Bipolar Disorder

Diseases A-Z

What is bipolar disorder

Bipolar disorder, also known as manic depressive disorder or depressive manic psychosis, is a disorder characterized by unusual oscillations of the mood tone and the person’s ability to function. Bipolar disorder is a serious mental illness that affects emotions and behavior. It is one of the most common mental disorders. Three to five percent of all adults in the world are affected. Both men, women and children can get the disease.

To better understand the variability of mood tone, we can think of the thermostat of a home: the task of the thermostat is to keep the temperature stable and regular and to respond to changes in the surrounding environment. The limbic system of our brain represents the thermostat of the mood and is responsible for keeping it stable and regular, ensuring that it responds adequately to stimuli and changes in the environment. In bipolar disorder, the limbic system does not function properly and this causes the tone of the mood to become variable, unstable and independent of the environment.

Bipolar disorder is characterized, in fact, by the alternation of a depressive state and of a maniacal (or hypomaniacal); when there is a coexistence of depressive symptoms and maniacal symptoms (that is, it is neither completely depressed nor completely crazy), with the predominance of irritability, anxiety and restlessness, one may present the mixed state

However, it is not necessary to confuse those commonly defined as “highs and lows” of the mood that each of us can have in their everyday life, with the severe manifestations of bipolar disorder, which can, however, ruin interpersonal relationships, cause loss of work and, in extreme cases, hesitate in suicidal behavior.

Bipolar disorder can be cured; the treatment of the disorder should be carried out by specialists who know the disease well. This illness is totally compatible with a normal, brilliant and productive life, but the treatments you frequently undergo last for the rest of your life. In the same way as cardiovascular disease and diabetes, in fact, bipolar disorder is a long-lasting disease that has to be constantly monitored throughout the patient’s life.

In most cases, the disease is not easily recognized and people may be ill for years before receiving proper diagnosis and proper treatment. About 4% of the population has a bipolar disorder. Usually, this disorder manifests itself for the first time before 30 years and the first episode can be both maniacal and mixed. It is slightly more common in women. How is bipolar disorder manifested? Depressive and manic (or hypomanic) episodes are present in bipolar disorder.

Symptoms of the depressive phase

The symptoms of depression are very well known and known: depressed mood, thoughts oriented towards depression (e.g. “I will never do it”; “There is no hope!”), feeling fatigue and lack of energy, agitation or psychomotor retardation, anxiety, sleep disturbances (excessive sleep, difficulty falling asleep, awakening with difficulty sleeping), ideas of death, lack of hope, lack of appetite or rare cases of hyperphagia, inability to derive pleasure from the activities that in the past provided joy and satisfaction, feeling that others may not understand this situation and that they are optimistic unnecessarily, reduced sexual desire, difficulty in concentration and attention, feelings of guilt and inferiority, irritability.

It is very important not to confuse depression with a normal feeling of sadness or with the physiological and natural depression following a mourning or a loss. You can talk about a depressive episode if the symptoms persist for a period of at least 2 weeks.

Symptoms of the maniac phase

Mania, on the other hand, is fairly striking, though with different gradations. The main symptoms are: excessive mood and perceived by others as unusual, very uninhibited behavior, extreme ease of spending money, shopping, a feeling of ever-intense energy and a sense of tirelessness, cheerfulness, hyper-attention but distractibility, ability to initiate many activities at the same time but with poor ability to complete it, aggressive and impulsive behaviors with serious work and personal consequences, increased restlessness, extreme frustration, increased speed of thoughts, tremendous distraction, reduced need for sleep, unrealistic confidence in your abilities, decreased judgmental capacity, increased sexual desire, drug abuse (especially cocaine, alcohol and drugs), provocative attitudes, modification of your make-up or dressing to use a more striking style and seductive (sometimes inappropriate). It is a manic episode if the symptoms persist for more than a week.

The hypomania

Hypomania is an altered mood of less intense than mania. It is necessary, however, to differentiate the hypomania from happiness, as the former has no precise cause, is perceived by others as unusual, is presented with instability of the mood and is generally preceded by a depressive phase.

