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  • Aug. 22, 2008

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

    By David Mrazek, M.D.

124 comments posted

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

Need more help?
  • National Suicide Prevention Lifeline
    1-800-273-TALK (8255)
  • Go to the nearest hospital or emergency room
  • Call your physician, health provider or clergy
  • 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.

124 comments posted

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  • January 2, 2012 12:15 p.m.

    My son has many mood swings, has been in the hospital for suicidal ideations, failure to thrive. His only diagnosis is Depression and Anxiety. Really. Please help, he is falling through the cracks with the mental health system, he has been told to deal with it. He is unable to work or go out of the house for that matter. He has no money left from his savings after paying his hospital bills. Who can he turn to for help. He has applied for disability and denied, with a doctor telling him to deal with it, an appeal does not look successful. I am really at a loss and very disappointed with the mental health system, I feel that most patients are put into one category, regardless if they had a successful career or have been on medicaid or drugs or a college student. HELP

    - Don

  • December 5, 2011 9:05 p.m.

    My wife has always had mood swings and been very detached from me and the kids. We have been married 23 years but currently live in separate bedrooms. She states she feels we are separated and has begun an affair with a 22 year old young man she works with.He has a drug and alcohol problem and recently left his pregnant wife and 15 month old daughter. She has started counseling but does not agree with the Bi-polar diagnosis and states she may stop counseling. She wants control of paying bills but then doesn't, she will "rage" at other drivers and has even gotten out of the van to talk to them. Kids say they cannot talk to her because she is always angry. What can I do to support her and still be there for the kids? Leaving home and them is not an option for me. I still believe with counseling and medications this marriage and family can be saved. Open to any suggestions, professional and family members.

    - Gil

  • November 27, 2011 10:10 p.m.

    I thought for a long time that my daughter was just spoiled, and just threw fits... Over the years it became harder for me to tolerate her outbursts.She is now 18 years old. I see it daily now that something just is not right with her. We can talk, we don't get along, and she's very negitive. And honestly it seems she's angry at the world for no reason! I'm now at the point I just push her away... I don't like being around her. She's very hurtful to me and family members. She has a great boyfriend that tolerates her attacking him! I feel for him, and it's so painful for me, that her behavior is out of control. It's as if she can not feel the pain she causes everyone around her. I don't know how to help her!!! But... I just can't take it anymore... I really do feel for her, but she makes all around her...dislike her. What can I do when I know she's bi polar? Help... a mother that just can't, how to help her. It saddens me every hour of the day!!! wHAT DO i DO TO SAVE HER?

    - Tresa

  • October 6, 2011 1:25 p.m.

    Hi Everyone, a work colleague "kicked off " at me a few weeks ago, we had raised voices ,accusations... (shes 28 I'm 50, her Mother is our boss and I'm Supervisor)she says she I'm nasty with everyone, (I can be abrupt sometimes) that I make her physically sick, an don that particular day she felt like cutting her wrists rather than come to work with me! she had previously changed shifts to avoid me, anyway she said she had a Dr app. next day a showed me a sheet of paper with a list of things that she said was wrong with her. Her Mother knows nothing of this episode, she says she cant talk to her Mother, says she doesnt notice shes there. Normally she would'nt have shown me this paper, so I feel she neede someone to talk to or help her. The out come was the Dr said nothing was wrong, but I've thought of nothing else, it really did upset me, but I really would like to help her,and think a lot of her symptoms are similar to Bipolar/Cyclothymia, I been thinking about a lot of things that have happened over the last 9/10 years, and realise she was ill (?) then. I feel an episode coming on theres tension... Can some one please try and advice me the best way to help,( I'm good friends with her Mother, but dont feel I should tell her her daughters not well or that she talks to me like s... Thanks for listening.

    - MARGARET

  • June 14, 2011 12:18 a.m.

    dear jenny: i'm glad u wrote in, sorry i didn't answer sooner, was on vaca. w. the grandkids, i'm not a professional, i just suffer from depression like your brother, try to get some pamphlets from his drs. office-they have material to help families understand the illness & ways that you can help, u may want to ask your brother if u can go with him to his dr. appt.? he may welcome this, as a way of showing care & concern, as i'm sure u have, if u can't get any written material, go on-line under any depression web-sites & you'll find lots of info., ur NOT wrong 4 feeling that u can't take him in, u have your family to think about 1st, DON'T feel guilty!! he has to want to change & accept more help (i.e. drug re-hab, finding a job, etc.), he can only do these things 4 himself, he has to want to change, how much help do u have as far as a support system (family members or close friends)?? they're very important!! hang in there, try not 2 worry bout him (i know it's hard), but he has to help himself 1st before you can try & support him (in his choices only), not in an enabling way, good luck, write back so i know how you're doing if you want to, hope this helped somewhat, you'll be in my prayers, there's a show on tv called "intervention", if it's in your area it may help you alot (it's on the A&E channel here in michigan) keep in touch

    - denise

  • June 3, 2011 4:54 p.m.

