by Noah Snyder ’24
“There is a particular kind of pain, elation, loneliness, and terror involved in this kind of madness. When you’re high it’s tremendous. The ideas and feelings are fast and frequent like shooting stars, and you follow them until you find better and brighter ones. Shyness goes, the right words and gestures are suddenly there, the power to captivate others a felt certainty. There are interests found in uninteresting people. Sensuality is pervasive and the desire to seduce and be seduced irresistible. Feelings of ease, intensity, power, well-being, financial omnipotence, and euphoria pervade one’s marrow. But, somewhere, this changes. The fast ideas are far too fast, and there are far too many; overwhelming confusion replaces clarity. Memory goes. Humor and absorption on friends’ faces are replaced by fear and concern. Everything previously moving with the grain is now against– you are irritable, angry, frightened, uncontrollable, and enmeshed totally in the blackest caves of the mind. You never knew those caves were there. It will never end, for madness carves its own reality.”1
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1 Jamison, Kay Redfield. An Unquiet Mind: A Memoir of Moods and Madness. Picador, 2015.
To understand bipolar disorder, we must put ourselves in the shoes of someone who has it. We must imagine what it feels like to be bipolar. From start to finish, we must define bipolar, label it, and identify its symptoms and episodes to best help those who struggle with it. Bipolar disorder, also known as manic-depressive illness, is a biological illness that impairs your capacity to control your mood and causes sensations of utter joy, utter sadness, or increased irritability.2 3
To be diagnosed with bipolar disorder, one must have experienced at least one episode of mania or hypomania (a less intense form of mania). Many people who have bipolar disorder also experience depression. Therefore, it is bipolar disorder because depression and mania coexist. Something to note is that bipolar disorder is highly individualized, meaning that everyone experiences bipolar disorder differently. Symptoms of mania and hypomania can occur at the same time as depression symptoms. This is known as a mood episode.4
Mania refers to the “high” of bipolar disorder. It is a mood shift that presents feelings of goodness, excitement, and euphoria (intense excitement and happiness). For example, in response to something good, a person with bipolar may experience a high for a few days rather than a few minutes or hours. Mania may also include feelings of irritability, argumentativeness, and impatience. In a manic episode, a person with bipolar may find themselves more hostile or argumentative. To have a manic episode, one must show signs of evident irritability or high and
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2 Caponigro, Janelle M. Bipolar Disorder: A Guide for the Newly Diagnosed. New Harbinger Publications, 2012.
3 Goodwin, Frederick K., and Kay Redfield Jamison. Manic-Depressive Illness Bipolar Disorders and Recurrent Depression. Oxford University Press, 2007.
4 Caponigro, Janelle M. Bipolar Disorder: A Guide for the Newly Diagnosed. New Harbinger Publications, 2012.
exhibit three or more symptoms of mania. Symptoms of mania include increased self-confidence, decreased need for sleep, talkativeness, racing thoughts, distractibility, increased goal-directed behavior, psychomotor agitation (restlessness/constant fidgeting), and excessive involvement in pleasurable activities.5 6
Not everyone experiences these symptoms in the same way, however. Some experience them more severely, and others less severely. If people with bipolar experience these symptoms more severely, it would be described as manic episodes, whereas if symptoms are less severe, it would be described as hypomanic episodes. A hypomanic episode is shorter than a manic episode and has less severe symptoms. A person with mania may experience a high for a week or more, while someone with hypomania would only experience it for four days. The main way in which mania and hypomania differ is how they affect everyday life. Mania will cause a person to experience disruptions in their everyday life (ex. financial problems, rash behavior, and increased family problems). Hypomania may not disrupt a person’s everyday life.7
Depressive episodes are the other episodes of bipolar disorder. A depressive episode consists of five or more signs of depression daily for two weeks for most of the day. At least one of these symptoms must be a loss of interest in pleasurable activities or a depressed mood. People with depression do not necessarily feel sad but rather empty. Depression in bipolar
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5 Caponigro, Janelle M. Bipolar Disorder: A Guide for the Newly Diagnosed. New Harbinger Publications, 2012. 1.
6 Johnson, S. L., L. R. Eisner, and C. S. Carver. 2009 Elevated expectancies among persons diagnosed with bipolar disorders. British Journal of Clinical Psychology 48:217- 22.
