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Bipolar Disorder:
Symptoms, Causes, Risk Factors, Diagnosis & Treatment



1.What is bipolar disorder?

Bipolar disorder is a psychological illness characterized by unpredictable swings in mood. Changes in mood vary from extreme elevation, known as mania, to episodes of depression. Earlier known as manic depression, bipolar disorder can affect everyday activities and maintaining relationships.

Bipolar disorder is a chronic illness, requiring at least 2 years of presenting symptoms to be clinically diagnosed. It also is a lifelong condition which can be controlled by a combination of psychotherapy and medication.

Bipolar disorder is common, affecting anywhere from 0.5 per 1000 to 21 per 1000 Indians annually, and typically manifests between 20 and 30 years of age. Women have more depressive episodes and men have more manic episodes over a lifetime.



2.What are the symptoms of bipolar disorder?

Symptoms of bipolar disorder should include at least one manic and one depressive episode. Usually each episode should at least last a week and cause significant emotional disturbance or affect your daily routine.

A manic episode is defined by a distinct period of persistently elevated or irritable mood, lasting at least one week duration with symptoms such as:

  • Inflated self-esteem or grandiosity
  • Reduced need for sleep
  • Pressure to keep talking
  • Flight of ideas or racing thoughts,
  • Easy distractibility
  • Increased activity or restlessness
  • Reckless involvement in pleasurable activities.

A depressive episode is defined by the experience of symptoms including:

  • A feeling of sadness or hopelessness
  • Loss of interest in almost all activities
  • Either insomnia or sleeping too much
  • Restlessness or slowed behaviour
  • Fatigue
  • Sense of worthlessness or excessive guilt
  • Inability to concentrate
  • Thoughts of suicide or attempting to end your life.

An untreated episode of depression or mania can be as short as a few weeks or last for up to 8–12 months.



3.What are the causes for bipolar disorder?

An exact cause for bipolar disorder is still unknown. Several factors may be involved in the etiology, such as:

Genetic factors:

A person with a parent or sibling with bipolar disorder has 4 to 6 times higher risk of developing it, when compared to someone who doesn’t. Researchers are still trying to isolate the gene involved.

Biological abnormalities of the brain:

Loss or damage of brain cells, imbalances in neurotransmitters, mitochondrial disorders are all considered in the pathogenesis of bipolar disorder. However, concrete evidence is still underway.



4.What are the risk factors involved in bipolar disorder?

Lifestyle risk factors:

  • Extreme stress
  • Physical or sexual abuse
  • Physical illness
  • Substance abuse
  • Death of a loved one
  • Excessive worry, about work or relationships

Age as a risk factor:

Bipolar disorder usually develops around the age of 25 years, or between 20 to 30 years of age. However, few show symptoms only after 40 years of age.

Gender as a risk factor:

Bipolar disorder has been known to affect both sexes equally, however, women tend to have more depressive episodes and men have more manic episodes in their lifetime.

Hormonal factors:

The thyroid hormones have an effect on brain functions as well as metabolism, growth and development. Abnormalities in the thyroid gland are associated with depression and bipolar disorder. Hypothyroidism, or reduced production of thyroid hormones is often diagnosed in such patients.



5.How is bipolar disorder diagnosed?

Bipolar disorder causes changes in mood and behaviour that significantly alters life on a day to day basis. Affected people show intense emotional changes.

Although bipolar disorder shows distinct symptoms, a single test does not confirm a diagnosis of bipolar disorder. Diagnosis is achieved by a combination of methods.

Before diagnosis, it may feel like something is not right and expressing yourself may be difficult. You may experience changes in mood and emotions. Feelings of hopelessness and despair can become intense. You may go from feeling full of energy one moment to feeling like your drowning in despair the next. Feeling low isn’t uncommon, and is faced by many people from time to time due to stress or other factors. But, variations in mood associated with bipolar disorder are usually more extreme. Your friends or family may also notice that something is wrong. Seek help if severe mood variations affect your daily activities or make you suicidal.

