Bipolar disorder, earlier called “manic-depressive illness,” is a severe and usually persistent mental disorder characterised by mood fluctuation between two opposite extremes: depression and mania.
There are four possible types of mood episodes in bipolar disorder: mania, hypomania, depression, and mixed episodes.
Manic phases with elevated mood, drive, and restlessness alternate with severe depressive episodes with sadness, lethargy, and loss of self-esteem. The episodes can appear a few times per year, rarely once in a few years.
In mixed episodes, patients experience elevated energy levels with irritability or dysphoria coexisting with depression.
Treatment for bipolar disorder, especially in cases with rare episodes, might lead to a full cure without the need of ongoing medication. However, in most of the cases, bipolar disorder requires life-long psychiatric treatment with medication and complementary treatment with psychotherapy and socio-therapy.
Book Consultation by Our Leading Psychiatrist, Dr. Kowal
Dr. Kowal is a German-certified consultant in psychiatry and psychotherapy with over 30 years of experience in psychiatry. Before moving to Dubai, he worked in Germany, passing all levels of psychiatric training. Dr. Kowal is specialized in the treatment of bipolar disorder.
In this article, we provide a comprehensive description of bipolar disorder, its symptoms, causes, diagnosis, and treatment options.
Learn more about Bipolar Disorder
- History of Treatment for Bipolar Disorder
- CANMAT Guidelines for Bipolar Treatment with Medication
- Mood Stabilizers in Treatment for Bipolar Disorder
- Treatment with Lithium for Bipolar Disorder
- What is Mania and Hypomania?
Bipolar I versus Bipolar II Disorder
While Bipolar I Disorder is easily recognizable because of unreasonable actions and irrational behaviour leading to more or less severe social consequences, bipolar II can remain undetected.
In BP II, the symptoms are milder. The patients can even enjoy such phases due to elevated mood and energy, which make them more productive. Typical for hypomania in BP II is a shortened sleep cycle with no daytime fatigue that patients may not mention unless specifically asked.
The main therapeutic obstacle in treatment for Bipolar Disorder is convincing the patient to comply with the treatment, especially with the intake of medication. Proper medication strategies in bipolar disorder are the prerequisite for therapeutic success. A “tailored” treatment requires precise diagnostics, differentiated medication strategies, close psychiatric monitoring, and an excellent therapeutic alliance between the patient, his family, and the therapist.
The current psychiatric diagnostic manuals, ICD 10 and DSM V, describe two types of bipolar disorder
Bipolar I Disorder
is the classic manic-depressive form of the illness characterised by episodes of mania and depression
Bipolar II Disorder
shows episodes of hypomania and milder depression
Mixed Episode in BD
A mixed episode of bipolar disorder is characterised by the coexistence of manic and depressive symptoms. The patient experiencing a mixed episode might be hyperactive, being unable to sleep or concentrate, and feeling at the same time very anxious and depressed. This combination of high energy and low mood increases the risk of suicide.
Mixed bipolar episodes can resemble ADD or ADHD. Although BD II is a fully recognized diagnostic entity, it is less reliably diagnosed than Bipolar I. The main reason is that the symptoms are less obvious than those of bipolar disorder I.
Criteria of Manic Episode in Bipolar Disorder I
The most precise criteria for identifying the BP disorder diagnosis have been outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V).
The periods of abnormally and persistently elevated mood and unusually increased goal-directed activity or energy must last at least 1 week. The symptoms have to be present most of the day, nearly every day. In the phase of mood disturbance and increased energy or activity, 3 (or more) of the following symptoms should be present to a significant degree and represent a noticeable change from usual behaviour.
Additional Symptoms
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- More talkative than usual
- Flight of ideas
- Distractibility
- Increase in goal-directed activity
- Excessive involvement in activities that have a high potential for painful consequences
- The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization
- The episode is not attributable to the physiological effects of a substance or to another medical condition.
Criteria of Depressive Episode in Bipolar Disorder I
Five (or more) of the following symptoms have been present during the same 2-week period:
- Depressed mood most of the day, nearly every day
- Markedly diminished interest or pleasure in all, or almost all, activities
- Significant weight loss
- Insomnia nearly every day
- Psychomotor agitation or retardation nearly every day
- Fatigue or loss of energy nearly every day
- Feelings of worthlessness or excessive or inappropriate guilt
- Diminished ability to think or concentrate
- Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
- Significant distress or impairment in social, occupational, or other important areas of functioning
- The episode is not attributable to the physiological effects of a substance or another medical condition.
Criteria of Bipolar Disorder II
The diagnostic criteria for Bipolar Disorder II are:
Criteria of Hypomanic Episode
A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day.
Additional Symptoms
During the above-described period, three (or more) of the following symptoms have persisted:
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- More talkative than usual
- Flight of ideas
- Distractibility
- Increase in goal-directed activity or psychomotor agitation
- Excessive involvement in activities that have a high potential for painful consequences
The episode is:
- associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic
- not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization
- not attributable to the physiological effects of drug abuse or a medication
Rapid Cycling in Bipolar Disorder
The course of bipolar disorder with four or more episodes within 12 months is called rapid cycling. The other criteria for the diagnosis of rapid cycling is the demarcation between the episodes, either by period of remission or switch to the opposite polarity. Mood switches in rapid cycling can last from days to months.