    I don't quite understand this bipolar disorder but my brother is diagnosed with this. He is in his early 40's. He takes med's and has also had a past of using drugs. Right now he is homeless, was sent to a rehab in LA for dual diagnosis. Left the program, made some bad decisions. I can't keep him here with me, I have teenage daughters, single mom. He hasn't gone to any group therapy. Am I wrong to feel this way. He does recieve SSI benefits, has some college education, and always ends up with no friends. Makes stupid financial choices. Can someone please help me understand....

    - jenny

  • May 14, 2011 12:24 a.m.

    dear lyda: if your friend has bi-polar disorder she needs to b on medication, the illness can not b cured, but can b managed with meds. & other therapy, if needed, i am not a professional, but in my opinion she doesn't sound like she is someone that should be in your life, some people r "toxic" 4 some other people, i feel this is the case (just my opinion), with u having panic attacks from being with her is not healthy 4 u @ all, u have to think of yourself right now, if she's on meds. or not taking them is a big issue, if ur bi-polar u have 2 be on meds. & don't let anyone tell u any different good luck 2 u keep writing if it helps u

    - denise

  • May 7, 2011 8:57 p.m.

    i am concerned about a relationship that I have been on and off with for a very long time,it seems to me that she goes along and suddenly she starts ranbling accuses me of not listen to what she is saying even though she has repeated herself several times in the same conversation,her favorite on a dailey basis is I don't understand I can't do it I am confused and with that I get angrymI am very low key and I do not know if I can continue being her partner the plan was She move to Florida and we could be together but now I am having huge second thoughts I do not want to break her heart but on the other hand being 2o years her senior I don't want to have a heart attack either and this morning I could hardly breath after dealing with her last nite I suffer from panic disorder but since I ran from our relationship one year ago I am feeling that and do not know if she will ever be on the right meds or meds at all.I really need some advise on if a person with bipolar ever gets better and stays better is there anyone out there that can give nme some sound advise.I really need to make a stand on if we are meant to be or not. Thank you

    - lyda

  • May 5, 2011 10:24 a.m.

    At 13, I had my first suicide attempt. At 14 I was placed in an institution. By 16 I was so wild no one could control me. I never could understand the mood swings i was having. The elated feelings I was having at one moment and then the severe depression that would follow it. Sometimes in the same day.Through years of criminal behavior and drug use, I realized that I was living in a nightmare and needed help.I am 38 years old now. I am sober, and live in my own apartment. I am independant and attend therapy regulary.I have tried every bi-Polar and Depression med there is. I found Lamictal, Trazadone, Cymbalta and Geodon have helped control my Manic- Depression. I am not drugged up because I choose to take low dosages.I have been diagnosed with Rapid- Cycling Bi-Polar, Depression, PTSD, and Borderline personality Disorder. Everyday is a struggle but I have learned how to control my anxiety as well as my actions. For those of you who have the symptoms but are not getting help, you can get off this Rollar Coaster of Hell.You have to want to get better.

    - Stephanie

  • April 21, 2011 9:25 p.m.

    to 'unknown'... Oh also, I meant to say Congratulations on your success with this frustrating disease. I'm so glad it's worked out well for you.

    - jill

  • April 21, 2011 9:21 p.m.

    hi 'unknown', I just wanted to mention that paxil is an anti-depressant only and if you have a bipolar component to your depression, you may want to look at taking a mood stabilizer like Lamictal or another drug. The Paxil may be doing the trick for right now, but you may not fare so well when you hit a swing. Just a thought.

    - jill

  • April 16, 2011 12:59 p.m.

    My brother suddenly started thinking his wife was being unfaithful to him. He thinks men are coming in their house and having sex with her, she is making her own porn videos, she has left and now he is having the same delusions and has hallucinations of people being in his home and being in his attic. He is obcessed with proving his wife is being unfaithful, he even had us look at porn on the net and thought the women in the videos were his wife. He went to rehab 3 months ago for a pain killer addiction ( prob self-medicating) He did well and stopped taking his suboxone after only 3 weeks. We don't know what to do or what's wrong with him, HELP! )

    - Marsha

  • April 2, 2011 1:08 p.m.

