What Are The Differences Between Mania & Hypomania And Bipolar I&II?

Excerpts from article: Alternative Depression Therapy
Benjamin Schwarcz MFT - Psychotherapist

Bipolar Symptoms are difficult to recognize without looking at your behavior patterns over time. The typical symptoms of bipolar disorder will depend on what type of episode you are going through.

To break it down as simply as possible, bipolar symptoms will show up in one of four types of episodes:

Depression (may look identical to any typical, "uni-polar" depression)
Mania (extreme elevated mood)
Hypomania (mild to moderate elevated mood)
Mixed (combination of depressive symptoms and increased energy, anxiety or agitation)
Different people experience different symptoms and patterns of this illness. Some may experience periodic manic or hypomanic episodes, followed by periods of normal moods. Others may crash into mild or severe depression, which may last for weeks or even months before resolving. When a person's bipolar symptoms cycle through four or more episodes within a 12 month period, it is called "rapid cycling." Rapid cycling can vary widely in it's frequency, and for some people can cycle several times within a day ("ultra rapid-cycling") or even one minute to the next ("ultra-ultra rapid cycling").

Alternative Mania or Hypomania is generally the only tip-off that a person may have Bipolar Disorder. In the case of "Soft Bipolar" - a milder form of Bipolar II - diagnosis may be especially difficult. And it must be determined that the the apparent bipolar symptoms are not caused by:

head injury or other neurological problem
over-active thyroid
allergic reaction/ food allergies
stimulant or other substance use
other mental illness such as Attention Deficit Hyperactivity Disorder (ADHD), Schizophrenia or Schizoaffective Disorder. (Schizophrenia is a diagnosis characterized by hallucinations and/or delusions, while Schizoaffective Disorder has the addition of bipolar symptoms).
What about "Spiritual Awakening", "Spiritual Crisis" or "Spiritual Emergence"?

Rarely acknowledged by traditional psychiatry, the spiritual dimension of mania and what is most often labeled as "psychosis" may often times reflect a deeper spiritual emergence, a dissolution of ego, or higher state of consciousness. This is rarely a pure spiritually realized state, but rather a sudden, intense expansion of consciousness which is a blend of true spiritual insight, intuition, wisdom, and even psychic experiences -- mixed with ego-level fear, anxiety and confusion. Professionals and crisis workers often fail to respect or recognize the spiritual truths that are part of this experience and instead focus on the "delusional" or psychotic process as pathological and meaningless. This is does a terrible disservice to the person in crisis.

Once the manic episode resolves, the person is often left feeling confused, depressed, frightened of their experience and alienated from others because the spiritual element of the experience is never validated and they cannot find meaning or value in the experience.

"The Natural Medicine Guide to Bipolar Disorder" by Stephanie Marohn, lists twenty factors in Bipolar Disorder. These factors can cause, or contribute to, bipolar symptoms. They are as follows:

genetic vulnerability
stress
chemical toxicity
heavy metal toxicity (such as mercury, lead, copper and aluminum)
food allergies
intestinal dysbiosis
sensitivity to food additives (two common ones are MSG and Aspartame)
nutritional deficiencies or imbalances
neurotransmitter deficiencies or dysfunction
hormonal imbalances
hypoglycemia
structural factors (cranial compression due to birth trauma or later injury)
medical conditions
medications
stimulants
lack of sleep
lack of exercise
lack of light
energy imbalances
psychospiritual issues

Bipolar Disorder is frequently misdiagnosed as depression or anxiety and it often takes more than 10 years for the average person to receive an accurate diagnosis.
In mainstream medical practices, considerations for making a diagnosis are usually restricted to the following:

Personal history/ patterns of mood changes/ symptomology
Response to medication
Family History - especially, blood relatives with Bipolar Disorder, or Depressive Illness.
Personal reflection, and observation by family and friends of a distinct pattern of changing moods, including periods of sustained, abnormally elevated mood, are usually the most reliable means of diagnosis.

"In the pre-drug era, bipolar patients were usually asymptomatic between episodes; 85% returned to their usual occupations; and they showed no signs of long-term cognitive decline. Today, bipolar patients are much more symptomatic; only about one-third return to their usual occupations; and they become cognitively impaired over the long term."
-Robert Whitaker, author of Anatomy of an Epidemic

There is a clear genetic influence for Bipolar Disorder, and although other factors can influence or trigger it, genetics can predispose you to the illness (sometimes referred to as a genetic vulnerability). According to the National Institute of Mental Health, more than two-thirds of people with bipolar disorder have at least one close relative with the disorder or with unipolar major depression.

