I personally use I am bipolar (identity-first) and I have bipolar disorder (person-first) almost interchangeably, with a preference for identity-first since bipolar disorder is with me for life. It’s part of who I am, even if I need medication to help manage it. As such, I use both identity-first language and person-first language throughout this article.
What is Bipolar Disorder?
Bipolar Disorder (also known as Bipolar Depression or Manic-Depression) is a mood disorder categorized by the presence of four specific mood-states. These are Major Depressive Episodes, Hypomanic and Manic Episodes, and Mixed Episodes. They each have specific criteria for what qualifies as an episode.
Bipolar Disorder is not just generic mood swings. Most of the time when people picture mood swings, they are short, rapid, and intense. They also can be for any emotion and lack any set standards. “Extreme happiness to extreme anger to uncontrollable laughter to uncontrollable crying and back within minutes” is the general media portrayal of mood swings. While these kinds of mood swings do exist in some diagnoses, they are not the hallmarks of Bipolar Disorder.
Bipolar disorder is called bipolar because it contains moodswings to two set extremes with specific criteria for them. Hypomania/Mania (Hypo/Mania) and Depression.
Depressive Episodes
The Depressive moods are the state most people will be more familiar with, as this state is Major Depression. For many people, especially Bipolar II, their Bipolar Diagnosis starts out as a diagnosis Major Depression Disorder.
Due to the fact Bipolar II often has longer lasting depressive episodes and the hypomanic episodes do not require hospitalization, their Bipolar Disorder can go undiagnosed for years. For Bipolar, the depressive episode must last at least two weeks, and may have a sudden onset and sudden resolution, or may have a build up and cool down time.
The Criteria for a Depressive Episode are as follows:
Five of the below, one of which must be 1 or 2
Depressed mood most of the day, nearly every day.
Significantly diminished interest in activities and hobbies most or all of the time
Significant changes (increase or decrease) in appetite and/or weight
Changes in sleep: Insomnia or hypersomnia
Psychomotor agitation or depression: Significant increase or decrease in movement.
Fatigue or significant loss of energy
Feelings of worthlessness or excessive guilt
Difficulty concentrating, increased indecisiveness, and agitation
Recurrent thoughts of death, suicidal thoughts, plans, or attempts
Hypomanic and Manic Episodes
Hypomania and Mania are characterized by extreme elevated mood, impulsivity, and movement and must last at least a week (for Mania) or four days (for Hypomania.) If psychosis is present or the person is hospitalized, the episode is Manic. If neither is present, the episode is Hypomanic. Bipolar I is given with the presence of at least one (1) Manic Episode.
Hypomanic and Manic Episodes Criteria are:
Persistent Elevated, Expansive, or Irritable Mood.
Three of the Below, Four if the mood is Irritable
Inflated Self Esteem or Grandiosity
Decreased Need for Sleep (Distinct from Insomnia)
Increased Talkativeness or Pressured Speech
Flights of Ideas and Racing Thoughts
Increased Goal-Directed Behavior or Psychomotor Agitation
Increased Distractibility
Increase in Risky Behaviors (Increased Impulsivity/Decreased Inhibitions)
Mixed States, Cycling, and In Between
Mixed Episodes or Mixed States are a “third” episode where symptoms for both a Depressive Episode and a Hypo/Manic episode are met and last at least a week.
Bipolar Disorder is relatively uncommon, with only about 2-3% of people experiencing it over a lifetime, and it affects men and women about equally. The average age of onset is in the mid-twenties (25), although it can happen earlier. (The first Hypomanic episode I’m aware of experiencing happened when I was 13. My Depressed episodes started in Elementary School.)
While the mechanisms for mood changes are not fully understood, they can be triggered by outside experiences. Good or Bad events in a person’s life can trigger a mood change, although they can also appear to happen for no reason.
The rate at which a person switches between Hypo/Manic and Depressed varies from person to person. Some people have episodes which last for years, some for months, and others for weeks. As such, the duration of your character’s episodes could last anywhere from weeks to years, although they tend to remain in a consistent pattern for an individual.
The way the episodes cycle is also variable from person to person. Some people will experience mixed episodes. Some people will switch between hypo/mania and depression without any in between time. Some people will experience hypomania as a build up to full mania. Some people will experience a baseline mood between episodes where they are neither hypo/manic or depressed.
Rapid Cycling Bipolar I/II are categorized as four or more mood changes in a year. There are various numbers given for the prevalence of rapid cycle, with 10-25% of Bipolar patients being average. Rapid Cycling is also tied to an earlier age of onset, more extreme symptoms, and is more common in females.
What do they feel like?
This is where we get into the subjective part of things. These are my own experiences with being Bipolar and as such may not reflect everyone’s experiences.
