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depressive episode

Bipolar Disorder – Euphoria vs. Dysphoria or Mixed Episode

Most symptoms of Manic Episodes appear to be positive

Manic-depression or Bipolar disorder is usually perceived on of two ways – a person who alternates between depression and euphoria – or a person who alternates between depression and craziness.

Often a person who is told that they are bipolar will identify one of those two states – and will object based on the fact that they have never been “euphoric“, and they have never been actually psychotic or “crazy”.

Bipolar disorder or Manic-Depression is defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) – “the Bible” of psychiatric disorders – as “…clinical course that is characterized by the occurrence of one or more Manic Episodes…”

7 “points” retrieved from: DSM IV Criteria for Manic Episode – Food and Drug Administration

A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week. With three or more of:

1. Inflated self-esteem or grandiosity
2. Decreased need for sleep (e.g., feels rested after only three hours of sleep)
3. More talkative than usual or pressure to keep talking
4. Flight of ideas, or subjective experience that thoughts are racing
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
6. Increase in goal-directed activity (either socially, at work or school or sexually) or psychomotor agitation
7. Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

There is another specifier – “The symptoms do not meet criteria for a Mixed Episode” which is left out in a lot of thought processes.

Bipolar - EuphoricOne problem that is often encountered when diagnosing Bipolar disorder – or when trying to convince someone who has Bipolar disorder that they do, indeed have the illness – is that most of the “symptoms” of a Manic Episode appear to be “positive” or “happy.”  If you examine the wording – it looks on the surface and is often described as periods of “Euphoria” or extreme happiness.

In truth, many people with Bipolar disorder don’t have periods of “euphoria,” they don’t have what is perceived as “inflated self-esteem or grandiosity“, and they don’t seek out “excessive involvement in pleasurable activities.”  They may have “dysphoria,” they may believe that they have to do everything themselves, they may experience psychomotor agitation…they may be in a really active bad mood.

This is a state of “dysphoria.”  It is also called a “mixed state” where the Manic Episode and the Depressive Episode occur at the same time.  Features may include the racing thoughts, irritability, lack of sleep, psychomotor agitation of a Manic Episode but also include anhedonia or lack of enjoyment, inappropriate guilt, or suicidal thoughts which are symptoms of depression.

Unfortunately, this disconnects in presentation, and lack of awareness of mixed states (in both the patient and some professionals) often gives the bipolar patient an “easy out” in acceptance of the diagnosis.

Melissa Lind

Mixed Episode or Manic Episode with Mixed Features is given too little attention!

What Causes Bipolar Disorder?

So, what causes Bipolar disorder?

It appears to be an interplay of genetic and physiological factors, coupled with stressful triggers, that causes Bipolar disorder…

Bipolar doctor

Manic depression, also called bipolar disorder, causes severe mood swings that can last for weeks or even months.

Everyone feels happy or sad sometimes. For someone with manic depression, however, these mood swings are much more intense. Scientists have not identified a single factor what causes bipolar disorder. Instead, it may have one or more of several different causes. These may be broken down into genetic, environmental and physiological causes.

There are three types of manic depression.

Bipolar Type I is characterized by at least one manic episode. A manic episode is a feeling of intense elation, restlessness and loss of inhibitions and over-activity. Sufferers during a manic episode may sleep for only three or four hours a night if at all.

Bipolar Type II, where there may be frequent episodes of depression with only mild manic episodes (called hypomania). Rapid cycling involves four or more mood swings over the period of a year.

Finally, there is Cyclothymia, where the mood swings last longer but they are less severe.

Genes is considered to be a contributing factor.

If one of your relatives has manic depression, there is a reasonable chance that you will develop it, too. Chromosome numbers 6 and 8 appear to have been implicated. Children of bipolar parents have an eight percent chance of developing the condition, compared with one percent in the general population.

A chemical imbalance in the brain may cause the disorder. Nerve signals travel from one neuron to another by way of chemicals called neurotransmitters. These include norepinephrine, dopamine, and serotonin. It is possible that excess levels of norepinephrine may cause a manic episode.

During a depressive episode, levels of this neurotransmitter may be excessively low. The picture, however, is not that simple, as there are other neurotransmitters involved.

Mood swings can also be triggered by stress. Abuse; either physical, emotional or sexual, may trigger an episode. Bereavement or the breakdown of a close relationship may also be a trigger.

Not all stressful triggers are negative experiences. A positive change, such as a marriage or a birth can also make a contribution.

Once diagnosed, the condition can be treated or controlled, although certain risk factors may trigger a recurrence. Failure to comply with medication carries a high risk of recurrence, as do alcohol or drug abuse. Other risk factors include poor support systems. For example, the lack of caring friends or relatives or an erratic lifestyle.

Manic depression can lead to psychosocial disturbances.

For example, Bipolar Type I and Bipolar Type II are associated with a high absentee rate at work. There is also a higher rate of suicide attempts and hospital admissions with these conditions. While both conditions have high rates of attempted suicides, Type II sufferers seem to have fewer hospital admissions than Type I, and consequently miss fewer days at work.

So, what causes bipolar disorder? It appears to be an interplay of genetic and physiological factors, coupled with stressful triggers.

Complying with medication, adopting a stable lifestyle, and developing healthy coping strategies, may all keep the condition under control.

It is essential to consult a medical professional and not attempt self diagnosis.