What is Bipolar Disorder?

Introduction

Bipolar Disorder is a psychiatric condition in which a person experiences recurrent episodes of shifts in mood from extreme highs to extreme lows, which last for several days and make it difficult for them to carry out day to day tasks.

The periods of highs are episodes of ‘mania’ characterised by elated or irritable moods, increased energy and activity, and impulsivity. A person having a manic episode is likely to talk fast, about many different things, and feel that their thoughts are changing rapidly. They may also develop unrealistic beliefs, start behaving inappropriately, and do reckless things such as spending a lot of money. The manic episodes may vary in severity, and severe symptoms may sometimes require hospitalisation.

Less severe episodes are known as hypomania. During a hypomanic episode, a person may feel optimistic and become more productive. Although they may not think that anything is wrong, people around them may notice a change in mood, behaviour and activity levels. Hypomania can also develop into more severe mania or depression without timely treatment.

The periods of lows, called ‘depression’, include feelings of sadness, loss of interest, or hopelessness, along with decreased energy and activity levels. A person experiencing depression will tend to feel tired and find it difficult to concentrate on and enjoy anything. There are often disturbances in sleep and appetite. Depressive episodes can vary in severity too, with severe episodes often being characterised by suicidal thoughts and impulses.  

Every person diagnosed with Bipolar Disorder has experienced at least one episode of mania or hypomania. An episode can also include symptoms of both mania and depression. In such an episode, people may experience sadness, emptiness, or hopelessness along with a lot of energy. This is called a mixed episode, or an episode with mixed features. Symptoms of Bipolar Disorder often appear in early adulthood, although they can begin in childhood or middle adulthood too.

Types

There are four types of Bipolar Disorder. These are:

• Bipolar I Disorder, which is characterised by recurrent manic and depressive episodes
• Bipolar II Disorder, which includes recurrent hypomanic and depressive episodes
• Cyclothymic Disorder (or cyclothymia), which is defined by periods of hypomanic and depressive symptoms that do not meet the criteria for hypomanic and depressive episodes. In cyclothymia, the symptoms last for more than two years in adults, and one year in children and adolescents.
• Other Specified and Unspecified Bipolar and Related Disorders, which includes symptoms of bipolar disorder that do not match the above three types

In Bipolar Disorder, a person will experience episodes of mania and depression throughout their life. While most people will be free of symptoms between these episodes, around one-third have residual symptoms and some experience chronic and unremitting symptoms even with treatment.

Bipolar disorder treatment can reduce the severity and frequency of these episodes, and help people with the disorder live a meaningful and productive life. Without treatment, the disorder tends to worsen over time, with more frequent and more severe episodes.