What Is Manic Depression?

Frequently Asked Questions



Q: What is Bipolar Disorder?

Bipolar Disorder is the medical name for Manic Depression; at various

times, it has also been known as Bipolar Affective Disorder

and Manic-Depressive Illness. It is a mood disorder that affects

approximately 1% of the adult population of the United States -- and

roughly the same percentage in other countries, as far as we know.

It's in the same family of illnesses (called "affective disorders") as

clinical depression. However, unlike clinical depression, which seems to

affect far more women than men, Bipolar Disorder seems to affect men

and women in approximately equal numbers.

It's characterized by mood swings. Though there is no known cure, most

forms of bipolar disorder are eminently treatable with medication

and supportive psychotherapy.

The textbook definition of Bipolar Disorder is: one or more Manic or

Hypomanic Episodes, accompanied by one or more Major Depressive

Episodes. These episodes typically happen in cycles.

All of these terms will be defined at greater length below...but in plain

English, a person who has Bipolar Disorder will be severely up some of the

time, severely down some of the time, and in the middle some or most of the

time.

There are two main types of Bipolar Disorder:

-- Bipolar I is the "classic" form of Bipolar Disorder. It most often

involves widely spaced, long-lasting bouts of mania followed by long-lasting

bouts of depression and vice-versa. However, the essential definition is

depression plus mania, or "mixed states."

-- Bipolar II involves at least one Hypomanic Episode and one Major

Depressive Episode, but never either a full-blown Manic Episode or

Cyclothymia. The essential definition is depression plus hypomania.

Although the shifts from one state to another are usually gradual, they can

be quite sudden. The "rapid-cycling" form of the disorder involves four or

more complete mood cycles within a year's time, and some rapid-cyclers can

complete a mood cycle in a matter of days--or, more rarely, in hours.

It is also possible for someone who has Bipolar Disorder to be in a "mixed

state." This means that they're in a mood state which has some

characteristics of depression and some of mania or hypomania.

There are a few rare documented cases of mania without depression, but

DSM-IV does not currently include a category for just "mania".

(This diagnosis was present in DSM-III, but is unaccountably

absent in DSM-IV!)

Using DSM-IV, a person exhibiting the symptoms of mania will almost

always be diagnosed as bipolar. The general feeling in the

mental health community seems to be that what or whom goes up, must

eventually come down.

The DSM-IV and "extended" definitions of depression and mania are

presented in the sections that follow. It is very important to

remember the following:

-- These definitions are not a guide for self-diagnosis!

-- One does not need to exhibit all of the symptoms of depression

to be depressed, nor does one need to display all of the symptoms

of mania to be manic.



Q: What is Depression?

Criteria for Major Depressive Episode (DSM-IV, p. 327)

A. Five (or more) of the following symptoms have been present during the

same 2-week period and represent a change from previous functioning;

at least one of the symptoms is either (1) depressed mood or (2) loss of

interest or pleasure.

Note: Do not include symptoms that are clearly due to a general medical

condition, or mood-incongruent delusions or hallucinations.

(1) depressed mood most of the day, nearly every day, as indicated by either

subjective report (e.g., feels sad or empty) or observation made by others

(e.g. appears tearful). Note: In children and adolescents, can be irritable

mood.

(2) markedly diminished interest or pleasure in all, or almost all,

activities most of the day, nearly every day (as indicated by either

subjective account or observation made by others)

(3) significant weight loss when not dieting or weight gain (e.g., a change

of more than 5% of body weight in a month), or decrease or increase in

appetite nearly every day. Note: In children, consider failure to make

expected weight gains.

(4) insomnia or hypersomnia nearly every day

(5) psychomotor agitation or retardation nearly every day (observable by

others, not merely subjective feelings of restlessness or being slowed down)

(6) fatigue or loss of energy nearly every day

(7) feelings of worthlessness or excessive or inappropriate guilt (which may

be delusional) nearly every day (not merely self-reproach or guilt about

being sick)

(8) diminished ability to think or concentrate, or indecisiveness, nearly

every day (either by subjective account or as observed by others)

(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal

ideation without a specific plan, or a suicide attempt or a specific plan for

committing suicide

B. The symptoms do not meet criteria for a Mixed Episode.

C. The symptoms cause clinically significant distress or impairment in

social, occupational, or other important areas of functioning.

D. The symptoms are not due to the direct physiological effects of a

substance (e.g., a drug of abuse, a medication) or a general medical

condition (e.g., hypothyroidism).

E. The symptoms are not better accounted for by bereavement, i.e., after

the loss of a loved one, the symptoms persist for longer than 2 months

or are characterized by marked functional impairment, morbid

preoccupation with worthlessness, suicidal ideation, psychotic

symptoms, or psychomotor retardation.

Well, the APA gives us a good starting point, but it all sounds sort of

clinical. Here's a more complete list of symptoms of depression that our

readers and participants have identified:

* Reduced interest in activities (like writing FAQs)

* Indecisiveness (maybe)

* Feeling sad, unhappy, or blue (pervasive attitude that life sucks)

* Irritability, dammit

* Getting too much (hypersomnia) or too little (insomnia) sleep

* Loss of, um, what were we talking about? Oh yeah, concentration

* Increased or decreased appetite

* Loss of self-esteem, such as my understanding that I suck

* Decreased sexual desire

* Problems with, whaddya call it? Oh yeah, memory

* Despair and hopelessness

* Suicidal thoughts

* Reduced pleasurable feelings

* Guilt feelings, which are all my fault anyway

* Crying uncontrollably and/or for no apparent reason

* Feeling helpless, which I can't do anything about

* Restlessness, especially when I can't hold still

* Feeling disorganized (hell, look at my desk)

* Difficulty doing things (again, like finishing this FAQ)

* Lack of energy and feeling tired

* Self-critical thoughts

* Moving and thinking slooooooowwwwwwwly

* Feeling that one is in a stupor, or that one's head is in a fog

* Speeeeeeeakiiinnnnng slooooooowwwwwwwly

* Emotional and/or physical pain

* Hypochondriacal worries; fears or illnesses which prove to be

psychosomatic

* Feeling dead or detached

* Delusions of guilt or of financial poverty

* Hallucinating



Q: What is Mania?

