Understanding Bipolar Mania
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Defining mania.
While much has been written over the years about depression in individuals with bipolar disorder, less attention has been paid to mania. Mania is generally what differentiates bipolar disorder from clinical depression. Its severity helps to determine how bipolar disorder is classified. Currently, there are four different classifications of Bipolar Disorder. They are as follows in order of severity (from least to most severe):
- Cyclothymia
- Bipolar Disorder Not Otherwise Specified (BP-NOS)
- Bipolar Disorder II
- Bipolar Disorder I
Please see my hub entitled Moody or More for additional information about the varying degrees of bipolar disorder diagnoses. For now, let's take a look at the definition of mania, so that we may better understand what makes bipolar disorder different, and in many cases, more difficult to treat than clinical depression.
Mania is defined by Merriam-Webster as "excitement manifested by mental and physical hyperactivity, disorganization of behavior, and elevation of mood; specifically: the manic phase of bipolar disorder." It is incredibly important to keep in mind that it is, unfortunately, a disorganization of behavior. The question then becomes: how does this disorganization of behavior manifest itself?
Mania, depression, or both?
Many assume that when a person experiences a manic episode, they are filled with productive energy and able to go days without sleep while accomplishing a myriad of tasks. Would that it were so! In truth, an individual in a manic phase may indeed be filled with energy but it is nearly impossible for them to zero in on anything productive. The mental hyperactivity results in thoughts that run through the bipolar mind at ridiculous speeds, making it virtually impossible for them to be caught and tamed by the manic individual.
In addition, mania may result in periods of extremely high anxiety, nearly crippling the person suffering from it. This overwhelming anxiety can often far outshine the "elevation of mood" that is part of the definition of mania. Unfortunately, the more severe the manic episode, the more likely it is that the individual will suffer high anxiety rather than any sort of elevation in mood.
An individual who suffers from bipolar disorder can often experience this mania along with severe depression, resulting in what is called a mixed episode. When this happens, not only does the bipolar person suffer from serious sadness, hopelessness, and a sense of being lost, but they suffer racing thoughts and high anxiety along with those emotions. It seems confusing to many people then that mania, which by definition should leave a person with an elevated mood, can coexist with depression.
Medication therapy.
This mixed episode is a huge part of the reason that bipolar disorder is more difficult to treat than depression alone. First, one of the side effects of many antidepressants is mania. If an individual with bipolar disorder is already suffering through a manic episode, it may get worse. Then it becomes necessary for the doctor to prescribe medications known as mood stabilizers. Some common examples of mood stabilizing medications are Lithium, Depakote, and Tegretol. Depakote and Tegretol are also used as anti-seizure medications.
Even the antidepressants and mood stabilizers, though, may not be enough if a person is suffering a mixed depressive/manic episode. In cases such as these, it is not uncommon for the prescribing physician to add an atypical antipsychotic. Examples of these medications include Abilify and Zyprexa. These help to further stabilize the mood of a bipolar individual.
Having been bipolar now for seven years, I am well aware of the fact that often, it is a trial and error procedure for the doctors to determine proper dosages for each of these medications. Along with that, many have side effects that make them unsuitable for some people. For example, my hands shake terribly when I take Depakote, to the point that I cannot sign a credit card receipt legibly. In addition, I get terrible headaches that are similar to migraines.
One of the most terrifying things to discover when you are diagnosed with bipolar disorder is that you will need to be on medication for the rest of your life. At least that is the case for anyone diagnosed with Bipolar Disorder I. It is possible for a person with Bipolar II to have periods where they are able to manage their illness with talk or cognitive therapies. Cyclothymia is generally managed without medication.
Fidelity to treatment.
Unfortunately, bipolar disorder tends to worsen with age, and it is likely that no matter where your diagnosis begins, you will wind up having to depend on medication to manage it. Do not despair! Proper usage of medication and adherence to a regular program of therapy can keep you as healthy and normal as anyone else.
It's vital for those who have been diagnosed with bipolar disorder to cooperate with their doctors. In the beginning, it will seem as though they are guessing, but I've discovered over time that there is indeed a method to the madness in prescribing psychotropic drugs. Adjusting medications and dosages are what will eventually allow you to function just like the average "normal" person. Don't give up on your doctors, be as honest with them as possible, and be faithful to the regimens they plot out for you. Eventually, one will take, and once it begins to work the way it should, you'll feel so much better!