Rapid cycling is more commonly observed in women. Furthermore, women tend to have a higher frequency of depressive and mixed episodes compared to men. Interestingly, men often have their initial encounter with bipolar disorder during a manic state, whereas women tend to experience their first episode in a depressive state.
Diagnosis of Bipolar Disorder
Untreated Bipolar Disorder can last for months. Once the disorder is activated, it typically persists, and untreated first episodes rarely remain dormant.
The first step in treating bipolar disorder is getting the correct diagnosis, which requires an extensive patient’s interview, ideally also involving close relatives. For the psychiatrist, it’s important to know not only the current symptoms but also past mood swings and the family history. Early diagnosis is crucial for a positive therapy outcome.
The fewer episodes a patient has had before starting treatment, the better they usually respond. Early treatment can also prevent the disorder from becoming chronic, which can have serious health and social consequences.
Diagnostic Problems in Bipolar Disorder
Bipolar Disorder should be diagnosed by an experienced psychiatrist. Apart from clinical interwiev, the diagnostic procedure includes physical examination, a set of laboratory tests, EEG, and CT or MRT brain scans. Those tests can help rule out other contributing factors, especially physical illnesses such as epilepsy, brain tumours, thyroid disorders, migraines, dementia, or Parkinson’s disease.
An in-depth investigation is also important because bipolar disorder can resemble other serious psychiatric conditions. Diagnoses such as schizophrenia, schizoaffective disorder, ADHD, or depression can be misdiagnosed as bipolar disorder.
On the other hand, the patient and his family may overlook hypomania symptoms.If depression appears first in the course of the illness, it’s unclear whether it is a unipolar (“one-sided”) or bipolar depression. On the other side, symptoms of hypomania can also be overlooked by the patient and his family.
Early Signs of Bipolar Depression
Some signs suggest a bipolar disorder: In bipolar depression, patients more often experience energy loss, an increased need for sleep, and increased appetite compared to unipolar depression. Also, those with bipolar disorder are, on average, younger (around 16 to 18 years old) when they first experience depression. About one-fifth of patients diagnosed with “unipolar depression” will go through a manic episode in the following years, meeting the criteria for bipolar disorder.
Treatment for Distinct Episodes in Bipolar Disorder
Untreated bipolar disorder leads usually to more frequent and more severe episodes than when the illness first appeared. In the worst-case scenario, the condition can evolve in developing the rapid cycling. Also, delays in getting the correct diagnosis and treatment make the patient more likely to experience personal, social, and work-related problems.
People with bipolar disorder need ongoing treatment due to the chronic nature of the illness. If left untreated, the symptoms of BD worsen; thus, early diagnosis and treatment are crucial.
Proper diagnosis and treatment help people with bipolar disorder to control their symptoms. In most cases, treatment helps reduce the frequency and severity of episodes, and in the best-case scenario, the illness can be lifelong and completely suppressed.
There is no one-size-fits-all approach for treatment of bipolar disorder because the symptoms of bipolar disorder vary in different people. The symptoms diverge widely in their pattern, severity, and frequency. Each type of bipolar disorder mood episode has a unique set of symptoms.
Depending on the phase of Bipolar Disorder the patient can be treated in the manic phase and severe depression in one of the psychiatric hospitals in Dubai; patients with hypomania or moderate depression can be treated in the outpatient setting at our clinic in Dubai.
Below we describe and treatment options for different phases of Bipolar Disorder.
Treatment for Mania
The term “mania” describes a state of extreme euphoria, unjustified optimism, and hyperactivity. Both mania and hypomania are combined with increased speed of thinking and talking as well as increased motor activities. The patient may stay awake for several nights without feeling tired. His sexual drive can be increased, and the inhibition (conscious control of his actions) decreased. His judgment will be always impaired.
Some of the patients will develop delusions and sometimes even hallucinations. Delusions are irrational thoughts; in mania, this is usually the delusion of grandeur. The existence of delusional (psychotic) symptoms can be confusing and lead to misdiagnosis of schizophrenia.
Treatment of mania requires hospitalization. In Dubai, Al Amal Hospital and the Psychiatric Department of Rashid Hospital can accommodate patients in acute manic states. The hospitalization is needed due to the patient’s irrational, sometimes aggressive behaviour. In the hospital, the medication can be adjusted instantly depending on the symptoms.
Treatment for Hypomania
A hypomanic episode is different from full mania. Its symptoms are less severe. The person can experience such a state as being very productive, being optimistic, and feeling happy. The hypomania doesn`t include psychotic symptoms (i.e., delusions), and the patient is able to keep some level of control.
Under the condition of the close support of the patient’s family, our CHMC Clinic in Dubai can treat hypomanic patients in an outpatient setting. The patients can stay at home under the supervision of their families, visiting more frequently our clinic until their full stabilization.
Treatment for Bipolar Depression
In the past, bipolar depression was not differentiated from regular depression. The results of research suggest that there are significant differences between the two. For example, certain symptoms are more common in bipolar depression than in regular depression. Bipolar depression is more likely to involve irritability, unpredictable mood swings, and feelings of restlessness.
