The Reality of Bipolar Disorder

By: Trishala Ballal
02 Aug 2020 Indian Academy, Bengaluru


A study published in a medical journal, The Lancet, showed that by 2017, one in every seven Indians was suffering from a mental disorder, with varying levels of severity. Yet, despite these alarming figures, mental illness continues to be viewed with scepticism in our country.


Bipolar disorder, in particular, is a disease that is barely understood, often dismissed as a behavioural quirk, and oversimplified as ‘moodiness’.


Awareness is crucial in dispelling the pain of people suffering from bipolar disorder, who are condemned to suffer even more due to the ignorance and apathy of those around them.


What are the common symptoms and signs of bipolar disorder?


Bipolar disorder is a mental illness characterised by dramatic mood swings. People suffering from this often experience periods of mania (characterised by euphoria and high energy), and then rebound into bouts of depression. Because of this, patients usually describe themselves as feeling motivated, joyful and optimistic for a length of time (onset of mania) and then lethargic and empty afterwards (onset of depression).


What is mania?


Though the manic period may sound pleasant to many, it’s typified by a euphoric response so intense, that there’s often a disconnect with reality. People in manic phases may make unfortunate choices on the spur of the moment, and engage in dangerous risk taking behaviour. The abundance of energy during manic phases may also leave one agitated, unable to sleep and losing weight. It can lead to grandiose perceptions of one’s abilities and, in super high states, can also involve hallucinations and delusions. Sometimes, patients are so empowered during their manic phases, that they become reluctant to take their medication.


The truth of the matter is, however, that mania almost always leads to depression, even if it takes ages to show up.


Mania isn’t the same for everyone, though. Many patients experience it differently from others. Some never feel the highs, and are just irritable and unable to sleep in their manic phases. Some tend to speak too quickly, jump from one idea to another, and become more frivolous with their expenditure, while others may experience what is called hypomania, a less severe form of mania which can escalate into a full-blown manic episode.


A person in the midst of his or her first manic episode may not even perceive it as a problem, and may be reluctant to believe others if they point it out, often growing irritable with their ‘lack of optimism’.


What is depression?


Many believe depression is synonymous with sadness, which is not true. Depression has been shown to be linked largely with an absence of feeling and a persisting sense of emptiness. When depression strikes, patients lose their manic zest for life, and may feel exhausted, demotivated and unable to make any decisions. Their boundless optimism morphs into pessimism and a lack of self-confidence, which can also lead to loss of appetite, loss of sleep or even excessive sleep. During extreme depressive phases, patients may also begin to feel suicidal. 


What are the types of bipolar disorder?


Just like with several other mental illnesses, bipolar disorder can be hard to box into specific ‘types’. However, based on evidence over the years, the following broad categories of this illness have been identified:


Bipolar I Disorder


A person diagnosed with Bipolar I Disorder has usually experienced at least one manic episode and a major depressive period thereafter.


(The doctor, upon establishing this, must then rule out other illnesses such as schizophrenia, PTSD and other psychotic disorders.) 


Bipolar II Disorder


A person diagnosed with Bipolar II Disorder has usually experienced at least one episode of hypomania and one or more bouts of depression.




People with cyclothymia experience comparatively milder depression, with episodes of hypomania.


Not Otherwise Specified 


When a person does not meet the criteria for type I, II and Cyclothymia, but still experiences bouts of abnormal mood swings, they may come under this category.


What causes bipolar disorder?


Like most mental disorders, there is no fully established causative factor for bipolar disorder. The illness, however, has been attributed to genetic disposition, with it being more common in people with a family history of the condition. Biological factors, brought on by physical changes in the brain, have also been surmised to be one of the possible causes. Other perceived causes are chemical imbalances in the brain, hormonal complications and environmental factors.


Is bipolar disorder treatable and curable?


Bipolar disorder is usually a lifelong illness, with no known cure. Given this, treatment for this illness aims to help manage symptoms. Without treatment, episodes of a manic and/or depressive phase can last for as long as a year.


Medicines have been shown to help in managing the alternating episodes. All medicines for this disorder can only be taken with a prescription, since they involve strong antipsychotics and anticonvulsants. Therapy has also helped patients deal with their symptoms. Depending on the degree of severity of the illness, psychotherapy, cognitive behavioural therapy, electroconvulsive therapy or hospitalisation may also be prescribed or administered. Doctors also recommend a structured routine, a healthy diet and regular exercise to patients.


How do you help someone with bipolar disorder?


People with bipolar disorder may know what triggers their manic or depressive episodes, but sometimes, it is left to their family and friends to identify it for them. While there is no substitute for medical assistance, people with this illness may benefit from their family or friends helping them identify and avoid the kind of environment or behaviour that triggers or aggravates their symptoms. 


In the thralls of mania, some people may be reluctant to seek or continue treatment; in such cases, it may be up to their loved ones to be patient with them, remind them of the low that is to come, and calmly reason with them. Keeping a close eye on the patients and catching the signs of an episode early on, may be a good way to prevent a full-blown manic or depressive episode.


As with all forms of mental illness, while the onus is primarily on the ailing to manage their symptoms, a world that is more perceptive of their condition and more compassionate towards it, will go a long way in making their lives easier, and in motivating them to stay the course of their treatment.


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