Understanding Bipolar Disorder - Symptoms

What Are the Symptoms?

The primary symptoms of bipolar disorder are dramatic and unpredictable mood swings. The illness has two (BI) strongly contrasting phases (polar).

1) bipolar mania or hypo-mania

• euphoria or irritability
• excessive talk; racing thoughts
• inflated self-esteem
• unusual energy; less need for sleep
• impulsiveness, a reckless pursuit of gratification (shopping sprees, impetuous travel, more and sometimes promiscuous sex, high-risk business investments, fast driving)

2) bipolar depression/major depression

• depressed mood and low self-esteem
• low energy levels and apathy
• sadness, loneliness, helplessness, guilt
• slow speech, fatigue, and poor coordination
• insomnia or oversleeping
• suicidal thoughts and feelings
• poor concentration
• lack of interest or pleasure in usual activities

Call Your Doctor if:

• You notice some of these symptoms in a family member. Note: Persons with bipolar disorder often deny anything is wrong, especially in the manic phase. If you are worried about a family member or close friend, a doctor can offer advice on how to handle the situation.
• You notice some of these symptoms in yourself.

Clinical experience suggests that mania may be more devastating to the family in a very short time; excessive spending can pile up huge debts, reckless driving and/or substance abuse can create legal problems, and  impulsive hypersexuality/extra-marital affairs may break down a marriage or relationship. The earliest signs of emerging mania can be progressive loss of sleep and extra energy. It can be a matter of hours in which such cases become manic psychosis. Very early intervention in such cases can be rewarding and prevent a hospital admission.

Because of the stigma still attached to bipolar disorder (and to many other mental diseases), patients are frequently reluctant to acknowledge that anything is wrong, and doctors often fail to recognize the disorder. In addition, the symptoms may sometimes seem to be merely exaggerated versions of normal moods. In any event, research suggests that almost 75% of cases go untreated or are treated inappropriately.

The American Psychiatric Association has established a long list of specific criteria for recognizing the disorder. Evaluation involves investigating the patient's history and any family history of mood swings or suicide. Other disorders must be ruled out -- particularly such childhood problems as school phobia and attention deficit disorder; aging problems of dementia, schizophrenia, schizoaffective disorder, and other psychotic states induced solely by alcohol or drugs. Drug or alcohol abuse is common in persons with bipolar disorder and can mask the symptoms, thus complicating diagnosis and treatment. Recognizing and treating any drug abuse is a priority, since it is a strong predictor of suicide, especially in men.

Before treatment begins, the patient receives a careful physical exam, and blood and urine are tested to detect conditions that could put medical constraints on the choice of treatment. A thyroid analysis is particularly important both because hyperthyroidism can look like mania and because lithium -- the principal drug treatment for bipolar disorder -- is known to lower thyroid function and/or impair kidney function. During treatment, frequent blood tests are necessary to see that adequate drug levels have been reached and to detect adverse reactions at an early stage.