Differentiating Bipolar Disorder from Other Mood Swings
Dr. Danish frequently works with patients experiencing mood swings and helps differentiate between bipolar disorder and other causes of mood fluctuations. This handout is based on research and is meant to provide a general understanding. Patients are encouraged to discuss these ideas with their provider for personalized advice.
Understanding Bipolar Disorder
Bipolar disorder is characterized by extreme mood swings, including episodes of mania or hypomania, usually intermixed with episodes of depression. These episodes of mania or hypomania are more intense and last longer than typical mood swings, significantly impacting daily life for multiple days (to weeks) at a time.
Manic Episodes: Involve heightened mood, increased energy, reduced need for sleep, impulsive behavior, and sometimes delusional thoughts or hallucinations. Manic episodes last at least one week and, by definition, significantly disrupt daily functioning.
Hypomanic Episodes: Similar to manic episodes but less severe and lasting at least four days. They may not disrupt daily life as much but are noticeable to others.
Depressive Episodes: Involve overwhelming sadness, hopelessness, loss of interest in activities, changes in appetite, sleep disturbances, and fatigue. These episodes last at least two weeks and significantly affect daily functioning.
Mood Swings from Other Causes
Mood swings can result from various factors and do not necessarily indicate bipolar disorder. Here are some common causes:
Depression: Persistent sadness and loss of interest without the manic or hypomanic episodes seen in bipolar disorder.
ADHD/IED: Mood swings related to attention-deficit/hyperactivity disorder (ADHD) or intermittent explosive disorder (IED) are often impulsive and reactive to external stimuli.
Anxiety: Anxiety-induced mood swings are typically short-lived and triggered by stress or anxiety-provoking situations.
Substance Use: Mood swings can be induced by substance use, including alcohol and drugs, which affect brain chemistry.
Personality Disorders: Conditions like borderline personality disorder can cause mood instability, but these swings are often in response to interpersonal stressors and are not as prolonged or severe as bipolar episodes.
Previous Trauma: Complex-PTSD (chronic-PTSD) can lead to mood swings triggered by trauma-related memories or stressors.
Key Differences
Duration: Bipolar manic or hypomanic episodes last longer (days to weeks) compared to typical mood swings (minutes/hours to a couple of days).
Intensity: Bipolar episodes are more intense and debilitating, often requiring medical intervention.
They are so intense that most others, even those outside of the home, notice the changes.
Impact on Life: Bipolar disorder significantly disrupts daily life across all domains, whereas other mood swings sometimes only affect specific aspects of life.
Bipolar mood swings can disrupt both home and work/school environments, whereas mood swings from other causes may sometimes affect only one area and are often easier to conceal from non-family members.
Risk Factors for Bipolar Disorder
Below are certain risk factors that, when combined, increase the likelihood of developing bipolar disorder or suggest its presence:
Family History of Mania/Hypomania: High in bipolar depression, low in unipolar depression.
Earlier Age of Onset of First Episode of Depression: Typically in the teens.
Intense Substance Abuse: Higher in bipolar disorder, lower in unipolar depression.
Premenstrual Dysphoric Disorder (PMDD) in Women: More common in bipolar disorder.
Postpartum Episodes: More common in bipolar disorder, less common in unipolar depression.
More Frequent and Brief Depressive Episodes: Indicative of bipolar disorder.
Rapid Symptom Remission of Depressive Episodes: Suggestive of bipolar disorder.
Depression with Psychotic Features: More common in bipolar disorder.
Depression with Higher Lethargy and Hypersomnia: During depressive episodes in bipolar disorder.
Treatment-Refractory Depression and Depression with High Anxiety: Suggestive of bipolar disorder.
Loss of Antidepressant Efficacy/Worsening of Symptoms on Traditional Antidepressants: Indicative of bipolar disorder.
History of Legal Problems: More common in bipolar disorder.
Easily Offended and Overly Sensitive: More common in bipolar disorder.
Irritability/Angry Temperament: More common in bipolar disorder.
History of Several Marriages/Divorces: More common in bipolar disorder.
History of High Scholastic/Professional Achievements: More common in bipolar disorder.
Wearing Loud/Colorful Clothing: More common in bipolar disorder.
Medical Comorbidities: Conditions like migraines, asthma, ulcers, high blood pressure, chronic fatigue, and psoriasis are more common in bipolar disorder. Up to 60% of those with Bipolar II may have co-occurring migraines.
Getting in Touch with Dr. Danish and his Team
At Philadelphia Integrative Psychiatry, we take pride in our ability to practice the most subtle nuances of psychiatry, which is an inherently subjective field full of misdiagnoses and lazy and inaccurate assessment techniques. We want to provide the level of care we would want for our own family members. Our holistic and integrative approach ensures that we consider all aspects of our patients' well-being in developing personalized treatment plans. If you or a loved one are seeking support for PDA or similar conditions, please text or call 610-999-6414 to learn how we can help.
For more on this topic and related subjects, check out these blogs:
Learn about the off-label use of pramipexole in treating unipolar and bipolar depression.
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