Bipolar Disorder

What is bipolar disorder?

Bipolar disorder is a mood disorder that causes intense mood swings:

• Sometimes you may feel extremely "up," elated, irritable, or energised — this is called a manic episode.
• Other times you may feel "down," sad, indifferent, or hopeless — this is called a depressive episode.
• You may have manic and depressive symptoms together — this is called a mixed episode.

Along with mood swings, bipolar disorder causes changes in behaviour, energy, and activity levels.

Bipolar disorder used to be called manic depression or manic-depressive disorder.

Bipolar disorder affects roughly 1 in 200 people worldwide — about 37 million people according to the WHO. Many people living with it are misdiagnosed or go untreated, and stigma remains a significant barrier to seeking help. With effective treatment, people with bipolar disorder can lead full lives.

What are the types of bipolar disorder?

There are three main types:

• Bipolar I disorder — manic episodes lasting at least 7 days, or manic symptoms so severe that immediate hospital care is needed. Depressive episodes are also common and often last at least two weeks. Mixed episodes can also occur.
• Bipolar II disorder — depressive episodes alongside hypomania (a less severe form of mania), but not full-blown manic episodes.
• Cyclothymic disorder (cyclothymia) — hypomanic and depressive symptoms that are less intense or long-lasting than full episodes. Symptoms usually last at least two years in adults and one year in children and teenagers.

With any type, having four or more episodes of mania or depression in a year is called "rapid cycling."

What causes bipolar disorder?

The exact cause is unknown. Several factors likely play a role — genetics, brain structure and function, and your environment.

Who is at risk for bipolar disorder?

You are at higher risk if you have a close relative who has it. Trauma or stressful life events may raise the risk further.

What are the symptoms of bipolar disorder?

Symptoms come in mood episodes:

• Manic episode — feeling very up, high, or elated; jumpy or wired; more active than usual; short-tempered or extremely irritable; racing thoughts and fast speech; needing less sleep; feeling unusually important, talented, or powerful; risky behaviour showing poor judgement (overspending, reckless sex, binge eating or drinking).
• Depressive episode — feeling very sad, hopeless, or worthless; isolating from others; slow speech and forgetfulness; low energy; sleeping too much; eating too much or too little; loss of interest in usual activities; thoughts of death or suicide.
• Mixed episode — manic and depressive symptoms at the same time, for example feeling very sad while also feeling extremely energised.

Some people experience milder symptoms (hypomania rather than mania). During hypomania you may feel very good and highly productive, and may not feel anything is wrong — though family and friends may notice the changes. Hypomania can be followed by severe depression.

Mood episodes may last a week or two, sometimes longer. During an episode, symptoms usually occur every day for most of the day.

How is bipolar disorder diagnosed?

To diagnose bipolar disorder, a doctor may use several tools:

• A physical examination
• A medical history — including symptoms, lifetime experiences, and family history
• Medical tests to rule out other conditions
• A mental health evaluation, by your doctor or a mental health specialist

What are the treatments for bipolar disorder?

Treatment can help many people, including those with severe bipolar disorder. The main treatments are medicines, psychotherapy, or both:

• Medicines can help control symptoms. You may need to try several to find the right one; some people need more than one. Take your medicines consistently and don't stop them without talking to your doctor. Contact your doctor if you have concerns about side effects.
• Psychotherapy (talk therapy) helps you recognise and change troubling emotions, thoughts, and behaviours, and gives you and your family education, support, and coping strategies.
• Other options for severe bipolar disorder that doesn't respond to standard treatment — including electroconvulsive therapy (ECT), a brain stimulation procedure done under general anaesthesia, and repetitive transcranial magnetic stimulation (rTMS), which uses magnetic waves. Both are available at select centres in India. Light therapy can help the depressive phase, especially when it worsens in autumn or winter. Healthy lifestyle changes — regular exercise, a consistent sleep schedule, keeping a mood journal — can also support treatment.

Bipolar disorder is a lifelong illness, but long-term, ongoing treatment can help manage symptoms and let you live a healthy, successful life.