Bipolar disorder is characterized by up-and-down episodes of mania and depression. During a manic phase, some patients can have a total break from reality.
But hypomania, which is also a symptom of the disorder, is a high-energy state in which a person feels exuberant but hasn’t lost his or her grip on reality.
"Hypomania can be a pretty enjoyable state, really," Dr. Bearden says. A person’s mood can be elevated, they may have a lot of energy and creativity, and they may experience euphoria. This is the "up" side of bipolar disorder that some people with the condition actually enjoy—while it lasts.
Inability to complete tasks
Having a house full of half-completed projects is a hallmark of bipolar disorder. People who can harness their energy when they are in a hypomanic phase can be really productive.
Those who can’t often go from task to task, planning grand, unrealistic projects that are never finished before moving on to something else.
"They can be quite distractible and may start a million things and never finish them," says Don Malone, MD, the director of the Center for Behavioral Health and chair of the Department of Psychiatry at Cleveland Clinic, in Ohio.
A person who is in a bipolar depressive state is going to look just like someone who has regular depression. "They have the same problems with energy, appetite, sleep, and focus as others who have 'plain old depression,'" Dr. Malone says.
Unfortunately, typical antidepressants alone don't work well in patients who are bipolar. They can even make people cycle more frequently, worsening their condition, or send someone into a break-with-reality episode.
"Antidepressants can be downright dangerous in people with bipolar because they can send them into mania," he says.
Some people with this condition suffer from "mixed mania," where they experience symptoms of mania and depression at the same time. During this state, they are often extremely irritable.
Everyone has bad days, which is one reason this kind of bipolarity is much harder to recognize.
"We are all irritable or moody sometimes," Dr. Bearden says. "But in people with bipolar disorder it often becomes so severe that it interferes with their relationships—especially if the person is saying, 'I don’t know why I’m so irritable…I can’t control it.'"
Some people are naturally talkative; we all know a motormouth or Chatty Cathy. But "pressured speech" is one of the most common symptoms of bipolar disorder.
This kind of speech occurs when someone is really not in a two-way conversation, Dr. Bearden says. The person will talk rapidly and if you try to speak, they will likely just talk over you.
They will also sometimes jump around to different topics. "What’s kind of a red flag is when it is atypical for the person to talk like this," doing it only when they are in a manic cycle but not at other times, she says.
Trouble at work
People with this disorder often have difficulty in the workplace because so many of their symptoms can interfere with their ability to show up for work, do their job, and interact productively with others.
In addition to having problems completing tasks, they may have difficulty sleeping, irritability, and an inflated ego during a manic phase, and depression at other times, which causes excessive sleeping and additional mood problems.
A lot of the workplace problems can be interpersonal ones, Dr. Malone says.
Alcohol or drug abuse
About 50% of people with bipolar disorder also have a substance abuse problem, particularly alcohol use, Dr. Bearden says.
Many people will drink when they are in a manic phase to slow themselves down, and use alcohol to improve their mood when they are depressed.
When they are in a manic phase, people with bipolar disorder can have an inflated self-esteem.
"They feel grandiose and don't consider consequences; everything sounds good to them," Dr. Malone says.
Two of the most common types of behavior that can result from this are spending sprees and unusual sexual behavior. "I have had a number of patients who have had affairs who never would have done that if they weren't in a manic episode…during this episode they exhibited behavior that is not consistent with what they would do normally," he says.
People with this condition often have sleep problems. During a depression phase, they may sleep too much, and feel tired all the time.
During a manic phase, they may not sleep enough—but still never feel tired.
Even with just a few hours of sleep each night, they may feel great and have lots of energy.
Dr. Bearden says staying on a regular sleep schedule is one of the first things she recommends for bipolar patients.
Flight of ideas
This symptom may be something that is hard to recognize, but it occurs frequently when someone is in a manic phase. People feel like their mind is racing and that they can't control or slow down their thoughts.
This flight of ideas sometimes occurs with pressured speech.
People with bipolar may not recognize or admit that their mind is racing out of control, says Dr. Bearden.
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Did you ever stop and think of that before you chewed out the poor offenders who just wanted you to be able to see in the house when you got home?
Now go give them a hug and apologize.
And no more beer for you till you make up with them.
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