Sometimes Hypomania Is So Hard To Identify That People With Bipolar Disorder Are Misdiagnosed
The first issue here is that people with hypomania and mania may not recognize that the symptoms are indicative of a disorder. They can instead write off signs of these conditions as simply having more energy or motivation than usual and view it as a good thing.
Even if someone experiencing hypomania does seek medical attention, they might receive a misdiagnosis because it can be so subtle. For instance, someone with bipolar IIwhich involves hypomanic and depressive episodesmay get diagnosed with major depressive disorder if they or a doctor miss those hypomanic symptoms.
Its key that doctors perform as thorough a psychiatric evaluation as possible if theres a chance someone is experiencing bipolar disorder because so much of treatment hinges on an accurate diagnosis.
What Are Bipolar Cycles
A bipolar cycle refers to the various stages a person with bipolar disorder experiences. They typically experience an initial stage of mania, which is behavior characterized by high levels of energy, excitement, and sometimes, agitation.
A person with bipolar II disorder may experience hypomania instead of mania. Hypomania is similar to mania but with milder symptomsa person is still able to function with hypomania.
In a bipolar cycle, the manic or hypomanic stage is followed by a stage of depression. A bipolar episode may last an entire day, several days, or several weeks.
What Is The Difference Between Major And Minor Depression
Dysthymic disorder/dysthymia Also known as a moderate form of depression, the symptoms last a long time at least two years but are not as severe as the symptoms of major depression. Minor depression This form of depression is similar to the others except the symptoms are not as severe and dont last as long.
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When To See A Doctor And Diagnosis
Anyone who suspects that they may have bipolar disorder or could be experiencing a manic episode should see a doctor.
Mania impairs a personâs ability to function. It can also lead to impulsive and risky behavior that can have serious consequences and even be life-threatening. People should seek immediate help if someone with bipolar mania symptoms has thoughts of suicide or self-harm.
In some cases, a person experiencing a manic episode may not be aware of the problem. Loved ones should encourage the individual to get the help that they need. Treatment is available that can lessen symptoms and improve quality of life.
According to the National Alliance on Mental Illness, to have a diagnosis of bipolar disorder, an individual must have had at least one episode of mania. If a person has the symptoms of a major depressive episode but has never had a manic or hypomanic episode, major depressive disorder is likely to be the more appropriate diagnosis.
A diagnosis occurs after an evaluation by a doctor or mental health professional using the criteria from the Diagnostic and Statistical Manual of Mental Disorders . The healthcare professional will only diagnose a person as having a manic episode if the unusual elevated mood or irritability lasts for at least a week or if the symptoms are severe enough to make hospitalization necessary.
Mixed Episodes And Mixed Features In The Dsm
The Diagnostic and Statistical Manual s used by mental health professionals as a standard tool for diagnosis of mental health conditions. In prior versions of the DSM these mixed episodes were designated as ‘mixed episodes’, but they are not referred to as bipolar disorder with mixed features” A mixed feature episode is detailed as being:
- Three or more depressive symptoms during a manic or hypomanic episode
- Or, three or more hypomanic or manic symptoms during a major depressive episode
How Prevalent Is Bipolar Disorder with Mixed Features?
Since the DSM-5 has broadened the definition of bipolar disorder episode with mixed features, old statistics have become outdated. However, some studies have explored how many people do have mixed features along with the bipolar disorder. For example, one study found that 40% of major depressive episodes also included at least one symptom of hypomania. What’s more, those in the study who had that experience were more likely to be diagnosed with bipolar disorder later on. While more research needs to be done to get a full picture of the disorder, doctors and scientists already know that bipolar disorder episodes with mixed features are not at all uncommon.
Mixed Affective Episode Symptoms
The following are symptoms commonly associated with bipolar disorder manic episodes.
These symptoms must last for at least one week and be present most of each day
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What Is Rapid Cycling
Some people with bipolar disorder develop rapid cycling where they experience four or more episodes of mania or depression within a 12-month period. Mood swings can occur very quickly, like a rollercoaster randomly moving from high to low and back again over a period of days or even hours. Rapid cycling can leave you feeling dangerously out of control and most commonly occurs if your bipolar disorder symptoms are not being adequately treated.
The different faces of bipolar disorder
Bipolar I Disorder This is the classic manic-depressive form of the illness, characterized by at least one manic episode or mixed episode. Usuallybut not alwaysBipolar I Disorder also involves at least one episode of depression.
Bipolar II Disorder In Bipolar II disorder, you dont experience full-blown manic episodes. Instead, the illness involves episodes of hypomania and severe depression.
Cyclothymia Cyclothymia is a milder form of bipolar disorder that consists of cyclical mood swings. However, the symptoms are less severe than full-blown mania or depression.
