Manic depression or bipolar depression is an oft-misunderstood and at times scary disorder. Unlike major depressive disorder and milder forms of depression, a bipolar disorder is characterized by regular mood cycles. Although not completely understood, something in the brain seems to make people who struggle with bipolar experience life through several different lenses.
Because it is not fully understood, there are a lot of misconceptions around manic depression, or bipolar disorder. First: they are both the same thing, but with a different name. Second: there are several different types of bipolar disorder, with varying degrees of intensity or severity, and different treatment approaches. Lastly: bipolar disorder is different from simply having severe mood swings. People with bipolar struggle with manic episodes as well as depressive episodes. These episodes can last days, weeks, or even months. On average, a person will go through 1-2 cycles per year. More rapid cycles, usually alongside milder symptoms, points towards cyclothymia – a milder form of depression, characterized by episodes of a consistent and irrationally low mood.
What is Mania?
The biggest challenge in recognizing a bipolar disorder isn’t in the depressive symptoms, but in the mania. To most people, mania is understood to be a form of exaggerated emotion. When people think mania, they think of an unhealthy obsession. For the most part, this is accurate – but to be more specific, mania is a state of mind characterized by hyperactivity. Everything is bigger, louder, and more urgent in a state of mania. Someone currently manic would:
- Not get much sleep.
- Engage in multiple activities at once (extreme multitasking).
- Talk loudly, incessantly, and excitedly.
- Struggle to stay focused.
- Risky behavior.
- Rapidly changing subjects and ideas.
- Potential irritability.
- Increased vigor and zeal, pompous personality changes.
Sure, everyone gets excited, some people simply have active and outgoing personalities, and some of these symptoms can be the result of a buttload of caffeine. But if a person consistently exhibits these symptoms alongside hyperactivity and a general change in behavior and personality, they may be going through a manic episode.
It’s important to understand that mania is not a good thing. It’s not a positive thing. Despite being on the opposing side of the mania-depression spectrum of bipolar disorders, it doesn’t represent happiness. Rather, it represents activity and excitability, mental arousal, and the consequences of feeling “in-flight”. Someone consciously going through a manic episode may feel constantly endangered, anxious, and generally in a precarious mental state of flux.
Another possible way in which mania can express itself in cases of bipolar disorder is through hypomania. Generally classified as a less severe form of mania with many of the same symptoms, hypomania and mania are differentiated purely based on subjectivity. A doctor or professional is going to make a diagnosis of manic symptoms or hypomanic symptoms off a patient’s self-reporting, and there are no definitive tests for figuring out which you’re experiencing. The main difference is that:
- Mania severely interferes with a person’s ability to function normally, impeding social contact.
- Hypomania may mildly interfere with a person’s day-to-day functions, but not enough to pose a debilitating threat.
Mania is treated with anti-manic medication, lithium, anti-seizure drugs if seizure is a concern. Yes, lithium is prescribed for bipolar disorder. Why it works is generally a mystery, but it may have something to do with helping the brain better regulate neurotransmitters.
A professional diagnosis of mania is much safer than a hunch off the internet, but if any of this sounds familiar, it’s not a bad idea to call a doctor or a therapist and get yourself checked out. There is much more to discuss about bipolar conditions outside of the peculiarity of mania. While many people with bipolar disorder struggle with the anxieties and irritability of going through a manic phase, the subsequent depressive phase isn’t easier to deal with, in most cases.
Mild to Major Depression
Just as hypomania and mania describe one side of the bipolar spectrum, mild to severe depressive symptoms dominate the other side. Depression is characterized by a consistently low mood, lack of euphoria or joy, frequent doubt and negative thinking, and potential self-harm. Other ways depression in a bipolar disorder manifests itself include:
- Having little energy.
- Irregular sleeping patterns.
- Irregular appetite.
- Struggling to get out of bed.
