What Is Manic Depression?
Frequently Asked Questions Page 2
and dysphoria?
Q: What is the difference between euphoria
There are two basic types of mania (or hypomania): euphoric and dysphoric.
A person can experience both types when they have bipolar disorder.
In euphoria, a person is high, in love with the world, one with the world,
feeling boundless energy, talking a mile a minute, mind is racing, deluded
with grandiose thoughts, etc. This kind of mania is generally the kind
described in the popular literature.
Dysphoria is another type of mania. In dysphoria one is "high" but in a
different sense: agitated, destructive, full of rage, talking a mile a
minute, mind racing, deluded with grandiose thoughts, paranoid, full of
anxiety, panic-stricken.
In addition, dysphoria can also come into the depressive side. These are
often referred to as "mixed episodes." Mixed episodes are quite
dangerous; suicidal ideation often accompanies this state.
What's the difference between agitated depression and
dysphoric (hypo)mania?
Dr. Ivan Goldberg ([email protected]) explains: "While folks in an
agitated depression show increased motor activity, they never show
increased sociability, increased creative thinking, joking and punning
that may be seen in someone experiencing a dysphoric (hypo)manic state."
Q: What is a Mixed State?
Criteria for Mixed Episode (DSM-IV, p. 335)
A. The criteria are met both for a Manic Episode and for a Major
Depressive Episode (except for duration) nearly every day during at least
a 1-week period.
B. 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.
C. 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).
Comment: This may be an instance in which the DSM-IV definition is a
bit too narrow. Many readers and participants in ASDM and SSDM
report experiencing mixed states with hypomanic, but not fully manic,
features.
Q: What is Rapid Cycling?
The "rapid-cycling" form of Bipolar 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.
Studies show that women are more likely than men to be diagnosed as
rapid-cyclers.
Q: What are delusions and hallucinations?
-- What are delusions?
Delusions are, in general, "false beliefs." The DSM-IV (p. 763) defines a
delusion as:
A false belief based on incorrect inference about external reality that is
firmly sustained despite what almost everyone else believes and despite
what constitutes incontrovertible and obvious proof or evidence to the
contrary.
People who are in a manic or depressed episode may have delusions. Some of
these might include delusions of reference, where the individual feels like
events, objects, or other persons have a particular and unusual significance.
The individual may also have grandiose delusions or delusions of persecution
(such as paranoia).
It's important to note that delusions must be diagnosed in terms of
cultural, social, and religious norms. A belief that one is in direct
communication with God, for example, might be either a delusion or an
expression of certain kinds of religious faith.
-- Can people with bipolar disorder have hallucinations?
Most certainly. The DSM-IV (p. 766) defines a hallucination as:
A sensory perception that has the compelling sense of reality of a true
perception but that occurs without external stimulation of the relevant
sensory organ. Hallucinations should be distinguished from illusions, in
which an actual external stimulus is misperceived or misinterpreted.
Some people know that they are having hallucinations, and others do not.
Most people who have bipolar disorder realize that the hallucinations
are not actual perceptions of reality. However, this realization does not
keep them from occurring.
-- What kind of hallucinations are there?
Hallucinations may occur in any of the senses: auditory
(for example, hearing voices or music), gustatory (for example,
unpleasant tastes), olfactory (for example, unpleasant smells),
somatic (for example, a feeling of "electricity"), tactile
(for example, a sensation of being touched, or "skin crawling" sensations),
visual (for example, flashes of light, colors, images on the periphery).
bipolar disorder apart?
Q: How do you tell unipolar depression and
If the person in question is known to have had even a single Manic or
Hypomanic Episode, then there is virtually no question; the diagnosis is a
form of bipolar disorder (or, in the case of hypomania, possibly
cyclothymia.)
If the person in question is currently depressed, and his or her history is
not known, or is incomplete, the following guidelines by Dr. Ivan Goldberg
may prove to be useful:
The things that make me suspect bipolarity in a patient diagnosed as
unipolar are:
- oversleeping when depressed
- overeating when depressed
- a history of bipolarity in the family
- a patient who when depressed can still joke and laugh
- anyone with a history of frequent depressive episodes (rapidly cycling
unipolar disorder)
- success as a salesperson, politician, or actor (in school or real world)
- extreme rejection sensitivity
- a history of having ever been diagnosed as bipolar or given lithium
(except to potentiate antidepressants)
Of course, a unipolar patient can still sleep too much, unipolar depression
or bipolar disorder can surface earlier or later in life, and so on. These
are guidelines, not hard-and-fast rules.
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