Each bipolar disorder illness is unique!
When nearly anyone thinks about bipolar disorder, they think of the symptoms of “regular” bipolar disorder. Not that any person with bipolar disorder is “regular” (and most would not want to be), but there are several different subtypes of bipolar disorder.
One big problem with bipolar disorder is that each illness is unique. Psychiatrists may classify them into categories – but they don’t always fit. Here are some case scenarios: (bipolar episodes – bipolar groups)
• Jennifer has episodes where she is extremely agitated and unhappy and never seems to sleep very much. These periods seem to last for a long period of time – but can alternate with months where she is simply unhappy and doesn’t feel like doing anything.
• Max has had periods of depression before. A lot of times, they go away after a couple of months and then he seems normal but recently he “disappeared” for a couple of weeks after some really bizarre behavior. His friends never knew that he was any kind of bipolar until he told them he had been at the hospital.
• Ben has periods of depression that can last for several months but when he is not depressed, he is productive and seems quite outgoing.
• Sandra’s mood state can switch erratically. One day she is all about shopping and the next time you call her, she is still in bed at noon. This is a constant issue – and you never know what you are going to get.
These are three examples of bipolar disorder that don’t seem to fit the “normal” pattern. None of these patients seems to be “regular” bipolar.
Bipolar disorder is defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) as:
Bipolar I Disorder: manic or mixed episodes that last at least 7 days – or if manic symptoms are severe enough to need hospitalization. This, usually, includes periods of depression that last at least two weeks.
Jennifer and Max both fit into this category. Even though Max never had a severe manic episode, having a bipolar episode that warrants medical attention, he qualifies for the Bipolar I category. Jennifer has mixed episodes – rather than euphoria or traditional mania – she has periods of “dysphoria” where she is agitated, irritable and irrational but with an excess of energy.
Bipolar II Disorder: depressive and hypomanic episodes in a pattern – but manic episodes are not severe.
Ben has Bipolar II disorder. He has periods of depression that are debilitating, but his non-depressed periods are quite productive, and he doesn’t exhibit manic behavior.
Bipolar Disorder Not Otherwise Specified: (Bipolar Disorder NOS) symptoms of illness don’t meet any other group, but the symptoms are clearly not within the standard range.
Sandra has BP-NOS. She is what is commonly called a “rapid cycler,” meaning that she switches back and forth from mania to depression much faster than other people with bipolar disorder.
There is also a very mild form of bipolar disorder known as cyclothymia. It is a cyclical pattern of hypomania alternating with periods of mild depression. Many people would not even realize this is a problem.
Bipolar disorder is hard to classify. It may be easy to determine that someone has a problem – but the uniqueness of each bipolar case makes it more difficult for even a patient to identify with the diagnosis. Each type of bipolar disorder is, usually, treated the same medically. With an anti-manic agent (Lithium), anti-epileptic (Lamictal, Depakote) or atypical antipsychotic (Abilify, Zyprexa) – and sometimes with an antidepressant.