Mild and major depression are differentiated by risk of self-harm, as well as the severity of the negative thoughts. Someone with a mild depression might be making their way through life with a constant dark cloud hanging above their head, struggling to be happy or cheerful, and maintaining a low mood despite no apparent cause. Someone with a severe depression, on the other hand, would be having much darker thoughts of suicide, helplessness, and worthlessness.
Depressive symptoms in cases of manic depression or bipolar disorder are not different from depressive symptoms in MDD or other forms of depression. What sets bipolar apart is the change from depressed to manic, and manic to depressed.
Why Do Bipolar Disorders Occur?
Depression occurs most often in people who have a family history of depression and is triggered by some form of high-stress leading to the kind of thinking that quickly catapults a person into a downward spiral. We’re not 100% sure how or why this happens, and it’s one of the major shortcomings in our understanding of neurobiology and psychiatry – we can identify when a person’s behavior is so severely influenced by an abnormality that they’re struggling with a disorder, but the exact cause or mechanism of the disorder is poorly understood.
The same thing goes for bipolar disorders. Yes, doctors and therapists can diagnose someone with bipolar, and if they’re thorough enough, it will be an accurate diagnosis. It can take time and requires sifting through a lot of information to figure out where on the spectrum a person lands, but the important part is identifying whether an individual struggles with depression, or depression coupled with mania.
As for what causes this difference, it’s not currently known. Genetics still play the biggest part. If one parents has or had a diagnosis of bipolar disorder, then there is about a 1 in 10 to 1 in 6 chance that their child will struggle with the disorder as well. If both parents are bipolar, the chance jumps to about 1 in 3. But genetics aren’t the only reason. Even in genetically-identical twins, the risk of developing a bipolar disorder in twin B if twin A was diagnosed is between 40-70%. So, while genes play a role, the environment is important as well.
Consistently negative or severely traumatic childhood experiences are most likely to contribute to a mood disorder like depression or bipolar. Going through a particularly rough experience in high school or struggling with poverty throughout college can kickstart a bipolar disorder. It usually starts early on in life, and rarely begins after a person has moved on past their teens.
If you have bipolar, there’s no telling exactly why or how it started. The idea that depression is a matter of neurochemical imbalance is compelling but doesn’t have a lot of convincing evidence. Hormones play a big role, which is why physical causes for depression do exist – things like a benign brain tumor or hypothyroidism.
More troubling is the fact that, sometimes, antidepressants can trigger mania. This means if you’ve been struggling with depression but haven’t had a manic episode and have history of bipolar disorder, antidepressants might kick off your bipolar disorder. Stimulants are even more dangerous – drugs that excite the system and increase dopamine production and retention, like cocaine, ecstasy, and amphetamine. Usually, these medication-caused manic episodes end after quitting the drug/going off the medication. Anti-manic drugs do exist to help counteract the manic symptoms in cases where antidepressants induced the mania – but again, these are short-term solutions for a problem that’s best approached through therapy and alternative treatments.
Mania Without Depression
Whereas about 2.5% of adolescents have some form of bipolar, only 1.7% experience mania without depression. Mania with depression is associated with greater severity, greater disability, and impairment, as well as greater risk of comorbidity (which means having other mental health issues, such as disordered/stress eating or anxiety).
The thing about manic depression and bipolar disorder is that both are effectively a misnomer – while manic depression implies both mania and depression, and bipolar disorder implies both sides of the spectrum, the actual diagnosis for bipolar I just requires one verified episode of mania (bipolar II requires mania *and* a major depressive episode). Meaning, if someone experiences mania without the subsequent low mood or depression, they’re still technically dealing with a bipolar disorder.
The treatment for severe mania largely involves medication (antipsychotics), but hypomania or manageable forms of mania can be treated with therapy and calming exercises, meditation, breathing, regular exercise, and a supportive home environment.
Bipolar disease comes and goes, either in the form of mania, or mania and depression. While it cannot be cured in the sense that the symptoms stop occurring, it can be managed, and effectively curbed. You can stop a bipolar disease from taking over your life – but the first step is to seek out help, from friends, family, and professionals.