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mania might be given a different name and be seen as a religious experience. The important thing isn't definitions, which change over time, but effects, which vary from person to person. For some people, mania has the effect of a revelation or mystical experience, while for others it only causes misery.

      PUTTING IT ALL TOGETHER

      Here's how mania might look. The numbers below refer to the symptoms listed on pages 26 and 27.

      Let's say you work at a call center for IBM. You spend all day on the phone to customers, helping them fix their computer problems. You're also in charge of logging their questions and complaints in a database. Over the course of a week, you start to notice connections between calls that you never noticed before (4). You realize there's a pattern to the database that could revolutionize the future of IBM (1). You start staying at the office long past closing time, working on solving this pattern far into the wee hours (6). Solving the pattern is more important than eating or sleeping (2). When you tell your coworkers and supervisors about the pattern you discovered, they seem confused, though you talk about it incessantly (3). You get frustrated because nobody else can see how important and revolutionary your discovery is. Even your girlfriend doesn't understand your great discovery, but she wants you to tell Dr. Brunner about it because she thinks she will.

      HYPOMANIA

      For hypomania, take the mania section and turn the volume down several notches. You talk faster, walk faster, and think faster—enough for other people to comment. Maybe you start writing a novel, building a sailboat, and recording an electro album all on the same day. Or you join a rock-climbing gym because you “suddenly” realize you'd make a fabulous rock climber. It's hard to sleep and hard to sit still and listen when someone else is talking. Other people seem to be talking and moving incredibly slowly. Sitting in class is torture because it seems to drag on for hours and hours, and you've got more important things to do! You might be agitated and elated at the same time, the life of the party, but your engine's running a little hot. You dance down the street, filled with this wonderful sense of how happy the world is, or flit around your room like a trapped fly.

      The DSM-V definition of hypomania includes the same seven symptoms as for mania, but the difference is that the episode is not severe enough to land you in the hospital or make it impossible for you to get through a normal day at work or school. It also notes that a change in your mood and behavior should be observable to other people (i.e., that your parents or friends notice that you're talking faster and making uncharacteristic judgments). A hypomanic episode marks a distinct change from your usual self, and the elevated, expansive, or irritated mood should last for at least four days. Hypomania usually isn't accompanied by psychosis, and it doesn't count (at least, not to the guy in the white coat) if your symptoms are due to your taking a drug like ecstasy.

      Hypomania can imbue you with wonderful feelings of confidence, talent, creativity, self-esteem, charm, and intelligence, all of which can help you achieve great things. It can also feel distinctly uncomfortable and irritating—sometimes both at once.

      HOW MIGHT MY FRIENDS REACT TO MANIA OR HYPOMANIA?

      A good way to gauge whether or not you're acting abnormally is to pay attention to your friends' and family's reactions. Sometimes, nobody will realize you're manic until it's too late. But people who know you can usually sense when something is a little off. From a friend's perspective, your “perfectly reasonable” obsession with the pattern in the IBM call database is not perfectly reasonable. A friend can have good insight even when you've lost it. Here are some comments friends might make if you're acting unusually.

      “You're acting really intense.”

      “You've been working on that project nonstop for a week. Don't you ever sleep?”

      “Are you high?”

      “What are you talking about? You're not the CEO of Microsoft!”

      “Slow down, you're not making sense.”

      “Are you drunk?”

      If friends know you have a bipolar diagnosis, they might give feedback like:

      “You're getting a bit speedy.”

      “Have you been sleeping?”

      “This is really out of character for you.”

      It can be really annoying to hear these comments, especially if you feel strongly that you're not manic or hypomanic. But it's worth being patient with them, because a trusted friend's insight can help you rein in your energy before it gets out of hand.

      DEPRESSION AND SADNESS: WHAT'S THE DIFF?

      A bunch of nerds had a conference in Las Vegas. After enjoying steak and strippers (male strippers! lots of male strippers!), they defined clinical depression as having a handful of symptoms that persist for at least two weeks and represent a change from your regular functioning. If you've experienced depression, you can probably list the symptoms yourself: a sad, depressed mood for most of the day; a loss of pleasure in activities you normally like; changes in eating and sleeping; crying a lot; fatigue; recurring thoughts of death. At the extreme, people can become catatonically depressed: too depressed to move or speak. The symptoms of depression overlap with conditions such as vitamin deficiencies and chronic fatigue. So it's important for doctors to rule out other factors when making a diagnosis. Unfortunately, many people with bipolar disorder experience more depressive episodes than manic or hypomanic episodes in their lifetime. How do doctors differentiate between depression and normal sadness or grief? Back to the DSM-V!

      1 Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful)You feel sad, down, and empty. Maybe you cry a lot. This feeling persists from day to day.

      2 Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)You don't feel like going out with friends, doing your laundry, calling your girlfriend, or going to the gym. Activities you normally enjoy feel sad or painful to you.

      3 Significant weight loss when not dieting or weight gain (e.g., a change of more than 5 percent of body weight in a month), or a decrease or increase in appetite nearly every dayYou find it hard to eat, or you eat a whole box of ice cream just to distract yourself from the sadness. Your body feels strange and makes different hunger demands than usual.

      4 Insomnia or hypersomnia nearly every dayYou have a terrible time getting or staying asleep at night. Or all you want to do is sleep—you start sleeping twelve hours a day, every day.

      5 Psychomotor agitation or retardation nearly every day (observable by others, no merely subjective feelings of restlessness or being slowed down)You look and feel like you're moving through molasses. It takes you thirty seconds to take your bowl of oatmeal out of the microwave. Your friends get impatient because it takes you forever to put on your jacket. Or you feel agitated and move around like an angry old man.

      6 Fatigue or loss of energy nearly every dayYou dread the time between periods when you have to walk from one lecture hall to the other. You feel really tired—too tired to do the things you normally do.

      7 Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)You feel extremely guilty about being a terrible friend or being a bad person, for no apparent reason. You feel like you have no worth as a person.

      8 Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)You can't make decisions or prioritize tasks. Thinking about whether to go to the bank or the library first nearly kills you. You can't concentrate on a dinner menu, let alone your thesis.

      9 Recurrent thoughts of death (not just fear of dying), recurrent

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