    Thinking back, now at 47, I realize that I was severely depressed by age 11, and by 13 was experiencing my first manic episodes.This started after we moved when I was 9 from R.I to ME., up til then life seemed pretty normal. Then dad bought into a logging businesss, ended up going bankrupt, cheating on my mom, oh yeah and mom was pregnant with #3 and also has mental health issues that have never been addressed, then he left us, our home was in foreclosure, it was winter, no "welfare" as we know it now,....Life got real tough ...for me thats when severe depression set in. Later on we moved to CT. inner city had to be tough take care of my family,because there was nobody else that was. Thats when anger came in, and is this not the opposite of depressed? So... this must be where I began riding the "Bipolar Rollercoaster", only I never knew what was wrong with me. Through the years things at times have been alot better, but throughout it always comes back to hitting bottom on one end or the other. I hope that by keeping myself informed and not letting Dr.s junk me out,or turn me into a zombie I may one day find the right med. that will change this "Rollercoaster" into something more like a ride around the park on "The Monorail"!!!! Most Docs seem to think slow and sleepy is the way to be. Well I dont see that as acctceptable.I've been in a very manic state for about 3 weeks now med adjustments no good new med next week hope it works!

    - mary

  • March 9, 2011 4:42 p.m.

    my son is twenty four years old has had many jobs he always thinks he doing good but he always ends up losing his job. he lives withmy husband and i very hard to live with doesnt get along withanyone. very irritable trys really hard just cant manage to lead a normal life!lots of other things to much to write he can be violent and seems to give up everytime he loses a job playys video games constantly i need help he wont go to the doctor i dont know what to do

    - vicki

  • February 3, 2011 10:19 p.m.

    Although I'm sure that I had bipolar disorder since my early teens, I was not diagnosed until I was 36. I stayed awake for 5 days straight without one minute of sleep.I was speaking a mile a minute, changing subjects repeatedly. I didn't know what bipolar disorder was. I thought I had a brain tumor or something. A neurologist sent me to a psychiatrist and after three visits she knew what my problem was. My mother probably had it. She committed suicide when I was 10. Two of my sisters are bipolar. Things got worse for me. I lived through sheer hell. I had horrible anxiety 24/7 for years. I suffered manic periods where I did things like walk in circles for hours because of the nervous energy. I did crazy things like buying a $40,000 horse that I could in no way afford. I went into deep depressions where I plotted my own death because I couldn't take the anguish of living. I was put on so many different meds, I can't remember them all. I went through a terrible divorce where I was throwing up daily because of my anxiety. I finally became so mentally ill that my doctor told me that I should not live by myself. Then finally after all of those years I began to level off. I take my medication religiously because I never want to go back to that hell of a life. I work full time now and live by myself. I still have some mood swings, but they are mild compared to what they were. I just want to encourage everyone to get help and don't stop taking your meds when you feel better. Take care

    - Terry

  • January 31, 2011 5:54 p.m.

    Iam tinking that i have bipolar desorder iam ok and allof a son i blow up i have depresion sents my Brother pess a wey and ma dad in 5 years 5 dets in th Fameli i have verry bad depresion and anczery i have bad mood same time i woant to did nating als

    - Natalija

  • January 22, 2011 1:12 a.m.

    hey mark where r u wanna know how u r doing?? write soon

    - denise

  • January 10, 2011 11:53 p.m.

    dear marc glad u wrote i'm not a professional, just a person that suffers from depression, it's good that ur aware of what is going on, alot of people would just ignore the symptoms & try 2 self medicate w. drugs or alcohol, i'm sorry 2 say that the ups & downs will not go away on there own, u need 2 c a psych. dr. to get the right medicine just for u, make sure u get a good dr., that u have a good repor with & that is familiar with what ur going thru, it may take some time 2 find the right dr., but most of them r good, they've found out that alot of the depression, that we suffer from is genetic, not that that helps us, but it does run in families, good luck 2 u & write back

    - denise

  • January 10, 2011 11:39 p.m.

    dear tammy there is a web-site called web m.d., go 2 that site & follow the prompts, it will ask u several questions & it will give u some kind of answer 2 your question, i am not a professional, just a person that suffers from depression & myasenia gravis, this is a muscle weakness (auto-immune disease) that has several other symptoms besides the muscle weakness, i'm not saying that u have this, but in my opinion i would see a neurologist, just from the symptoms that ur having, have u tried another psych. dr. 2 get meds. 4 the bi-polar, i can't even imagine what ur going thru & dealing w. the rapid-cycling on top of it, as i said b 4 i'm not a professional, but another opinion i have is that it may be fibromyalga (both things i mentioned r treatable, people w. fibro. suffer w. alot of pain in different parts of their body, good luck 2 u & write back

    - denise

  • January 5, 2011 9:43 p.m.

