Bipolar disorder is a severe mental illness which has its onset mostly in adolescent years. It is popularly known as manic depressive illness. It is seen in around 0.5 per cent of the people and 70 per cent of those with the illness are not receiving treatment as per the National Mental Health Survey of 2015-16. It is a long-term illness and the diagnosis given is usually for life. Bipolar Disorder Day is observed every year on 30 March internationally to create awareness about this mental illness; this day marks the birthday of the famous Dutch painter Vincent Van Gogh, who reportedly had the condition and died by suicide at a young age.

A psychiatrist took her baby’s life before taking her own life tragically when she became ill; this occurred a few weeks after the birth of the baby in London in the year 2000. An inquiry into this incident found that she had stopped her treatment for a known Bipolar disorder, and felt it could have been prevented had there been regular check-ups, especially during pregnancy and post-delivery.

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Generally, emotions such as anger, disgust, joy, fear, surprise and sadness are experienced; they last for short periods, and occur typically in response to a particular situation. These emotions bring physiological changes such as raised heart rate or fast breathing and also some obvious changes in behaviour. The emotions which can last for several hours to days are generally referred to as mood. Several factors like interaction and communication with people around us, social issues, health, environment, and food can all influence mood. It is common to experience fluctuations in emotions and mood, however most of us are able to manage them well enough to control our behaviour.

In Bipolar disorder, which is a disorder of mood, there is a loss of regulation of mood, due to various reasons resulting in either depression, usually referred to as ‘lows’, or so-called mania, usually referred to as ‘highs’. To keep it simple, the person would be diagnosed with Bipolar illness if he or she has at least two clear episodes of mania or at least one episode each of mania and depression.

The cause of Bipolar disorder is not known. Some patients have one or more of their family members who have this same condition, or recurring depression. One theory says it is due to chemical alterations in the brain. Incidents of trauma in childhood, stressful life events and growing up with parental discord have also been proposed as contributing factors. Each of the episodes of mania or depression is usually triggered by a stressful event. Sleep deprivation can be an early trigger.

A person with bipolar disorder may be brought by family members with a ‘high’ or mania, which is a distinct feature of this illness. The person might have had a previous episode of either mania or a depressive episode or the current presentation could be the first. During depressive episodes, or the so-called ‘lows’, in addition to feeling sad or ‘low’, there could be tiredness with trivial effort suggesting low energy, reduced interest to meet friends or relatives or to go to any family function, preferring to stay alone, a low in confidence levels and significant reduction in activities compared to previous levels. The person is not able to enjoy activities like before and may experience negative thoughts such as seeing no future, or that there is nobody to help and that the person is of no use to anyone. There are also changes in appetite, weight or sleep pattern. In extreme cases, the person may feel life is not worth living and may have suicidal thoughts and also may attempt it. Typical depressive episodes last up to 12 months, if not treated early. If a person is having only depressive episodes, the diagnosis including the treatment plan will be different.

Most of the features of mania are opposite to that seen in depression. This means there is a feeling of excessive happiness which is why it is called a ‘high’. Experiencing high energy, the person indulges in over-socialisation, has overconfidence and feels there is a reduced need for sleep. The area of concern is if the person starts losing appropriate judgement of spending money. The person can become hyperactive and restless during the night, talking excessively and may even be seen singing, which becomes difficult for family members. Sometimes, the person may become more interested in sexual activity and also drink alcohol or smoke excessively. The person feels thoughts racing in the mind; is busy making plans and sometimes abnormally believes he has special powers. The person will insist there is nothing wrong with him and therefore it is hard to initiate treatment. When mania is at a lower intensity, they may appear jovial and lively, so some people like being with them.

Either mania or depression may occur at any point in time usually triggered by some negative events during their life. Sometimes, these episodes could lead to behavioural disturbances, which in turn have caused family break-ups or separations. Some people with this condition may be high achievers. The person may function well during the period when there is no mania or depression. Sometimes there may not be any episodes for several years and the person may be functioning well.

The patient as well as the spouse or parents need to learn about the illness, especially about the episodes. The treating team generally involves them in planning treatment for the short and long term. There is a need to follow up with the psychiatrist for a very long duration, despite long periods of feeling well. Understanding how to identify early warning signs of recurrence of episodes could help to seek help to make quick and necessary medication adjustments. Medications such as lithium and valproate, just to name a few, are so-called mood stabilisers generally prescribed for a longer term. In a crisis, where the episodes are severe, where the person is restless and aggressive, or suicidal, treatment in a hospital with antipsychotic medication may be needed. The key thing is a regular review with your psychiatrist and the family must ensure the person takes medications, and finds ways of managing stress.

(The writers are Psychiatrists at DIMHANS, Dharwad & NIMHANS, Bangalore respectively.)