Join Indian Psychiatric Society

Click the link below to Join Indian Psychiatric Society

Bipolar Disorder

What Are Bipolar Disorders?

Bipolar disorders are brain disorders that cause changes in a person’s mood, energy level and functioning. Bipolar disorder is a category that mainly includes three different conditions — bipolar I, bipolar II and cyclothymic disorder.

People with bipolar disorders have extreme and intense emotional states that occur at distinct times, called mood episodes. These mood episodes are categorized as manic, hypomanic or depressive. People with bipolar disorders generally have periods of normal mood as well. In between the episodes patients usually return to pre-morbid level of functioning. Patient usually improves form the episode to almost 100%. Bipolar disorders can be treated, and people with these illnesses can lead full and productive lives.

Bipolar I Disorder

Symptoms of Bipolar I Disorder

Bipolar I disorder can cause dramatic and frequent mood swings. During a manic episode, people with bipolar I disorder may have elated or euphoric mood and feel on top of the world, powerful and blessed or they may be uncomfortably irritable. During a depressive episode they may feel sad, worthless and hopeless. Duration of these episodes varies and there are often periods of normal moods in between these episodes. Bipolar I disorder is diagnosed when a person has a manic episode.

Manic Episode

A manic episode is a period of at least one week when a person has euphoric or irritable mood for most of the day for most days, has incresed energy than usual and experiences at least three of the following, showing a change in behavior:

  • Exaggerated self-esteem or grandiosity
  • Decreased need for sleep
  • Excessive talkativeness, talking loudly and quickly
  • Easily distractibility
  • Doing many activities at once, scheduling more events in a day than can be accomplished
  • Increased risk taking behavior (e.g., reckless driving, spending sprees)
  • Uncontrollable/continuous racing thoughts or frequently changing ideas or topics

The changes are significant and clear to friends and family. Symptoms are severe enough to cause dysfunction and problems with work, family or social activities and responsibilities. Symptoms of a manic episode may require a person to get hospital care for early and good recovery. The average age for a first manic episode is 18, but it can start anytime from early childhood to later adulthood.

Hypomanic Episode

A hypomanic episode is similar to a manic episode but the symptoms are less severe and need at least 4 days of symptoms. Hypomanic symptoms do not lead to the major problems that mania often causes and the person is still able to function. Many a time family members are happy with more activities, mild increased energy and planning in these patients.

Major Depressive Episode

A major depressive episode is a period of two weeks in which a person has at least five of the following (including one of the first two):

  • Intense sadness or despair; feeling helpless, hopeless or worthless
  • Loss of interest in activities that were previously pleasurable
  • Feeling of worthlessness or guilt
  • Sleep problems — insomnia or sleeping more
  • Feeling restless or agitated (e.g., pacing or hand-wringing), or slowed speech or movements
  • Changes in appetite (increase or decrease)
  • Loss of energy, fatigue
  • Frequent mistakes while doing any work
  • Difficulty concentrating, remembering or making decisions
  • Frequent thoughts of death, suicidal ideas or attempts

Bipolar disorder can disrupt a person’s life and relationships with others, particularly with spouses and family members, and cause difficulty in working or going to school along with disturbances in social life. People with bipolar I disorder often have other mental disorders such as attention-deficit/hyperactivity disorder (ADHD), or substance use disorder. The risk of suicide is significantly higher among people with bipolar disorder than among the general population.

Etiological Factors

Bipolar disorder can run in families. In fact, 80-90 percent of individuals with bipolar disorder have a relative with either depression or bipolar disorder. Environmental factors can also contribute to bipolar disorder — extreme stress, sleep deprivation, drugs and alcohol may trigger episodes in vulnerable patients.

Treatment and Management

Bipolar disorder is treatable. Medication alone or in combination with psychotherapy is often used to manage the disorder over time. Each patient is different and treatment needs to be individualized. Different people respond to treatment in different ways. People with bipolar disorder may need to try different medications and therapy before finding what works for them.

Medications known as “mood stabilizers” are the most commonly prescribed type of medication for bipolar disorder. Anticonvulsant medications are also sometimes used. In psychotherapy, the individual can work with a psychiatrist or psychologist to work out their problems, better understand the illness and rebuild relationships. A psychiatrist is also able to prescribe medications as part of a treatment plan. Because bipolar disorder is a recurrent illness, meaning that it can relapse, ongoing preventive treatment is recommended. In most cases, bipolar disorder is much better controlled if treatment is taken as prescribed and regular.

In some cases, when medication and psychotherapy have not helped, a treatment known as electroconvulsive therapy (ECT) may be used. ECT is given under anesthesia. The procedure takes about 10-15 minutes and patients typically receive ECT two to three times a week for a total of six to 12 treatments.

Since bipolar disorder can cause serious disruptions and create an intensely stressful family situation, family members may need to be psycho-educated and supported.

Bipolar II Disorder

Bipolar II disorder involves a person having at least one major depressive episode and at least one hypomanic episode (as described above). People return to usual function between episodes. People with bipolar II often first seek treatment for depressive symptoms, which can be severe.

People with bipolar II often have other co-occurring mental illnesses such as an anxiety disorder or substance use disorder.


Treatments for bipolar II are similar to those for bipolar I — medication and psychotherapy as needed. Medications most commonly used are mood stabilizers and antidepressants, depending on the specific type of symptoms. If depression symptoms are severe and medication is not working, ECTsmay be used. Each patient is different and treatment need to be individualized.


Cyclothymic disorder is a milder form of bipolar disorder involving many mood swings, with hypomania and mild depressive symptoms that occur often/frequent and fairly constantly. People with cyclothymia experience emotional ups and downs, but with less severe symptoms than bipolar I or II.

Cyclothymic disorder symptoms include the following:

  • For at least two years, many periods of hypomanic and depressive symptoms, but the symptoms do not meet the criteria for hypomania or depression.
  • During the two-year period, the symptoms (mood swings) have lasted for at least half the time and no symptom free period for more than two months.


Treatment for cyclothymic disorder can involve medication and psychotherapy. For many people, psychotherapy helps to deal with the stresses of ongoing high and low moods. People with cyclothymia may not be compliant with the treatment over time.