Physical examination

There aren’t any blood tests or brain scans that can diagnose bipolar disorder. Even then, a routine set of tests are done to rule out other causes such as hypothyroidism, substance abuse or side effects of any medicine. The thyroid gland is situated in the neck and lack of adequate activity has been found to have an effect on mood and cause depression.

Mental health evaluation

Your treating psychiatrist or psychologist will ask you a series of questions to assess your overall mental health status. Evaluating bipolar disorder is done by asking about your symptoms- how long they last and how they affect your daily life. You will also be questioned on risk factors such as family history of similar illnesses and history of medication or substance abuse.

Bipolar disorder is known for its episodes of depression and mania. A diagnosis of bipolar disorder requires at least one manic episode and one depressive episode. You will be asked about your feelings during and after such episodes. They will want to know if you feel helpless or in control during manic periods and how long they last.With your permission, they may speak to relatives and loved ones about your behavior and the changes they may have noticed for an accurate assessment. Diagnosis is made after considering all aspects of your medical history and medications you have taken in the past.

As an aid to accurate diagnosis, Diagnostic and Statistical Manual of Mental Disorders (DSM) is used. This provides criteria enabling diagnosis of bipolar disorder. Here is a guideline on the terms and symptoms looked for:

How is mania defined?

Mania is defined as a “distinct period of abnormally and persistently elevated, expansive, or irritable mood” by the DSM. This manic episode should at least last a week and should include at least three of the following symptoms:

  • Inflated self-esteem or a feeling of grandiosity
  • Reduced need for sleep
  • Pressure to keep talking or fast and rapid talking
  • Flight of ideas or racing thoughts,
  • Easy distractibility while performing any activities
  • Increased activity, restlessness or psychomotor agitation such as pacing, shaking your leg.
  • Reckless involvement in pleasurable activities that may involve risk or hazard such as unprotected sex or drinking and driving.

How is depression defined?

A major depressive episode should have at least 4 of the following symptoms that have recently appeared or suddenly become worse:

  • Either insomnia or sleeping too much, change in weight, appetite or activity
  • Fatigue and decreased energy
  • Sense of worthlessness or excessive guilt
  • Inability to concentrate, difficulty in thinking or making decisions.
  • Thoughts of suicide or attempting to end your life.

Diagnosing bipolar disorder in children

Bipolar disorder has also been known to affect children. Diagnosis in children is often difficult due to overlap of symptoms with Attention-Deficit and Hyperactivity Disorder (ADHD), which is a more common problem among children. If your child is not showing improvement of symptoms on treatment for Attention-Deficit and Hyperactivity Disorder, he or she may be suffering from bipolar disorder. The symptoms to look out for include:

  • Emotional outbursts
  • Periods of being sad or upset
  • Hyperactivity
  • Aggressive behaviour
  • Impulsiveness
  • Irritability

The criteria to diagnose bipolar disorder in children is the same as for adults, and your doctor may ask you and your child a set of questions to ascertain the type and severity of symptoms.
Your doctor may also look for a family history of similar conditions and do a physical examination including blood tests to assess thyroid gland function.



6.What are the types of bipolar disorder?

Bipolar disorders include a spectrum of different types of disorders depending on the predominant symptoms.

Bipolar disorder type I:

This involves one or more manic episodes (or even a mixed depressive and manic episode) and may or may not be followed by a depressive of hypomanic episode.

Bipolar disorder type II:

Bipolar disorder type II is defined by one or more major depressive episodes followed by at least one hypomanic episode. Hypomania is defined by a milder form of mania. There are no episodes of mania, but there may be a mixed episode.

Although it is less debilitating than Bipolar disorder I, it can cause significant distress at work or school and with relationships. People with such episodes tend to lose memory of the hypomanic episode.


This is characterized by alternating low lying depression and hypomanic episodes. The symptoms should be present for at least one year in children and for at least years in adults for a diagnosis of cyclothymia. Symptom free episodes usually do not last for over a month in children and over two months in adults.

Rapid cycling bipolar disorder

Rapid cyclers suffer from a more severe form of bipolar disorder. It involves at least 4 episodes or major depression, mania, hypomania or mixed episodes within one year. Rapid cycling disorder is seen more commonly in women compared to men.

