Ari Asks…

I have a friend who has most symptoms of bipolar, but doesn’t seem to have any obvious sign of depression. He has most other signs of bipolar. He’s had about four episodes of manic behavior in the last five months which had lasted three to four days. Could he be bipolar in your opinion – like rapid-cycling bipolar disorder without the obvious sign or suffering of depression?

Dr. Fink Answers…

Without seeing your friend, I cannot offer a diagnosis, but I can answer the general question of whether a person can have bipolar disorder without depression. The answer is yes – a diagnosis of Bipolar I only requires at least one manic episode – the diagnosis does not require an episode of major depression. While Bipolar I most typically expresses itself with episodes of major depression and episodes of mania, only the mania is necessary to make the diagnosis. Alternatively, in making a diagnosis of Bipolar II disorder, a major depressive episode is necessary, and in Bipolar II the “up” periods can only be hypomania rather than full blown mania. Once there is full blown mania, the diagnosis changes to Bipolar I.

That being said, episodic mania without episodic depression is unusual. Although manic episodes do point to the possibility of a Bipolar I diagnosis, other conditions must be ruled out first. For example, the mania cannot be drug-induced, attributed to another identifiable medical condition, or be attributed to a schizoaffective disorder.

Your friend should see a qualified psychiatrist, preferably one who has experience diagnosing and treating bipolar disorder.

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    Last reviewed: 12 Jun 2009