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Bipolar Mood Disorder


Millions of people with bipolar disorder find apt treatment with pharmacotherapy and psychotherapy, often in combined therapeutic sessions.


Bipolar Disorder

For those affected by bipolar disorder, life is an emotional roller coaster of intense highs and crippling lows. Many treatment options are available to help control these extreme changes in mood. Although there is no cure, with proper treatment, many people diagnosed with bipolar disorder can live normal lives. Change may not come overnight, but with the right treatment, you can keep having bipolar disorder from driving your life.


What is Bipolar Disorder?

The word bipolar indicates the two poles, or extremes, that characterize the disorder. Bipolar disorder can affect a person's ability to experience a normal range of mood. If you picture a globe, the North Pole would be mania, and the South Pole would be depression. Every time you experience symptoms at one pole for at least 1 week, it is an episode. Experiencing four or more episodes of mania and/or depression in a year is rapid-cycling bipolar disorder.


Bipolar disorder includes four main mood episodes: Mania, Hypomania, Depression, and Mixed Mood.



Types of Bipolar Mood Episodes

Manic Episode(Mania) is a distinct period during which there is an abnormally and constantly elevated, expansive, or irritable mood, lasting at least 1 week.

Hypomanic Episode(Hypomania) is a milder form of mania that lasts at least 4 days.

Major Depressive Episode (Depression) is a period during which there is either depressed mood or the loss of interest or pleasure in nearly all activities, lasting for at least 2 weeks.


Mixed Episode is a period of time during which a person experiences both manic and major depressive symptoms nearly every day for at least 1 week.

Types of Bipolar Disorders

Bipolar I Disorder

One or more manic episodes or mixed episodes and often one or more major depressive episodes. The depressive episode may last for several weeks or months, alternating with intense symptoms of mania that may last just as long. Between episodes, there may be periods of normal functioning. Season changes may also affect symptoms.

Bipolar II Disorder

One or more major depressive episodes accompanied by at least one hypomanic episode. Hypomanic episodes have symptoms similar to manic episodes but are less severe. Between episodes, there may be periods of normal functioning. Season changes may also affect symptoms.

Cyclothymic Disorder

This is a chronic fluctuating mood disturbance involving periods of hypomanic symptoms and periods of depressive symptoms. It is a milder form of bipolar disorder; the periods of both depressive and hypomanic symptoms are shorter, less severe, and do not occur with regularity. Many people with cyclothymic disorder may develop more severe symptoms.

Bipolar Disorder Not Otherwise Specified (NOS)

When the bipolar disorder is not characterized by any of the above mentioned types of bipolar disorder, it is diagnosed as Bipolar NOS.  The experiences of bipolar disorder vary from person to person. Occasionally someone will experience the symptoms of a manic episode and a major depressive episode, but not fit into the above mentioned types of bipolar disorder. This is known as Bipolar Disorder Not Otherwise Specified (NOS), and just like the other types of bipolar disorder, Bipolar Disorder NOS is a treatable disorder.


Several established and replicated studies on bipolar symptoms indicate that a substantial number of patients with bipolar depression, especially bipolar II depression, are initially diagnosed with unipolar major depressive disorder. For example, Ghaemi and colleagues found that providers are misdiagnosing bipolar depression as unipolar depression in 37% of patients who initially sought treatment with a mental health clinician following their first manic or hypomanic episode. Consequently, earlier use of antidepressants was more common than mood-stabilizers in these patients, resulting in new or worsening rapid cycling in 23%. In a survey of members of the Depression and Bipolar Support Alliance (DBSA), Hirschfeld and colleagues found that 60% of respondents initially diagnosed with unipolar depression actually had bipolar symptoms.


Moreover, an average of 10 years elapsed between the onset of mood symptoms and accurate diagnosis of bipolar symptoms. Why is bipolar depression so difficult to diagnose? First, hypomanic and even manic episodes may go unreported by patients. Second, more than 50% of patients with bipolar disorder experience a depressive episode as their first mood episode. Third, although atypical depressive symptoms (e.g., hyperphagia, hypersomnia, profound fatigue, and psychomotor retardation) may occur more commonly in bipolar depression, they are not pathognomic bipolar symptoms for depression and can occur in unipolar depression as well. Fourth, the diagnosis of bipolar II disorder, bipolar disorder NOS, and cyclothymia can be difficult to diagnose because the brief and relatively mild excursions into hypomania may be difficult for patients to recall or characterize as abnormal, and therefore difficult for clinicians to elicit.


With these diagnostic pitfalls in mind, there are fortunately several ways of improving diagnostic sensitivity for bipolar symptoms. Two screening instruments devised for bipolar disorder have reliable psychometric properties: the Mood Disorder Questionnaire (MDQ) and the Bipolar Spectrum Diagnostic Scale (BSDS).


The mental health research team, Manning and colleagues, also identified clues for the detection of subtle presentations of bipolar symptoms and mixed states.


Detecting Subtle Bipolar Symptoms

  • Established bipolar family history
  • Mood stabilizing treatment response in first-degree relative
  • Loaded 3-generational family history of mood disorder
  • Pharmacologically induced mania or hypomania
  • History of mixed states
  • Premorbid hyperthymia, cyclothymia, irritable or dysthymic temperament
  • Periodic depression with abrupt onset and termination or seasonal pattern
  • Psychotic depression in a teenager or young adult


Detecting Mixed States of Bipolar symptoms

  • Unrelenting dysphoria or irascibility are typical bipolar symptoms
  • Severe agitation
  • Refractory anxiety
  • Unendurable sexual excitement
  • Intractable insomnia
  • Suicidal obsessions
  • "Histrionic" demeanor yet with genuine expressions of intense suffering
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