Bipolar disorder is a spectrum of opposing signs and symptoms and emotional states featuring a constant shift between manic episodes and depressive episodes. These patients have emotional lability and often feel a wide range of emotions throughout the day or throughout the week. In some cases, bipolar disorder is also associated with psychosis and has similar symptoms to schizophrenia. These patients often feel detached from reality and may even have hallucinations or delusions.
In bipolar disorder, the exact root cause is still not known, but there is an interplay between genetic and environmental factors, and certain activities and behaviours such as lack of sleep and eating certain foods may sometimes trigger the symptoms. We all experience ups and downs, but the emotional lability and the severity of the episodes in people with bipolar disorder compromise their normal adaptation to society and create a series of behavioural problems that affect their working and academic performance and may deeply impact their relationships with loved ones and family members.
In this article, we will break down the symptoms of bipolar disorders in two different categories. First, we’re going to talk about the symptoms commonly found in a manic episode and then we’re going to cover the signs and symptoms of a depressive episode.
A) Manic episode symptoms
1. Feeling elated or overly enthusiast
In bipolar disorder, one of the most predominant symptoms in the manic episode is feeling overly enthusiast and happy. This state of mind might be perceived as positive in normal cases, but bipolar patients display an exaggerated emotion that is often fueled by their own detachment from reality.
They feel excited and elated about almost anything in a degree that feels awkward and even bothering to everyone else around them because their emotions are not based on reality. During a manic episode, these patients have delusions of grandeur and feel they can do anything without restraint.
2. Irritability
Patients during a manic episode tend to be irritable when something does not happen the way they are expecting or when someone is not behaving accordingly to what they want or need. Manic episodes are not merely feeling happy all the time. They have constant mood shifts during a manic episode, and if they don’t have coping strategies to manage their irritability, it quickly turns into anger and may lead to aggressive behaviour.
Not every patient with bipolar disorder experiences irritability during a manic episode, and each case is different. It highly depends on the patient’s personality and whether or not they are able to identify and correctly drain this negative feeling during a manic episode.
3. Racing thoughts and speech
Certain people think and speak faster than others, but in manic episodes racing thoughts and speech are perceived as more than normal because thoughts cannot be quieted down and they flow like an aggressive river without any restraint to the point that it takes over the patient’s consciousness and impair their normal social behaviours.
In severe cases, racing thoughts may even affect the patient’s ability to fall asleep, and in most cases, it leads to express their thoughts verbally without apparent connection and common sense. Manic patients jump from one topic to another, and they become unable to hold a conversation topic for a long time. In some cases, their symptoms are associated with psychosis, but this is not a cause of racing thoughts.
4. Lack of proper sleep
Patients with bipolar disorders usually have severe sleeping problems due to their overly active state of mind. This may lead to insomnia in the most severe cases or make it difficult to fall asleep or maintain sleep for the whole night.
Patients with bipolar disorder often wake up in the middle of the night or very early in the morning and go around the house, waking up everybody else with or without intent. In severe manic episodes with psychosis, they may also incur in abnormal behaviour such as turning up the music and the lights regardless of everybody else in the house or going out for a walk in the middle of the night and collecting trash in the streets.
5. Being more active than usual
These patients have excess energy they are unable to drain. They are more active than the average person, burn more energy and usually eats more food. This is a primary criterion to diagnose a maniac disorder, which is described as a period or persistently increased activity or energy by the DSM-5.
Increased levels of activity should be differentiated with other psychiatric syndromes featuring hyperactivity, and the key feature to contrast one against the other is the existence of depressive episodes alternating with manic episodes over and over again. Talk to your doctor if you have a doubt or believe you or your loved one may suffer from bipolar disorder.
6. Active search for pleasurable activities
Patients with bipolar disorder are usually looking for pleasurable activities every time. They usually eat plenty and may sometimes engage in unhealthy and dangerous sexual behaviour. Clinically, we would call this symptom a disturbance in the hedonic experience, which is the active seeking of pleasure. These activities become excessive in the manic state, and some patients may find pleasure in risky activities or intentionally putting themselves in danger.
This behaviour might be related to a reduction in the regulation of behavior by the prefrontal area of the brain, which is usually activated to measure the consequences of actions and to make decisions according to a moral and “safe” pattern.
7. An exaggerated opinion about oneself
In a maniac episode, patients with bipolar disorder have delusions of grandeur or at least an exaggerated opinion of themselves. They feel capable of doing almost anything and may sometimes undergo risky behaviour just because they feel they are able. They often use exaggeration and lie to make their accounts and feats more interesting for their listeners and sometimes genuinely believe their own lies.
These patients truly believe they are important people or have important friends. Thus, they are often uncontrolled in shops and spend a lot of money believing they can pay their debts afterwards.
B) Depressive episode symptoms
1. Sadness
The basic feeling of bipolar disorder patients during a depressive episode is sadness, but not every case is manifested the same way. It is not a normal feeling of sadness one might experience over the loss of loved ones and other episodes. This is extreme sadness and despair and works differently than people with depression.
