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  • Aug. 22, 2008

    Bipolar isn't simple; there can be many sets of symptoms

    By Gabrielle J. Melin, M.D.

73 comments posted

Bipolar affective disorder is a disorder of mood that involves a depressive phase and a nondepressed or manic phase.

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  • National Suicide Prevention Lifeline
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  • National Alliance on Mental Illness
    www.nami.org
    1-800-950-NAMI (6264)
Bipolar means literally two opposite poles, thus explaining the meaning of the word. It isn't quite that simple, though. People can experience the nondepressed or manic phase in more than one way. The mood during the manic phase can be euphoric or irritable or even a combination of the two. Furthermore, people can experience a "mixed episode" and can have both depressive and manic symptoms during the same episode of illness.

The specific set of symptoms is important as some medications, such as Lamictal, are better for a mixed bipolar episode. Medications used to treat bipolar (mood stabilizers) are different than medications used to treat depression.

The manic phase is characterized by elevated or irritable mood plus 3 to 4 of the following symptoms happening during the same time period (at least one week continuously):

  • Decreased need for sleep (feeling refreshed on little sleep)
  • Decreased appetite
  • Grandiosity (inflated sense of self worth)
  • Distractibility
  • Excessive involvement in pleasurable activities that have a high potential for painful consequences (buying sprees, sexual indiscretion, foolish business ventures)
  • Flight of ideas (talking and thinking that jumps from one topic to another-racing thoughts)
  • Increase in activities involving school, work or social life
  • Agitation

The person may also experience psychosis, which means being out of touch with reality. The manic phase is a change in previous life functioning that is not caused by drugs or alcohol. The manic phase alternates with a depressive phase.

The Mood Disorder Questionnaire (MDQ) is a self-screening tool that can be used in conjunction with a visit to a mental health provider. Mood swings alone do not mean you have bipolar.  Borderline personality symptoms can look like bipolar and other mental illness, too. Time and accurate information help to make the correct diagnosis and provide the best treatment.

73 comments posted

blog index
  • November 16, 2009 11:32 p.m.

    Please, please help. My sister is 51; she's always been an "A" type personality; go, go go; assertive, organized, punctual, "anal retentive". Now, she's pale, disinterested, and literally, not making sense. Her "dream" house and move to another state are not what she thought it'd be. She can't put a sentence together, exhibits paranoid like behavior, is pale, disinterested, and not the person we know. Her husband says it's all menpause. Too many friends are asking what's wrong with her to be just menopause. Most recently, she told someone she "forgot" to go to the bathroom and didn't make it in time, literally. What do we do? We've asked if she's on medication and the respone is "No" or "I don't know". My other sister and I really, really want her to go to the doctor. Maybe it's a tumor, who knows, but her husband is brushing it all off. Too many people think it's more; most recently, a cousin told us that it seems she's on the verge of a nervous breakdown. Someone who confronted her recently got cut off from her for bringing up her behavior, so I hesitate to confront her. I just want her better. If anyone can help, please, please give me some advice. Thank you, so much. j7dYf7

    - Jessica

  • November 16, 2009 9:03 p.m.

    i was diagnosed with bi-polar disorder and panic attacks 20 yrs. ago, and it seems the older i get the worse my depression is, i have symptons of SAD all year long, i lose weight in the summer and eat like a pig in the winter, my doctor sometimes raises my dosage of PROZAC, it seems to help, sometimes i cry for no reason at all, or everything is overwhelming for me, but i know it"s just my bi-polar working on me so i handle it the best i can,

    - karen

  • November 16, 2009 11:45 a.m.

    Sorry to take up more time but Quantum, if you still come to this website, you don't have a clue of what you are talking about. If you could walk one day in our or our loved one's shoes, you might know something about this. I have met many Quantums and I stay away from them because this could happen to anyone. I would trade this disease and the feelings and all the meds to you if I could. It sounds like you need some help. I pray for anyone that has this disease na their loved ones that go through all of this. I will also pray for you too Quantum.

    - Sheryl

  • November 16, 2009 11:10 a.m.

    This is really the first time that I have read all of the comments. I am 50 years old and was diagnosed with bi-polar when I was 40. I had always had a stable job, took care of my son and tried to be a good wife. First, when you get this disease after you have pretty much been a responsible adult all your life, no one seems to believe you. In the last five years my husband of 21 years divorced me even though he went to counseling with me and read all of this information about this disease, he still did no t have a clue. I got my disability in 2007 but it is very difficult to live on the amounts that we get and all of the prescriptions we have to have. I had to come to this conclusion in life. You have to think of yourself first. It sounds selfish and probably cannot be done for people with small children or stressful jobs. Please don't give up! If you feel like you are not on the right meds, tell your doctor. I am lucky in the aspect that I was able to get help. Believe in yourself. I have had to learn the trigger points myself. The way it has been for me is that someone will tell you that they understand and they will let you know if you can't realize you are talking to much, spending too much or just whatever. My experience is by the time someone says something they are mad and criticizing makes you feel like your not worth anything. You are though. I have apologized to so many people about thing that really were not my fault. We are the ones that battle this! God Bless

    - Sheryl

  • November 13, 2009 4:40 a.m.

