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Bipolar Disorder (Manic Depression) Part II

© John McManamy

"So little is actually known about the illness that the pharmaceutical industry has yet to develop a drug ..."

Let's start with the boring stuff:

The DSM-IV (the doctor's Bible) divides bipolar disorder into two types, rather unimaginatively labeled I and II. "Raging" and "Swinging" are far more apt:

Raging bipolar (I) is characterized by at least one full-blown manic episode. This may include inflated self-esteem, decreased need for sleep, being more talkative than usual, flight of ideas, distractibility, increase in goal-oriented activity, and excessive involvement in risky activities.

The symptoms are severe enough to disrupt the patient's ability to work and socialize, and may require hospitalization to prevent harm to himself or others. The patient may lose touch with reality to the point of being psychotic.

The other option for raging bipolar is at least one "mixed" episode on the part of the patient. The DSM-IV is uncharacteristically vague as to what constitutes mixed, an accurate reflection of the confusion within the psychiatric profession. More tellingly, a mixed episode is almost impossible to explain to the public. One is literally "up" and "down" at the same time.

Depression is not a necessary component of raging bipolar. The DSM-IV seems to take for granted what goes up must come down, and leaves it at that.

Swinging bipolar (II) presumes at least one major depressive episode, plus at least one hypomanic episode. The same characteristics as mania are evident, with the disturbance of mood observable by others, but the episode is not enough to disrupt normal functioning or necessitate hospitalization, and there are no psychotic features.

Those in a state of hypomania are typically the life of the party, the salesperson of the month, and more often than not the best-selling author or Fortune 500 mover and shaker, which is why so many refuse to seek treatment. But the same condition can also turn on its victim, resulting in bad decision-making, social embarrassments, wrecked relationships, and projects left unfinished.

Hypomania can also occur in those with raging bipolar, and may be the prelude to a full-blown manic episode.

Major depression is part of the DSM-IV criteria for swinging bipolar, but the next edition of the DSM may have to revisit what constitutes the downward aspect of this illness. At present, the DSM-IV criteria for major unipolar depression pinch-hits for a genuine bipolar depression diagnosis. On the surface, there is little to distinguish between bipolar and unipolar depression, but certain "atypical" features may indicate different forces at work inside the brain. These atypical traits include increased need for sleep (as opposed to losing sleep), psychomotor retardation (as opposed to psychomotor agitation), and weight gain (as opposed to weight loss.

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