Understanding Bipolar Disorder Episodes

Types of episodes

Bipolar disorder symptoms can occur as manic, hypomanic, or depressive episodes. Some episodes can include symptoms of manic and depressive episodes. This phenomenon is called a mixed state, or a mood episode with mixed features.

Episodes may be sporadic, and there may not be any symptoms between episodes. For some, manic and depressive episodes may be frequent and interfere with work and relationships.

Manic episodes

A manic episode is a period of extreme happiness, overly outgoing behavior, or extreme irritability combined with increased energy. These episodes last for one or more weeks and may result in hospitalization.

Someone in a manic episode may:

• talk very quickly or
  loudly or interrupt others
• be frequently distracted
  and unable to focus on one task or thought at a time
• require less sleep than
  they usually do
• go on spending sprees
• engage in risky sexual
  behavior
• have an unusually high
  self-esteem

Moods can shift rapidly from happiness to anger, sadness, or irritability during a manic episode. The symptoms are severe enough to cause problems at work or in one’s personal life. A person experiencing a manic episode may not know they are ill and may not want to seek treatment.

Hypomanic episodes

A hypomanic episode has similar symptoms to a manic episode. It lasts for at least four days, with symptoms present most of the day nearly every day of the episode. Generally, a hypomanic episode does not cause as severe of problems in one’s work or personal life as a manic episode.

Depressive episodes

A major depressive episode typically lasts for at least two weeks. It includes multiple features of depression that interfere with work or relationships. A person in a depressive episode may feel sad or hopeless. They may withdraw from social situations. They may also lose interest in people and activities they usually enjoy.

Features of a depressive episode include:

• trouble concentrating
• feelings of fatigue
• irritability
• changes in eating or
  sleeping patterns
• thoughts of death and
  suicide

Diagnosing bipolar disorder

A person’s mood changes and behaviors need to be significantly different than their typical moods and behaviors to receive a diagnosis of bipolar disorder.

Bipolar disorder can present in many different ways. The severity of the symptoms can also vary greatly. Some people have very mild symptoms. For these people, treatment can significantly limit the impact bipolar disorder has on their lives. Other people have more severe symptoms. Even with treatment, bipolar disorder can have a significant impact on these people’s lives.

The types of bipolar disorder differ based on the type and intensity of the mood episodes.

Bipolar I disorder

This type causes manic episodes with mixed features. Episodes last at least a week. The episode can be so serious that you need to be hospitalized for the safety of you and those around you. Manic episodes of bipolar I disorder are preceded or followed by a major depressive episode. The depressive episode lasts at least two weeks.

Bipolar II disorder

This type causes least one hypomanic episode and one major depressive episode. It causes no serious manic or mixed episodes.

Bipolar disorder not otherwise specified

This type causes manic and depressive symptoms. However, the symptoms are not much more severe than a person’s usual range of emotions and behaviors. People that have some but not all features of bipolar disorder may be given a diagnosis of bipolar disorder not otherwise specified.

Cyclothymic disorder

This type causes numerous episodes of mild hypomania and mild depression that persist for at least two years. In cyclothymic disorder, symptoms don’t rise to the level of full-blown hypomania or major depression.

Bipolar disorder due to a substance or medication

This results in symptoms of bipolar disorder brought on by exposure to a substance or medication. For example, recreational drugs like cocaine or phencyclidine (PCP) or medications such as prednisone can cause symptoms of a manic episode.

Bipolar disorder due to a medical condition

With this type, a person experiences symptoms of bipolar disorder that occur due to another medical condition.

Rapid-cycling bipolar disorder

This is a more complicated version of bipolar disorder. It’s defined as having at least four episodes of mania, hypomania, or major depression within 12 months. Women may be more likely to have rapid-cycling bipolar disorder. It’s also more common among people whose first episode occurred when they were young.

Bipolar disorder with psychotic features

This is another serious version of bipolar disorder. During a mood episode, a person can hallucinate or have delusional beliefs. These are features of psychosis. An example of a hallucination is hearing someone talk to you when there is no one there. An example of a delusional belief is thinking you have special powers.

Taking hold of your bipolar disorder

One of the most important steps in dealing with bipolar disorder is to become educated on the condition. It’s also important to learn as much as you can about your specific type of bipolar disorder. The more knowledgeable you are, the more confident you’ll feel about living with bipolar disorder and gaining better control over your life.

Pay attention to the things that trigger episodes. Identifying signs that an episode is coming on can help. Include the people close to you in this process. They can offer support. They can also alert you to possible triggers or behavior changes. These may indicate that an episode is starting. When you can recognize that an episode is developing, you can intervene. Use strategies that you’ve learned in therapy.

You should also try to follow a healthy lifestyle that includes:

• sufficient sleep of at
  least seven hours a night
• daily exercise
• balanced diet
• no alcohol or recreational
  drugs
• stress-relief activities
  such as yoga, meditation, and tai chi

According to one study, even brief periods of meditation may sometimes help prevent a manic or depressive episode from getting more severe.

Treatment

Bipolar disorder is a lifetime condition. It can be managed with a combination of medications, therapy, and a healthy lifestyle. You’ll be able to better handle bipolar disorder if you’re engaged in your treatment. Self-management means you actively try to avoid triggers and control the behaviors that you can.

Several types of psychotherapies can help relieve symptoms, prevent new mood episodes, and improve functioning. These include:

• psychoeducation
• family-focused therapy
• cognitive behavioral
  therapy (CBT)
• interpersonal and social
  rhythm therapy

Cognitive behavioral therapy

Doctors are increasingly turning to CBT for the treatment of bipolar disorder. CBT helps people identify the causes of negative thoughts and feelings. After identifying these causes, a person is given tools to change how they think and react to them. CBT may help prevent bipolar depressive episodes. Some research has shown that it’s less successful in preventing manic episodes.

Medication

There are also several types of medications your doctor may prescribe. These may include:

• mood stabilizers
• antipsychotic
  medications
• antidepressant
  medications

The use of antidepressants for bipolar disorder is controversial. That’s because some studies have suggested that antidepressants can sometimes trigger manic episodes.

Not everyone reacts the same to medication. A medication that works for someone you know may not work for you. It may also cause unwanted side effects. Be prepared to try a few different medications to find the safest and most effective treatment for you.

Hospitalization

Even with treatment and support, episodes can sometimes become quite serious and require hospitalization. If you feel you’re losing control, or you’re concerned about someone who has bipolar disorder, don’t hesitate to call 911 and get emergency assistance.

Getting help

Bipolar disorder may be difficult to identify at first. You may not even be aware that your behavior is noticeably different when an episode occurs. If you feel that you’re not as in control of your emotions or behaviors as you should be, seek out a mental health professional. Explain your symptoms and concerns. Also, talk with your friends and relatives. Listen to their observations and concerns with an open mind.

Bipolar disorder can get worse without treatment. It’s better to intervene as soon as you become aware of your symptoms. Even if you have a mild form of bipolar disorder, you can learn how to control symptoms so they don’t interfere with your quality of life.