Bipolar disorder
Psychiatry clinic for bipolar disorder: differential diagnosis from depression, mood-stabilising treatment and relapse prevention.
What it is
Bipolar disorder alternates depressive episodes with episodes of mania or hypomania: periods of elevated or irritable mood, with less need for sleep, more energy, racing thoughts, and excessive spending or activity. Between episodes there can be long periods of stability, and that's exactly the goal of treatment.
Why it takes so long to diagnose
Because people come to the clinic during the depressive phase: nobody asks for help when they're feeling euphoric and productive. If previous episodes of elevated mood aren't specifically asked about, the picture gets labelled as depression and treated with antidepressants alone, which in bipolar disorder can destabilise things. That's why there's such an emphasis on the full history and on talking to family, who often remember those periods better than the person themselves.
Treatment
- Mood stabilisers as the background treatment, with whatever blood test monitoring each medication requires.
- Specific treatment for each phase, acute or maintenance.
- Regular sleep and routine: this isn't a minor piece of advice, it's part of the treatment â lack of sleep is a classic trigger.
- Psychoeducation for the person and their family to recognise warning signs and act before the episode takes hold.
- Avoiding alcohol and other substances, which make the course worse.
Follow-up
It's a chronic condition and follow-up is long-term, with regular reviews even during good periods. With ongoing treatment, most people work, study and lead normal lives; stopping medication once feeling well is the most common cause of relapse.
Frequently asked questions
Why does bipolar disorder take so long to diagnose?
Because people seek help during the depressive phase: nobody asks for help when they feel euphoric and productive. If previous episodes of euphoria are not specifically asked about, the picture is labelled as depression and treated with antidepressants alone, which can destabilise the patient.
Can you lead a normal life?
Yes. With sustained treatment and follow-up, most people work, study and go about their lives normally, with long periods of stability between episodes. Stopping the medication once you feel well is the most frequent cause of relapse.
What triggers a relapse?
Lack of sleep is a classic trigger, along with alcohol and other substances and sudden changes of schedule. That is why regular sleep and routines are part of the treatment, and why patients are taught to recognise the warning signs and to act early.
What are the 3 types of bipolar disorder?
Type I, with full manic episodes; type II, with hypomania and depressive episodes that are usually what brings people to the consultation; and cyclothymia, with milder but sustained mood swings. Telling them apart matters because it changes the treatment and the follow-up.
How can you tell if someone is bipolar?
Not from mood swings over the course of a day, which is the most common misunderstanding. It is about episodes lasting days or weeks: periods of elevated or irritable mood with less need for sleep, racing thoughts and excessive spending or activity, alternating with depressive phases. The diagnosis is clinical and is made by a psychiatrist.
Questions and comments
Ask the specialist who reviews this page or leave us a comment. Everything is reviewed before it is published.
To write, first confirm your email: we will send you a code.
Content reviewed by Dr Klejda Cibuku