In the brain, bipolar patients in their depressive episodes are different than clinically depressed patients. This is why the traditional antidepressant treatment for clinical depression does not work with bipolar disorder, and we should look for alternate ways to improve the symptoms of these patients. Similar to clinical depression, bipolar patients are unable to control or regulate their emotions, and whenever they have a bout of severe depression, they are unable to bounce back to feeling optimistic once again.
2. Slow motion and tiredness
Fatigue is associated with clinical depression and the same happens with bipolar patients in a depressive episode. These patients feel overly tired, and their energy levels are dramatically reduced. They usually become slow and clumsy; a symptom clinically named psychomotor retardation. It results from a defective secretion of the neurotransmitter dopamine in brain centres associated with the motor cortex, such as the thalamus.
Diminished body movements are often associated with diminished thoughts and speed of thought. It is not only associated with bipolar disorders but may also be the result of certain drugs and medical conditions that also trigger slow mental activity and sluggish body movements.
3. Sleeping too much or too little
In the maniac episode patients often sleep too little, but in the depressive episodes they may either sleep too much or too little. They usually have an altered pattern of sleep, and it is usually a lack of sleep instead of excessive sleeping because these patients do not experience a complete depression as clinically depressed patients do. Their depression is an anxious type of depression, and often struggle trying to fall asleep.
4. Concentration problems
We have mentioned how depressive episodes affect the train of thoughts and the psychomotor abilities of the patient. These patients often have severe concentration problems, and it is difficult for them to solve problems and perform complex tasks. Patients with bipolar disorder think more slowly and have delayed responsiveness to people’s speech or to whatever they are trying to read. They take very long in deciding things and even longer in accomplishing their goals. This severely affects their performance in the working and academic fields during depressive episodes.
5.Forgetfulness and muteness
Associated with concentration problems and psychomotor alterations, patients with bipolar disorders also have memory problems in the depressive episode. Memory problems and forgetfulness often make it difficult to perform day-to-day activities and affect a student’s grades and a worker’s accomplishments. Memory problems are more common in the depressive phase, but it is reported throughout the syndrome. They are usually worse when the symptoms are more severe.
Muteness is patients with bipolar disorder is prevalent during a depressive episode. It is especially worrying when associated with catatonia, which is an unresponsive behavior featuring muteness with no motor movements. These patients only respond to pain and some visual stimuli, and it is found in severe cases of bipolar disorder or may result from extreme side effects of certain medications.
6. Lack of interest
Similar to clinically depressed patients, bipolar disorder patients experience a complete lack of interest in topics and activities that usually makes them feel excited or interested. They do not have any enthusiasm to practice their favourite sports or their hobbies, and this is a marked symptom when compared to their previous state of excitement and happiness during a maniac phase.
7. Feelings of hopelessness
This is a common symptom in major depression and bipolar disorder, and makes patients more susceptible and dangerous when present because it is associated with a higher risk of suicide and suicidal thoughts. Since these patients are not likely to speak up and chat about their feelings, it is often undetected until suicidal behaviour starts.
Thus, if you feel a family member or your loved one is having a different attitude towards life and may need professional help, talk to your doctor about your concern and follow his recommendations. It is important to evaluate and treat every case individually, and early diagnosis and treatment will always bear the best outcomes.
Patients with bipolar disorder may or may not cycle in and out of maniac and depressive episodes. They may stay in between them and live a normal life for a while and then experience a setback once again. Psychotherapy along with medication is one of the best treatments to improve the symptoms in these patients, and the goal is to force the patient out of their maniac or depressive episode with medication to treat them afterwards and maintain them in a state that is in-between both extreme episodic symptoms.
Many of the symptoms described above are found in patients with major depression. Others are shared with patients with schizophrenia and other psychotic alterations. Therefore, it is important to talk to your doctor if this list of signs and symptoms rang any bell or warning signal. Mild cases of bipolar disorder are easier to treat, but they may be more difficult to detect and may go unnoticed. Thus, do not neglect your symptoms and look for professional help if you suspect anything is wrong with your own behaviour or that of your family members and loved ones.
References
Machado-Vieira, R., Luckenbaugh, D. A., Ballard, E. D., Henter, I. D., Tohen, M., Suppes, T., & Zarate Jr, C. A. (2016). Increased activity or energy as a primary criterion for the diagnosis of bipolar mania in DSM-5: findings from the STEP-BD study. American Journal of Psychiatry, 174(1), 70-76.
Tso, I. F., Grove, T. B., & Taylor, S. F. (2014). Differential hedonic experience and behavioural activation in schizophrenia and bipolar disorder. Psychiatry research, 219(3), 470-476.
Marvel, C. L., & Paradiso, S. (2004). Cognitive and neurological impairment in mood disorders. Psychiatric Clinics, 27(1), 19-36.
Muneer, A. (2014). Catatonia in a patient with bipolar disorder type I. Journal of neurosciences in rural practice, 5(3), 314.
Acosta, F. J., Vega, D., Torralba, L., Navarro, S., Ramallo-Fariña, Y., Fiuza, D., … & Siris, S. G. (2012). Hopelessness and suicidal risk in bipolar disorder. A study in clinically nonsyndromal patients. Comprehensive Psychiatry, 53(8), 1103-1109.