What Is Bipolar Disorder?
Bipolar disorder, also known as manic-depressive illness, is a chronic and often misunderstood mental health condition characterised by significant shifts in mood, energy, and behaviour. These fluctuations can range from emotional highs—referred to as mania or hypomania—to devastating lows known as depressive episodes. Affecting millions globally, bipolar disorder presents unique challenges for individuals, families, and healthcare providers alike. As a condition that typically begins in adolescence or early adulthood, it is recognised as one of the leading causes of disability worldwide.
Symptoms and Types of Episodes
The hallmark of bipolar disorder lies in its alternating mood episodes. During manic or hypomanic phases, individuals may feel unusually elated, irritable, or energised. These episodes often involve reduced need for sleep, rapid speech, inflated self-esteem, impulsive decision-making, and increased goal-directed activity. While hypomania is a milder form of mania and may not result in severe functional impairment, full-blown mania can lead to hospitalisation or psychosis.
Conversely, depressive episodes involve a prolonged period of sadness, hopelessness, or loss of interest in previously enjoyed activities. People may experience fatigue, changes in appetite, sleep disturbances, difficulty concentrating, and in severe cases, suicidal thoughts. Mixed episodes can also occur, in which symptoms of both mania and depression appear simultaneously, creating an especially disorienting experience.
Types of Bipolar Disorder
There are several types of bipolar disorder, each defined by the nature and duration of the mood episodes. Bipolar I disorder is diagnosed when a person experiences at least one manic episode, with or without depressive episodes. Bipolar II disorder involves at least one major depressive episode and one hypomanic episode, but no full manic episodes. Cyclothymic disorder, or cyclothymia, is a milder, chronic form of the condition marked by frequent mood swings that do not meet the criteria for full manic or depressive episodes. In addition to these, there are other specified and unspecified bipolar-related disorders, often tied to substance use or medical conditions.
Diagnosis and Misdiagnosis
Diagnosing bipolar disorder is a careful and often complex process. It involves a detailed clinical evaluation by a mental health professional, including a thorough review of the patient’s psychiatric history, behavioural patterns, and life events. Tools such as the Mood Disorder Questionnaire (MDQ) may be used to screen for symptoms, but diagnosis primarily depends on clinical judgment and the criteria outlined in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). Because many individuals initially present with depressive symptoms, bipolar disorder is frequently misdiagnosed as unipolar depression, delaying appropriate treatment.
Causes and Risk Factors
The causes of bipolar disorder are multifactorial. Genetics play a significant role, with studies indicating that up to 85% of the risk may be inherited. Individuals with a first-degree relative who has bipolar disorder or major depression are at significantly higher risk. However, there is no single “bipolar gene.” Rather, multiple genes likely interact with environmental triggers such as trauma, chronic stress, sleep disruption, or substance misuse to activate the condition in vulnerable individuals. Neurobiological factors, including imbalances in neurotransmitters like dopamine and serotonin, abnormalities in brain circuitry, and disruptions in circadian rhythms, have also been implicated.
Treatment Options and Management
Managing bipolar disorder effectively requires a comprehensive and long-term approach. Medication remains the cornerstone of treatment. Mood stabilisers such as lithium are widely used and have proven efficacy in reducing mania and suicide risk. Anticonvulsants like valproate and lamotrigine, as well as atypical antipsychotics including quetiapine and aripiprazole, are also commonly prescribed depending on the individual’s symptom profile. In some cases, antidepressants may be used cautiously in combination with mood stabilisers to address depressive episodes. However, monotherapy with antidepressants is discouraged due to the risk of triggering mania.
In addition to pharmacological treatment, psychotherapy is a critical component of management. Cognitive behavioural therapy (CBT) helps individuals identify negative thinking patterns, manage stress, and recognise early warning signs of mood changes. Interpersonal and social rhythm therapy (IPSRT) aims to stabilise daily routines, which can help regulate mood by aligning the body’s natural biological rhythms. Family-focused therapy involves the patient’s support system in treatment planning and can significantly improve outcomes by enhancing communication and promoting adherence.
Lifestyle and Holistic Care
Lifestyle modifications are equally important in managing bipolar disorder. Maintaining a regular sleep schedule, engaging in physical activity, and avoiding alcohol or recreational drugs can reduce the frequency and severity of episodes. Many individuals benefit from using mood tracking apps or journals to monitor their symptoms and identify triggers. In severe or treatment-resistant cases, electroconvulsive therapy (ECT) has shown high efficacy, particularly in managing acute mania or bipolar depression.
Challenges in Diagnosis and Adherence
Despite the availability of effective treatments, challenges in diagnosis and adherence remain significant barriers. Many patients discontinue medication due to side effects or a lack of insight into the illness, often resulting in relapse. Stigma surrounding mental illness can also deter individuals from seeking help or staying engaged with care. Moreover, comorbid conditions such as anxiety disorders, ADHD, and substance abuse can complicate diagnosis and treatment.
Long-Term Outlook and Prognosis
Prognosis varies widely among individuals. While bipolar disorder is generally a lifelong condition, many people can achieve prolonged periods of stability with consistent treatment. However, the risk of suicide remains high—estimated at 15–20%—underscoring the need for ongoing risk assessment and support. Bipolar disorder is also associated with a reduction in life expectancy due to both psychiatric and physical health complications.