7 Caponigro, Janelle M. Bipolar Disorder: A Guide for the Newly Diagnosed. New Harbinger Publications, 2012.
disorder is no different than depression without manic symptoms. People who do not experience manic symptoms but have depression have what is known as unipolar depression. Depression for bipolar disorder often comes suddenly and is felt more intensely than unipolar depression. Depression is a change in mood characterized by extreme melancholy, emptiness, or worthlessness. Symptoms of depression include changes in eating habits, changes in sleep, psychomotor agitation or slowing (restlessness or extreme slowness), fatigue or lack of energy, feelings of worthlessness or guilt, distractibility or indecisiveness and suicidality.8 9
There are three different types of bipolar disorder. There is bipolar 1, bipolar 2, and cyclothymia. To be diagnosed with bipolar 1 disorder, a person must have experienced at least one manic episode in their lifetime. Depression is not required to be diagnosed with bipolar 1 disorder, but it is very common. Bipolar 2 disorder requires a person to have experienced hypomania and a depressive episode. Cyclothymia deals more with chronic and regular mood changes. Cyclothymia pays attention to how long a person feels a change in their mood. People with cyclothymia often have a difficult time feeling anything other than “high” or “low”. In order to be diagnosed with cyclothymia a person has to experience mood fluctuations for a long time. For adolescents this is one year and for adults it is two.10 11
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8 Caponigro, Janelle M. Bipolar Disorder: A Guide for the Newly Diagnosed. New Harbinger Publications, 2012.
9 Cuellar, A. K., S. L. Johnson, and R. Winters. 2005. Distinctions between bipolar and unipolar depression. Clinical Phycology Review 25:307-339.
10 Roland, James. “What’s the Difference between Cyclothymia and Bipolar Disorder?” Healthline, Healthline Media, 29 June 2022, https://www.healthline.com/health/bipolar/cyclothymia-vs-bipolar#cyclothymia-vs-bipolar.
11 Caponigro, Janelle M. Bipolar Disorder: A Guide for the Newly Diagnosed. New Harbinger Publications, 2012.
Throughout a person’s life, one may begin to no longer experience symptoms of bipolar disorder. Remission is a period in one’s life where symptoms are not present. Conversely, a new episode (meaning one has already happened in the past) after the first episode is called a relapse. Many treatments and professional help are provided to limit symptoms, but unfortunately, bipolar disorder has yet to be cured. 12
The brain of a person with bipolar disorder is very different from that of a person without bipolar disorder. Bipolar disorder disrupts two primary neurotransmitters known as dopamine and serotonin. Dopamine causes a person to create goals based on a reward system. It makes a person have wants for different things. Serotonin is responsible for mood regulation. Because of this, a person with bipolar disorder has a distorted reward system and difficulty regulating their mood. 13 14
Seventy to eighty percent of developing bipolar disorder is genetic. However, even though this is known, researchers still do not know the exact cause of the illness. It is thought to be a mixture of genetic and environmental factors. Some environments may cause a person to have the gene expressed, while other environments may not. Most children of a parent with bipolar disorder will likely not develop the disorder, however, it does increase the risk of developing the disorder by fourfold and sixfold. You do not need to have a family history of
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12 Caponigro, Janelle M. Bipolar Disorder: A Guide for the Newly Diagnosed. New Harbinger Publications, 2012.
13 Johnson, S. L. 2005b. Mania and dysregulation in goal pursuit: A review. Clinical Psychology Review 25:241-262
14 Caponigro, Janelle M. Bipolar Disorder: A Guide for the Newly Diagnosed. New Harbinger Publications, 2012.
bipolar disorder in order to develop it. Developments before birth and environmental factors after birth can contribute to developing bipolar disorder. 15 16
There are many co-occurring illnesses with bipolar disorder, but I want to focus on one, ADHD. This is because it is often difficult to tell the difference between ADHD and bipolar disorder at an early age. ADHD is usually diagnosed in childhood, and people with bipolar disorder typically aren’t aware of the disorder until later in life. Many people are diagnosed with ADHD, which they may have, but are not aware that they are also bipolar. On average, it takes ten to thirteen years to realize.17 There are two main differences between ADHD and bipolar disorder. The first is symptoms and how often they are experienced. One article from psychiatric times states that “most symptoms of ADHD are also seen in mania and hypomania: distractibility, hyperactivity, impulsivity, racing thoughts, excess talking, and irritability. That leaves only three manic criteria to tease them apart: expansive mood (extreme moods that last for longer periods of time), grandiosity (feeling special or important), and decreased need for sleep.”18 Bipolar disorder is mostly a mood disorder while ADHD affects attention and behavior. ADHD is chronic and bipolar is episodic.19 The second main difference between bipolar disorder
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15 Caponigro, Janelle M. Bipolar Disorder: A Guide for the Newly Diagnosed. New Harbinger Publications, 2012.
16 Nurnberger, J. I., and T. Foroud. 2000. Genetics of bipolar affective disorder. Current Psychiatry Reports 2:147-157
17 Goodwin, Frederick K., and Kay Redfield Jamison. Manic-Depressive Illness Bipolar Disorders and Recurrent Depression. Oxford University Press, 2007.
18 Chris Aiken, MD. “7 Questions That Separate ADHD from Bipolar Disorder.” Psychiatric Times, Psychiatric Times, 2 Feb. 2021, https://www.psychiatrictimes.com/view/7-questions-thatseparate-adhd-from-bipolar-disorder.
