Bipolar I: Severe mania, with depression
Distinct periods of elevated, expansive or irritable mood
Inflated self esteem/grandiosity
Decreased need for sleep
More talkative than usual
Racing thoughts/ideas
Distractibility by the irrelevant
Increased goal directed activity, psychomotor agitation
Excessive/impulsive behavior in pleasurable activities
Bipolar II: Major depression, hypomania (milder mania)
Mood elevated or irritable
More energy than usual
Talkative
Decreased sleep
Inflated self-esteem
Hypersexuality
Excessive involvement in pleasurable acitivities
Major depression:
No interest or pleasure (Most common symptom)
Depressed mood
Weight loss/gain
Insomnia/hypersomnia
Psychomotor retardation
Fatigue or loss of energy
Feelings of worthlessness/guilt
Decreased concentration
Recurrent thoughts of death
Cyclothymia:
For at least 2 years, periods of
hypomania and depression symptoms that do not meet major depression criteria
Bipolar NOS:
Official diagnosis for significant
bipolar symptoms, but not
enough to qualify for BPI, II, CT

Mood stabilizing medications treat depression and mania:
Anticonvulsants
Depakote*
Lamictal**
Tegretol
Trileptal
Gabitril
Topamax
Keppra

Atypical Antipsychotics
Zyprexa* **
Risperdal* ****
Seroquel*
Geodon*
Clozaril
Abilify*
Other Options
Lithium* **
Thyroid
Symbyax***
FDA approval for:
*Mania
**Maintenance (Stabilization)
***Bipolar depression
****Mixed episodes

The spectrum of bipolar disorders is characterized by mood instability and impulsivity. About 1% (2 million) of the population is bipolar I. Bipolar has multiple forms. It ranges in severity from mildly disruptive to life destroying. As in other medical conditions such as diabetes and hypertension, the vulnerability to bipolar disorder is inherited. Once you have it, you have it for life. Fortunately, like hypertension, it can be medically controlled.
Mood swings usually start in the 20’s, but can start in childhood or during the teens. If depression is present in these early years, there is an increased risk of bipolar. Sometimes, the first major mood swing doesn’t occur until the 30’s or occasionally, later.
If mood is compared to room temperature, (too cold equals depression and too hot equals mania), bipolar disorder is like having a defective thermostat. The thermostat gets
stuck at one extreme (mania or depression) and the temperature (mood) goes out of control.
Mood swings can occur abruptly. They may be induced by seasonal changes, hormonal changes, certain medications (such as steroids, decongestants, antidepressants, stimulants, recreational drugs), or too much or too little sleep.
One of the biggest problems facing those with bipolar disorder is what is described as the “kindling effect.” This means that every episode of abnormal mood (low or high), increases the sensitivity of the brain’s mood regulators. This makes it easier to have mood swings in the future.
Many of my patients are unquestionably bipolar and many show no signs of the disorder. But, patients that fall in a “gray” area with some symptoms present, make pinpointing the diagnosis very difficult. These individuals often appear to be primarily oppositional, substance abusers, or have personality disorders. This group is the greatest challenge to psychiatry and requires the closest scrutiny. Because of its complexity, bipolar disorder usually needs to be treated by a Psychiatrist.