The patients suffering from bipolar depression are more likely to develop psychotic symptoms with delusional thoughts and/or delusions. The depressive phase of bipolar disorder can also be more severe, including the risk of suicide. In fact, people suffering from bipolar disorder are more likely to attempt suicide than those suffering from regular depression. Furthermore, their suicide attempts tend to be more lethal.
In cases of severe depression with suicidal tendencies, the patient should be admitted to the psychiatric hospital in Dubai (Al Amal or Rashid Hospital). In less severe cases, we can treat the patient in an outpatient setting at CHMC in Dubai.
Long-Term Treatment for Bipolar Disorder
Bipolar disorder is a complex psychological condition. The diagnosis can be tricky, and treatment is often difficult.
Patients suffering from BP, which is a lifelong and recurrent illness, need long-term treatment to maintain control of symptoms. Therefore, psychiatrists should closely monitor the mental health of their patients and adjust medication accordingly. Psychologists should address their patients’ concerns openly, thereby improving their insight and coping skills.
Since bipolar disorder is a chronic, relapsing illness, it`s important to continue treatment with medication even when the patient feels better. The appearance of two manic episodes makes life-long medication treatment necessary.
However, medication alone is not enough to prevent the relapses. The most effective treatment strategy involves a combination of medication, therapy, lifestyle changes, and social support.
Treatment for Bipolar Disorder with Medication at CHMC Dubai
Some people believe that bipolar disorder can be healed with psychotherapy. The question that arises though is how a person can benefit from psychotherapy (counselling/talk therapy) if they are in a state of confusion, are irrational, and possibly aggressive. During a manic episode, patients are often in denial about their condition and have no ability to gain insight. The only way to treat patients during acute mania is to use medication. In most of such cases, the psychiatrist must initially hospitalise the patient. After the patient is discharged from the hospital, the psychiatrist can continue the treatment in an outpatient setting. The treatment providers should not add psychotherapy until the patient gains psychological stability. At that point, the combination of medication and psychotherapy is the best treatment for individuals with bipolar disorder.
The medication treatment of bipolar disorder is one of the biggest challenges in the field of psychiatry. The patient with bipolar disorder can be compared with someone balancing on a tight rope between mania and depression. Adding too much weight on one side can lead to a collapse. Effective treatment of bipolar disorder requires profound knowledge, experience, and dedication from the psychiatrist and psychologist involved in the process. A large percentage of patients suffering from bipolar disorder need lifelong treatment.
Classes of Medication Used in Bipolar Treatment
The untreated acute phase of bipolar disorder can last for several months. The manic episodes tend to last 3-6 months; the untreated depressive episodes are longer, up to one year. The treatment with medication significantly reduces the duration of the episodes. The goal of the treatment between the episodes is to extend stable periods and, in the best-case scenario, to keep the patient symptom-free lifelong. After two manic phases of bipolar disorder, psychiatrists will frame it as a chronic illness, thus the patient needs an ongoing treatment. Untreated bipolar disorder might end in frequently appearing manic episodes, followed by depressive phases.
Psychiatrists use the term “rapid cycling” for this type of presentation. Patients who develop rapid cycling are not able to participate in social and professional life. Therefore, fast and early beginning of treatment are crucial for therapeutic success.
Psychiatrists treat bipolar disorder with medication belonging to three main categories: mood stabilisers, antipsychotics, and antidepressants. Treatment of bipolar depression entails a combination of at least two, sometimes three drugs, including antidepressants.
Antipsychotics in Treatment for Bipolar Disorder
Antipsychotics such as aripiprazole, lurasidone, olanzapine, quetiapine, risperidone, and ziprasidone are well established in the treatment of acute manic phases. They are mostly used in combination with a mood stabiliser. Among them, only quetiapine has approval for relapse prevention and is effective even in bipolar depression. Evidence suggests that antipsychotics may also enhance the effects of mood stabilizers after the acute phase.
Although all these medications can cause extrapyramidal side effects and akathisia, the risk is lower with more sedating drugs like quetiapine and olanzapine. Long-term side effects may include significant weight gain and the development of metabolic syndrome, which involves weight gain, excess abdominal fat, insulin resistance, and dyslipidemia. The risk of these metabolic effects is lower with less sedating antipsychotics like lurasidone, ziprasidone, and aripiprazole.
Mood stabilizers
The mood stabilizers are psychiatric medications used for treatment in bipolar disorder. Mood stabilizers can be used alone or in combination with antipsychotics. They can be used throughout all treatment phases, stabilizing mood swings during both manic and depressive episodes. Some mood stabilizers are effective only for the treatment of mania, the others for bipolar depression. Few of them protect the patients “on both sides”: from mania and from depression. They stabilize the prevailing mood without inducing opposite episodes, which is crucial in preventing relapse even during stable phases. The most frequently applied mood stabilizers are lithium, valproate, lamotrigine, and carbamazepine.
