By HAYDEN FINCH, PhD
In my last post, we started chatting about the difference between Bipolar Disorder and being “bipolar.” And we reviewed some of the diagnostic criteria for being manic. Today, let’s continue our discussion by talking about the other “pole,” the depressive side of the illness.
Diagnostic Criteria: Depressive Episode
A major depressive episode is a specific “thing,” not just a period of feeling down. It’s depressed mood OR loss of interest or pleasure in activities for TWO WHOLE WEEKS (weeks, not minutes…see how that’s different from people who are “bipolar”). That’s a long time. Plus five of these:
- Depressed mood most of the day, nearly every day
- Markedly diminished interest or pleasure in all or almost all activities most of the day, nearly every day
- Significant weight gain or weight loss (more than 5% of your body weight in a month) or major change in your appetite
- Feeling super agitated or slowed WAY down
- Fatigue or loss of energy nearly every day
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day
- Diminished ability to think or concentrate OR indecisiveness nearly every day
- Recurrent thoughts of death, recurrent suicidal ideation, a suicide attempt, OR a specific plan for committing suicide.
Bipolar-Type Conditions
There are several different Bipolar Disorders, so here’s a little bit about the most common ones and how they’re different.
Bipolar I Disorder is the most severe. If a person has ever had a manic episode, like Mary in the last post, and that manic episode really REALLY messed up their functioning (like at work) or they had to be put in the hospital to keep from hurting themselves or others, then they might have Bipolar I Disorder. This person may or may not (but probably does) also have periods of major depressive episodes, but really all they need is one manic episode ever and that’s pretty much sufficient to be diagnosed with Bipolar I Disorder.
Bipolar II Disorder is less severe than Bipolar I but is still a gnarly mental health condition. Now for Bipolar II Disorder, you have to have had at least one hypomanic episode AND at least one major depressive episode that caused major problems with how you were doing at work, how you were taking care of yourself, how your relationships were going, etc. If you’ve ever had a manic episode, then you’d have Bipolar I, not Bipolar II. Sticking with me?
Cyclothymic Disorder is more complicated. Over a period of two years, this person has had multiple times when they’ve had some hypomanic symptoms but not ever met full criteria for a hypomanic episode AND had multiple times when they’ve had some major depressive symptoms but not ever met full criteria for a major depressive episode. At least half the time of those two years were spent with either hypomanic or major depressive symptoms, and they’ve never, ever had a full manic, hypomanic, or major depressive episode. Complicated. Like for real. And tough to determine whether you or anyone else meets those criteria. We’ll get back to that in a minute.
Alright, so now we’re ready to explore the questions we started with in the last post. Now that we know exactly what a manic episode is, what a hypomanic episode is, and what a major depressive episode is, we can figure out whether someone has Bipolar Disorder or whether that person is “bipolar” or maybe just normal. I’ll be back soon to chat about that because that’s the really juicy stuff. Make sure you subscribe so you don’t miss it!
Hayden C. Finch, PhD,
is a practicing psychologist
in Des Moines, Iowa.
