Bipolar Disorder

Bipolar disorder may be diagnosed when someone experiences dramatic shifts in mood, energy level, thought process, and activity level. Individuals will experience periods of "mania" or "hypomania" with extreme elevations of mood and energy levels. Mania may cause irritability or agitation, but often enhances mood and can even feel good in the moment. Unfortunately, the poor decision making that typically accompanies manic episodes can have serious long-term consequences. Nearly all individuals with bipolar disorder also experience "depressive episodes" with an extreme drop in mood and energy level, although depression is not always required for a diagnosis. Mixed episodes where one experiences symptoms of mania and depression at the same time are also possible.

There are three primary types of bipolar disorder: Bipolar 1, bipolar 2, and cyclothymic disorder.

Bipolar 1 disorder is diagnosed when there are severe manic episodes. Manic episodes in Bipolar 1 disorder must last at least 7 consecutive days. Bipolar I manic episodes cause an extreme impairment in functioning, require hospitalization, and/or include psychotic symptoms. Depressive episodes are also common though not required for a bipolar 1 diagnosis.

Bipolar 2 disorder is diagnosed when there are less severe manic episodes referred to as "hypomanic" episodes. These hypomanic episodes must last at least 4 consecutive days. Bipolar 2 disorder also requires that an individual experiences depressive episodes.

Cyclothymic disorder is diagnosed when someone experiences depression and hypomania symptoms to a degree that does not fully meet the criteria for bipolar 2 disorder. For adults they must experience these shifts for at least a 2 year period of time. Cyclothymic disorder will eventually progress to bipolar disorder in 1/3 of cases (as a very rough approximation). 

Symptoms of mania/hypomania are:

  1. Inflated self-esteem or feelings of superiority or invincibility.
  2. Engagement in risky or dangerous behavior. This may be sexual promiscuity, illicit drug use, shopping sprees, gambling, investing in sudden unplanned business ventures, and so on.
  3. Able to maintain energy at or above baseline level with around 3 hours of sleep or less per night.
  4. More talkative than usual. May be speaking at a more rapid pace than usual.
  5. Easily distracted.
  6. Increase in goal-related activity or increased purposeless movement.
  7. Racing thoughts or flight of ideas (jumping to different unrelated topics).

An individual must have a certain number of these symptoms and the symptoms must be a clear change from their baseline behavior. Symptoms of mania and hypomania are the same, but hypomanic symptoms are less severe, may not last as long, and do not significantly impair ones ability to function at work or school.

Symptoms of depression:

Depressive episode symptoms can be found on our depression page (clicking this link will open the page in a secondary browser tab). While depression symptoms are the exact same in bipolar disorder and major depressive disorder, treatment is radically different. Treatments for major depressive disorder can make bipolar disorder worse and therefore appropriate diagnosis is extremely important.

Mixed Episodes:

When an individual experiences manic and depressive symptoms together at the same time.

Treatment We Provide

We can diagnose and treat most cases of Bipolar II disorder and cyclothymia. Due to the limitations of this outpatient telehealth practice we do not treat Bipolar I disorder or any case with a history of psychotic symptoms.

Please see our services & pricing page for more information on our evaluation.

References: U.S. Department of Health and Human Services. (n.d.). Bipolar disorder. National Institute of Mental Health. Retrieved from