Manic-Depressive Illness

Diagnostic Criteria

The Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV), published by the American Psychiatric Association (APA), establishes the diagnostic criteria used by clinicians in diagnosing bipolar disorder and defines both episodes of this illness: mania and depression. Mania is a clearly defined period of unusually elevated or irritable mood that is of at least one week in duration and is usually accompanied by at least three of the following symptoms: exaggerated self-esteem, decreased need for sleep, more talkative than normal, racing thoughts, high distractibility (cannot concentrate well), abuse of pleasurable activities such as spending money or sexual activity, drug abuse (particularly cocaine and alcohol), aggressive or intrusive behavior, or a denial that anything is out of the ordinary. In addition, these disturbances in mood cause significant diminishing in social or professional functioning and are not related directly to substance abuse or a medical illness.

The criteria for an episode of major depression include any of the five following signs and symptoms: lasting sad mood or feeling of emptiness, significant loss of interest in activities once pleasurable, significant weight loss or gain, sleeping too much or too little, decreased energy, fatigue or feeling “slowed down,” feelings of guilt or worthlessness, inability to concentrate or make decisions easily, and persistent thoughts of death or of suicide.

These symptoms should be present nearly every day for two weeks or longer and cause significant diminishing in social or professional functioning also not related directly to substance abuse or a medical condition and do not occur in the two months following the death of a loved one.

Bipolar disorder is classified into two distinct subtypes. Bipolar I disorder is the “classic” form of the illness; patients have a history of at least one manic episode and may or may not have experienced previous depressive episodes. Patients with bipolar II disorder may not have symptoms of severe mania and instead suffer a mild to moderate mania called hypomania along with episodes of major depression. Four or more mood episodes in the last 12 months constitute the definition of rapid cycling bipolar disorder. Between 10 and 15 percent of individuals with bipolar disorder experience rapid cycling, and in general, rapid cycling is found to be more common in women than in men.

Other disorders with similar features may coexist with manic-depressive illness: schizophrenia, posttraumatic stress disorder, substance abuse, and personality disorders. Also, preexisting conditions such as multiple sclerosis and medications, steroids, or substance abuse may contribute to or complicate the treatment process. A complete medical evaluation and psychiatric history are essential in establishing a diagnosis of manic-depressive illness.

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