    Hi, I have bp 1 mdd,ptsd i take 1200 mg seroquel i am 42 was diagnosed at 19 did not seek treament till i was 39 I only have extreme ups and downs never in the middle i cant' relax ever .and i think i am getting td or i have rls or both i was a mechanic for 16 years when i strated my meds i could not do anything i was so confused and like disarranged still to this day all that seroquel is slowly killin me ...... I have been married and divorced it lasted 7 years now i am in a relationship for 10 years now and i can't believe she is still here ....after all my highs and lows ...

    - Dan

  • November 11, 2009 11:28 a.m.

    I was wondering About Bipolar 2 Can any one give me info on it ...what are the symptoms ?? Most appreciate it God bless you all suffering with mental Illness no matter what you feel there is always HOPE ..Dont give up<< Thankful

    - Marie

  • November 4, 2009 10:03 p.m.

    i was told i was bipolar at the age of 56, i am on alot of meds, i can go from a few yrs an then it hits me bad, i just iolate myself an want to sleep, it is a trebible sickness, no one know how you live in hell with it, an donnt want to understand it, i am a christian, an pray alot, but i have a horrible life right now, i am really down, so all who belive in prayer pray for me an i will be praying for you God Bless

    - lois

  • October 5, 2009 12:08 a.m.

    Has anyone tried or heard of the treatment Transcranial Magnetic Stimulation (TMS)? Its currently being used in Canada to treat Bipolar, in addition to depression and other illnesses. It was recently approved by the FDA in 2008, but is not usually covered by insurance yet. It would be a great alternative to those who couldn't physically tolerate the medication for bipolar well or have had little success with it. New alternative avenues of therapy are necessary, especially when there is a dwindling number of psychiatrists (and good ones) in the US.

    - Nicole

  • August 28, 2009 6:55 a.m.

    Here's a message of hope. I am 54 and was only diagnosed 6 years ago. The last episode was so bad I decided I would do everything I could to avoid putting myself and my family through that again. I am managing my life by living responsibly - eating well, no alcohol, sleeping enough, avoiding stressful situations (and that involves getting real and cutting out certain people and even changing my job). I also started meditating and exercising. I treat myself well. As a result I take only a low dose of lamictal. I have been stable for six years - with normal highs and lows. I do sometimes feel a bit down, but more often I am creative and happy. It doesn't just happen though - you help it to happen.

    - Angela

  • August 26, 2009 4:06 a.m.

    dear desperate in topeka, please get a second opinion!... i think you need to get a new psychiatrist... the 1st one helped you and the meds worked... but the second one did not help, and in fact, made your symptoms much worse with the meds he prescribed... all psychiatrists are not equally competent... please seek a second opinion!

    - jeno

  • August 4, 2009 10:37 a.m.

    i am 59, diagnosed with rapid cycling bipolar at 42. it's been hell. my latest big ride was i bought a new chrysler 300. i don't even like those cars. i put my down payment with all my savings. i don't have a dime now.the dealer said he was bi-polar, a lie i'm sure. no help from him. i do not see how i can possible make the payments and if i let the car go there goes my $7000.00 dollars..pray for me...this weekend i went to the beach a girl friend went with me one the d--- crysler. i drank quite a bit, no got drunk meds and alchol do not mix. i drove the 1 mile and blacked out. i called 911 for help they came and took me to jail. the worst experience i ever had. pulled my license and have no idea what the fine is. alot in florida since i'm from alabama. IN SHORT A CAR I HAVE NO IDEA ABOUT, CANNOT PAY FOR, A DUI I HAVE NOT A DIME TO PAY THE FINE, IMY DISABILITY CHECK IS 693 a MONTH. MY FAMILY HAS NEVER OR WILL NEVER HELP.i've been faithfully under a psycholist care. i feel better just making this comment.GOD BLESS ALL OF YOU WITH THIS AWFUL DISEASE ITS FOR LIFE IS WHAT'S SO BAD...SINCERLY PAT

    - pat

  • July 31, 2009 10:49 p.m.

