A hypomanic episode is similar to a manic episode, however the symptoms are less dramatic, may last only 4 days, and do not lead to the major problems and dysfunction.

The major depression in bipolar disorder is defined as a period of at least two weeks with at least five of the following (including one of the first two):

Intense sadness or despair

Loss of interest in activities once enjoyed

Feeling helpless, hopeless, guilty or worthless

Sleeping too little or too much

Feeling restless or agitation

Increase or decrease appetite

Loss of energy, fatigue

Difficulty concentrating

Frequent thoughts of death or suicide

In the mental illness commonly referred to as “Major Depression”, the symptoms are often less severe, come on slower and are much longer lasting,

People with Bipolar I must have a period of major depression and a period of obvious Mania and often have other mental disorders such as attention-deficit/hyperactivity disorder (ADHD), an anxiety disorder or substance use disorder.

Bipolar II disorder has at least one major depressive episode and at least one hypomanic episode, and patients often first seek treatment because of the severe depressive symptoms, that, unlike Major Depression, will last only a short time.

Cyclothymic disorder is best described as a milder form of bipolar II disorder, characterized by frequent but milder mood swings that “cycle” between major depression and hypomania, but periods do not last long enough and are not severe enough to qualify as true major depression, mania, or hypomania.

A fourth and as of yet unclassified Bipolar like illness, manifests as short but intense bouts of severe depression, lasting only a few days, and very little if any hypomania, with periods of near normalcy for weeks between episodes.

Environmental and lifestyle factors trigger or contribute to bipolar disorder, including extreme stress, drug and alcohol use, physical or mental abuse, and exhaustion. Bipolar disorder seems to run in families, with 85 percent of individuals with bipolar disorder having a relative with either depression or bipolar disorder.

Treatments for all three bipolar disorders include lifestyle and nutritional modification, stress reduction, meditation, medication and psychotherapy. The medications most commonly used are mood stabilizers and antidepressants, depending on the patient and the severity of their symptoms. Each person is different and as such treatment needs to be individualized, and multiple options are often necessary for maximum benefit. Bipolar is often recurrent, and most experts recommend longterm ongoing treatment and therapy to decrease the severity of relapse, if and when they occur.


Bipolar disorders can devastate a person’s life and relationships, particularly with spouses and family members, creating an intensely stressful family situation. Family members may also benefit from mental health professionals and support groups. From these resources, families can learn strategies to help them cope, to gain support for themselves, and to be an active part of the treatment team.

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