Bipolar disorder

Bipolar disorder is a long-term mental health condition characterized by extreme and disruptive changes in mood, energy, activity levels, and behavior. These shifts usually alternate between episodes of mania or hypomania (abnormally elevated or irritable mood, high energy, and impulsivity) and episodes of depression (persistent sadness, low energy, and loss of interest). The disorder can significantly impact daily functioning, relationships, and overall quality of life if left untreated.

Types of Bipolar Disorder

1. Bipolar I disorder

   • Defined by at least one episode of mania lasting at least 7 days, or severe enough to require hospitalization.

   • Depressive episodes typically occur as well, often lasting at least 2 weeks.

   • This form tends to be the most severe.

2. Bipolar II disorder

   • Characterized by recurring episodes of depression and hypomania (less severe than mania).

   • Unlike Bipolar I, full manic episodes do not occur.

   • Hypomania may improve productivity, but depressive episodes can be disabling.

3. Cyclothymic disorder (Cyclothymia)

   • A chronic pattern of hypomanic and depressive symptoms lasting at least 2 years (1 year in children/adolescents).

   • Symptoms are less severe than Bipolar I or II but still interfere with functioning.

4. Other specified or unspecified bipolar disorder

   • Diagnosed when mood symptoms don’t fit the criteria for the above categories but still cause significant impairment.

Symptoms

Mania/Hypomania may include:

• Inflated self-esteem or grandiosity

• Decreased need for sleep

• Excessive talking or rapid speech

• Racing thoughts

• Increased goal-directed activity

• Risky behaviors (e.g., spending sprees, unsafe sex, reckless driving)

Depression may include:

• Persistent sadness or emptiness

• Loss of interest or pleasure in activities

• Fatigue or low energy

• Changes in sleep and appetite

• Feelings of worthlessness or guilt

• Difficulty concentrating or making decisions

• Suicidal thoughts or behaviors

Causes and Risk Factors

The exact cause is unknown, but several factors contribute:

• Genetics: Strong hereditary component; relatives with bipolar or other mood disorders increase risk.

• Brain chemistry and structure: Imbalances in neurotransmitters (serotonin, dopamine, norepinephrine) and structural brain changes are implicated.

• Stressful life events: Trauma, loss, or major changes can trigger episodes.

• Substance misuse: Can worsen or mimic symptoms.

Complications

If untreated, bipolar disorder can lead to:

• Substance abuse

• Financial or legal problems due to impulsive behaviors

• Relationship breakdowns

• Suicidal thoughts or actions

• Poor work or academic performance

Diagnosis

Diagnosis is clinical, based on:

• Detailed psychiatric evaluation

• Medical history and family history

• Exclusion of medical conditions (e.g., thyroid disease) and substance-related causes

• Use of standardized diagnostic tools such as DSM-5 or ICD-11 criteria

Treatment

Bipolar disorder requires long-term management. A combination of medications and psychotherapy is typically recommended.

Medications

1. Mood stabilizers

   • Lithium carbonate: First-line; reduces mania and prevents relapse. Typical dose: 600–1,200 mg daily, adjusted to maintain therapeutic serum levels (0.6–1.2 mEq/L).

   • Valproic acid (sodium valproate): Often used in acute mania and maintenance; dose: 750–2,000 mg/day depending on serum levels.

   • Carbamazepine: Useful for mania and rapid cycling; dose: 400–1,200 mg/day.

   • Lamotrigine: More effective for bipolar depression than mania; dose: 100–200 mg/day (must be titrated slowly due to risk of rash).

2. Atypical antipsychotics (useful for acute mania, mixed states, and maintenance)

   • Olanzapine: 5–20 mg daily.

   • Quetiapine: 300–800 mg daily (effective for mania and depression).

   • Risperidone: 2–6 mg daily.

   • Lurasidone: 20–120 mg daily (particularly effective in bipolar depression).

3. Antidepressants

   • Used cautiously (usually with a mood stabilizer to prevent manic switch).

   • Fluoxetine: 20–40 mg daily may be used in combination with olanzapine for bipolar depression.

Psychotherapy

• Cognitive-behavioral therapy (CBT): Helps challenge negative thought patterns and improve coping.

• Psychoeducation: Improves awareness of early warning signs and adherence to treatment.

• Interpersonal and social rhythm therapy (IPSRT): Stabilizes daily routines and sleep patterns to prevent relapses.

• Family-focused therapy: Involves relatives in education and communication strategies.

Lifestyle and Self-Care

• Maintaining regular sleep patterns

• Avoiding alcohol and recreational drugs

• Stress management techniques (e.g., mindfulness, exercise)

• Adherence to medication regimen

• Support groups for social and emotional support

Prognosis

With treatment, most individuals can manage symptoms effectively and lead fulfilling lives. However, bipolar disorder is chronic and lifelong, and relapses can occur without ongoing management. Early diagnosis, consistent treatment, and a strong support network significantly improve outcomes.