    I have had a relationship with someone and saw signs of paranoid personality or other mood disorder. He had bizzar ways. He would tell me to listen to certain songs that reflected the way he felt. He would always say he wanted to push society out of his way and that he did not want to cope. He also would go from job to job because of fights with boss. He also was manic and would be high and then crash and feel very low. what do you think help me.

    - dana

  • July 11, 2009 3:45 p.m.

    I have been researching bipolar because I feel that my boyfriend may have it. We lived together for over a year. Had a wonderful and healthy relationship. A month ago he decided to move out with the only explanation being that he felt miserable with himself and that he needed to figure out what was going on in his head & that when he felt this way he had to get away. He moved everything out quickly. He told me that he had felt this way before & that it was about 3 or 4 yrs ago the last time. He was in a similar situation, living with an ex and quickly moved out. They ended up getting back together but the relationship ended for other reasons. His family also told me that this has happened repeatedly since he was in college. A couple weeks before his depression set in he was spending a lot of money. He spent $200 on me one day. Then a few days later we went to a casino and he ended up taking out $800 on his credit and debit cards. He said it was because he wanted me to have a good time since it was my first time there. When I told him that was way too much he commented a few times that "it's just money, I'll make more." The research I've done tells me that he may have Bipolar 2. The times that we have spoken since he left he has sounded extremely depressed with almost a strange voice or slurred-like speech. I have a friend whose husband is bipolar and this same scenerio has gone on in her relationship with him a few times. Can anyone give me any advice?

    - JR

  • June 22, 2009 2:29 p.m.

    I don't have a comment but a question. My sister is married to a man who was diagnosed bypolar at age 17. He goes from one stage to the next in a heartbeat. He is now not sleeping but a few hours at a time and does not remember any of his really agressive behaviors, some physical. Does sleep deprivation increase all of the highs and lows of someone who is bypolar? HELP IS NEEDED. Thank you

    - Tina

  • June 14, 2009 3:17 a.m.

    I became so agitated that I did not sleep much and I began running into difficulties at work. My psychiatrist told me that it was clear that I had bipolar disorder and said that the Zoloft had been making it worse. He switched me to Lithium and Lamictal along with the Seroquel. After that, all I could do was either sit and stare or cry. I was placed on disability by my employer (I had been managing over 75 employees), as I could not think or make decisions. My psychiatrist has now added Geodon to my mix of medications but my bipolar disorder has become even worse. I never even interact with my husband or sons now. When I try to lie in bed at night I feel like I am vibrating on the inside. My ears are always ringing now. My psychiatrist says this is common with bipolar disorder. Will my disease ever get better or will I feel worse and worse? Am I disabled by bipolar disease?

    - desperate in Topeka, post #2

  • June 14, 2009 3:04 a.m.

    I am a 41 year old woman with two sons and a wonderful husband. For 17 years I worked as an executive in the corporate world, where my life was often frenetic but always worthwhile. Nearly eight years ago I was raped. I thought I was doing well after the rape, but as time went on I began having nightmares and bad sleep. Eventually, I became listless and irritable throughout the day and began to feel as if I was loosing my "life." I began to feel anxious when I walked down a city street or sat with my back facing a restaurant door. I became very tense when leaving the safety of my home or office. I went to see a psychiatrist in the city where we formerly lived. He placed me on 50mg of Zoloft and 5mg of Valium per day. He told me I could break the Valium into four pieces and just take 1.25mg when I felt frightened. I rarely ever needed more then 2.5mg per day. Within one month I felt like "myself" again and resumed my normal life. This worked well for about six and one-half years. We moved to Topeka where I found a new psychiatrist who told me that taking Valium was very dangerous and that I was at risk of becoming a drug addict. He switched the Valium to Seroquel because it was non-addictive and because he said it would work better than Valium. It was after this change that I became nervous and tearful much of the time. I was afraid to leave our home and I fely like there was a motor running in my mind that I could not turn off. I became so agitated that I

    - desperate in topeka

  • May 30, 2009 1:44 p.m.

    I need more info about the manic stage of bipolor. My 73 yer old father was diagnosed last year after he had a manic episode and then the depression. He was hospitalized for 12 days and released with meds etc. It lasted about 2 weeks and then he began not to take his meds regularly. He is manic about 80% of the time. He has no concept of date or time and he has complusive behaviors,mostly concerning money, He buys cheap items and then swears they are worth millions etc.. He suffers from impluse control and the worst part is he is very violent. He was a great business man at one time and now he is delusional and truthfully an "evil" energizer bunny. He never stops and continuially threatens my mom and us. We have spoken to his docs but here in LV it is a joke. Noone will help. Does anyone have any ideas? We are scared of him and he feels power from that. We need help. Thanks ,Diana

    - Diana

  • May 14, 2009 10:02 a.m.