Not otherwise specified

This category is for people with symptoms of bipolar disorder that do not fit into the above mentioned types. It is diagnosed when multiple symptoms of bipolar disorder are identified, but do not fit the criteria for any of the sub types. They include rapid mood changes that do not last enough to qualify for bipolar disorder episodes and those with multiple episodes of hypomania without major depressive periods.



7.How is bipolar disorder treated?

An array of treatments are available for the management of bipolar disorder, usually involving a combination of psychotherapy, medications and lifestyle changes. Even natural remedies have been known to show some benefit.

Medical therapy:

Medications for bipolar disorder, like all mental illnesses are available only as prescription-only drugs and must not be self-prescribed at any cost. Your treating doctor with adjust dosages and duration based on your symptoms and taper them accordingly. These include drugs targeting individual symptoms such as:

  • Lithium or similar drugs to stabilize mood changes.
  • Antipsychotic drugs like olanzapine
  • Antidepressants such as fluoxetine
  • Anti-anxiety medication such as benzodiazepines


Psychotherapy includes a combination of cognitive behavioral therapy, interpersonal and social rhythm therapy and psychoeducation:

Cognitive behavior therapy

This type of therapy is by communicating with your therapist, helping you to understand your thinking patterns, coming up coping strategies and ways to manage your condition.


Psychoeducation helps your loved ones and you to understand bipolar disorder and what it means to be diagnosed with it. Understanding your situation helps family and friends cope with it and manage it better.

Interpersonal and social rhythm therapy

Interpersonal and social rhythm therapy (IPSRT) helps by focusing on daily activities such as sleeping, exercising and eating. Effectively managing these activities help maintain a balance in your daily life and coping with bipolar disorder.

Other treatment options:

Other supplementary treatment options may be recommended to you such as:

  • Acupuncture
  • Electroconvulsive therapy
  • Medications for sleep
  • Supplements

Lifestyle modifications:

Making changes in your daily activities are simple steps that will help you manage bipolar disorder such as:

  • Maintaining a routine for sleeping and eating
  • Recognizing mood swings
  • Asking a friend or relative for support on your treatment plans
  • Talking to a doctor or therapist



8.Living with bipolar disorder

Bipolar disorder is characterized by severe mood changes between both highs- being joyful and energetic and lows- being weary and uninterested.

Coping with these changes can be difficult with depressive episodes especially making it challenging to get through the day. Here are some suggestions to help improve your mood during a depressive phase.

1.   Stick to a routine

Unhealthy eating and sleeping habits can make your symptoms worse and make coping with depression harder. When you are depressed, you tend to sleep too little or too much. The same goes for eating, either having a total loss of appetite for food or over eating even after you are full. Consider these healthy practises to inculcate in your daily life:

  • Improve your diet by including more vegetables, pulses and fibres.
  • Eat at fixed times throughout the day, including fixed times for snacks and meals.
  • Try to get seven to nine hours of sleep every night.
  • Wake up and sleep at the same time everyday.

2.   Give your day structure

Similar to eating and sleeping on schedule, scheduling other activities of your day also helps coping with bipolar disorder.

Creating lists of daily tasks and chores and ticking them off as you complete them, gives your day meaning and helps achieve a sense of satisfaction. You can use reminders, calendars or notes to keep track of your activities. Ensure you have made provisions for adequate breaks and periods of free time in between, so you do not get exhausted or frustrated. Always prioritize your medical appointments to help you get better sooner.

3.   Stay active

Exercising has been shown to improve mood and alleviate symptoms of depression. Exercising for thirty to forty minutes for at least three to four times a week gives best results.

4.   Fight the fear

When you are depressed, activities that you usually like to do, may seem too taxing or disinteresting, such as reading a book or meeting friends. Despite lack of motivation, try to participate in activities you usually like. This can actually help improve your mood. While you may fear that you may not enjoy the activities as much, do not let that stop you from trying them out, you will end up feeling better.