Anticonvusants with Mood Stabilizing Effect
Anticonvulsants that act as mood stabilizers, particularly valproate and carbamazepine, are commonly used to treat acute mania and mixed states (mania and depression). Lamotrigine is effective for mood swings and depression. While the exact mechanism of anticonvulsants in bipolar disorders remains unclear, it may involve gamma-aminobutyric acid (GABA) pathways and G-protein signaling systems. Compared to lithium, their primary advantages are a wider therapeutic range.
Valproate dosing depends on target serum levels and can be adjusted based on weight-based protocols to achieve quicker symptom improvement. Common side effects include nausea, headaches, sedation, dizziness, and weight gain.
Carbamazepine requires gradual dose escalation to reach therapeutic serum levels and carries risks of nausea, dizziness, sedation, and imbalance, with severe but rare side effects such as agranulocytosis.
Lamotrigine dose is adjusted based on potential interactions with other medications. Rapid dose escalation increases the risk of skin rash and, rarely, life-threatening Stevens-Johnson syndrome. Patients taking lamotrigine should report any new skin rash, hives, fever, swollen glands, mouth or eye sores, or swelling of the lips or tongue.
Lithium Carbonate
Lithium stabilizes bipolar mood swings. Patients with a family history of typical bipolar disorders are more likely to respond positively to lithium.
Lithium carbonate is usually titrated based on blood levels, tolerability, and response. Higher maintenance blood levels provide better protection against manic episodes (though not depressive episodes) but are associated with more side effects. Adolescents with very good kidney function typically require higher doses, while older patients require lower doses.
The most common mild acute side effects include fine tremor, nausea, diarrhea, polyuria, polydipsia, and weight gain (partly due to the consumption of calorie-rich drinks). These effects are generally temporary and often respond to a slight dose reduction, splitting the dose into smaller portions (e.g., three times daily), or using sustained-release formulations. Once the dosage is stabilized, the entire dose should be taken after the evening meal, as this once-daily regimen can improve adherence. Lithium blood levels should be monitored every six months and after any dose adjustments.
Sedatives
e.g., Diazepam, Lorazepam, Alprazolam can be used temporarily for agitation, aggressive impulses, and anxiety.
Antidepressants
According to the guidelines, there is no clear recommendation on whether an antidepressant can be used as monotherapy in the acute treatment of bipolar depression. Similarly, there is no recommendation for a specific medication.
During the course of bipolar depression, symptoms can relatively quickly shift to a manic or mixed episode. It is not proven what role the use of antidepressants plays in such a “switch.”
Specific antidepressants (e.g., selective serotonin reuptake inhibitors, SSRIs) are sometimes used for severe depression, but their effectiveness is controversial. They are generally not recommended as monotherapy for bipolar depression, although there is evidence suggesting the use of SSRIs (selective serotonin reuptake inhibitors) like fluoxetine, paroxetine, or sertraline.
The other option could be the use of an atypical antidepressant belonging to norepinephrine–dopamine reuptake inhibitor (NDRI), bupropion. A number of smaller studies indicate that tranylcypromine might be more effective in treating bipolar depression than other antidepressants. A higher risk appears to be associated with treatment using tricyclic antidepressants and venlafaxine.
Due to the risk of switching to a manic episode, antidepressants are most commonly used in combination with a mood stabilizer or an antipsychotic in the treatment of bipolar depression.
Treatment with Medication in Manic Phase of Bipolar Disorder
During the manic phase, the patient’s irrational behaviour can severely affect his social and economic status. The patient can overspend, buying useless but expensive items, gambling, or even donating money, which can end in a financial catastrophe or even total impoverishment. In the manic state, the person’s “moral brakes” are out of control. This can lead to oversexualized or aggressive behaviour, causing irreparable damages to him and his family. Therefore, in most of the cases, the patients require hospitalization. The medication used in the acute phase must be administered quickly and in sufficient dosage. The most frequent medication used in the acute phase is a combination of atypical antipsychotics (Quetiapine, Olanzapine, and Risperidone) and a mood stabilizer, preferably Valproic acid.
Treatment with Medication for Bipolar Depression
In the depressive phase, the problems are different. The patient suffers from lack of energy, low mood, sleeplessness, and often develops suicidal ideation. Depressive episodes in bipolar disorder are far more common than mania and have a more detrimental effect on patient’s lives.
In some patients, mood stabilizers may be sufficient to modulate the depressed mood. However, the standard treatment for bipolar depression is the combination of an antidepressant and a mood stabilizer. The mood-stabilizing medication improves mood, social interactions, and the patient’s level of functioning. The sole use of antidepressants in bipolar depression carries the risk of transitioning into a hypomanic or manic phase. The mood stabilizer of choice in the treatment of bipolar depression is lithium because of its antisuicidal properties.
Only one of the atypical antipsychotics, Quetiapine, is worth mentioning, as it can achieve good antidepressant effects at doses of 300-600 mg in bipolar depression.
Prophylaxis in Treatment for Bipolar Disorder
For the prophylaxis phase, it is recommended to continue prescribing the substances that have successfully stabilized the patient during the maintenance phase. At this stage of the illness, the patient typically feels much better or is even symptom-free, which often leads to a decrease in motivation to take daily medication. It is important to emphasize to the patient that discontinuing the medication causes a significant risk of relapse.