What Does Your Brain Look Like When You Have Depression
Grey matter in the brain refers to brain tissue that is made up of cell bodies and nerve cells. People with depression were shown to have thicker grey matter in parts of the brain involved in self-perception and emotions. This abnormality could be contributing to the problems someone with depression has in these areas.
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Not Everyone With Bipolar Disorder Goes Through Hypomania
Bipolar disorder is based on the mix of episodes a person experiences.
In order to be clinically diagnosed with bipolar I disorder, you have to have at least one manic episode lasting at least seven days , per the National Institute of Mental Health . You may also experience episodes of hypomania. While the minimum is four days, these can last up to several months, Dr. Ghaemi says. Someone with bipolar I may also experience depressive episodes lasting at least two weeks, or mixed episodes with symptoms of depression and mania. Basically, someone with bipolar I may deal with a variety of mood phases that dont necessarily include hypomania.
In order to be diagnosed with bipolar II disorder, you must have at least one hypomanic episode and one depressive episode, but no manic episodes, the NIMH explains. Hypomanic episodes are a non-negotiable part of this diagnosis.
Treatments For Bipolar Disorder
The high and low phases of bipolar disorder are often so extreme that they interfere with everyday life.
But there are several options for treating bipolar disorder that can make a difference.
They aim to control the effects of an episode and help someone with bipolar disorder live life as normally as possible.
The following treatment options are available:
- medicine to prevent episodes of mania and depression these are known as mood stabilisers, and you take them every day on a long-term basis
- medicine to treat the main symptoms of depression and mania when they happen
- learning to recognise the triggers and signs of an episode of depression or mania
- psychological treatment such as talking therapy, which can help you deal with depression, and provides advice about how to improve your relationships
- lifestyle advice such as doing regular exercise, planning activities you enjoy that give you a sense of achievement, as well as advice on improving your diet and getting more sleep
Its thought using a combination of different treatment methods is the best way to control bipolar disorder.
Help and advice for people with a long-term condition or their carers is also available from charities, support groups and associations.
This includes self-help and learning to deal with the practical aspects of a long-term condition.
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Brain Structure And Function
Researchers are learning that the brain structure and function of people with bipolar disorder may be different from the brain structure and function of people who do not have bipolar disorder or other psychiatric disorders. Learning about the nature of these brain changes helps doctors better understand bipolar disorder and may in the future help predict which types of treatment will work best for a person with bipolar disorder. At this time, diagnosis is based on symptoms rather than brain imaging or other diagnostic tests.
Common Symptoms Of Bipolar Disorder
Bipolar disorder affects an estimated 2.3 million Americans . Most people with the condition have bipolar 1 or bipolar 2. The most noticeable difference between bipolar 1 and bipolar 2 is the severity of manic episodes. Those with bipolar disorder 1 usually experience more intense periods of mania, which can include symptoms including:
- Racing thoughts.
- Euphoria, often accompanied by an exaggerated sense of self-importance and self-confidence.
- An inability to sleep.
- Risky behaviors, such as having unprotected sex or committing crimes.
During the most intense periods of mania, some individuals with bipolar disorder experience hallucinations.
Between manic periods, people with bipolar 1 may experience major depressive episodes that include symptoms such as:
- Depressed mood.
- Loss of appetite .
- Lack of interest in activities that were once considered enjoyable.
- Feelings of worthlessness or guilt.
- Difficulty concentrating and making decisions.
- Insomnia or excessive sleeping.
At least a quarter of people with bipolar disorder attempt suicide at least once in their lives .
People with bipolar disorder also have higher rates of substance abuse and addiction. You can learn more about this topic by reading the Guide to Mental Health and Substance Abuse. When someone struggles with bipolar and substance abuse, recovery often requires a medical detox program at Summit Detox & Mental Health in addition to counseling.
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How Often Do People With Bipolar Disorder Cycle
Verywell / Cindy Chung
In the context of bipolar disorder, a mental illness that involves extreme swings in mood, a cycle is the period of time in which an individual goes through one episode of mania or hypomania and one episode of depression. Unfortunately, there is no definitive answer to how often these cycles occur.
The frequency and duration of bipolar cycles are as varied as the people who experience them. A change or “mood swing” can last for hours, days, weeks, or even months.
What Is Bipolar Ii Disorder
A person affected by bipolar II disorder has had at least one hypomanic episode in their life. Most people with bipolar II disorder suffer more often from episodes of depression. This is where the term “manic depression” comes from.
In between episodes of hypomania and depression, many people with bipolar II disorder typically live normal lives.
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What Are The Treatments For Bipolar I Disorder
Manic episodes in bipolar I disorder require treatment with drugs, such as mood stabilizers and antipsychotics, and sometimes sedative-hypnotics which include benzodiazepines such as clonazepam or lorazepam .