Depression:
My experiences here line up pretty well with what you’d see in Major Depressive Disorder. It is a long dark damp tunnel that’s not so much cold as just has an absence of heat that feels bone-chillingly cold. My body generally feels heavy and nothing seems to be worth the effort required to do anything. There is crushing sadness and hopelessness about everything, but that generally comes and goes in waves. Most of the time it’s just an empty “blah” feeling, where it is too much effort to feel anything.
Generally, this lasts about two months before I can expect the depression episode to swing into a hypomanic one. This doesn’t make it any easier to deal with, mostly because when I’m depressed, I can’t remember what it’s like to not be. It feels like I’ve always been this depressed and will always be this depressed. Trying to remember what it’s like to feel hypomanic is an effort in futility, because I just can’t imagine feeling anything but depressed.
Hypomanic:
Being hypomanic feels really, really good; almost too good. It’s like eating too much cotton candy and getting motion sick at a carnival. It’s feeling amazing and on top of the world, like nothing can bring you down. It’s like riding down a mountain on a gravel path on a bike knowing if you fall or spin out, it’s going to hurt so much, but the rush of adrenaline and the wind blowing by is almost like flying and it’s so so exhilarating. It’s having electricity running through your veins, making you move like a motor and constantly on the edge of burning out.
It’s feeling like you can do anything, and doing it.
It’s having six million ideas in the span of a minute and wanting to jump on every single one of them because it’s so great and you want to do everything because everything is so so good. It’s having the confidence to do all the things you’ve ever thought of doing but were too scared to. Being hypomanic is having all your thoughts running faster than you, and racing behind them to catch up, and when you speak having them pour out like Niagra Falls.
It’s sleepless nights because there’s so many things to do and experience and neither your mind or body tire. You’re beyond the mere mortal need for sleep. It’s spending all your money in a week because you’ve started a new project that you’ll drop as soon as the hypomania ends. It’s being impulsive because there’s no reason not to be. It’s getting irritated at people because they don’t move fast enough to keep pace with you, because they say no to something your entire being in saying yes to, because you’re flying and they’re trying to keep you on the ground.
Hypomania is existing in the realm of metaphors and knowing in the back of your mind that sooner or later it is going to come crashing to a painful end, and that that longer it goes on the worse it’ll be when you finally come down.
Generally, I get two/three weeks in a hypomanic state—and the longer it goes on, the harder the depressive episode that follows tends to hit me. I get super productive, and being autistic, my special interests and need to focus on one thing at a time helps mitigate the distractibility aspects and keeps me focused on projects I’ll be more likely to already have supplies for or will keep at after the hypomania ends. I also know I can redirect myself (or have other people redirect me) towards writing projects or ones I already have supplies for as a way to mitigate the damage done by spending sprees.
While hypomanic, I also feel like meds aren’t a help. That they’d just make me tired and unproductive. I’m currently on my meds and I can tell as soon as I miss a dose because I can feel the electric buzz in my muscles and the constant motor driven energy levels, thoughts, and desire to work on things come back. When I’m on them, I know they’re helpful.
Mixed Episodes and the “In Between Episodes” Time
I don’t usually experience mixed episodes and have only had a handful of them over the years. They are like drinking nyquil and six million energy drinks because you’re both depressed and hypo/manic. As much as hypomania can be too many pieces of candy sickening, mixed episodes are being stuck on a terrifying clown ride.
As I said above, my depressive episodes tend to last about two months. My hypomanic episodes last two to three weeks. Unmedicated, I tend to have no non-depressed non-hypomanic mood between the episodes. I can have a lessening of symptoms where I feel the episode easing up for a few days, which is my warning that I’m going to flip, and then it can take a few days for the other episode to set in.
Medicated on anti-depressants, I only notice depressive episodes when I get bad about taking my meds regularly. Taking antidepressants also can kick me into a hypomanic episode, and skipping doses (don’t do this; I’m not supposed to) or lowering them helps (also not supposed to). But the real thing that helps is the mood stabilizers and antipsychotics. These take the highs-’n-lows and evens them out. I still experience episodes, but they’re not as extreme and they’re easier to manage. It’s trial and error to figure out what works, and I’m still in the trial and error phase of medication. They’re also expensive.
I’m pretty bad about taking my meds, whether because I forget or because they’re making me feel worse. It’s also pretty common for patients to stop taking their meds when they start feeling better. People also stop taking them because they can’t afford them. None of these are things people should do because they can end up making symptoms worse, but nevertheless are things people do. Which means they’re great things for characters to do if you want to throw medicine-related complications at your character.
Photos by Julia Rendleman & Marcus Ingram at soon-to-be dismantled Robert E. Lee Statue on Monument Avenue in Richmond, former capital of the Confederacy. A symbolic & actual victory, and these photos really capture the moment…
