Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Mania and depression are the opposing phases in bipolar disorder.
Mania (the "high" of bipolar disorder): A person in the manic phase may feel indestructible, full of energy, and ready for anything. Other times, that person may be irritable and ready to argue with anyone who tries to get in the way.
Unrealistic plans, spending sprees, an increase in
sexual affairs, or other reckless behavior, such as wild driving, also may
The person with mania can stay up all night but may
find that not much was accomplished because he or she was easily distracted.
The person in a manic phase may talk very quickly
and jump from subject to subject. They often exhibit pressured speech during
mania: The person speaks very fast, as if his or her mouth can't keep up with the rapid thoughts. The person may be unable to respond to social cues to stop talking.
Increased activity and gestures (pacing, tapping feet) may be seen.
Poor temper control and irritability can be especially upsetting to friends and loved ones.
Self-esteem may be inflated. A person may have exaggerated self-confidence.
Decisions regarding business and finances are often made hurriedly and without careful consideration; this poor judgment may be the result of inappropriate optimism.
Clothing choices may also change, and the person in
a manic phase may start wearing brighter, more flamboyant clothes.
They are grandiose and may have delusions (false ideas) of grandeur (greatness).
In severe cases, delusions (false, fixed beliefs) and hallucinations (seeing or hearing things that aren't real) may be seen.
Hypomania refers to a milder form of mania. People affected by this mood disorder have many of the same features as those with mania, without the negative impact on day-to-day functioning. In fact, they may seem to have a great deal of energy and can be very productive, needing less rest than others.
These behaviors, which can be quite upsetting, usually prompt a family member to take notice and try to get the person help.
Most people who are going through the manic phase of bipolar disorder deny that anything is wrong with them and refuse to see a medical professional.
Depression (the "low" of bipolar disorder): Although mania is said to alternate with
depression, most people have more depressive episodes than manic ones.
Sadness and crying spells are common, as are excessive worrying and guilt.
People who are depressed may not care enough to
wash or comb their hair, change clothes, or even get out of bed in the
These people may sleep too much (hypersomnolence) or have difficulty getting to sleep (insomnia). A loss of energy may result from the change in sleep habits.
Many of these people have no interest in food or
have no appetite and lose weight. However, some eat excessively.
People with depression have trouble thinking; they
may forget to do important things such as paying bills because they feel so
down and have difficulty focusing on tasks.
They withdraw from friends, and social interactions suffer.
Hobbies and activities that used to bring pleasure suddenly hold
no interest for people who are depressed.
Depression brings feelings of hopelessness,
helplessness, pessimism, and worthlessness.
Some people may develop chronic pain or
other bodily complaints that do not actually have any physical cause.
People who are depressed may not see a point in
living anymore and may actually think about ways to kill themselves.
Untreated bipolar disorder has a 15% risk of death by suicide.
The risk of attempted suicide is nearly 10 times higher in patients with manic-depressive illness than in the general population.
Some people with bipolar disorder cycle between the
two extremes every few months or weeks. Other people with bipolar disorder may
cycle several times within the same day. This is referred to as rapid cycling.
Substance abuse is common in people with bipolar disorder. The use of drugs or excessive alcohol use can trigger or worsen symptoms. Alternatively, some people may use drugs and alcohol in an attempt to treat their symptoms. Other conditions that may co-occur with BD include conduct disorders, eating disorders, attention-deficit/hyperactivity disorder, thyroid disorders, migraine, and anxiety.
Reviewed by Melissa Conrad Stöppler, MD on 4/15/2013