    I think I need help. I've never seen a doctor about the problems I'm having. I'm not sure what my first move should be. I moved to another state about five years ago thinking that would hep me, but it hasnt. I thought if I changed my scenery, it would help me kick the state I'm in. It's gotten worse. I'm still not sleeping, I still think I'm not good enough, I sleep around sometimes to feel "something", I still hurt myself at times, sometimes I take a fork and press it so hard into my thighs, I draw blood, and I still think my family would be better off without me. Truth is, I'm tired. I'm tired of feeling like this. So today I wanted to reach out. Call it my first step. Well, not really. I've tried praying to "make me right" but I end up with the same effed up feeling everyday. I can't take it anymore. I don't want to be labeled crazy but I seriously think I am. Somethings wrong....HELP ME!!!!

    - BrokenandDamaged

  • May 13, 2009 9:16 a.m.

    Hi, I'm bipolar and having a good day today insofar as it's not as bad as yesterday. I try to manage my bipolar disorder without medication but in consultation with and under the monitoring/supervision of my General Practitioner, psychiatrist, and psychiatric nurse. It isn't an easy thing to do, and it's inevitable that there come times when I need to medicate but bipolar disorder and medication throw up identity issues which I find difficult to cope with when medicating for an episode. When I've been down, it's been a time to avoid going near the sea or high places where I can jump from. I tried to kill myself three times. Twice jumping from the passenger seat of a car, once when my wife was using the fact that she was driving to ensure I listened to her "common sense" lecture, which was really badly-timed and seemed like a cheap shot aimed at hurting me. When you're down, you're not "depressed about" anything; you're just depressed and you try to rationalise what you are feeling down about, fixing on all sorts of bad things like "pegs" to hang your depression on. You can always find bad things to "fix" on, bereavements, lost love, lost home, lost careers, all sorts of opportunities. I'm not afraid of dying but the reality is that to suicide isn't an answer or a solution to any problems, it just hands problems on to the people you love who love you. I think the same is true about abusing drugs and alcohol to

    - Kenni

  • May 9, 2009 12:13 p.m.

    Has anyone experience of medication that controls bipolar and doesn't counteract epilepsy medication? Many of the more recent meds cause day time seizures and I have been restricted in what controls my depression

    - WornoutnotinSeattle

  • April 28, 2009 7:20 a.m.

    I don't see any easy way to diagnose a BP besides thorough anamnesis or multiple consultations. Alcohol, sometimes drugs comes into play, inappropriate medications can switch symptoms from dysthymia to cyclothymia. And even, some deep depressive episode could mislead the diagnostic too. My question is quite simple. How do you know you're not dealing with an army of BP patients when you can't possibly detect most of them ? I guess the screener form apply only if there's a suspicion for BP. Hence, how can we get real stats on this disorder ? Aren't we all a bit Cyclothymic ? Right on the edge of the BP rift...

    - Vinh

  • April 22, 2009 4:39 p.m.

    Not all people have the same side effects with medication-discuss side effects with your provider and ask about alternatives if the side effects are intolerable. Lithium is a tried and true medication that is very effective, but sometimes side effects occur.

    - MC.Com Staff

  • April 21, 2009 12:49 a.m.

    PSS: my boyfriend is now 43 yrs old. He also has mild panic attacks but again has never been treated for anxiety. Sorry for so many posts, just tired

    - ignite

  • April 21, 2009 12:33 a.m.

    I also need to add that my b oyfriend is very smart(Mensa smart) and weaned himself off of lithium approxiamately 6-7yrs ago and put himself on Prozac 20mg. He said that being on lithium he was in a fog all the time and could not even think straight

    - ignite

  • April 21, 2009 12:28 a.m.

    I have a long time boyfriend of 5 yrs, who was diagnosed with Bipolar Disorder when he turned 18. He ended up in a behavorial hospital, because he believed he was God. He tells me that this happened when he was told by his parents that he could not go away or college, that he had to stay @ home. He then had another episode when he was 21 and again was in the hospital. He was on lithium for several yrs, saw a pysch doctor at MHMR for a short time so he could get his lithium, but stopped going because he says he was "never told what to do". In the 5 yrs that I have been dating him, I have never observed any signs or symptoms of Bipolar except depressive symptoms such as, sleeping for long periods of time, an extremely messy room/house, and inability to make quick decisions about basic things, but can always make the decision to eat, but does not eat uncontrollably. He tends to be more depressed with the onset of fall/winter or if cold fronts blow in or the barometric pressure drops. I am a nurse, but do not work in the mental illness department. Is it possible to be Bipolar if you've only ever had 2 episodes of mania? Please respond to this comment, as his symptoms point more toward major depression instead of Bipolar Disorder.

    - ignite

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