19 “Bipolar Disorder or ADHD? How to Tell the Difference.” WebMD, WebMD, https://www.webmd.com/add-adhd/childhoodadhd/bipolar_disorder_or_adhd#:~:text=Bipolar%20disorder%20is%20primarily%20a,depressio n%2C%20mania%2C%20or%20hypomania.
and ADHD is medication. Kids and adolescents who potentially have ADHD should be first treated with stimulants. If that shows adverse effects, then in addition treat with a mood regulator or atypical antipsychotic. Adjunctive atypical should not be recommended for long term maintenance. People with bipolar disorder react badly to stimulants and drugs that are intended for people with unipolar depression.20
Professional help for bipolar disorder can vary but are all highly recommended. Psychiatrists, therapists, psychologists, social workers, marriage and family therapists, caseworkers, and nurse practitioners are all thought to be helpful resources regarding professional help.21 Types of medication for bipolar disorder can also vary on what kind of bipolar disorder a person shows symptoms. There are many unwanted side effects of medication, but also many positives. Some negative side effects include weight gain, fatigue, and dietary restrictions. This does not cover all side effects, but some of the common ones.
Types of medication for bipolar disorder include mood stabilizers (such as lithium carbonate), antiseizure medications (carbamazepine, valproic acid, topiramate, and lamotrigine), and antipsychotic medications (chlorpromazine, haloperidol, risperidone, olanzapine, etc.). Antidepressant medications do not help and may cause manic episodes unless taken with a mood stabilizer.22
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20 Goodwin, Frederick K., and Kay Redfield Jamison. Manic-Depressive Illness Bipolar Disorders and Recurrent Depression. Oxford University Press, 2007.
21 Caponigro, Janelle M. Bipolar Disorder: A Guide for the Newly Diagnosed. New Harbinger Publications, 2012.
22 Caponigro, Janelle M. Bipolar Disorder: A Guide for the Newly Diagnosed. New Harbinger Publications, 2012.
There are also other alternative forms of treatment when combined with medication that may help. This includes psycho education, cognitive behavioral therapy, family focused therapy, and interpersonal and social rhythm therapy. Some people with bipolar disorder claim to be cured after taking these alternative forms of treatment. While this may be true for some, it does not mean that it will be true for all. Bipolar disorder is individualized meaning everyone experiences it differently. 23 24
Lastly, it is important to note that bipolar disorder does not define a person’s life. Many people with bipolar disorder fully enjoy day to day life with hobbies, goals, family, and more. God can work through anything. He uses all things for good. He comforts and guides and never leaves or forsakes. As a person with bipolar disorder myself, God has called me to help those in similar situations understand that everything is possible through Christ. Never give up hope. “Be joyful in hope, patient in affliction, and faithful in prayer.” Rom 12:12 NIV.
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23 Caponigro, Janelle M. Bipolar Disorder: A Guide for the Newly Diagnosed. New Harbinger Publications, 2012.
24 Miklowitz, D. J., E. L. George, J. A. Richards, T. L. Simoneau, and R. L. Suddath. 2003. A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder. Archives of General Psychiatry 60:904-912.
Works Cited
Jamison, Kay Redfield. An Unquiet Mind: A Memoir of Moods and Madness. Picador, 2015.
Caponigro, Janelle M. Bipolar Disorder: A Guide for the Newly Diagnosed. New Harbinger Publications, 2012.
Goodwin, Frederick K., and Kay Redfield Jamison. Manic-Depressive Illness Bipolar Disorders and Recurrent Depression. Oxford University Press, 2007.
Johnson, S. L., L. R. Eisner, and C. S. Carver. 2009 Elevated expectancies among persons diagnosed with bipolar disorders. British Journal of Clinical Psychology 48:217- 22. 5. Cuellar, A. K., S. L. Johnson, and R. Winters. 2005. Distinctions between bipolar and unipolar depression. Clinical Psychology Review 25:307-339.
Roland, James. “What’s the Difference between Cyclothymia and Bipolar Disorder?” Healthline, Healthline Media, 29 June 2022, https://www.healthline.com/health/bipolar/cyclothymia-vs-bipolar#cyclothymia-vsbipolar.
Johnson, S. L. 2005b. Mania and dysregulation in goal pursuit: A review. Clinical Psychology Review 25:241-262 8. Nurnberger, J. I., and T. Foroud. 2000. Genetics of bipolar affective disorder. Current Psychiatry Reports 2:147-157
Chris Aiken, MD. “7 Questions That Separate ADHD from Bipolar Disorder.” Psychiatric Times, Psychiatric Times, 2 Feb. 2021, https://www.psychiatrictimes.com/view/7-questions-that-separate-adhd-from-bipolardisorder.
“Bipolar Disorder or ADHD? How to Tell the Difference.” WebMD, WebMD, https://www.webmd.com/add-adhd/childhoodadhd/bipolar_disorder_or_adhd#:~:text=Bipolar%20disorder%20is%20primarily%20a,de pression%2C%20mania%2C%20or%20hypomania.
Miklowitz, D. J., E. L. George, J. A. Richards, T. L. Simoneau, and R. L. Suddath. 2003. A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder. Archives of General Psychiatry 60:904-912.