People with bipolar disorder often switch from feeling overly happy and energetic (or irritable) to feeling very sad. Between these mood extremes, they may have normal moods. Because of the extreme highs and lows, this condition is sometimes called manic depression or bipolar depression.
There are many symptoms of mania and depression in bipolar disorder. Many of these could apply to anyone, depending on whether we're having an up or down day. However, with bipolar disorder more symptoms occur daily for weeks or months, even years. The shifts between depression and mania involve mood, energy, and the ability to function.
People with bipolar disorder often have cycles of elevated and depressed mood that fit the description of "manic depression." When a person's illness follows this classic pattern, diagnosing bipolar disorder is relatively easy.
But bipolar disorder can be sneaky. Symptoms can defy the expected manic-depressive sequence. Infrequent episodes of mild mania or hypomania can go undetected. Depression can overshadow other aspects of the illness. And substance abuse can cloud the picture.
"Bipolar disorder often gets confused with ADHD in children," says Michael Aronson, MD, a clinical psychiatrist and consultant for WebMD. "There are very similar symptoms, the distractibility, the periods of depression."
Childhood or adolescent bipolar disorder is often the most difficult diagnosis to make, Aronson tells WebMD. "It can be difficult to distinguish whether it's normal mood swings, bipolar disorder, or ADHD. Also, in adolescence, depression manifests itself differently than in adults. There's anger, irritability, rebellious behavior, drug use. Drug abuse is in the spectrum of symptoms of bipolar disorder." To better differentiate recurrent anger outbursts from bipolar disorder in children and adolescents, a new diagnostic category called Disruptive Mood Dysregulation Disorder (DMDD) has been created.
In adults, other problems often accompany bipolar disorder. Women with bipolar disorder are more prone to have four or more episodes in a one-year period -- called "rapid cycling." They're also more likely to have mania and depressive symptoms in the same episode -- called an episode with "mixed features." Also, up to about 60% of all people with bipolar disorder have drug or alcohol dependence, seasonal depression, or certain anxiety disorders, like posttraumatic stress disorder (PTSD). The effects of street drugs can sometimes cause depression or mimic the symptoms of mania, making diagnoses especially challenging in substance abusers and not always straightforward.
Signs of mania: increased activity; less need for sleep; overly euphoric mood; racing thoughts; forceful, rapid speech.
Signs of depression: sad or anxious mood; excessive feelings of guilt or worthlessness; loss of interest in pleasurable activities (like sex); difficulty concentrating.
WebMD Medical Reference: "Bipolar Disorder (Manic Depressive Disorder)."
WebMD Assess Plus: Bipolar Disorder Assessment. National Institute for Mental Health: "Step-BD Womens Studies."Massachusetts General Hospital Bipolar Clinic & Research Program.
MedicineNet.com: "Bipolar Disorder (Mania)."
WebMD Medical Reference: "Effects of Untreated Depression."
American Psychiatric Association: "Practice Guideline for the Treatment of Patients With Bipolar Disorder."