Manic - Hypomanic - Depressive

To talk about Bipolar Disorder, we need to understand what a are:

• manic episode
• hypomanic episode
• depressive episode. 
  

A manic episode is characterized by: A. Having a very euphoric or irritable mood. This mood is present for most of the day for at least one week and may require hospitalization. B. There are at least three symptoms (or four if the subject is only irritable) among: feelings of grandiosity, decreased need for sleep, a strong tendency to talk, having many ideas (ideation), being easily distracted, a desire to engage in many activities, being very involved in risky activities. C. The situation compromises the individual's life. D. There are no different causes that can explain the episode.

Let's give some examples of behaviors that fall into a manic episode: Feeling on top of the world, initiating conversations with strangers spontaneously, having an exaggerated self-confidence (hypertrophic self-esteem), speaking quickly because the number of ideas is exceptionally high, planning so many activities without worrying about the consequences, spending more money than they have, approaching numerous partners without worrying about being intrusive.

A hypomanic episode is characterized by: A. Having a very euphoric or irritable mood. This mood is present for most of the day for at least four consecutive days. B. Coincides with the previous one. C-D-E. The episode is something that is "strange" for the individual, meaning people close to them notice that something is off. However, the episode is not severe enough to compromise the individual's life and does not require hospitalization. F. There are no different causes that can explain the episode.

A depressive episode is characterized by: A. Manifesting at least 5 of the following symptoms:

1. Depressed mood
2. Anhedonia, i.e., inability to experience pleasure
3. Significant weight loss not due to diet
4. Insomnia or hypersomnia
5. Agitation or motor retardation
6. Lack of energy
7. Excessive self-blame and feelings of guilt
8. Inability to concentrate
9. Recurrent thoughts of death.

Depressed mood or anhedonia must be present, and some of the symptoms must be present for most of the day.

B. The symptoms cause significant distress. C. There are no different causes that can explain the episode.

As you can see, the hypomanic episode is somewhat "softer" than the manic episode, to the extent that individuals don't complain about it. It's not the hypomanic episode that determines impairment, but rather the depressive episode or the unpredictable alternation between the euphoria of the hypomanic episode and depression.

Sources:
- American Psychiatric Association (2013) - Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
- Bernhill, J. W. (2014) - DSM-5 Clinical Cases.

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