Criteria for Manic Episode (DSM-IV, p. 332)

A. A distinct period of abnormally and persistently elevated, expansive, or

irritable mood, lasting at least 1 week (or any duration if hospitalization

is necessary).

B. During the period of mood disturbance, three (or more) of the following

symptoms have persisted (four if the mood is only irritable) and have been

present to a significant degree:

(1) inflated self-esteem or grandiosity

(2) decreased need for sleep (e.g., feels rested after only 3 hours of sleep)

(3) more talkative than usual or pressure to keep talking

(4) flight of ideas or subjective experience that thoughts are racing

(5) distractibility (i.e., attention too easily drawn to unimportant or

irrelevant external stimuli)

(6) increase in goal-directed activity (either socially, at work or school,

or sexually) or psychomotor agitation

(7) excessive involvement in pleasurable activities that have a high

potential for painful consequences (e.g., engaging in unrestrained buying

sprees, sexual indiscretions, or foolish business investments)

C. The symptoms do not meet criteria for a Mixed Episode.

D. The mood disturbance is sufficiently severe to cause marked impairment

in occupational functioning or in usual social activities or relationships

with others, or to necessitate hospitalization to prevent harm to self

or others, or there are psychotic features.

E. The symptoms are not due to the direct physiological effects of a

substance (e.g., a drug of abuse, a medication, or other treatments) or a

general medical condition (e.g., hyperthyroidism).

Note: Manic-like episodes that are clearly caused by somatic

antidepressant treatment (e.g., medication, electroconvulsive therapy,

light therapy) should not count toward a diagnosis of Bipolar I Disorder.

Again, the APA gives us a good starting point for studying mania, but the

language is awfully clinical. Here's a plain-English version, with some

extensions:

* Decreased need for sleep.

* Restlessness.

* Feeling full of energy.

* Distractibility (what was that?)

* Increased talkativeness (or increased typeativeness)

* Creative thinking.

* Increase in activities.

* Feelings of elation.

* Laughing inappropriately

* Inappropriate humor.

* Speeded up thinking.

* Rapid, pressured speech, that you can teach, eating a peach, while on

a beach.

* Impaired judgment

* Increased religious thinking or beliefs.

* Feelings of exhilaration.

* Racing thoughts, which can't be taught, and can't be bought, although

they ought, you might get caught.

* Irritability (dammit, there it is again!)

* Excitability.

* Inappropriate behaviors.

* Impulsive behaviors.

* Increased sexuality (also known as "platoon-of-Marines-on-shore-leave

syndrome")

* "clang associations" (the association of words based on their sound, a

possible reason so many poets are bipolar, also why we have pun fun)

* _decreased_ interest in sex, or any other interpersonal relationships,

due to obsessive interest in some other subject or activity

* Inflated self-esteem (so prove I'm NOT the world's leading authority!)

* Financial extravagance.

* Grandiose thinking.

* Heightened perceptions.

* Bizarre hallucinations.

* Disorientation.

* Disjointed thinking.

* Incoherent speech.

* Paranoia, delusions of being persecuted.

* Violent behavior, hostility

* Severe insomnia

* Profound weight loss

* Exhaustion



Q: What is Hypomania?

Hypomania means, literally, "mild mania."

It's sometimes difficult to draw a distinct line between "manic" and

"hypomanic," as "marked impairment" is a necessarily subjective evaluation.

Also, one of the reasons that bipolar disorder often has a delayed

diagnosis may be that hypomanic episodes are often overlooked amid

the "Sturm und Drang" of adolescense and early adulthood.

The associated features of mania are present in Hypomanic Episodes,

except that delusions are never present and all other symptoms are

*generally* less severe than they would be in Manic Episodes.

Criteria for Hypomanic Episode (DSM-IV, p. 338)

A. A distinct period of persistently elevated, expansive, or irritable mood,

lasting throughout at least 4 days, that is clearly different from the usual

nondepressed mood.

B. During the period of mood disturbance, three (or more) of the following

symptoms have persisted (four if the mood is only irritable) and have been

present to a significant degree:

(1) inflated self-esteem or grandiosity

(2) decreased need for sleep (e.g., feels rested after only 3 hours of sleep)

(3) more talkative than usual or pressure to keep talking

(4) flight of ideas or subjective experience that thoughts are racing

(5) distractibility (i.e., attention too easily drawn to unimportant or

irrelevant external stimuli)

(6) increase in goal-directed activity (either socially, at work or school,

or sexually) or psychomotor agitation

(7) excessive involvement in pleasurable activities that have a high

potential for painful consequences (e.g., engaging in unrestrained buying

sprees, sexual indiscretions, or foolish business investments)

C. The episode is associated with an unequivocal change in functioning that

is uncharacteristic of the person when not symptomatic.

D. The disturbance in mood and the change in functioning are observable

by others.

E. The episode is not severe enough to cause marked impairment in social or

occupational functioning, or to necessitate hospitalization, and there are no

psychotic features.

F. The symptoms are not due to the direct physiological effects of a

substance (e.g., a drug of abuse, a medication, or other treatment) or a

general medical condition (e.g., hyperthyroidism).

Note: Hypomanic-like episodes that are clearly caused by somatic

antidepressant treatment (e.g., medication, electroconvulsive therapy, light