5.   Don’t keep to yourself

Being depressed can make being in social situations seem overwhelming. It is important not to isolate yourself as being alone can aggravate symptoms of depression. Spend time in groups that share your interests or stay in touch with family and friends. Knowing you have the support of loved ones helps elevate your mood.

6.   Find new ways to relieve stress

This may be the least of your interests when you are in a depressed mood. But engaging in new activities could help alleviate your symptoms. Activities that are known to calm your senses such as aromatherapy, getting a massage or even learning yoga may help being relaxed and happier.

7.   Join support groups

Being around and talking to people with bipolar disorder will be reassuring and let you know you are not alone. Discussing your feelings during depressive episodes and listening to other coping methods can be both beneficial and therapeutic.



9.How does bipolar disorder affect family and relationships?

Living with bipolar disorder can put an enormous strain on your relationships, especially romantic relationships. Being honest and open about your condition is the best approach to managing your relationship. Whenever you are ready to open up about your illness, these facts will help them understand you better:

  • How long you have been affected
  • What to expect during such episodes
  • How you usually cope with these episodes
  • How they can help you
  • One of the best ways to make your relationships work is by adhering to your treatment and following your doctors advice. This helps in keeping your symptoms at bay, allowing you more time to focus on your relationships.

    The bottom line

    Bipolar disorder can be controlled and you can manage to have a functioning lifestyle even if there is no cure. Following a treatment plan and making modifications in your lifestyle can go a long way.

    Unless severe depressive episodes requiring brief hospitalization occur, bipolar disorder can be managed by medication and therapy alone.

    Getting over a depressive episode may seem impossible and very hard, but remember that there are always ways to elevate your mood and cope with your illness.

    Don’t hesitate to call your therapist or loved ones when you need help.

    Incase of suicidal thoughts that you are not able to fight or ignore, call your local suicide helpline number. Counselors are available 24/7 and are there to help.



10.Bipolar Disorder FAQs: All your concerns addressed.

Q.  What does bipolar mean?

  1. Bipolar means having or relating to two poles or extremes. Similarly, bipolar disorder is typically characterized by extreme variations in mood, namely depression or lows, and mania, or highs.

Q.  How is bipolar disorder different from depression?

  1. The major difference between clinical depression and bipolar disorder is the presence of manic or hypomanic (a milder form of mania) episodes. It is important to understand that the presence of a depressive episode is not enough to diagnose bipolar disorder. Even the history of one episode of mania is sufficient for a diagnosis of bipolar disorder in a depressed person.

Q.  If I am diagnosed with bipolar disorder, will I be on medication for the rest of my life?

  1. Not as a hard and fast rule. However, if the risk involved with stopping medication is very high, affecting your health, relationships or finances, then it may be advised to take them indefinitely.

Q.  Can someone have medical conditions that mimic symptoms of bipolar disorder?

  1. Many medical conditions can affect mood, mimicking bipolar disorders. It is important to rule out these conditions before making a diagnosis. They include:
  • Hypothyroidism. Thyroid dysfunction has been known to affect mood and can cause depressive episodes.
  • Brain tumours, especially ones that involve or compress the amygdala, which is the region of the brain that decides your mood, can cause similar symptoms.
  • Neurological infections such as Lyme disease, HIV or syphilis should be ruled out based on associated symptoms and signs.
  • Treatment history of high dose of steroids, medications for tuberculosis or HIV, have been reported to affect mood.
  • Vitamin deficiencies, especially vitamin B12 can cause neurological deficits and affect mood.

Q.  What do I need to tell my doctor about my illness?

  1. Before you visit your doctor, it may be advisable to first prepare a list of things that you would like to share to help him or her understand your condition better:
  • Write down the symptoms you have had
  • Write down key personal information about yourself
  • Make a list of medications you are on
  • Write down all the questions and queries you have
  • Take a friend or family member along with you.

what your personality used to be like according to people around you. Tell your doctor how you feel you are different now, and how your symptoms are affecting your daily life. Also ensure that you have understood the different treatment options and what might be most suitable for you.



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