    Hi, I am a rapid cycler and was taken off my meds because 2 years ago I started to develope a different disease that the doctors can't diagnose. So now I am going through these terrible moods as well as a host of other symptoms I don't know what to do. 2 years ago I started falling for no reason at all until I got so weak I couldn't walk without a walker. My larynx swelled now I sound like a chipmunk. My eyesight was failing, I can't raise my toes off the floor. I have so much pain in my hands the tops of my feet and general aches are so bad now. Migraines are furious now. Falling down is like an everyday occurance. I feel so alone I am so scared. I went to get glasses today and there is no reason I can't see to drive but I can't. Neuologically there is something blocking me from seeing to drive. Can you help me??

    - tammy

  • December 13, 2010 4:05 p.m.

    Hi. I have only recently worked out that I'm bipolar looking back on my life I've had weeks of ups then downs it's has definitely effected my relationships, I push all my girlfriends away when I loss the thrust for life or I think I can do so much better when I am feel up. This has also been the same in my working life, taken on more then I can cope with or sticking with jobs because I don't think I can do any better. My question is this, now that I'm aware of myself and have just turned 40 should I try not to take any medication as I feel I've managed to get this far without going anything too drastic and will the ups and downs fad away now that I understand what has been going on???

    - Marc

  • October 27, 2010 8:14 p.m.

    I have lived with this man for 23 yrs. He is a good person. Then he can drink 1 beer and his whole personality changes. he becomes very agitated, inflated self esteem, won't shut up talking a mile minute jumping from one subject to the next, always broke, thinks he can do no wrong although he has had 7 DUI'S, irritability, thinks he is better than everyone. the more he drinks the worse he gets. I feel like he bipolar, but just when he drinks. He is now an alcoholic. He won't stop drinking. Can you please tell me what it is or what I can do? Thanks

    - Donna

  • October 1, 2010 4:03 p.m.

    john, Just from all of my reading about bi-polar disorder, it does appear to me that your wife is probaly suffering from it in a big way. Being that I am not a licensed professional I hope that you are in some way able to get her to see a professional so that she can get the help that she needs. Three of my sisters have been diagnosed with the disorder. It is a horrible disorder. It is hard on both the person who has it, and their families. Thankfully, we have been able to get them all into treatment. It was very hard to get one of my sisters into treatment the last time she was in a manic phase. I wish you the best of luck for a good solution to all that you and your family have been through. To Nancy, just because you have not had an episode for a few years,and feel relatively normal right now does not mean that you do not have the disorder. One of my sisters goes for years without a problem and then all of a sudden she is in a manic phase. She also thought that she had been misdiagnosed untill the last episode. We had a hard time getting her into treatment the last time.

    - louise

  • September 23, 2010 9:52 a.m.

    I have been with my wife 13yrs married 5yrs and we have a 6yr old daughter. Every 5yrs or so we end up splitting up usually it's over her spending habits, sexual indiscretions, risky behavior with drugs, aggressiveness when I confront her over the situation she says she is leaving to go back to her parents in another state, in the end we end up staying together and things are fine for a while. After our daughter was born she battled a thyroid condition, endured a stroke and had a hole in her heart repaired so she has been through a lot in 6 years. Over the years she was a party girl then 4 years ago "she found god" became extremely active in church and now she's back the party girl with a lot of the same symptoms she had earlier in our relationship. Her aggressive behavior is more apparent towards our daughter, screaming profanities at her, using excessive force when disciplining her and making remarks to our daughter that she has ADHD and Bipolar. Just recently I confronted her over improper behavior she said she was leaving the state with our daughter for her parents in another state after so I filed for divorce before she could leave. Someone asked if I thought she could be Bipolar, I knew as a kid she was ADHD so I started to research the condition. A lot I read is confusing to me but she does exhibit a lot of the symptoms shown. How do I get her help if she is denial? I really want to save my family and get her help if she is Bipolar but don't know how.

    - John

  • September 16, 2010 2:09 p.m.

    Please dont lose heart if you are newly diagnosed with bi polar disorder. Having been put on lithium 600 and sertraline 100 some calm has been restored to my life and to that of my husband and children. It was not an overnight success I have been on all the first line drugs in British medicine Zyprexia, Risperidone, Seroquel, Lamictal. I think I must have experienced every side effect known to man. At first I think my Dr was frustrated that I was so non compliant, then realised I wasnt being difficult , I had awful difficulty with the crawling, agitated restlessness that can occur. Anyway, I have been on the lithium for a year and have had no major cycling , I am back at work, the kids are happy my marriage is great. This time last year I thought I would never work again and my husband would leave me. Oh and by the way Im a nurse in a very busy clinic, sometimes the staff who treat you may understand what you are going through better than you think .XO

    - melanie

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