More about living with Bipolar Disorder
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Hey Girl!
This cuts close to home. Very close. I may give you my phone number in an e-mail. I've got some decisions to make here in the next six months. More on that some other time ..
This was put together extremely well my friend. You get a damn "10"!!
Talk to ya soon!
jim
Thanks, jack! I can understand your apprehension. I was quite fearful for my future when I was originally diagnosed, but I have a great deal more confidence now.
I'll admit that I have learned through my own mistakes the utmost importance of being faithful to treatment. :) I'm so glad you enjoyed the hub, and I appreciate the kind words.
Jim, you're welcome to pick my brain anytime, via phone, email...shoot, even telepathy if you can figure out how to make it work for ya! :) Thanks for kind words. I learn more about this particular illness everyday, and I'm happy to be of assistance to anyone with questions about it. If I don't know the answer, I'll sure work to find it for you.
Talk to me soon! It'll be a blessing. :)
Prayers are on the way for you, as always.
Michele
You should write a hub about the DSM IV and how all diagnosis are subjective and there are NO Medical test that can determine this illness.
So with no medical test - no blood work, no x ray, no ct, no nothing. How does one treat it with medication?
Think about that. How can there possibly be a baseline for medical treatment with no test to establish a chemical imbalance.
People can certainly be mentally ill... but they do not have a Paxil, Zoloft, ________ choose your medication deficiency.
Great write up! A lot of people I know get wrongly diagnosed as bipolar. The medicines that are prescribed for bipolar disorder is some pretty strong medicine. Voted up.
MikeNV, as far as medication therapy goes, the particular drugs that are prescribed for mental illness do not add anything to the body chemically. They alter the way the brain uses its own chemicals to balance moods. A common misunderstanding is that antidepressants are mood "elevators." They are not. They allow the brain to properly utilize serotonin and norepinephrine, which are naturally occurring chemicals that allow the neurotransmitters in our brain to function properly. It is well known in psychiatric medicine that there is a malfunction in the processing of these chemicals in the brain that makes a person experience depression, and likewise mania.
I am not a medical doctor, and cannot speak to what tests are available to diagnose mental illness. I can speak quite truthfully, however, about the success I've experienced personally with psychotropic drugs. Flat out, I have been told by doctors, and have found myself in complete agreement, that if you are NOT experiencing a true chemical imbalance, or, more accurately, if your brain is properly processing the chemicals that it produces, psychotropic drugs will have little to no effect. In essence, an antidepressant is not a happy pill, and mood stabilizers and antipsychotics are not downers.
I appreciate your comments. If you are indeed a medical doctor who can point to errors in my hub, I welcome that. If you simply disagree with the information that I've shared (quite subjectively, of that I'm well aware), that's a different ball game.
rorshak, thank you for your comments. I appreciate the visit and the feedback. I agree that any drug that alters brain behavior could easily be considered "heavy" but they are indeed necessary for those of us whose brains function in a way that is out of the ordinary. I readily admit that there is a lot of trial and error that goes into an accurate diagnosis of bipolar disorder, and many illnesses are wrongly classified as such. I think the important thing to remember is that in a truly bipolar brain there is an abnormally wide disparity between moods that doesn't exist for others. Effective psychotropic drugs help to narrow the gap.
This sounds like such a painful illness for everyone touched by it. My heart goes out to these people. You did a great job educating us about this awful disease.
Thanks for the praise, Hyph. I appreciate it. It can be devastating, in all honesty, but with proper therapy and fidelity to that therapy, an individual with Bipolar Disorder can live as fulfilling a life as anyone else. It's far from easy, but it most certainly can be managed. :) Thank you for reading.
MO - I didn't realize there we so many facets to Bipolar - I've heard of it a lot. But didn't fully understand much about it. Especially about the mania - very interesting too! I do know there are lots of people out there who could benefit from meds - but they are afraid to face this stuff. I am so glad you write about this with an open mind and open heart. Way up!
A very well informed hub about this awful disease.
Motown2Chitown...sad thing about us humans is that once any disease strikes our body..we become aware of it and start respecting this machine of ours otherwise, all of us are running after something or the other.
I wish and pray that we all realize it before it is too late.
I never knew that Bipolar Disorder can get worse with age. I found your article very educational.
