Johns Hopkins Health Alert
Bipolar Disorder Type 1 or 2: How to Tell the Difference
Bipolar disorder can begin with a bout of either depression or mania, but about two thirds of cases start with a manic episode, and mania tends to predominate. Just as there are many forms of depression, there are several types of bipolar disorder. The two main subtypes are bipolar type 1 and bipolar type 2. Both are characterized by one or more major depressive episodes, but the type and degree of mania differ.
- Bipolar type 1. People with bipolar type 1 experience mania consisting of distinct periods of persistently elevated, expansive or irritable mood. The mania may involve delusional ideas and impaired judgment. A manic episode is diagnosed if elevated mood occurs with three or more other symptoms for most of the day, nearly every day, for one week, or longer.
- Bipolar type 2. People with bipolar type 2 experience what's called hypomania, a mild to moderate level of mania that is generally a less destructive state than mania. Hypomania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Impaired judgment is rare.
Symptoms of bipolar type 2 can be so mild that patients -- and their doctors -- mistake these periods of good mood for recovery between depressive episodes. Therefore, even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can turn into severe mania in some people or can switch into depression.
By definition, a manic episode may include psychotic symptoms (such as hallucinations or paranoia) during the euphoria. About one-half to two-thirds of people with mania have psychotic symptoms. In hypomania, no psychotic symptoms are present.
Getting the correct diagnosis is crucial. Certain medications and health conditions can cause significant mood swings that mimic the symptoms of bipolar disorder. These include corticosteroids, antidepressant or antianxiety drugs, drugs for Parkinson's disease such as tolcapone (Tasmar), abuse of alcohol or other drugs, an underactive or overactive thyroid gland, a neurological or adrenal disorder, vitamin B12 deficiency and other mental health conditions such as schizophrenia. These potential causes of mood swings should be taken into account when a person is suspected of having bipolar disorder or is not responding to treatment.
Posted in Depression and Anxiety on January 17, 2012
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