Hi, I'm Dr. Tracey Marks,
a psychiatrist and I make mental health education videos.
Today, I'm answering a viewer question:
Can a person have unipolar mania?
Another way of asking this is,
can you only have manic episodes
and never really have depression?
And if so, is it really bipolar disorder?
Bipolar disorder is a disorder
where you have reoccurring episodes of depression or mania.
Because these mood states are opposite in nature,
we say that they have opposite polarity.
It's like a magnetic pole
that has opposite ends of attraction.
At one pole of the mood disorder spectrum,
you have depression,
which is a low mood state and low energy state.
And at the opposite pole is mania
where you have a high mood state and high energy state.
For more details on what mania and hypomania look like,
watch this video in my bipolar playlist.
The traditional thinking
is that mood disorders have two categories:
unipolar depression and bipolar disorder.
With unipolar depression,
you have reoccurring episodes of depression only.
The depression within bipolar disorder
is believed to behave differently from unipolar depression
and respond differently to medication.
For example, we treat unipolar depression
with antidepressants and or psychotherapy.
Specific psychotherapies like cognitive behavior therapy
and interpersonal therapy
are considered standalone treatments for depression
without the need for medication.
On the other hand, the primary medications we use
for bipolar depression are mood stabilizers first.
Because many times, the antidepressants
will make you more unstable
by triggering rapid cycling and mixed episodes
where you have a mixture of depression and mania.
So what if you only have mania
and don't have any depression?
Well, unipolar mania
is not an official diagnostic condition,
but it does happen and it has been studied.
It's considered to be a rare situation
that someone would never have a depressive episode.
What we don't know is if the predominance of mania
is a separate condition or if it's just happenstance
that you haven't had a depressive episode yet.
The way we treat unipolar mania
is not much different from bipolar mania,
except that you may require less medication
than if you had bipolar disorder
because you don't have to address the depressive episodes.
Also some research studying unipolar mania
has shown that people with unipolar mania
tend to have less comorbidities.
Common comorbidities or illnesses that come along
with bipolar disorder are anxiety disorders, ADHD, and PTSD.
So studies show that people with unipolar mania
tend to have less of these other illnesses.
And this is a good thing
because it's much easier to treat mania all by itself
than also have to address other problems
like attention problems and anxiety.
In my own experience,
I find treating bipolar depression much harder
than treating mania,
because with mania, you're in a hyped up state.
And although mania with psychosis can be very dangerous,
we have lots of medications that are sedating
and that can serve the purpose of slowing down mania.
These medications can bring you down from the stratosphere,
which I also call being on a manic mission,
where you get focused on something with tunnel vision
and put all your resources
toward getting to the finish line.
If you've been there, you know what I'm talking about.
If you haven't been there,
I'm not talking about simply having a purpose
and being persistent.
I'm talking about losing sight of reality
and irrationally pursuing something
that's usually driven by a delusional belief.
So the analogy is if you've entered into the stratosphere,
I can give you something
that takes the wind out of your sails
and brings you back down to ground.
But it's much harder to pull you out
of the deep pit of depression.
With bipolar depression,
the antidepressants don't do a great job
of getting you out of depression.
So we end up adding more mood stabilizers
to deal with the depressive episodes.
It's pretty typical for someone with bipolar disorder
to be on at least two agents.
But with unipolar mania,
you don't have the problem of treating depressive episodes
and you don't get mixed episodes.
Episodes with a mixture of depression
and mania occurring at the same time
tend to be harder to treat than having pure mania
or pure depression.
In my practice, I have a handful of people
who have had a predominance of mania or hypomania.
And I say predominance because a few of them have had
like one episode of depression
in 10 to 15 years of being in treatment with me.
What I have noticed is that they are the ones
who do well on one mood stabilizer
and tend to have more of an upbeat high energy personality
when they're not manic.
This high energy personality has been described
as a hyperthymic temperament.
A hyperthymic temperament would be someone
with not only high energy, but also high optimism;
who's more talkative and risk-taking,
and they usually need less sleep than most people.
The normal amount of sleep for an adult
is seven to nine hours.
And people with hyperthymic temperament
have trouble sleeping longer than six hours.
Your temperament is your hard wiring that you're born with
and it lays the groundwork for your personality
and the disorders.
For example, someone with an anxious temperament
tends to be more tense and prone to worry
even if they never develop an anxiety disorder.
So the bottom line is unipolar mania exists
but it's not common,
and it may be that you eventually have a depressive episode
somewhere down the line.
But until you do, if you do,
you may do well on a simple medication regimen
that addresses only manic symptoms.
You'll have to stay vigilant though
to watch for the emergence of manic symptoms
because you can still have a breakthrough manic episode
even on your medication.
I talk about recognizing warning signs
that your mania is coming in this video.
And this video describes in detail what it looks like
to have a manic or hypomanic episode.
Thanks for watching.
See you next time.