Treatment for Bipolar Disorder in Pregnancy
The choice of medication for women with bipolar disorder should presume the future pregnancy. Ideally, the medication used in the treatment of bipolar disorder in young women should ‘t have any teratogenic effects on the baby.
If a woman with bipolar disorder gets pregnant while being on medication, it’s recommendable to continue the medication with a low spectrum of side effects on the embryo rather than stopping its intake. Therefore, discontinuing the medication during pregnancy contains the risk of a manic or depressive episode and, in consequence, the use of a higher dosage of medication to control the symptoms.
Treatment for Bipolar Disorder with Medication in Bullet Points
• Motivation: Medication needs to be thoroughly discussed with the patient. Many people with bipolar disorder struggle to accept that they need to take medication long-term or even permanently. Comprehensive conversations can help build acceptance and improve compliance, which leads to treatment success.
• Individualized therapy adjustment: It may take some time to find the right medication. Individual symptoms and side effects need to be considered in the medication treatment plan.
• Regular monitoring: The effect of maintenance and prophylactic phases needs to be regularly monitored.
• Acute mania in bipolar disorder: mood stabilizers such as lithium, valproic acid, carbamazepine, and lamotrigine, as well as atypical antipsychotics such as olanzapine, risperidone, quetiapine, ziprasidone, and aripiprazole are used. Combinations of both are usually more effective.
• Acute depression in bipolar disorder: Only combinations of mood stabilizers and antidepressants make sense, and antidepressants should not be used alone in bipolar disorder. Quetiapine is an alternative as monotherapy.
Psychotherapy in Treatment for Bipolar Disorder
The treatment for bipolar disorder, once primarily managed with medication, evolved to a more complex, comprehensive approach involving a combination of medication and psychotherapeutic and psychosocial interventions. However, psychotherapy alone can’t cure bipolar disorder. For instance, manic patients need medication since they lack insight and act irrationally. The same counts for severe depressive phases. The pharmacological intervention is necessary, especially in suicidal patients. Even during stable periods, relapses are highly probable.
The essential part of the treatment with psychotherapy is therapy during the stable phases of BD.
Psychotherapy Approaches in Treatment for Bipolar Disorder
Multiple psychotherapeutic and psychosocial treatment approaches have proven effective. These include family-oriented therapy, cognitive behavioral therapy, interpersonal and social rhythm therapy, and group psychoeducation. These approaches facilitate quicker recovery from depressive or manic phases, and between the phases reduce the likelihood of experiencing another episode.
One critical therapeutic objective is relapse prevention. This entails educating patients and their families. All involved parties need to understand the nature of the illness. There is an emphasis on ensuring patients consistently take their prescribed medications. Patients also learn improved stress management, early identification of episode warning signs, and the application of suitable coping strategies.
In the case of depressive episodes, psychotherapy closely resembles the treatment for unipolar depression. The goal is to establish a structured daily routine, motivate increased activity and enjoyable activities, and encourage social interactions. An important distinction in bipolar disorder is the therapist’s constant vigilance for potential shifts into hypomania or mania.
During acute manic or mixed episodes or severe depressive phases, psychotherapy is scarcely feasible. In these instances, medication is the most effective treatment method. Such phases often require the patient’s hospitalization.
While a hypomanic episode also necessitates appropriate medication, hospitalization is usually unnecessary. In such cases, continuing psychotherapy contributes to stabilizing the patient.
Cognitive-Behavioral Therapy (CBT) in Bipolar Treatment
This therapy has also proven effective in managing bipolar disorder. Therapists and patients collaboratively identify contributing factors to the disorder and specific risk factors for manic and depressive episodes. Therapists work with patients to underscore the importance of consistent medication adherence and encourage balanced daily routines.
In cognitive-behavioral therapy, patients also acquire general psychological skills, such as better expressing their emotions and needs, managing conflicts, and dealing openly with the illness. The therapy also focuses on identifying individual warning signs that may indicate the onset of mania, hypomania, or depression. For example, patients learn to differentiate between ordinary mood fluctuations in response to specific situations, such as irritation from criticism, joy from passing an exam, and emotional states that may serve as early indicators of mania or depression. Additionally, the therapy aims to help patients identify and address thought patterns that may precipitate manic or depressive episodes, such as thoughts like “I can do anything” or “My unique abilities are not properly recognized.”
Patients are often encouraged to maintain mood diaries to retrospectively identify mood fluctuations and their triggers. In cases of worsening symptoms, patients and therapists collaborate to establish a crisis plan outlining appropriate responses to early warning signs. These plans typically include multiple steps, such as finding tranquility through relaxation exercises and early bedtime for mild symptoms. For more severe symptoms, patients may be advised to visit the psychiatrist. In cases of pronounced symptoms, patients may be instructed to contact an emergency clinic.
Interpersonal and Social Rhythm Therapy for Bipolar Disorder
This approach operates on the premise that irregular sleep-wake cycles primarily trigger manic and depressive mood swings. Thus, therapy focuses on establishing regular sleep-wake patterns and relatively consistent daily routines. Simultaneously, patients receive support in resolving individual and interpersonal problems.
