Recognition of various mood states is essential so that the person who has manic-depressive illness can obtain effective treatment and avoid the harmful consequences of the disease (such as destruction of personal relationships, loss of employment and suicide). An extremely effective means of recognising these mood states is by tracking them. By consciously writing down feelings and changes many people with this illness have had great success in coping with thier illness. Print out our mood tracking sheet here.
Bipolar disorder involves cycles of mania and depression. These two mood states can be thought of as opposite ends of a range. At one end is severe depression; then moderate depression; mild and brief mood disturbances (that many people call 'the blues'); normal mood; hypomania (a mild form of mania); and at the other extreme is mania.
Some people with untreated bipolar disorder have repeated depressive episodes and only an occasional episode of hypomania (bipolar II). In the other extreme, mania may be the main problem and depression may occur only infrequently.
Signs and symptoms of mania include periods of:
- Excessively 'high' or euphoric feelings
- Increased energy, activity, restlessness, racing thoughts, and increased talkativeness
- Overly-inflated self-esteem
- Extreme irritability and distractibility
- Reduced need for sleep
- Unrealistic beliefs in one's abilities and powers
- Uncharacteristically poor judgement
- A sustained period of behaviour that is different from usual
- Increased sexual drive
- Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
- Provocative, intrusive, or aggressive behaviour
- Denial that anything is wrong
Signs and symptoms of depression include periods of:
- Persistent sad, anxious, or empty mood
- Feelings of hopelessness or pessimism
- Feelings of inappropriate guilt, worthlessness, or helplessness
- Loss of interest or pleasure in ordinary activities, including sex
- Loss of energy, a feeling of fatigue or of being 'slowed down'
- Difficulty thinking or concentrating, remembering, making decisions
- Restlessness or irritability
- Difficulties sleeping, or oversleeping
- Loss of appetite and weight, or weight gain
- Repeated thoughts of death or suicide; suicide attempts
An early sign of manic-depressive illness may be hypomania, in which the person shows a high level of energy, excessive moodiness or irritability, and impulsive or reckless behaviour. Hypomania may feel good to the person who experiences it, so even when family and friends learn to recognise the mood swings, the individual often will deny that anything is wrong. In its early stages, bipolar disorder may appear to be a problem other than mental illness. For example, it may first appear as alcohol or drug abuse, or poor school or work performance. If left untreated, bipolar disorder tends to worsen, and the person experiences episodes of full-fledged mania and clinical depression.
Severe depression or mania may be accompanied by periods of psychosis. Psychotic symptoms include: hallucinations (hearing, seeing, or otherwise sensing things which do not exist) and delusions (false beliefs that illogical, held despite evidence to the contrary).
Symptoms of mania and depression may be present at the same time ( mixed state). The symptoms often include agitation, trouble sleeping, a significant change in appetite, psychosis, and suicidal thinking. Depressed mood accompanies manic activation.
Symptoms (mania, depression, or mixed state) are usually limited to distinct episodes of illness. These episodes are separated by periods during which the person suffers few to no symptoms. Some episodes can be as long as 1 year whereas others may be as short as several hours, depending on the patient. With time, episodes become more frequent. When four or more episodes of illness occur within a 12-month period, the person is said to have manic-depressive illness with rapid cycling. In most patients, the number of episodes experienced in a lifetime is approximately 8-10, but many patients experience more. In rapid-cycling bipolar disorder, 4 or more episodes can occur in each year-long period.