This can happen in any order, this just happens to be how it happens to me, sometimes all in one day and more than once that same day. I'm under the impression that I'm not the norm, although there probably isn't one anyway. I am 57 years old, and I cannot remember life being any different, at any time.
Just vividly imagine this is happening to you while you read the following:
You climb on the ride, enjoying the bumps and plunges, because neither of them are something unbearable-stability. Soon, however, the climb up the to the highest point begins - ramping up to hypermania/euphoria. Abruptly, the little car stops at the very apex of the ride, and the person to your right stands up and gives you a shove. You then plummet down into a pit of quicksand - despair. To keep yourself from being overwhelmed and sucked deeper into the quicksand you kick, scream, and drag yourself out by your ragged fingernails - agitated mania. You finally pull yourself out of the pit, only to lie next to it for awhile exhausted and unable to function - depression. Then, without any conscious input of your own, you are compelled to climb back onto the roller coaster. Not because it was fun, not because you enjoyed the thrill, but because you have no choice.
*Please note, as far as I know, most people do not have both agitated mania and hypermania. I'm one of those that do. If you'd like to prove me wrong, feel free to do so in the comments below.
There are a multitude of combinations of these moods, and changes can happen over a long period of time or in any order (as I mentioned above). I have been told that it is one of the most difficult mental illnesses to treat. In the approximately 30 years that I and my psychs have been searching for the perfect cocktail (combination of psych medications), nothing that has worked has lasted, and most things have never worked at all. I'm one of those people who are listed under "The following side effects are very rare..." (lactation? really?); and quite often I have the opposite reaction to the basics (i.e. lithium, the "gold standard" mood stabilizer, makes me manic; drugs that are supposed to be "uppers" put me to sleep and vice versa). I became SSRI resistant, causing the psych I was seeing at the time to throw his hands up and actually say "I don't know how to help you." He then first had me undergo ECT (never again), and when that only made me worse he put me on an ancient anti-depressant, an MAOI (actual quote: "Why didn't I think of this before?"), which I am now in the long process of tritrating off so I can try the next greatest new psych drug (I wish I had a sarcasm font).
I am now at the point in my life where I can understand all those with whom I've been arguing about the merits of taking medication. I do not advocate going off one's medications, I have just become very tired of the non-stop "let's try this and see what happens." Before I started the unending perfect med search, in college I lived upstairs from a young chemist (an actually degreed person), who would like to experiment at home. That was the first place I constantly heard the aforementioned sentence, "let's try this and see what happens," which was just as effective as what I'm going through now. It's amazing I'm still alive...but then that's amazing for a whole slew of reasons...other stories for other times.
I hope you enjoyed your ride. If you have any questions, comments, corrections, or would like to describe your bipolar disorder in a simplistic or ridiculous manner, I would love to hear from you in my comments section.
If you would like more professional clarity on some of the terms I used, please visit Types of Bipolar Disorder-Depression and Bipolar Support Alliance. If you are now totally confused, ask a question below and I'll try to find the answer. Even though I've lived it, I don't always understand it.