Bipolar disorder is a chronic mental health condition characterized by significant, distinct shifts in mood, energy, activity levels, and concentration. The disorder involves recurrent episodes that represent a clear change from a person’s usual functioning. These episodes fall into two main categories: the elevated or irritable mood of mania or hypomania, and the low mood of major depression. Bipolar I disorder is defined by the occurrence of at least one full manic episode, while Bipolar II disorder involves at least one hypomanic episode and at least one major depressive episode.
The Hallmarks of a Manic Episode
A full manic episode is a severe and disruptive state that significantly impairs a person’s ability to function socially or professionally. This state is characterized by an abnormally and persistently elevated, expansive, or irritable mood, lasting for at least one week, or for any duration if hospitalization is necessary. A person experiencing mania often displays an inflated sense of self-esteem, sometimes reaching the level of grandiosity.
The observable behavior includes a decreased need for sleep, where an individual may feel completely rested after only three hours or less. They often become more talkative than usual, with speech that is pressured, fast, and difficult to interrupt. Internally, they describe a “flight of ideas” or the subjective experience that their thoughts are racing quickly through their mind. This high energy translates into excessive involvement in activities that have a high potential for painful consequences, such as unrestrained spending sprees or foolish business investments. The severity of the mood disturbance often necessitates hospitalization, and psychotic features like delusions or hallucinations may be present.
The Characteristics of a Depressive Episode
The depressive phase meets the criteria for a major depressive episode, involving five or more symptoms that persist for at least a two-week period and represent a change from previous functioning. At least one of these symptoms must be a depressed mood, such as feeling sad, empty, or hopeless, or a marked loss of interest or pleasure in nearly all activities (anhedonia).
Physical symptoms are common and include significant changes in appetite or weight, as well as sleep disturbances like insomnia or sleeping excessively (hypersomnia). Individuals often experience profound fatigue or loss of energy nearly every day. Their movements may slow down noticeably (psychomotor retardation), or conversely, they may exhibit purposeless restlessness and agitation.
The episode is frequently dominated by feelings of worthlessness, excessive or inappropriate guilt, and a decreased ability to concentrate or make decisions. Recurrent thoughts of death, suicidal ideation, or specific plans for suicide are also a serious concern during this low state.
Distinguishing Hypomania from Full Mania
Hypomania represents a milder form of mood elevation compared to a full manic episode. It involves an abnormally elevated, expansive, or irritable mood and increased activity or energy, lasting for at least four consecutive days. The symptoms, such as decreased sleep and racing thoughts, are the same as in mania but are less intense.
The defining difference lies in the level of functional impairment and severity. Unlike mania, a hypomanic episode is not severe enough to cause marked impairment in social or occupational functioning. It does not necessitate hospitalization and does not involve psychotic features. While a person in a hypomanic state may feel highly productive, the lack of severe consequences distinguishes it from the full manic state.
What Happens Between Episodes
Between the mood extremes, many individuals with bipolar disorder experience a period of relative mood stability known as euthymia. Euthymia is defined as a calm mental state where the person is neither manic nor depressed, allowing them to function closer to their baseline self.
However, the experience of euthymia is not always one of perfect normalcy, as some individuals experience residual symptoms that fall below the threshold for a full episode. Studies suggest that a significant number of individuals may not fully regain their premorbid level of occupational and social functioning even during these stable periods. Subsyndromal depressive or cognitive symptoms may persist, affecting overall quality of life and long-term recovery.