Euthymia in Bipolar Disorder

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Euthymia in bipolar disorder is simply defined as a relatively stable mood state—neither manic/hypomanic nor depressed. However, some dictionary definitions have shades of meaning that might be confusing in the context of bipolar disorder and similar mental illnesses. To further complicate things, a significant number of euthymic bipolar patients still show some traits of depression.

Why Euthymia Can Mean Different Things

The confusion in the basic definition begins with the root word of euthymia.

In Greek, the root word means "gladness, serenity, good mood." This leads to definitions like "a pleasant state of mind" and "joyfulness, mental peace, and tranquility."

However, in terms of bipolar disorder, such words as "pleasant" and "joyful" are not an essential part of the definition. A euthymic mood may be pleasant but it does not have to be.

In clinical terms, a euthymic mood is one that rates low on scales of both manic/hypomanic and depressive symptoms. However, studies show that often some depressive symptoms do appear during euthymia, notably anhedonia, which is a lowered sense of pleasure, as well as general cognitive impairment, such as memory problems.

For example, during euthymia, a patient might find herself able to focus on pastimes like working in a garden that are difficult when depressed and neglected for other activities when hypomanic.

Other Mood States Found in Bipolar Disorder

The goal of treatment for bipolar disorder is to help patients achieve moods that are stable enough to allow for improved daily functioning and quality of life.

However, other mood states and episodes can and do occur. How often they occur depends on the individual.

Manic Episodes

Manic episodes are found in bipolar I disorder and consist of the following symptoms:

  • Less need for sleep
  • Impulsive behavior and decisions, such as going on a spending spree, engaging in unprotected sex with multiple strangers or abusing alcohol or drugs
  • Feeling much more energetic and active than usual
  • Noticeable irritability and/or behaving aggressively
  • Feelings of extreme self-confidence and self-importance
  • Racing speech and thoughts
  • Feeling extremely happy or positive
  • If the episode involves psychosis, there may be delusions and/or hallucinations

Hypomanic Episodes

Hypomanic episodes are found in bipolar II disorder and cyclothymia, a milder form of bipolar disorder. Symptoms are similar to those found in manic episodes, but they are not as intense and never involve psychosis or a need for hospitalization. A person having a hypomanic episode will not have nearly the difficulty in functioning that a person having a manic episode does and the symptoms probably won't cause any impairment.

Depressive Episodes

Depressive episodes can be found in all three types of bipolar disorder. Symptoms include:

  • Long periods of feeling sad and/or hopeless
  • Eating more or less than normal
  • Sleeping more or less than normal
  • Feeling irritable
  • Losing interest in activities you used to enjoy
  • Difficulty concentrating
  • Having thoughts of death or suicide or suicidal behavior
  • Feeling tired and lacking energy

Mixed Episodes

In bipolar I, you can sometimes have a mixed episode, which means you experience symptoms of both mania and depression at the same time.

Sources:

Mann-Robel, MC, et al. Meta-analysis of neuropsychological functioning in euthymic bipolar disorder: an update and investigation of moderator variables. Bipolar Disorders. June 2011, 13:4-334-342.

"Bipolar Disorder." National Institute of Mental Health (2016).

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