Couple and Family Therapy for Bipolar Disorder
This therapy is particularly valuable because bipolar disorder often triggers conflicts within families or partnerships. These conflicts can trigger mood swings in patients, raising the likelihood of slipping into mania or depression. Couple and family therapy can prove highly beneficial in managing bipolar disorder and significantly reduce the risk of relapse. Key aspects of this approach include educating families about the disorder and its causes (psychoeducation), assisting in resolving everyday problems (problem-solving training), improving communication skills, and providing guidance for the patient and his family. Over time, the patient and his family gain a better understanding of each other’s viewpoints, potentially leading to mutually satisfactory solutions.
For example, family members may often notice the patient’s changing moods and become concerned, while the patient may not perceive their state as problematic. When family members attempt to intervene, suggesting, “You’re behaving differently; you should see a doctor,” the patient may feel patronized. Conversely, family members also bear the burden of the patient’s condition.
Other Treatment Approaches for Bipolar Disorders
Psychoeducational and socio-therapeutic approaches have also proven beneficial for managing bipolar disorder. Patients receive information about the origins of their condition and learn better coping strategies. Additionally, self-help groups can be valuable, enabling patients to share difficulties with others and obtain helpful insights into managing their condition.
Family Support in Treatment for Patients with Bipolar Disorder
Like other serious illnesses, dealing with bipolar disorder is difficult for spouses, family members, and friends. Relatives and friends must cope with the person`s serious behavioral problems. Patients in manic states tend to go on wild spending sprees or other irrational behaviours, often breaching social norms. Patient in the depressive phase goes to the other extreme. He withdraws socially and, in some cases, can get suicidal. Such extreme mood swings can end for the patient in total social and professional disaster. That’s why the involvement of family and friends in the treatment is crucial in the recovery process.
Treatment Prognosis of Bipolar Disorder
Factors suggesting a worse prognosis include such attributes as poor job history, alcohol abuse, psychotic features, depressive features between periods of mania and depression, male sex, poor general health condition, inconsistent psychiatric treatment, or no treatment at all.
Factors correlating with the positive outcome of the treatment are the short duration of the episodes, late age of onset, few psychotic symptoms, good general health, and consistent psychiatric monitoring.
The prerequisite for successful treatment of bipolar disorder without relapses is the consistent psychiatric monitoring by experienced psychiatrists.
Causes of Bipolar Disorder
The age of onset of bipolar disorder varies. For both BP I and BP II, the age range is from childhood to about 50 years, with a mean age of about 21 years. Individuals are between 15 and 19 years old when bipolar disorder emerges. The second most frequent age range of onset is 20–24 years. At least half of all cases start before age 25.
The lifelong prevalence of bipolar disorder in the United States ranges from 1% to 1.6%. International statistics: lifelong prevalence rate according to the World Health Organization Composite International Diagnostic Interview determined the aggregate lifetime prevalence for bipolar I disorder: 0.6%. However, the prevalence estimates vary based on the criteria used for diagnosis and the studied population.
Bipolar disorder impacts various demographics, including genders, races, and socioeconomic groups.
The root causes of BD disorder are multifactorial, with genetics being the strongest. Identical twins have a 50% correlation. However, genetic predisposition does not guarantee the onset of the disorder.
The genetic predisposition can be compared to someone walking on ice; in some cases, the ice may be thin but won’t break if the person moves smoothly. On the other hand, people without genetic predisposition but with triggering physical illnesses and/or stressful life events can develop BD.
Impact of Genetics on Bipolar Disorder
The current research shows that the genetic component of bipolar appears to be complex. Multiple genes appear to underlie the disorder. Those studies suggest complex gene interaction and genetic heterogeneity, with different genes being implicated in the onset of bipolar disorder in different families.
Scientists have shown that some people are genetically predisposed to develop bipolar disorder. However, not everyone with an inherited vulnerability develops the illness.
Bipolar tends to run in families. Children with a parent or sibling who has bipolar disorder are four to six times more likely to develop the illness in comparison with the general population.
Genetics are not the only risk factor for bipolar disorder. Studies of identical twins have shown that the twin of a patient with bipolar illness does not always develop the disorder; only 50% of the twins will develop the illness.
Twin studies
Scientists know the role of genetic factors. Twin, family, and adoption studies all show that bipolar disorder has a genetic component. In fact, first-degree relatives of a person with bipolar disorder are approximately 7 times more likely to develop this disorder than the rest of the population.
Influence of Environmental Factors on Bipolar Disorder
The external factors can set off the onset of bipolar disorder. Psychiatrists call these factors triggers. Triggers can set off new episodes of mania or depression or make existing symptoms worse. Such triggering factors like stressful life events, sleep deprivation, and substance abuse can set off the onset of bipolar disorder in someone with a genetic vulnerability. These events tend to involve drastic or sudden life changes, exposing an individual to a high level of emotional tension. Psychiatrists also say that the events could be such as seasonal changes, sleep deprivation, use of drugs, getting married or losing a partner or loved one, losing a job, etc.
Race-related differences in incidence: no racial predilection exists.
Psychological Factors and Bipolar Disorder
Psychodynamic factors also possess an important role in bipolar disorder. The psychoanalytical observations suggest that the mania serves as a defence against the feelings of depression. Melanie Klein was one of the major proponents of this formulation. Other psychodynamic-based studies found by bipolar patients personality disturbances and a higher level of neuroticism.
