It can take most people 10 years to get an accurate diagnosis of Bipolar and therefore put the right treatment plan in place. Understanding the type of Bipolar you have is the first step.
There are several types of Bipolar disorder – the main ones being Bipolar 1 and Bipolar 21. Diagnosing Bipolar disorders is difficult, partly because the symptoms are experienced so differently – for instance ‘manic’ episodes can range from feeling hugely energised and motivated or feeling hugely irritable and angry. With depressive episodes, some people will find they need to sleep a great deal and others not at all. There is no one size fits all.
The defining feature of Bipolar disorders is the occurrence of severe mood swings — moving between episodes of feeling elated to feeling low in mood which may including clinical depression.
The essential feature of Bipolar I is that the person experiences a full manic episode, which is defined as:
a “distinct period of abnormally and persistently elevated, expansive, or irritable mood” associated with increased energy or activity and lasting at least one week.
Apart from the elated mood, the criteria of a manic episode includes experiencing at least three of the following symptoms:
In severe cases, manic episodes can be accompanied by psychotic symptoms e.g. delusions of grandeur, paranoid feelings and hearing things that aren’t there.
Besides manic conditions, people with Bipolar I could have major (i.e. severe) depressive episodes.
The DSM-5 outlines the following criteria to make a diagnosis of major depression. At least one of the symptoms should be either:
(1) depressed mood or
(2) loss of interest or pleasure.
In addition, the individual must be experiencing four or more symptoms from the list below during the same 2 week period:
Bipolar II can often be difficult to diagnose and can be confused with recurrent depression because the sufferer experiences major depressive episodes alternating with hypomania which is a milder form of mania.
Hypomanic episodes last on average 4 days, which is shorter than the manic periods with Bipolar 1. Hypomania symptoms are also not severe enough to cause serious impairment in functioning, and will not be accompanied by psychotic symptoms during this episode.
There are many similarities between Bipolar 1 and Bipolar 2; they both share episodes of ‘manic’ behaviour and episodes of depression.
The main difference between Bipolar I and Bipolar II is the experience of the manic period – in Bipolar I the mania is extreme and would be considered abnormal within the general population. In Bipolar II, the manic period is less severe and is known as hypomania – the symptoms might be highly unusual for the individual but might not be considered completely abnormal within the general population.
Dr Surguladze MR
Cyclothymia is a milder form of Bipolar. It is commonly misdiagnosed because the symptoms aren’t as extreme. The depressive periods may be seen as feeling lower in mood than normal – the ‘manic’ periods may be experienced as being more energised than normal.
To diagnose cyclothymia, the following symptoms have to have been experienced for at least 2 years which is another reason why the illness is often misdiagnosed – 2 years is a long time and not many people will be able to accurately recall their moods across this time.
Cyclothymia can often go undiagnosed because the symptoms are milder, but if undiagnosed there is an increased risk of developing full-blown Bipolar disorder at a later stage.
What are the signs (apart from mild fluctuations of mood) that should alert us of potential cyclothymia? We need to check out whether or not the symptoms disrupt everyday functioning, or cause problems with personal and work relationships. If this is the case – one would certainly need to see a psychiatrist.
Dr Surguladze MR
Recent evidence has shown that some people treated with antidepressants may develop manic or hypomanic states. These episodes emerge during antidepressant treatment, such as taking medication or electroconvulsive therapy, but persist beyond the physiological effect of the treatment.
Taking illicit drugs e.g. cocaine or amphetamines can also cause medication induced Bipolar disorder – signs this is occurring may include mood elevation that clearly outlasts the clearance of the provoking drug.
Substance and medication induced Bipolar disorder is complex and needs careful diagnosis by a Psychiatrist who is an expert in the field of Bipolar. If you are experiencing adverse reactions whilst taking medication it is important to seek help as early as possible.
I felt completely at ease with Dr Surguladze; his reassurances that my condition was treatable with the right medication were incredibly comforting. His treatment plan has been a huge success for me – I never dreamt it could make such an impact.
Rapid cycling Bipolar is where there are four or more episodes of mania, hypomania or depression within a twelve month period. Episodes or phases are separated either by switches to an opposite mood or by ‘remissions’ lasting 8 or more weeks.
Rapid cycling Bipolar affects a significant proportion of Bipolar patients and is more likely in those who:
The origins of rapid cycling remain unclear, although there is some discussion about the role of antidepressants usage, and hypothyroidism is also considered to be a risk to developing the illness.