As the following chart shows, family genetics seems to play a strong role in bipolar disorder, but is not the only factor. Environmental and other factors such as stress, trauma, lack of sleep, drug and alcohol use, and giving birth, can trigger or "uncover" a bipolar vulnerability - setting the disorder in motion. (See the above list of bipolar factors)

Evaluation by a qualified mental health professional is extremely important in order to make an accurate diagnosis. Medical causes of mood changes (such as thyroid problems) should always be tested and ruled out first by a medical doctor before treating bipolar symptoms. Other problems should be ruled our as well, such as food allergies or nutritional deficiencies. Your medical doctor may disregard or minimize this as a relevant cause of bipolar symptoms, so you may need to see a holistic health practitioner for this type of evaluation. Mainstream doctors very rarely consider nutrition and diet in diagnosis or treatment.

Mania
"....I never noticed anything out of the ordinary about Jim before. He's a really high energy person - a real people person. He's incredibly driven and manages to be very successful in his own business and still have time for friends and family. But lately, since his father died, he's been going without sleep. He's started to act strangely and keeps talking about magical powers. He says he can read people's minds. He's been making huge purchases of office equipment that we don't even need. He's been drinking more than usual, and gets even more bizarre, and even hostile when he's had a few drinks. It's almost impossible to get a word in when he's talking and he jumps from one subject to another. He says he's on a mission from God. Today he was nearly arrested for reckless driving...."

Signs and symptoms of mania (or a manic episode) include*:

Increased energy, activity, and restlessness
Excessively "high," overly good, euphoric mood
Extreme irritability
Racing thoughts and talking very fast, jumping from one idea to another
Distractibility, can't concentrate well
Little sleep needed
Unrealistic beliefs in one's abilities and powers
Poor judgment
Spending sprees
A lasting period of behavior that is different from usual
Increased sexual drive
Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
Provocative, intrusive, or aggressive behavior
Denial that anything is wrong
A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present. Of all Bipolar Symptoms, manic symptoms are the most easy to identify by an outside observer.

Signs and symptoms of depression (or a depressive episode) include*:

Lasting sad, anxious, or empty mood
Feelings of hopelessness or pessimism
Feelings of guilt, worthlessness, or helplessness
Loss of interest or pleasure in activities once enjoyed, including sex
Decreased energy, a feeling of fatigue or of being "slowed down"
Difficulty concentrating, remembering, making decisions
Restlessness or irritability
Sleeping too much, or can't sleep
Change in appetite and/or unintended weight loss or gain
Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury
Thoughts of death or suicide, or suicide attempts
A depressive episode is diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer. Bipolar Symptoms showing up as a depressive episode are difficult to diagnose as Bipolar Disorder, without a known history of manic or hypomanic episodes.

A mild to moderate level of mania is called hypomania. Hypomania (characteristic of Bipolar Type 2)may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Thus even when family and friends learn to recognize the mood swings as possible bipolar symptoms, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression.

Sometimes, severe episodes of mania or depression include symptoms of psychosis (or psychotic symptoms). Common psychotic symptoms are hallucinations (hearing, seeing, or otherwise sensing the presence of things not actually there) and delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person's usual cultural concepts). Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at the time. For example, delusions of grandiosity, such as believing one is the President or has special powers or wealth, may occur during mania; delusions of guilt or worthlessness, such as believing that one is ruined and penniless or has committed some terrible crime, may appear during depression. People with bipolar disorder who have these symptoms are sometimes incorrectly diagnosed as having schizophrenia, another severe mental illness.

It may be helpful to think of the various mood states in bipolar disorder as a spectrum or continuous range. At one end is severe depression, above which is moderate depression and then mild low mood - a common and transitory state when it is short-lived but is termed "dysthymia" when it is chronic. Then there is normal or balanced mood, above which comes hypomania (mild to moderate mania - a characteristic of Bipolar Type 2), and then severe mania (which is required for a diagnosis of Bipolar Type I).

In some people, however, bipolar symptoms may include elements of both mania and depression -- what is called a mixed bipolar state. Symptoms of a mixed state often include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. A person may have a very sad, hopeless mood while at the same time feeling extremely energized. This can be extremely disruptive to a person's sense of order and sense of self. And it can be confusing to family and friends because it is so hard to understand what the person is experiencing.

Much research has been done, and continues to show that fish oil is useful as a mood stabilizer and anti-depressant, and it is non-toxic. It is widely recognized as a natural medicine for depression and bipolar symptoms. It also has multiple other health benefits including heart health, prevention of stroke, diabetes, cancer, and arthritis.   


This information may serve as a self-help tool, but the use of this information does not constitute a therapist/client relationship and should not serve as a means of self-diagnosis or a substitution for actual psychotherapy. The information on this site is for informational purposes only. If you are experiencing depressive or bipolar symptoms it is advised that you see your doctor or therapist for an evaluation. If you are having active thoughts of suicide please call 911 or your local Psychiatric Emergency Service, or call the National Suicide Hotline: 1-800-SUICIDE.