Physical Illnesses and Their Impact on Bipolar Disorder
Some organic diseases, for example, hyperthyroidism, illnesses of the central nervous system, and intoxication, can lead to similar symptoms as bipolar disorder. The diagnosis of the bipolar disorder includes a profound anamnesis, physical examination, a battery of tests, EEG, as well as a brain scan to exclude an organic cause.
Substance Abuse and Bipolar Disorder
Another risk factor for bipolar disorder is the abuse of alcohol or drugs. Studies show that about 50% of people with bipolar disorder have a substance abuse or alcohol problem. Also, people suffering from bipolar disorder tend to use alcohol or drugs, especially during the depressive periods, trying to enhance their mood. Conversely, manic episodes’ recklessness leads to substance misuse.
Treatment for Bipolar Disorder. Summary
As the name suggests, bipolar disorder has two poles, with mood swinging between mania and depression. In the course of bipolar disorder, depressive symptoms cause more severe suffering and last longer than manic episodes. Patients with mania or hypomania with elevated mood or even euphoria are less likely to visit a psychiatrist on their own. In more severe cases, hospitalisation is necessary.
For therapy of bipolar depression, a treatment with medication should be used from the beginning. Psychotherapy should be added after patients reach a stable phase.
Social and psychological factors, such as gene-environment interactions and epigenetics, play an important role in the onset and course of the disorder. For these reasons, a biopsychosocial treatment approach is recommended, incorporating an integrated collaborative care model. This model should involve the cooperation of different experts and diverse treatment programs. Treatment strategies include therapy with medication, psychotherapy, physical exercises, and lifestyle coaching.
Untreated patients with bipolar disorder have a high risk of relapse, making long-term therapy with medication necessary. To achieve maximum therapy success, an individualised medication approach is needed.
FAQ about Bipolar Disorder
In the below Frequently Asked Questions section, we provide the answers to the most common concerns of our patients about bipolar disorder.
What is bipolar disorder?
Bipolar disorder is a mental health disorder that causes changes in a person’s mood, energy, and functioning. People with bipolar disorder alternate between intense and conflicting emotional states. These mood swings are classified as manic or hypomanic (abnormally happy or irritable mood) or depressive (sad mood), with periods of neutral mood in between. The mood swings called mood episodes can last weeks to months. One of such extremes is depressed mood, also called bipolar depression; the other is mania or hypomania.
Under the condition of a proper diagnosis and professional treatment, people with bipolar disorder can be stabilised on the “baseline” mood level, allowing them to live a normal life without limitations.
What are the types of bipolar disorder?
Bipolar disorder presents in various forms, including Bipolar I Disorder, which entails manic episodes lasting at least seven days or those requiring immediate medical attention due to their severity. Bipolar II Disorder involves depressive and hypomanic episodes but lacks full-blown mania. Additionally, Cyclothymic Disorder is a milder form of bipolar disorder, characterized by less severe mood swings.
What is rapid cycling?
Rapid cycling is not a type of bipolar disorder but is a term used to describe the course of illness in people with bipolar I or II disorder. In rapid cycling, the mood episodes occur four or more times in a year. Women are more likely to experience rapid cycling than men.
Are Bipolar Disorder and Bipolar Depression the same?
No, bipolar disorder and bipolar depression are not the same. Bipolar disorder is a mental health condition distinguished by drastic mood swings, encompassing episodes of mania or hypomania as well as periods of depression. Bipolar depression specifically refers to the depressive episodes experienced by individuals with bipolar disorder. While bipolar depression is a component of bipolar disorder, the disorder includes both depressive episodes and manic or hypomanic episodes.
How do you recognise the normal mood fluctuation from bipolar episodes?
Even people without bipolar disorder have mood swings. However, these mood swings usually last for hours, maximum a few days instead of weeks or months. Moreover, the “normal” mood swings are usually triggered by external circumstances, and they are not accompanied by an extreme degree of behavioural changes. During the mood swings, people without bipolar are still fully functional. On the contrary, a person affected by bipolar disorder exhibits during depressive or manic episodes difficulties in daily living and social interactions. Depressive as well as manic episodes can disrupt relationships, creating severe social and professional consequences.
What Bipolar Disorder feels like?
Bipolar disorder can feel like experiencing intense emotional highs (mania or hypomania) and lows (depression). During manic episodes, individuals may feel euphoric, have racing thoughts, and engage in risky behaviours. During depressive episodes, they may feel hopeless, sad, and lack energy or motivation. These mood swings can disrupt daily life and relationships.
I have mood swings; sometimes I’m feeling down...
Question:
I have lived in Dubai for seven years. For four years I have had mood swings. At the beginning I felt only depressed; however, for two years I feel sometimes “better than usual.” After my “down phase” is over and I sleep less, I’m more active and talkative. Such phases can last two-three weeks.
Do I have bipolar disorder? If so, how to treat it?
Answer:
People without bipolar disorder also have mood swings. However, these mood swings usually last for hours, maximum a few days. As I understand it, you experience phases of depression followed by periods of elevated energy and sleeplessness lasting a few weeks. Apparently during such phases you are still functional without losing touch with reality. Such mood swings are typical for bipolar disorder 2. Nevertheless, for a proper diagnosis, a profound investigation would be necessary.
