Bipolar Disorder

Mood refers to something broader than the hourly emotional shifts a person experiences. The general emotional tone that lasts for days or weeks, along with energy, sleep, speed of thought, movement, interest, and the relationship with life, are all parts of mood.

In mood disorders this general tone changes in a lasting way. During a depressive episode low spirits, loss of motivation, energy loss, and hopelessness may be prominent. During a manic or hypomanic episode expansiveness, excessive energy, acceleration, a marked increase in self-confidence, and risky behaviors can appear.

Bipolar disorder is a condition in which these mood changes occur in episodes. It should not be confused with everyday ups and downs. Here the change is markedly different from the person's usual functioning and is often noticed by those around them.

During a manic episode a person may feel far better than usual, strong, energetic, special, fast, or invincible. This sense of well-being is not ordinary joy. It can last for days, the need for sleep can decrease markedly, and the person may feel very energetic despite sleeping little.

Thoughts can speed up, speech can increase, and it can become hard to interrupt. The person may start many projects, spend money, engage in risky sexual behavior, become overly familiar with strangers, or make dangerous decisions in traffic or at work.

Mania can look like cheerfulness from the outside. In some people, alongside the expansiveness there can be marked anger, irritability, and aggression. In severe mania, psychotic symptoms in which contact with reality is disrupted can appear and hospitalization may be necessary.

When a person sleeps little but does not feel tired, shows extreme acceleration, sees themselves as exceptionally powerful, and begins making risky decisions, this should be carefully evaluated from the perspective of the bipolar spectrum.

Hypomania is an elevated period that resembles mania but follows a milder course. The person may appear more energetic, talkative, productive, social, and confident. Functioning may not be fully disrupted; the person may even experience this as a productive period. Yet there is still a marked difference from their usual state.

During the depressive episode the picture can turn to the opposite. Unhappiness, low spirits, loss of interest, decreased energy, fatigue, changes in sleep and appetite, thoughts of worthlessness, and a sense of disconnection from life can appear. Some people may experience intense guilt during a depressive episode because of things they did during a manic episode.

One of the things that makes bipolar disorder difficult is that the person can appear to be almost a different person in different episodes. In one episode they may be extremely lively, fast, and bold, while in another they can be quiet, slow, withdrawn, and hopeless.

In Bipolar I disorder there is at least one manic episode. Depressive episodes may also occur, but the presence of mania is the defining feature for the Bipolar I diagnosis. In Bipolar II disorder, hypomanic episodes and major depressive episodes occur, but there is no full manic episode.

In the cyclothymic pattern, milder hypomanic and depressive symptoms fluctuate over a long period. The person can sometimes be lively and active, sometimes quiet and gloomy. This can at times be interpreted as a personality trait, but the continuity, the fluctuation, and the impact on functioning should be carefully assessed.

During mixed-feature episodes, manic and depressive symptoms can appear at the same time. The person may feel both accelerated and intensely restless, both energetic and hopeless. These presentations require clinical attention.

In bipolar disorder, biological and genetic predisposition is strong. This does not mean it is the person's fault. Just as hereditary predisposition matters in some physical illnesses, the biological sensitivity of the mood-regulation system matters in bipolar disorder.

Sleep patterns, seasonal changes, intense stress, loss, the postpartum period, substance use, overwork, long journeys, and disruptions to rhythm can trigger episodes. In some people, medications used to treat depression can also lead to manic shift when proper assessment is not made.

For this reason, bipolar disorder is a serious but treatable mood disorder that unfolds through the interaction of biological rhythm, genetic predisposition, sleep, stress, and life events. "Being emotional" or "having an up-and-down temperament" does not describe this picture.

In bipolar disorder, medication is often one of the core parts of treatment. Mood stabilizers, certain antipsychotic medications, and other medications depending on the episode can be used under a physician's assessment. Lithium is one of the foundational options that has been used in this field for many years.

One of the greatest risks is that a person, feeling well, tells themselves "it is over now" and stops treatment on their own. Yet bipolar disorder can be episodic and recurrent. Protective treatment is important for preventing new episodes or reducing their severity.

Psychoeducation, recognizing early warning signs, regulating sleep and life rhythm, informing family, stress management, problem solving, and interpersonal rhythm work can strengthen treatment. Psychotherapy does not replace medication, but it can help the person build a more informed and protective relationship with their condition.

When there is excessive energy, acceleration, and risky behavior despite sleeping little.

When the person is experiencing unrealistic grandiose thoughts, excessive self-confidence, or expansiveness.

When there are suicidal thoughts or serious loss of functioning during depressive episodes.

When risk is arising in areas of family, work, financial management, sexuality, or safety.

When mood fluctuations have become recurrent, a psychiatric evaluation is needed.