Understanding Bipolar Disorder: A Patient-Friendly Explanation
Bipolar disorder is a chronic brain condition that causes extreme shifts in your mood, energy, and ability to function, cycling between periods of abnormally elevated mood (mania) and often periods of depression. 1, 2
What Happens in Bipolar Disorder
The Manic Phase (High Periods)
During manic episodes, you experience a distinct period of abnormally elevated, expansive, or irritable mood lasting at least 7 days (or requiring hospitalization), along with: 1, 2
- Decreased need for sleep without feeling tired—this is one of the most characteristic signs 1
- Racing thoughts and pressured, rapid speech 1, 2
- Grandiosity—inflated self-esteem or unrealistic beliefs about your abilities 1, 2
- Increased activity and energy that's markedly different from your usual self 1
- Excessive involvement in pleasurable activities with high potential for painful consequences (like spending sprees, risky sexual behavior, or impulsive business decisions) 2
- Mood lability—your emotions may shift rapidly and unpredictably 1
In severe cases, you may experience paranoia, confusion, or psychotic symptoms (losing touch with reality). 1
The Depressive Phase (Low Periods)
Depressive episodes in bipolar disorder typically involve: 1
- Psychomotor retardation—moving and thinking more slowly 1
- Hypersomnia—sleeping excessively 1
- Profound sadness and loss of interest in activities 3
- Sometimes psychotic symptoms 1
Depression is often the most prominent and disabling phase of bipolar disorder, occurring more frequently and lasting longer than manic episodes. 4
Different Types of Bipolar Disorder
Bipolar I Disorder
- Requires at least one full manic episode lasting 7 days or more 2
- You don't need to have depression to be diagnosed, though most people do experience depressive episodes 2
- This is the more severe form 2
Bipolar II Disorder
- Involves periods of major depression and hypomania (milder elevated mood lasting at least 4 days) 2
- You never have full-blown manic episodes 2
- Hypomanic episodes don't cause severe impairment or require hospitalization 2
Mixed Episodes
- You experience symptoms of both mania and depression simultaneously for 7 days or more 2
- This might feel like having racing thoughts and high energy while also feeling profoundly sad 2
How Common Is It?
Approximately 2-2.6% of people worldwide have bipolar disorder. 5, 6 The illness typically begins in young adulthood, with peak onset between ages 15-30 years. 1
Important Realities About This Condition
Bipolar disorder is a lifelong, recurrent condition that requires ongoing treatment. 7 Without treatment, episodes will likely recur, and the illness can be devastating. 8
This is a leading cause of disability and premature mortality, particularly due to high suicide risk during depressive episodes. 6, 1 Adolescents with bipolar disorder have especially high rates of suicide attempts. 1
The condition often comes with other problems: 1, 7
- High rates of substance abuse 1
- Anxiety disorders 1
- Other psychiatric conditions 7
- Chronic medical illnesses 7
The Illness Represents a Marked Change
A critical point: bipolar disorder represents a significant departure from your baseline functioning—it's not just your personality or temperament. 1 The mood changes are distinct periods that are clearly different from how you normally are, not just reactions to situations or stress. 1
The symptoms should be evident and impairing across different areas of your life (work, relationships, self-care), not isolated to one setting. 1
Treatment Is Essential
Medication (mood stabilizers like lithium, anticonvulsants, or antipsychotic medications) is the primary treatment and must be continued indefinitely due to high relapse risk. 1, 7 Lithium remains the most effective overall treatment, though newer medications are also used. 6, 7
Psychotherapy is an important addition to medication, not a replacement. 7, 8 Lifestyle factors—good sleep hygiene, regular exercise, proper nutrition, avoiding alcohol and drugs—are also crucial. 7
A critical warning: antidepressants alone can be dangerous in bipolar disorder and may trigger manic episodes or worsen the illness. 4 This is why accurate diagnosis is essential.
Why Diagnosis Can Be Challenging
Many people with bipolar disorder initially present with depression, making the condition easy to miss. 7, 4 If you have treatment-resistant depression (not responding to antidepressants), bipolar disorder should be strongly considered. 4
The illness can look quite variable between individuals and even within the same person over time. 6 Irritability is common, especially during mixed states or rapid cycling (more than four episodes per year). 4