What is bipolar disorder?

Bipolar disorder is a mental condition that causes a person to fluctuate between periods of gloomy depression and periods of abnormal optimism (mania). Bipolar depression is also called manic-depressive disorder, but the latter moniker is now outdated and seldom used.

Bipolar disorders can be beaten. Highly effective bipolar relief programmes by our treatment clinic in Cape Town.

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Bipolar disorder is often confused with depression, but it actually differs from it. The main difference is that depression is about feeling only negativity and hopelessness, whilst bipolar disorder has an extra component called mania. When mania kicks in, the condition swings from depression to abnormal optimism. The two conditions follow each other in alternating cycles. In other words, bipolar people have mood swings from one extreme to the other. Depression without mania is called a unipolar condition (denoting only one condition); whilst bipolar means that the person suffers both conditions (depression and mania).

A bipolar condition is not the same for everyone. Some may feel depressed most of the time, while others have mostly manic phases. It often results in poor job or student performance, poor relationships and other problems. There is an increased risk of suicide, particularly during the depressive periods but also during the manic periods.

Symptoms of bipolar disorder

Symptoms of the depressive phase include:

  • Feelings of worthlessness, low self-esteem, emotional emptiness
  • Overwhelming sadness, pessimism, guilt feelings, self-criticism, self harm
  • Apathy, disinterest in decisions and activities, withdrawal, loneliness
  • Eating and sleeping problems, poor hygiene, poor appearance, self-neglect
  • Feelings of fatigue, low energy, lack of motivation and initiative
  • Poor concentration, forgetfulness
  • Suicidal thoughts or suicide attempts

On the other extreme, the manic episodes include:

  • Intense joy, excitement, euphoria, optimism, high energy
  • Racing thoughts, rapid speech, loss of focus, poor concentration
  • Restlessness, staying awake for long periods
  • Being easily distracted, abandoning tasks / starting new ones, tackling too many tasks
  • Inflated self-importance, over-confidence, unrealistic believe in their abilities
  • Shifting between extreme mirth, irritability, agitation, anger
  • Poor judgment, impulsivity, rash acts (spending sprees, gambling, unsafe sex, etc.)
  • Abuse of drugs, particularly alcohol, sleeping medications and cocaine

There is a milder form of mania, called hypomania. The symptoms are similar to that of mania, but less intense and they do not last as long. It does not impact a person’s life too much, but if it escalates to mania, it can land you in hospital.

There are also different types of bipolar disorder (see below).

Types of Bipolar Disorder

Bipolar I
This is when the person has either alternating episodes of depression and mania, or mixed episodes (depression and mania at the same time), or pure manic episodes (without depression). In all cases the symptoms are very much out of character with the person’s normal conduct. The person may react so severely that it requires immediate hospitalisation and professional care.

Bipolar II
This is a pattern of depression interspersed with hypomania episodes. Usually the depression lasts longer than the hypomania. Though it is (clinically) less severe than bipolar I, it still requires treatment, as the severity and the person’s reaction is unpredictable – it can change or escalate very quickly.

Rapid-cycling Bipolar Disorder
People with this disorder have four or more episodes of bipolar I or II in one year. The cycles can come and go in a matter of days or hours. Bipolar II sufferers are more inclined to rapid-cycling. This is a very serious form of bipolar disorder and always requires urgent professional remediation.

Mixed-state bipolar
This is when people experience the states of depression and mania, both at the same time. Scientific tests have shown that we can have both episodes simultaneously, much like the common “laughing through the tears” phenomenon. When this happens, a bipolar person will be in a state of confusion and too unstable to carry out a task properly. One part of them wants to do it, while another part rejects it. It is not an exclusive phenomenon, as it can affect any bipolar I or II sufferer at any time. It causes extremely rapid and volatile shifts in emotions.

Cyclothymic Disorder (Cyclothymia)
Cyclothymic disorder is a relatively mild disorder, diagnosed when someone has mood swings that cycle between mild depression and hypomania, with periods of normality in between. Although milder than bipolar I and II, it might interfere with work and relationship functions. It increases the risk of developing severe bipolar disorder.

Causes of bipolar disorder

The causes vary a lot and can only be determined through individual analysis, but here are some general causes:

  • Traumatic events, anxiety or stress can activate it.
  • Genetic inheritance – it tends to run in families.
  • Mania can be worsened by certain antidepressants.
  • Lack of sleep, overly demanding lifestyle or use of drugs.
  • Cranial trauma, thrombosis, encephalitis, epilepsy.
  • Seasonal variation – the start of episodes at the same time each year, perhaps due to weather conditions or the anniversary of a traumatic event.

Treatment for bipolar disorder

Mood disorders are treatable and it is important not to delay treatment – The person’s state and behaviour can change very quickly and unexpectedly, resulting in serious injury or damage.

The first avenue of treatment for bipolar disorder depends on whether a patient is medically compromised or not. A medical practitioner’s task is to apply immediate medical care, for instance treatment of injuries or coma, and to then refer the patient for psychological treatment combined with related medication.

If a patient has been on a certain course of medication, that medication should not be withdrawn suddenly, unless instructed to do so by a medical doctor or psychiatrist. It is essential to tell the doctor or counselor about all the symptoms and medications, past and present, so they can make the right diagnosis.

The status of bipolar disorder varies widely and determines the treatment the patient receives. Mania that occurs during medical treatment is usually quickly resolved, but there is a danger of relapse if the person does not receive preventative or maintenance treatment, such as cognitive behavioural therapy.

Psychological treatment of patients with bipolar disorder should be carried out by specialists, as this disorder is very complex and difficult to treat. Self-treatment of bipolar disorder is not viable.

Suicide and damage prevention
If you think someone is at immediate risk of self-harm, hurting others or causing damage:

  • Stay calm – do not judge, argue, threaten or shout.
  • Call your local medical emergency number.
  • Remove any guns, knives, medication or other things that can cause harm.
  • Stay with the person until help arrives.

Treatment goals

  • Analysing the state of the patient
  • Reducing the risk of suicide
  • Respecting the patient’s rights to privacy and dignity
  • Providing a safe and comfortable environment
  • Providing appropriate sleep and a healthy diet
  • Designing an effective, modern treatment program for the patient
  • Applying non-punitive therapy (patients must not be “punished”)
  • Establishing regulated treatment, including efficient administration of medication
  • Providing professional counseling to prevent relapse
  • Training the patient to handle uncomfortable / embarrassing situations after treatment
  • Intervening with employers (if required) on behalf of the patient
  • Counseling relatives and friends about the nature and treatment of the disorder
  • Returning the patient to a normal, healthy and happy life

If you suspect that you, or someone you know, may have bipolar disorder, call the number at the top of this page for more advice or a confidential interview with a professional psychiatric counsellor.