Bipolar disorder can be well treated, keeping the mood on a stable level. However, in the majority of patients, especially after 2-3 hypomanic mood swings, a lifelong treatment might be necessary.
What are the symptoms of bipolar disorder?
Symptoms of Bipolar Disorder can vary but typically include periods of unusually intense emotional states, extreme changes in activity levels, and shifts in energy, concentration, sleep patterns, and self-esteem.
Who can develop bipolar disorder?
Bipolar disorder can affect people of any age, ethnicity, or gender. However, it typically develops in late adolescence or early adulthood and is usually diagnosed in late teens or early twenties. The genetic predisposition doesn’t result by default in the onset of bipolar disorder. Environmental factors such as stress, sleep disturbances, drugs, and alcohol can provoke the onset of the illness in at-risk individuals.
Despite high genetic predisposition, people can manage to avoid the onset of bipolar disorder by avoiding stressful events, creating proper life-work balance, and avoiding drugs and alcohol. On the other side, people with no genetic predisposition but being exposed to traumatising life circumstances, physical illnesses, or the usage of drugs and alcohol are at high risk of developing the illness.
How do you diagnose bipolar disorder?
People with bipolar disorder are often misdiagnosed, changing frequently the therapists along with the medication. Sometimes they are luckier and will get an accurate diagnosis and effective treatment. The diagnosis of bipolar disorder can be secured by an experienced psychiatrist. Recognising bipolar disorder II or cyclothymia is more difficult due to the less pronounced symptoms.
Is Bipolar Disorder Treatable? Where can I treat it in Dubai?
Yes, Bipolar Disorder is treatable with a combination of medication, psychotherapy, and lifestyle changes. Mood stabilizers, antipsychotic medications, and antidepressants are commonly prescribed to manage symptoms. Psychotherapy, such as Cognitive-Behavioral Therapy (CBT) or interpersonal therapy (IPT), can also be helpful in managing mood episodes and improving coping skills.
Bipolar disorder in a stable phase can be treated in an outpatient setting at CHMC in Dubai. However, in unstable phases such as severe depression or mania, the patient should be admitted to a psychiatric hospital.
What are the proper treatment of bipolar disorder?
The first step in the treatment of bipolar disorder is the correct diagnosis. In the second step, the psychiatrist should find a balanced medication keeping the symptoms at bay. The most effective treatment is the combination of medication, psychotherapy, and lifestyle changes. The key role is the patient’s education about the disorder. Establishing the therapeutic alliance with the psychiatrist and psychologist is the prerequisite of an effective treatment. Early recognition of bipolar warning signs can prevent the escalation of the illness, which makes it easier to control its dynamics.
Can bipolar disorder be healed?
Bipolar disorder can’t be “cured” in the proper sense. Bipolar disorder is a long-term mood disorder. The difference between bipolar I and II types is the range of severity of the mood swings. Each of the bipolar episodes is time-limited, which means people will typically return to their baseline of functioning. The treatment objective is to stabilise the patients on their baseline of functioning without switching to one of the extremes. Keeping the symptoms under control allows the individual a normal life. Without treatment, bipolar disorder tends to become chronic with more frequent and more severe episodes.
What causes bipolar disorder?
The exact causes of bipolar disorder are unknown, but it’s believed to be a combination of genetic, biological, and environmental factors. Imbalances in brain chemicals called neurotransmitters may also play a role.
What are the complications of Bipolar Disorder?
Bipolar Disorder can lead to various complications, including problems with relationships, work, and school; substance abuse; legal or financial issues; and suicidal thoughts or behaviours. It’s essential for individuals with bipolar disorder to seek treatment and support to manage their condition effectively.
Where Does Bipolar Disorder Affect the Brain?
Bipolar disorder affects various regions of the brain involved in mood regulation, emotion processing, and thinking. These include the prefrontal cortex, amygdala, hippocampus, and areas of the limbic system. Imbalances in neurotransmitters such as serotonin, dopamine, and norepinephrine also play a role in the development and manifestation of bipolar disorder.
Famous people who suffered from bipolar disorder
- Ernest Hemingway, American writer
- Graham Greene, English writer
- Jack Irons, drummer, formerly of Red Hot Chilli Peppers and Pearl Jam
- Vivien Leigh, actress
- Jack London, American writer
- Edvard Munch, artist
- Edgar Allan Poe, poet and writer
- Jackson Pollock, American artist
- Robert Schumann, German composer
- Kurt Cobain, musician
- Vincent Van Gogh, artist
- Amy Winehouse, musician
- Virginia Woolf, writer
Useful links
International Society for Bipolar Disorders
The International Society for Bipolar Disorders (ISBD) is a non-profit organisation. The society sponsors research and education for bipolar disorders. ISBD members are mental health professionals as well as patients and their families. ISBD and has branches in fifty countries.
Although both experts are educated to assist individuals with mental and emotional difficulties, their roles, methods of treatment, and training differ greatly. Knowing these distinctions will enable you to choose a professional depending on your particular need.