The dramatic mood episodes of bipolar disorder do not follow a predictable pattern. Depression does not always follow mania. A person may experience the same mood state several times -- for weeks, months, even years at a time before experiencing a remission or change in mood state. Also, the severity of mood phases can differ from person to person.
The periods of depression can be equally intense. Sadness and anxiety affect every aspect of life -- thoughts, feelings, sleeping, eating, physical health, relationships, and ability to function at work. If depression is not treated, it often only grows worse until it may suddenly go away. However, there may seem to be no way out of this overwhelming mood.
These depressed feelings have been described this way:
Depression: I doubt completely my ability to do anything well. It seems as though my mind has slowed down and burned out to the point of being virtually useless... . [I am] haunt[ed] ... with the total, the desperate hopelessness of it all. Others say, "It's only temporary, it will pass, you will get over it," but, of course, they haven't any idea of how I feel, although they are certain they do. If I can't feel, move, think, or care, then what on earth is the point?
An episode of depression involves feeling sad or blue, or getting no pleasure from life, plus at least five or more of these additional symptoms most of the day -- nearly every day -- for two weeks or longer:
- Loss of energy
- Feelings of guilt, hopelessness, or worthlessness
- Loss of interest or enjoyment from things that were once pleasurable
- Difficulty concentrating
- Low energy
- Feeling physically or mentally sluggish or restless and agitated
- Increased need for sleep or inability to sleep (insomnia)
- Change in appetite causing weight loss or gain
- Thoughts of death or suicide or attempting suicide
In addition, people experiencing a major depressive episode may also feel anxious, irritable, and tearful or have trouble making everyday types of decisions.
When a person experiencing a depression has psychosis, there may be delusions of guilt or worthlessness -- perhaps there is an inaccurate belief of being ruined and penniless, or having committed a terrible crime or sin.
If untreated, episodes of depression can recur and may sometimes come closer together and may then be harder to treat. They may switch into mania. But treatment can help to prevent this from happening. With medication and therapy, it’s possible to live normally -- to have a happy, productive life.
Hypomania is a less-severe form of mania. Hypomania is a mood episode that many don't perceive as a problem. It actually may feel pretty good. You have a greater sense of well-being and productivity. However, for someone with bipolar I disorder, hypomania can evolve into mania -- or can switch into serious depression.
The experience of these manic stages has been described this way:
Hypomania: At first when I'm high, it's tremendous ... ideas are fast ... like shooting stars you follow until brighter ones appear... . All shyness disappears, the right words and gestures are suddenly there ... uninteresting people, things become intensely interesting. Sensuality is pervasive, the desire to seduce and be seduced is irresistible. Your marrow is infused with unbelievable feelings of ease, power, well-being, omnipotence, euphoria ... you can do anything ... but somewhere this changes.
Mania: The fast ideas start coming too fast and there are far too many ... overwhelming confusion replaces clarity ... you stop keeping up with it ... memory goes. Infectious humor ceases to amuse. Your friends become frightened ... everything is now against the grain ... you are irritable, angry, frightened, uncontrollable, and trapped.
If you feel unusually euphoric or irritable and over-energized, and have at least three of the mania symptoms noted below most of the day (four if your mood is only irritable) -- nearly every day -- for one week or longer, you may be having a manic episode of bipolar disorder:
- Increased activity (such as at work or school, or socially or sexually), with a tendency to become over-involved with many (often unrealistic) plans and activities
- Less need for sleep without feeling tired the next day
- Talking very fast and being hard to interrupt
- Racing thoughts
- Tendency to show poor or impulsive judgment (such as deciding to suddenly quit a job) or reckless behaviors (such as lavish spending sprees, impulsive sexual indiscretions, abuse of alcohol or drugs, or ill-advised business decisions)
- Inflated self-esteem or grandiosity -- unrealistic beliefs in one's ability, intelligence, and powers; may be delusional
Some people with bipolar 1 disorder become psychotic. For example, they may hear voices that aren't there. They may hold onto false beliefs, and cannot be swayed from them. In some instances, they see themselves as having superhuman skills and powers -- even consider themselves to be God-like.