Somebody who is having a manic episode usually feels elated or euphoric, but it can also make people irritable. They may be easily distracted, have a low attention span, increased sex drive, unusual impulsive behaviour and racing thoughts. Sometimes a person can become aggressive, feel unstoppable, or have delusional ideas such as that they are "chosen" or "on a special mission". At its most severe, manic symptoms can progress to full-blown psychosis.
Hypomania is a shorter and less extreme version of mania, still with elevated or irritable mood but with fewer symptoms and less severity. A 'mixed episode' is one where symptoms of depression and mania are present at the same time.
There are three specific types of Bipolar Disorder - Bipolar I, Bipolar II and Cyclothymia. Some people, however, may have an illness which seems to be a kind of bipolar depression but they don't fit into any of the three categories. Those people might be technically labelled with 'Bipolar Disorder Not Otherwise Specified'.
Bipolar I Disorder
- People with Bipolar I will have had at least one full manic episode.
- A diagnosis of Bipolar I requires only the presence of one manic episode, but many people with Bipolar I experience periods of major depression or hypomania as well.
- Bipolar I is the most severe form of Bipolar Depression.
- Bipolar II is characterised by cycles of depressed episodes and hypomanic episodes.
- To be diagnosed with Bipolar II, the sufferer has to have had at least one hypomanic episode, and at least one major depressive episode.
- Only people who have never had a manic episode are diagnosed with Bipolar II. If somebody with Bipolar II experiences a manic episode, their diagnosis will be changed to Bipolar I.
- Cyclothymia is a chronic type of Bipolar Depression where hypomanic episodes are present chronically for at least 2 years, but without any periods of clinical depression
- People with Cyclothymia can experience chronic low mood, but not severe enough to quality as a major depressive episode, so they do not fulfull the criteria for a diagnosis of Bipolar II.
- The longest period somebdoy with cyclothymia has been free of symptoms is two months. If it's more than that, they will be given a different diagnosis.
It's also poorly treated. Only around 5 per cent have psychological therapy and just a third of known sufferers have a yearly check of their state of mind.3 Many famously creative individuals are known or believed to have suffered from bipolar disorder, e.g. Vincent Van Gough, Spike Milligan, Sylvia Plath, Virginia Woolf, and Ernest Hemingway. Stephen Fry, a much-loved British actor and comedian, is one such example. He has openly admitted to having manic depression - specifically cyclothymia.4 He famously walked out on a part in a West End show called Cell Mates and disappeared. It later emerged that he had tried to kill himself, then took a ferry to France and eventually went to America for treatment. Of his own diagnosis, he said, and I quote:
"Bipolar has the highest suicide rate out of all mental illnesses... So people not treated soon enough are having their lives put at risk."2
"I'd never heard the word before, but for the first time, at the age of 37, I had a diagnosis that explains the massive highs and miserable lows I've lived with all my life ... There's no doubt that I do have extremes of mood that are greater than just about anybody else I know. The psychiatrist in the hospital recommended I take a long break... My mind was full of questions. Am I now mad? How have I got this illness, could it have been prevented, can I be cured of it? Since then, I have discovered just how serious it is to have bipolarity, or manic depression as it's also called. Four million others in the UK have it and many of them end up killing themselves."5
Bipolar disorder has the highest suicide rate of any psychiatric illness. Around 15% of sufferers kill themselves. This makes the shockingly low rate of diagnosis and proper care for those with the illness all the more worrying. For more information, try the following resources:
1, 2, 3. The Independent, "Stephen Fry: My Battle With Mental Illness"
4. BBC "The Secret Life Of Depression" microsite
5. Stephen Fry - "The Secret Life Of Depression"