The Subtypes of Bipolar:
A Better Understanding of a Misunderstood Illness
Most people know bipolar disorder as a mental illness with two distinct poles – mania and depression – but did you know that there are actually different types of bipolar disorder? The disease can be split up into five different subtypes:
- bipolar I
- bipolar II
- rapid cycling
Understanding the main signs and symptoms of each subtype is important when determining which type of treatment is best for you.
So what do these different types mean, and how can you tell them apart? First, it’s important to know the terminology behind this disorder.
• Mania: Known as the “high” part of this disorder, mania is characterized by feelings of euphoria and invincibility. Although mania can feel wonderful for a period of time, those experiencing a manic episode can easily become angry and irritated without provocation. Psychotic delusions are common during periods of mania. Manic episodes have been correlated with high levels of norepinephrine in the brain.
• Hypomania: Known as a less-intense form of mania, hypomania is characterized by feelings of elation and hyperactivity. As opposed to mania, psychotic delusions are not usually found. Because of this, the person may believe that they are functioning properly and may ignore any signs of hypomania.
• Depression: Known as the “low” part of this disorder, depression is characterized by feelings of intense self-hatred and sluggishness. Common bipolar depression symptoms include guilt and feelings of restlessness, which aren’t common in major depressive disorder. The cause of bipolar depression is thought to be a drop in levels of serotonin in the brain.
Now that you have an idea of the different mood swings common in bipolar disorder, you can better understand the different subtypes of this illness.
• Bipolar I: Most people diagnosed with bipolar I experience extreme episodes of both depression and mania. In some cases, they may only experience mania. Bipolar I is distinguishable due to its intense manic phase, which can last from several weeks to several months and is usually accompanied by delusions. In more extreme cases, patients may need to be hospitalized for their own safety due to risky behaviors.
• Bipolar II: Bipolar II is distinguishable from bipolar I because those suffering from this subtype experience episodes of depression mixed with episodes of hypomania. Since hypomania can feel extremely good to patients who have been suffering through periods of depression, some may stop taking their medications in order to unnaturally cause a hypomanic episode. When symptoms reappear after stopping medication, they are typically more intense and harder to control the next time around. Though bipolar II is typically known as a more mild form of bipolar, the suicide rates for this subtype are higher.
• Cyclothymic Disorder: People suffering from this disorder alternate between periods of hypomania and mild depression. Though it is not severe as the first two subtypes, it persists for longer periods of time with no break in symptoms. In some cases, cyclothymic disorder can develop into either bipolar I or bipolar II, though in other cases it continues as a chronic condition. In order to be diagnosed with cyclothymic disorder, you must have experienced periods of hypomanic symptoms and depressive symptoms for at least 2 years. During this time, these symptoms cannot meet the criteria for a full hypomanic episode or major depressive episode.
• Rapid Cycling: In most cases of bipolar disorder, patients have an average of 8 to 10 manic or depressive episodes during the course of their lifetime. In rare cases, people can experience what is known as “rapid cycling”, which is when they can experience periods of both mania and depression in one day. In order to be diagnosed with rapid cycling, you must have at least four mood swings in one year.
• Mixed Episode: When a mixed episode occurs, symptoms of both mania and depression can occur at the same time. The combination of depression and increased energy makes this the most dangerous of bipolar episodes; a mixed episode is when the majority of bipolar suicides occur.
The specific subtype of bipolar disorder that you are diagnosed with determines how you will move ahead with treatment. Though most types of bipolar symptoms are treated with the same medications, you may need to have different dosages depending on how many episodes of mania, hypomania, and depression you experience. It’s important to keep track of your high and low episodes, including how long they last and how often they occur. The better you understand the different types of bipolar disorder, the better you can understand yourself or your loved ones.
From our hearts to yours,