As a psychiatrist with over 25 years of experience, one of my core clinical and research interests has been bipolar disorder. Previously known as manic depression, bipolar disorder causes extreme shifts in mood, energy, and activity levels that can significantly impair a person’s life. My goal is to increase public understanding of this complex mental health condition.
What is Bipolar Disorder?
Bipolar disorder is a lifelong chronic mental illness characterized by dramatic mood swings between periods of mania (highs) and depression (lows). These episodes represent a major change from the person’s typical behavior.
Bipolar symptoms generally start emerging between ages 15-25. An estimated 2.8% of American adults have bipolar disorder. Obtaining an accurate diagnosis is key to accessing effective treatments.
Key Symptoms of Bipolar Disorder
Bipolar disorder involves alternating episodes between two poles or extremes, mania/hypo-mania and depression:
Mania causes euphoric or irritable elevated moods with symptoms like:
- Extreme optimism, self-confidence and enthusiasm
- Rapid speech, racing thoughts, and flight of ideas
- Impulsiveness with shopping, sexual activity, reckless behaviors
- Agitation, irritability, and argumentativeness
- Decreased need for sleep without experiencing fatigue
- Inability to concentrate well or finish tasks
- Possible delusions or hallucinations in severe cases
Hypo-mania refers to milder manic symptoms that are still beyond normal mood fluctuations. Classic features include:
- Heightened self-esteem and confidence
- Extremely energetic and productive activity
- Rapid decision-making and implementation of plans
- Increased risk-taking and pursuit of goals
- Lower inhibition and greater social engagement
- Reduced need for sleep
Major Depressive Episodes
Bipolar depression shares features with major depression such as:
- Depressed, sad mood lasting most of the day
- Loss of pleasure and interest in activities
- Significant weight loss or gain
- Sleep disturbances – insomnia or excessive sleep
- Fatigue, loss of energy and motivation
- Feelings of worthlessness or guilt
- Reduced concentration, indecisiveness
- Recurrent thoughts of death or suicide
These mood swings are more severe than normal ups and downs.
Bipolar Disorder Types
There are several distinct bipolar disorder sub-types with differing patterns of mood episodes:
Bipolar I – Manic episodes alternating with depressive episodes
Bipolar II – Milder hypomanic and depressive episodes
Cyclothymic Disorder – Chronic, fluctuating mild hypomania and depression
Rapid Cycling – Frequent episodes of major mood shifts
Correctly identifying the subtype through psychiatric assessment guides optimal treatment.
Common Symptom Triggers
While mood episodes can occur without identifiable causes, common bipolar triggers include:
- Major life stresses – relationship conflicts, financial hardship, work issues
- Medication changes or non-compliance
- Substance use disorders with alcohol, cannabis, stimulants
- Hormone changes like perimenopause or postpartum
- Disruptions in sleep-wake cycles or “social jet lag”
- Seasonal changes particularly decreasing sunlight in fall/winter
Learning individual’s unique triggers helps manage recurrences proactively through lifestyle changes, support and early intervention.
People with bipolar disorder have increased prevalence of:
- Anxiety disorders – generalized anxiety, social phobia, PTSD
- Substance abuse disorders
- Personality disorders – borderline, antisocial
- Metabolic syndrome and cardiovascular disease
Managing co-occurring conditions improves overall treatment outcomes.
Causes and Risk Factors
While the exact causes are still under investigation, contributing factors likely include:
- Genetics – bipolar disorder runs strongly in families
- Neurotransmitter imbalances – serotonin, nor-epinephrine, dopamine
- Hormonal changes – cortisol, thyroid, reproductive
- Brain structure variations – under-activity in prefrontal cortex
Major stress, drug use, or lack of sleep can trigger the first episode in a genetically predisposed person. Ongoing research aims to better understand bipolar’s complex origins.
Getting a Diagnosis
Since bipolar disorder varies widely in symptoms and severity, thorough clinical assessment by an experienced mental health professional is essential for an accurate diagnosis.
In-depth evaluation of current signs, family history, and past episodes through methods like clinical interview, physical exam, mood questionnaires, and psychological testing helps differentiate bipolar from other potential causes of mood swings.
Early bipolar detection and treatment provides the best opportunity for long-term management.
Treatment Options for Bipolar Disorder
While not curable, a combination of medication, therapy, and healthy lifestyle changes effectively manages bipolar disorder. Recommended components include:
- Mood stabilizers (lithium, anticonvulsants)
- Atypical antipsychotics
- Antidepressants combined with mood stabilizers
- Anti-anxiety medications as-needed
- Cognitive behavioral therapy (CBT)
- Interpersonal therapy
- Psychoeducation and skills training
- Family therapy
- Regulating sleep schedule
- Reducing stress and avoiding triggers
- Minimizing stimulant use
- Maintaining routines with calendars and reminders
- Joining peer support communities
- Developing a crisis management plan
Using individualized, multimodal strategies tailored to the person enables successfully managing bipolar disorder. Consistency and commitment to treatment are key.
Tips for Living with Bipolar Disorder
In addition to professional treatment, making lifestyle adjustments enables thriving with bipolar:
- Track mood and symptomsusing apps, journals or charts to identify triggers and episode patterns early.
- Practice mindfulness and relaxation techniqueslike meditation, yoga, or deep breathing to relieve stress.
- Maintain regular sleep routinesgetting adequate restful sleep (8+ hours) and avoiding sleep deprivation.
- Limit caffeine and other stimulant intakeas it can trigger manic symptoms.
- Reduce alcohol and recreational drug useas substance abuse worsens episodes.
- Plan meaningful activitiesfor when depressed and calm hobbies for when manic.
- Recruit trusted friends and familyto provide empathy, accountability and support.
With proper treatment and self-care, individuals can effectively manage their bipolar symptoms long-term and continue pursuing their goals.
As an experienced psychiatrist, I partner with patients to develop individualized treatment and wellness plans aimed at long-term mood stability and symptom reduction. My office provides compassionate, evidence-based mental healthcare for those living with bipolar disorder. Please don’t hesitate to reach out for any guidance or support needed along your journey.
Professor Dr. Ghulam Hassan Consultant Psychiatrist Lahore, Pakistan