Bipolar disorder has a strong biological and hereditary component. It is a chronic but treatable illness: the aim is to treat episodes and, above all, to prevent them.
What it is
It is characterised by episodes of mania or hypomania, usually alternating with depressive episodes and periods of stable mood. In bipolar I disorder there is at least one manic episode; in bipolar II, there are episodes of hypomania, which are less intense, and depressive episodes, which usually dominate the course of the illness.
Signs and symptoms
Mania and hypomania:
- elevated, expansive or irritable mood, and increased energy and activity;
- greatly reduced need for sleep without feeling tired;
- racing thoughts, rapid speech, distractibility;
- inflated self-esteem, unrealistic plans;
- impulsive behaviour with consequences (spending, decisions, driving, relationships).
In mania the symptoms are severe, may include psychotic symptoms and may require hospital admission; in hypomania they are milder and not always recognised by the person. Depressive episodes are similar to those of depression.
Why diagnosis is often delayed
The illness often begins with depressive episodes, and hypomania may go unnoticed or be experienced as a good period. As a result, many people are treated for years as having depression. The distinction matters: treatment with an antidepressant alone may be ineffective or destabilise mood.
What the assessment involves
The diagnosis is clinical and rests on the lifetime history. Information from family members or people close to the person is often decisive, and a daily record of mood and sleep helps identify patterns. Medical causes and the effects of substances are ruled out. Before starting some mood stabilisers, such as lithium, baseline blood tests are requested, including kidney and thyroid function.
Treatment
- Mood stabilisers: lithium remains a cornerstone of relapse prevention; some second-generation antipsychotics and anticonvulsants are alternatives or add-ons, chosen according to each person's profile.
- Psychoeducation: understanding the illness, recognising early signs of relapse and having a plan for those moments reduces the frequency of episodes.
- Regularity: stable sleep schedules and avoiding alcohol and other substances are part of treatment.
- Ongoing follow-up, with monitoring of medication levels and side effects where applicable.
Planning a pregnancy should be discussed in advance, because some medicines, in particular valproate, are contraindicated or require special precautions.
Frequently asked questions
Can bipolar disorder be cured?
It is a chronic illness that tends to recur. With maintenance treatment and follow-up, many people remain stable for long periods and lead full personal and professional lives.
Is lithium dangerous?
It is an effective and well-studied medicine that requires monitoring: regular blood tests of its levels and of kidney and thyroid function. With that follow-up, it has been used safely for decades.
What is the difference between mood swings and bipolar disorder?
We all have variations in mood. In bipolar disorder there are well-defined episodes lasting days to weeks, with changes in sleep and energy and a clear change from usual functioning.
References
- National Institute for Health and Care Excellence. Bipolar disorder: assessment and management (CG185). 2014, updated 2023.
- Yatham LN, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord. 2018;20(2):97–170.
- European Medicines Agency. New measures to avoid valproate exposure in pregnancy. 2018.
This page is for information only and does not replace an individual medical assessment. Clinical review: Pedro Zuzarte, psychiatrist · Published and reviewed: .