Bipolar

Bipolar disorder is a mood disorder marked by shifts in energy, mood, and activity levels that range from depressive lows to manic highs. It’s highly treatable, and with the right support, individuals can lead stable and fulfilling lives.

Causes & Risk Factors

Biological Factors

  • Genetics: Strong familial link—especially in first-degree relatives
  • Brain chemistry: Irregularities in neurotransmitters like dopamine, serotonin, and norepinephrine
  • Structural differences seen in brain imaging studies (e.g., prefrontal cortex and amygdala)

Environmental Triggers

  • Stressful life events (e.g., trauma, abuse, loss)
  • Substance use or withdrawal
  • Sleep disruption or circadian rhythm imbalance
  • Significant life transitions (e.g., childbirth, relocation, relationship changes)


Common Symptoms


Mania / Hypomania (Elevated Mood)

  • Increased energy, activity, or restlessness
  • Euphoric or irritable mood
  • Inflated self-esteem or grandiosity
  • Decreased need for sleep
  • Racing thoughts or rapid speech
  • Risky behaviors (spending sprees, unsafe sex, impulsive decisions)
  • Distractibility or poor focus

Hypomania is a milder form of mania without psychosis or severe impairment.

Depression (Low Mood)

  • Persistent sadness or hopelessness
  • Loss of interest or pleasure in most activities
  • Fatigue or low energy
  • Sleep disturbances (too much or too little)
  • Appetite or weight changes
  • Feelings of guilt, worthlessness, or emptiness
  • Difficulty concentrating or making decisions
  • Thoughts of death or suicide

Assessment

Clinical Interview

  • Detailed history of mood episodes, timing, triggers, and functioning
  • Screen for family history of mood disorders
  • Evaluate for psychotic symptoms, suicidality, and medical/medication causes

Standardized Screening Tools

  • Mood Disorder Questionnaire (MDQ)
  • Young Mania Rating Scale (YMRS)
  • Beck Depression Inventory (BDI)

Diagnostic Criteria (DSM-5)

  • At least one manic episode is required for Bipolar I
  • Bipolar II involves at least one hypomanic and one major depressive episode
  • Symptoms cause significant distress or functional impairment
  • Not better explained by substances or another condition

Treatment

Medication

  • Mood stabilizers: lithium, lamotrigine, valproate
  • Atypical antipsychotics: quetiapine, olanzapine, lurasidone
  • Antidepressants: used cautiously and usually in combination with a mood stabilizer
  • Benzodiazepines: short-term for agitation or insomnia

Medication should be regularly monitored, especially lithium (requires blood levels).

Therapy

  • Cognitive Behavioral Therapy (CBT)
    Addresses negative thoughts, promotes coping skills
  • Interpersonal and Social Rhythm Therapy (IPSRT)
    Focuses on stabilizing daily rhythms and relationships
  • Psychoeducation
    Helps patients and families recognize mood shifts early
  • Family-Focused Therapy
    Improves communication and reduces relapse risk

Lifestyle & Support

  • Sleep hygiene is essential (irregular sleep can trigger episodes)
  • Routine and structure for meals, exercise, and sleep
  • Avoid alcohol and recreational drugs
  • Track mood changes with journals or apps
  • Support groups or peer counseling