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Bipolar disorder is a manic-depressive illness. It is a brain disorder that contributes to unusual shifts in a person’s mood, ability to function, and energy level. When associated with the disorder, the mood may persist for one or two days or longer. It is typically dramatic; a person may feel overly high and/or irritable or may experience a persistent sadness or hopelessness.

A severe change in behavior is linked to multiple mood changes. Periods of highs and lows, which are called episodes, can be distinct or recur over time. They may also occur over a mixed state. A person with bipolar disorder may experience periods of normal mood even between dramatic mood episodes.

A manic episode may be diagnosed when a person experiences an elevated mood with three or more symptoms. The experience of these symptoms may fall under day, nearly every day, or for at least one week. With irritable moods, four additional symptoms must be persistent and must be present for a diagnosis of manic episode.

A depressive episode is defined as five or more depressive symptoms that fall under one of these categories: last most of the day, nearly every day, or for a period of two weeks or longer.

Signs and symptoms of a depressive episode include the following:

  • Lasting sad mood
  • Feelings of hopelessness
  • Loss of interest in enjoying activities
  • Fatigue, decreased energy
  • Difficulty concentrating
  • Sleeping too much
  • Suicide attempts, thoughts of suicide

Bipolar disorder is essentially a spectrum of moods. For example, on one end, is severe depression; on the other end is mild low mood, or the blues; in the middle is moderate depression.

Dysthymia is more chronic. The spectrum extends to normal or balanced mood to hypomania, which is a mild mania that is less severe, to severe mania, which is a contributor to hallucinations, delusions, and common symptoms of psychosis.

Sufferers of depression may also experience both mania and depression together in what is called a mixed bipolar state.
Symptoms of a mixed bipolar state include the following:

  • Agitation
  • Trouble sleeping
  • Change in appetite
  • Psychosis
  • Suicidal thinking

To best understand this concept, a person may experience sadness and hopelessness while simultaneously feel extremely energized. This mixed bipolar state, or co-occurring anxiety disorder and bipolar disorder, has been studied by leading professionals in psychiatry.

“According to Naomi M. Simon, MD, Associate Director of the Center for Anxiety and Traumatic Stress Disorders at Massachusetts General Hospital and Assistant Professor in psychiatry at Harvard Medical School, making a diagnosis of an anxiety disorder plus bipolar disorder can be confusing, and it is best to seek help from a mental health professional” (ADAA, “Co-Occurring Anxiety Disorder and Bipolar Disorder,” 4/4/2013).

Dr. Simon suggests that there are a few clues to consider when determining the presence of two disorders occurring simultaneously. For example, the first clue is a person who exhibits panic attacks, anxiety, nervousness, and worry. The second clue is a person who develops symptoms early as a child or young adult.

Persistent anxiety and significant problems with sleep when not in a manic state or failing to respond to initial treatment is another clue. Lastly, increased sensitivity to the side effects of medication is another clue.

Sufferers of both an anxiety disorder and a bipolar disorder have experienced decreased functioning; both disorders have affected their quality of life and have increased their likelihood to abuse drugs and commit suicide. Insomnia, which is a common anxiety disorder symptom, is a trigger for manic episodes.

When the presence of anxiety interferes with everyday life functions, it is often disabling. Within this context, a person may have an anxiety disorder. The next section explores the role of anxiety disorder in everyday life.