Lithium : This simple metal in pill form is especially effective at controlling mania that involves classical euphoria rather than mixtures of mania and depression simultaneously. Lithium has been used for more than 60 years to treat bipolar disorder. Lithium can take weeks to work fully, making it better for maintenance treatment than for sudden manic episodes. Blood levels of lithium as well as tests to measure kidney and thyroid functioning must be monitored to avoid side effects.
Valproate : This antiseizure medication also works to level out moods. It is faster acting than lithium for an acute episode of mania. It is also often used off label for prevention of new episodes. As a mood stabilizer that can be used by a loading dose method beginning at a very high dose valproate allows the possibility of significant improvement in mood as early as four to five days.
Some other antiseizure drugs, notably carbamazepine and lamotrigine , can have value in treating or preventing manias or depressions. Other antiseizure medicines that are less well-established but still sometimes used experimentally for the treatment of bipolar disorder, such as oxcarbazepine .
A Condition Called Cyclothymic Disorder Which Presents As A Less Severe Form Of Bipolar Disorder Also Involves Hypomania
Much like hypomania is a less severe version of mania, cyclothymic disorder is a less extreme version of bipolar disorder, according to the NIMH. If you have cyclothymic disorder, you go through alternating periods of hypomanic and depressive symptoms that arent severe enough to fulfill the criteria of having actual hypomanic and depressive episodes. In order to qualify as having cyclothymic disorder, you must experience these symptoms on and off for at least two years.
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Where To Restore Your Well
If you are struggling with your mental health and substance abuse, help is available. At New Found Life, we have served our Long Beach community and facilitated connections since 1993. Our evidence-based continuum of care has been successful for hundreds of clients because we account for everyones unique physical, psychological, social and spiritual needs. To learn more, reach out to us today. We are here for you 24/7.
Other Options In The Treatment Of Acute Manic Episodes
Electroconvulsive therapy is effective during manic episodes however, because it is an invasive procedure and has negative side effects on memory , the indications are limited. Exuberant behaviour that needs to be controlled immediately, catatonic symptoms, resistance to current treatment and causes that limit the use of drugs such as pregnancy and old age are among the indications of ECT . There are studies that found the less invasive repetitive Transcranial Magnetic Stimulation both successful and unsuccessful in the treatment of manic episodes. The supplemental implementation of the rTMS to pharmacological treatments in the conducted studies might have been the cause of contradictory results. Moreover, the methodological differences between the studies might also have resulted in contradictory outcomes. For instance, in the studies the points of application appear to be different. Different regions of application in the rTMS procedure may result in differing effects. Therefore, more controlled studies are needed. In the literature, only one study on transcranial Direct Current Stimulation has been found . Still, in studies for other episodes of bipolar disorder, there is promising results for tDCS .
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Who Is At Risk For Bipolar Ii Disorder
Virtually anyone can develop bipolar II disorder. About 2.5% of the U.S. population suffers from some form of bipolar disorder – nearly 6 million people.
Most people are in their teens or early 20s when symptoms of bipolar disorder first start. Nearly everyone with bipolar II disorder develops it before age 50. People with an immediate family member who has bipolar are at higher risk.
What Is The Outlook
Bipolar disorder isnt curable. But with proper treatment and support from family and friends, you can manage your symptoms and maintain your quality of life.
Its important that you follow your doctors instructions regarding medications and other lifestyle choices. This includes:
Including your friends and family members in your care can be especially helpful.
Its also helpful to learn as much as you can about bipolar disorder. The more you know about the condition, the more in control you may feel as you adjust to life after diagnosis.
You may be able to repair strained relationships. Educating others about bipolar disorder may make them more understanding of hurtful events from the past.
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What Steps Can I Take To Better Cope With Or Manage My Mania
Although episodes of mania cant always be prevented, you can make a plan to better manage your symptoms and prevent them from getting worse when you feel a manic episode may be starting.
Some ideas to try during this time include:
- Avoid stimulating activities and environment such as loud or busy places or bright places. Instead choose calm and relaxing activities and environments.
- Stick to routines. Go to bed at a set time, even if youre not tired. Also, stick to the same times for eating meals, taking medications and exercising.
- Limit the number of social contacts to keep you from getting too stimulated and excited.
- Postpone making any major life decisions and big purchases.
- Avoid people and situations that might tempt you to make poor or risky choices, such as taking recreational drugs or drinking alcohol.
- Consider selecting someone to manage your finances during a manic episode.
If you ever have thoughts of harming yourself, tell family or friends, call you healthcare provider or contact the National Suicide Prevention Lifeline at 800-273- . Counselors are available 24/7.