Real, I think so many people hold onto the stigma of mental illness so tightly that it keeps them from living their lives to the fullest with medication and proper therapy. It's sad. I know that I was incredibly reluctant in the beginning to accept my diagnosis because I was terrified that it meant I was "crazy." Overall, once I understood that it was simply an illness that could be properly managed with medication, I was able to accept the help I needed to move forward.
Ruchira, thank you for your kind words. I agree that too often we are unaware of our own fragility until it is thrust upon us in illness. These days, though, with education, treatment, and support from others who suffer the same troubles, we can shake off the shame and get ourselves well.
Susan, that is what the doctors have always told me. One contributing factor, though, is that people choose not to treat the disorder for so long, for so many different reasons, that it becomes more severe and more difficult to manage. Another is that it is such a hard diagnosis to make because of the many facets of the illness and because of the fact that we cope with SO much stress sometimes in our daily life that we don't recognize when our behavior is situational versus when it's truly outside the scope of normalcy because of the way our brain is firing.
I have been on medication for depression before. I have never found a medication that made me feel right, so I always ended up pulling myself off. Depression can be a scary place to be. Kudos to you for being strong enough to write about it.
Thanks, BBG. :) It's a rough road sometimes, and writing about it helps to smooth the path a bit. :D
I am a bit of a closet depressant. I had an accident with my medication and my parents didn't even know I was on it. I got lectured for awhile about how stupid I was. Gee - cause that is going to make someone feel better when they were already depressed.
I hear ya, BBG. I think that's why it's so important to be open and honest with friends and family about what you're going through. We tend to keep it to ourselves because of embarrassment or shame...but no one can truly offer assistance if they don't know what's happening. AND, it helps us to know that we're not alone. :)
Great information here Mo. Well written and easy to understand. Thanks!
Sharyn
Thanks, Sharyn. It's therapeutic to write about it, believe it or not, and I'm always hopeful that it will be useful to those who struggle with an illness that's misunderstood by so many - including those of us who live with it on a daily basis. :) Thanks for stopping by!
This is valuable information you have shared here. I find that depression is a socially acceptable disorder, but most every other disorder is highly stigmatized. It is great that you are sharing your information so we can all learn about it and not be afraid of it.
Thanks for stopping in, MT. My hope is that in being really open about what I struggle with, others will be far less ashamed than I have been and seek the help and support they need.
Motown.....I would like to tell you that I admire you and am impressed at how well-informed and involved you have made yourself on this subject....to include being properly informed on the medications.
This is so vital and valuable, as I'm sure you are aware. Sadly not enough individuals take such an interest in being the Dr's best partner in Health.
No one should ever feel alone...because the reality is, we are not alone. For every one, every where, there will always be an understanding heart and hand to hold. Bless you. UP ++
Effer, thanks for stopping in and for your very kind words. I don't believe that anyone with a mental or physical illness should be a bystander of their own treatment. Knowing what I know and continuing to learn is what continues to motivate my recovery...because I am not alone...and others may need to be motivated and encouraged as well.
I recieved A packet from my doctor with this info, now this coming week I have a doctors appointment to be tested/diagnosed for bipolar.
Im kind od scared, i dont really know why am. Should I be?
ladywithwords, thank you for stopping by. I can certainly understand being scared or nervous. In the beginning, when I was diagnosed, I felt much the same way. You are completely justified in feeling that way...it can be a scary thing to face. I would say just to know that this is an opportunity to make your life so much better! Knowing that we're bipolar (or not) can allow us to put a plan into action to make ourselves feel so much better and make our lives so much better!
I think we're afraid sometimes because of the stigma attached to mental illness and because it's something that we don't necessarily understand about ourselves.
I encourage you to be open with the doctor and gentle with yourself. Walking in, it's an overwhelming thing, but treatment is so important and so valuable - and you'll find yourself so much stronger by going through it.
I wish you all the best. If there is anything I can do to help, please do not hesitate to contact me again...either through this hub, or through the contact link on my profile.
Wishing you all the best and will be keeping you in prayer.
Peace! :)
stclairjack Level 4 Commenter 6 months ago
well done here, i have a history of this in my family, and my boyfriend is diagnosed bi-polar and major depressive dissorder,... dealing with others suffering from this is tough but possible, depending on the personalities and severity of episode.
looking into my own future has me a bit aprehensive as i see symptoms in myself at my age, but my dealings with others have given me a "boots on the ground" education that i have been able to apply to myself.
once again, this was well done,... i especialy like your stressing of "being faithfull" to the treatment.