Bipolar Disorder: Symptoms, Causes, and Modern Treatment Approaches

Bipolar affective disorder (BAD) is a chronic mental illness characterized by alternating depressive and manic (or hypomanic) episodes. In the past, it was called manic‑depressive psychosis. The disorder usually begins at a young age (15–25 years) and, without proper treatment, makes life unbearable. However, it can be well compensated and brought into remission – but this is hardly possible without the help of a psychiatrist. The disease is marked by alternating phases of mania and depression: a person either feels bursting with energy or sinks into deep depressive melancholy.

Main Symptoms of Bipolar Disorder

The clinical picture of BAD consists of two polar states – mania and depression. Between them, there may be periods of normal mood (intermissions).

Manic Phase

Mania is a state of pathologically elevated mood lasting at least one week. Key signs:

Excessive energy and activity, disproportionate to circumstances, going beyond reasonable limits and off the scale. The person is obsessed with ideas.
Inflated self‑esteem, a sense of grandeur (sometimes to the point of delusional ideas). The patient feels that absolutely everything is within their reach.
Reduced need for sleep – they may sleep only 2–3 hours per night and immediately jump back into developing their ideas.
Rapid thinking and speech, «flight of ideas» – thoughts race and leap over each other without clear focus on any single goal.
Distractibility, inability to concentrate – as described above.
Reckless behaviour – unjustified spending, risky driving, indiscriminate sexual relationships.
Irritability and aggressiveness when opposed or interrupted.

Hypomania (a milder form of mania) has weaker symptoms and does not lead to serious social impairment, but still requires attention.

Depressive Phase

A depressive episode in BAD lasts at least 10–20 days and is characterized by:

Low mood, sadness, apathy.
Loss of interest in previously enjoyed activities (anhedonia).
Decreased energy, marked fatigue.
Sleep disturbances – insomnia or, conversely, excessive sleepiness.
Changes in appetite and weight.
Feelings of guilt, worthlessness, thoughts of death or suicide.
Slowed movements and speech.

I would say that this fits within the framework of ordinary depression, but it is extremely painful and distressing for the patient. In this phase, everything feels especially severe.

Mixed States

Sometimes symptoms of mania and depression occur simultaneously – this is a mixed episode. For example, a person may be depressed and anxious but also have high energy and irritability. Such states are particularly dangerous in terms of suicide risk.

Causes of Bipolar Disorder

The exact causes of BAD are not fully understood, but several key factors are identified:

Genetic predisposition – people whose relatives suffered from this disorder have a significantly higher risk.
Biochemical imbalances – an imbalance of neurotransmitters (dopamine, serotonin, noradrenaline) in the brain.
Stressful events – severe losses, trauma, sudden life changes often trigger initial episodes.
Seasonal and hormonal changes – exacerbations may be linked to changing seasons or hormonal fluctuations.

Bipolar disorder is by no means a weakness of character – it is a disease. Therefore, family members should approach it with understanding.

How Is Bipolar Disorder Diagnosed?

Diagnosis of BAD is the task of a psychiatrist. The difficulty is that depressive episodes are often mistaken for ordinary (unipolar) depression, and manic states for character traits or «temporary difficulties». To make an accurate diagnosis, the doctor must thoroughly interview the patient – in medical terms, take a history.

Conducts a detailed conversation with the patient and their relatives, gathering anamnesis.
Assesses the duration, frequency, and severity of symptoms – identifying both depressive and manic phases.
Rules out other mental and somatic conditions.
Uses international diagnostic criteria (DSM‑5 or ICD‑11) for «automated» assessment.

Often, years pass from the first symptoms to an accurate diagnosis. So be attentive to your loved ones.

Modern Treatment Approaches for Bipolar Disorder

The goal of psychiatric care is to achieve remission (absence of episodes) and prevent relapses. The main directions include:

1. Medication Therapy

Mood stabilisers (normothymics) – lithium preparations, valproates, lamotrigine. This is the foundation of treatment; they smooth out mood fluctuations.
Atypical antipsychotics (quetiapine, olanzapine, aripiprazole) – used to manage acute manic and mixed states, as well as for long‑term maintenance.
Antidepressants – prescribed with caution, only in combination with mood stabilisers, to avoid triggering a switch into mania.

All medications are chosen individually, with gradual dose titration. Abrupt withdrawal may cause a nervous breakdown. Doses are usually adjusted during treatment, and sometimes one drug is replaced by another, even if they are analogues.

2. Psychotherapy

To be honest, I am not a psychotherapist, so I will simply outline the directions without commentary.

Cognitive‑behavioural therapy (CBT) helps identify and change destructive thoughts and behaviours, and manage stress.
Interpersonal therapy improves relationships with others and reduces conflict.
Family therapy involves relatives in the treatment process, teaching them to respond appropriately to episodes and support the patient.

3. Lifestyle Modifications

A regular sleep‑wake schedule – insomnia or a chaotic routine can disrupt emotional stability and trigger a relapse of mania.
Avoiding alcohol and drugs, which, as psychostimulants, destabilise the nervous system and again lead to breakdowns. I would also include smoking here, as it is also a stimulant.
Moderate physical activity – I would say the more physical exercise, the more stable the emotional background. I have long believed that physical activity is the best mood stabiliser.
Mastering relaxation and stress‑management techniques. This is not easy. Everyone wants to get better by taking pills; few are willing to work on themselves and master these methods. This is real self‑work.