How to Diagnose Bipolar Disorder

To understand bipolar disorder, think of a pendulum. People with this disease swing between episodes of depression and periods of mania.

Glenn Koons, 50, of Reading, Penn., says when he was depressed, "I totally turned inward." But when he swung into a manic phase, "You start thinking you are invincible. And in the work world, it can have a positive side, but then it spins out of control."

Steven D. Hollon, PhD, professor of psychology at Vanderbilt University in Nashville, says that manic bipolar patients can destroy their own families. "Manias are like a mildly controlled cocaine high," he says.

In full-blown mania, people may hallucinate or lose touch with reality.

Three categories of bipolar disorder exist.

• Bipolar disorder I is the classic type. People have depression, get better for a time, then go into a manic episode.
• Bipolar disorder II is similar. People have episodes of depression, but the manic phases aren't as serious or destructive as in bipolar I. For example, instead of being grandiose or delusional, the person may be extremely self-confident, cocky, or ambitious. These milder manic episodes are also called hypomania. In addition, people with bipolar II tend to have fewer manic episodes than people with bipolar I.
• The third type of bipolar disorder is called the rapid-cycling form. People with this type have four or more episodes of depression and/or mania in a 12-month period. They may be healthy between episodes of depression and mania, or they may go directly from depression to a manic episode.

It's crucial to tell your doctor if you've had mania in the past, even if you're very depressed right now. And be fussy about the doctors you see. "The diagnosis of bipolar depression should be made by an expert because it has important implications for treatment," says Walter Brown, MD, clinical professor of psychiatry at Brown University and Tufts University School of Medicine.