People with bipolar disorder experience mood shifts that range from significant lows (depression) to extreme highs (mania). These emotional fluctuations differ from regular mood changes in their intensity and impact on quality of life.

What Is Bipolar Disorder

Bipolar disorder is characterized by two main mood states: depression and mania (or hypomania).

During a depressive episode, a person may experience a significant drop in mood, an inability to feel joy or pleasure, a loss of energy, indifference to surroundings, sleep and appetite disturbances, feelings of guilt, difficulty concentrating or making decisions, and low self-esteem.

Mania is marked by unusually high energy levels, irritability, elevated mood and optimism, inappropriate confidence, euphoria, and excessive talkativeness. Sleep needs significantly decrease, and memory and concentration often suffer.

There are two types of bipolar disorder.
Bipolar I disorder involves at least one manic episode and usually several depressive episodes.
Bipolar II disorder includes depressive episodes along with hypomanic episodes, which are milder than mania. Hypomania involves persistently elevated mood, increased activity, and a heightened sense of well-being, but the symptoms are less severe than in mania.

Episodes can last from a few weeks to 3–6 months. Depressive episodes typically last longer than manic or hypomanic ones.

The cycle - the time from the beginning of one episode to the start of another - varies significantly among individuals. Some may experience only a few episodes in a lifetime, while others may have rapid cycling, with 4 or more episodes per year.

The risk of suicide attempts or completed suicides among individuals with bipolar disorder is estimated to be 20 to 30 times higher than in the general population.

The causes of bipolar disorder are not yet fully understood. Causality is often linked to genetic theories, with twin studies showing a hereditary component of up to 90%. It is also understood that individual genetic and biological predispositions interact with environmental and psychosocial factors. The prevalence of bipolar disorder is estimated at 0.3%–0.6% of the population and does not differ significantly between men and women.

The disorder usually manifests between ages 20 and 30, though it can appear at any stage of life.

Impact on Life

Bipolar disorder is considered one of the more severely experienced mental disorders, as it greatly affects a person’s daily functioning, relationships, and work, and is also subjectively distressing - particularly during depressive episodes. During these periods, feelings of hopelessness, meaninglessness, guilt, and low self-esteem cause significant emotional suffering.

The other side of the disorder, mania, can lead to long-term problems across all areas of life and even to accidents, financial difficulties, or legal troubles. Maintaining stable employment can be challenging due to unpredictable mood swings. During manic episodes, impulsive decisions may be made, and individuals might start several projects simultaneously, unable to realistically assess the time or skills required.

High energy levels may appear at unusual times of day, such as during the night instead of normal sleep. Excessive optimism, grandiosity, and poor judgment often result in financial losses or reckless sexual behavior. These mood extremes strain relationships with others. Friends and family may struggle to understand the behavior of someone with bipolar disorder, leading to conflicts and misunderstandings.

Impulsive behavior during manic episodes and feelings of worthlessness during depressive episodes can lead to dangerous situations, including substance abuse or self-harm.

People with this disorder often experience external stigma as well as self-stigmatization, both of which worsen their condition.

Treatment

During severe manic or depressive episodes, hospitalization is often required. Even less severe mania may need inpatient treatment if there is a risk of self-harm, harm to others, or if serious complications are present (such as substance abuse). Most individuals with hypomania can be treated on an outpatient basis.

Although bipolar disorder is chronic, structured treatment can lead to stable and lasting remission. Treatment includes medication, psychotherapy, psychoeducation, and support from the environment.

Pharmacological treatment may include mood stabilizers such as lithium and some anticonvulsants. Lithium helps prevent mood shifts but takes 4 to 10 days to begin working, so faster-acting medications (antipsychotics or anticonvulsants) may be needed initially.

Antidepressants are used cautiously in bipolar disorder as they can trigger manic episodes. If mood stabilizers are not effective for depressive episodes, electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS) may be considered.

The primary role of psychotherapy in bipolar disorder is to help the individual better understand their condition, learn to manage it, and, most importantly, adhere to treatment