Bipolar Disorder

Bipolar Disorder is a disorder that involves switching between periods of both depression and mania.  It is called Bi-polar as people experience both poles: 'highs' and 'lows'.  For this reason, in the past it has been called manic-depression.  It is generally agreed that there are two different types of Bipolar depression: Bipolar I and Bipolar II.

Bipolar I Disorder

People with Bipolar I Disorder have periods where they meet the classification for major depression, then eventually their mood alters and they begin to experience the extreme opposite - increased energy and feelings of well-being.

The major depression phase of Bipolar I can consist of the following:

• Loss of interest and enjoyment 
• Reduced energy 
• Fatigue 
• Lethargy 
• Apathy 
• Depressed mood 
• Lowered concentration and attention 
• Reduced self-esteem and self-confidence 
• Guilt 
• Unworthiness 
• Become pessimistic 
• Diminished sleep and appetite   
• Ideas or acts of self-harm or suicide

The Manic phase of Bipolar disorder consists of quite opposing symptoms:

• A distinct increase in energy and activity 
• Impaired judgement
• Lack of insight
• Distractability
• Hostile behaviour
• Disjointed thinking
• Feelings of well-being 
• Physical efficiency 
• Mental efficiency

While a person experiencing mania may appear more sociable and talkative, they may feel like they are losing control with all these extreme feelings.  With Bipolar I, the person may also experience paranoia and hallucinations which modify their perceptions of the world around them.

Bipolar II disorder

A person with Bipolar II disorder will experience both ups and downs such as those with Bipolar I, and feels the same sense of depression.  However, the important difference between Bipolar I and II is that the person experiences hypomania, not mania. 

Hypomanic symptoms include:

• Becoming more sociable 
• Feeling the constant need to talk 
• Being overfriendly 
• Experiencing a decrease in the amount of sleep needed

A person with Bipolar II Disorder will not have hallucinations or paranoid ideas.  The manic feelings are less extreme in this type of Bipolar Disorder, however the impact on the person can be similar.  The depression phase of both conditions is what causes the most impairment to life.  This phase lasts longer than the manic or hypomanic phases, and is considered to be the most distressing feature of Bipolar Disorder.  Cyclothymia is a related condition, however Bipolar disorders can improve within a number of years, while Cyclothymia is a chronic condition that can last for a longer time.  The Bipolar II symptoms do not necessarily lead to a disruption in social or occupational environments, however they have the potential to negatively impact the life of those affected.

References:

National Institute of Health (USA);

Manic-Depressive Illness
Fredreick K. Goodwin and Kay Redfield Jamison 
1990

Bipolar depression: Phenomenological overview and clinical characteristics
Bipolar Disorders, 6, 530-539
Philip Mitchell and Gin Malhi
2004

The epidemiology of bipolar disorder: Sociodemographic, disability and service utilization data from the Australian national study of low prevalence (psychotic) disorders
Bipolar Disorders, 7, 326-337
Vera Morgan, Philip Mitchell & Assen Jablensky
2005

Australian and New Zealand clinical practice guidelines for the treatment of bipolar disorder
Australian and New Zealand Journal of Psychiatry, 38, 280-305
RANZCP
2004