Phases of Bipolar Disorder

The terms “mania” and “depression” are both associated with bipolar disorder, which was previously referred to as “manic depression.” What do these terms actually mean and how do they apply to life with bipolar disorder? The answer to that question varies depending on the individual, but a common feature of the disorder is alternating manic (elevated mood) and depressive (low mood) episodes.

Manic Phase

Mania is an abnormally elevated mood that can cause someone to feel grandiose, invincible, impulsive, irritable, agitated and even hypersexual. It often involves racing thoughts, difficulty organizing thoughts, and the inability to physically stay still. They often start scheming and making big plans for their life because of feeling energized (often to the point of not being able to sleep) and feeling a falsely elevated sense of self-esteem. People in a manic episode frequently make decisions they have not thought through, with little concern for the consequences. Sometimes they will make decisions that result in jobs and relationships being lost. Manic episodes can involve psychosis, though they don’t always. Even without psychosis, a manic episode can cause a person to make decisions that are dangerous to themselves or others. Hypomania is a term used to describe people whose mania does not interfere with their ability to function in their daily life and do not become psychotic. A hypomanic person may feel particularly creative and get more work than usual done during the day. Some people with bipolar disorder experience only (or mostly) hypomanic episodes as opposed to full-blown mania. Others experience hypomania only when their mood is moving from mania towards depression or vice versa.

Depression Phase

In the depressed part of the bipolar cycle, many manic symptoms reverse. Insomnia turns into wanting to sleep all the time. Feeling euphoric becomes a deep sense of sadness and hopelessness. A person may feel sluggish and not be able to perform their usual daily tasks. Life may feel overwhelming or the person may feel like they are worthless. This is the phase during which a person with bipolar disorder is most likely to think about suicide or to try to hurt themselves. Depression can also involve psychotic episodes.

Mixed Episode

The term “mixed episode” refers to times when a person with bipolar disorder has both features of depression and mania simultaneously. The conflict between depressive and manic symptoms can result in people feeling agitated and angry and sometimes even acting violently. These episodes are of particular concern and likely to led to hospitalization. Medication changes are likely to be recommended.

Rapid Cycling

Although most people with bipolar disorder experience one or two long-lasting manic/depressive episodes a year, in some cases individuals may experience more frequent cycling between manic and depressive phases. If they experience four or more manic, depressive or mixed episodes in a year, the term “rapid cycling” is used. Women are more likely than men to have rapid cycling bipolar disorder, and it is especially common in women with hypothyroidism.

Seasonal Pattern

It is not uncommon for a person with bipolar disorder to start to notice a pattern in their episodes that is related to the time of year. For example, some people find they are depression-prone throughout every season except for summer, when they are more prone to manic episodes. It is most common for fall and winter to be seasons when depression is prevalent.