Commonly, two forms of bipolar disorder are distinguished:

  • Type I bipolar disorder characterized by depressive episodes and manic episodes.
  • Type II bipolar disorder, characterized by depressive episodes and hypomaniacic episodes.

Cyclotymy is considered a minor variant of bipolar disorder, which often evolves towards type II bipolar disorder, or with less frequency, to type I. It is characterized by mild intensity but with high frequency of presentation and with behavioral changes which cause considerable psychosocial complications.

Sometimes, severe episodes of mania or depression include psychotic symptoms. Among these, the most common are hallucinations (e.g., hear voices that no one hears, smells that no one perceives) and delusions. Psychotic symptoms in bipolar disorder tend to reflect the mood stage. For example, delusions of greatness, such as believing one to be an important character, can occur during mania; delinquencies such as, for example, believing that they have committed a terrible crime may appear during depression.

Some patients with bipolar disorder also may attempt suicide attempts. Anyone who is thinking of suicide must immediately address a health care professional, preferably a psychiatrist or psychologist. It is important to remember that those who speak of suicide should be taken seriously into account. The risk of suicide is higher at the beginning of the illness when the subject still has no clue about what he or she is suffering from and how to deal with the disease. So first you recognize the bipolar disorder before you will learn to handle it and to seek help at the right time.

How to know if you have bipolar disorder

Usually, sufferers of bipolar disorder are referred to the physician or psychologist when they are in a depressive phase and very often omits to report having had phases of illness characterized by high mood or mania. For this reason, it is highly desirable for anyone who turns to a professional for the first time and is in a severe phase of depression can take advantage of the help of a family member to reconstruct the various phases of the disease (when the subject has an episode of establishing the diagnosis is extremely easy).

To make a proper diagnosis it is important to pay attention to the symptoms, as it is possible that a person suffers from anxiety-free depression; such type of depression is defined as monopolar depression or major depression. There are some clues that may be helpful in understanding whether it is bipolar disorder: having a family with bipolar disorder or mood disorder, having a depression characterized by very serious symptoms such as delusions, having had a temperament in your life Always very brilliant and extraordinary work ability, with little fatigue susceptibility, before the episode of depression.

Those who suffer from bipolar disorder and have psychotic symptoms occasionally receive the diagnosis of schizophrenia, another severe mental illness, and may therefore also be subjected to wrong treatments. However, we can recognize whether psychotic symptoms are the result of a bipolar disorder or if they indicate a psychotic disorder (e.g. schizophrenia), as in bipolar disorder delusions and hallucinations, as previously mentioned, tend to reflect the mood stage.


It is possible, even if very rarely, to diagnose bipolar disorder even in pediatric age: in these cases a careful assessment is needed to distinguish this condition from attention deficit and hyperactivity disorder or other childhood illnesses.

Causes of bipolar disorder

At present, we know that genetics play a crucial role in the genesis of bipolar disorder. Bipolar disorder, in fact, is a hereditary disease that has a biological base and is genetically transmitted. They therefore weight theories that claimed that various psychological or social factors were the cause of bipolar disorder. Today, it is believed that all these factors can trigger or aggravate the disorder, but do not cause it.

Though it is a hereditary illness it is good to point out that the child of a person affected by bipolar disorder does not have 100% chance of being sick: in fact the chances of having no affection are greater than those of being affection. Finally, bipolar disease is chronic and recurrent but with appropriate psycho-pharmacological treatments the risk of relapse becomes less frequent and shorter. One has to start thinking that having a bipolar disorder is not in itself more or less severe than suffering from other chronic conditions such as asthma or diabetes and that in most cases can be compensated by adequate therapy and adhering to a series of behavioral rules.

Different types of treatment for bipolar disorder

Most people with bipolar disorder, even with severe forms, can achieve an excellent level of stabilization of the disease and lead to normal life. Since bipolar disorder is a recurrent illness, it is almost always indicated a long-term treatment, even life time.

Treatment combining pharmacotherapy together and psychosocial treatment (psychotherapy and life hygiene) is optimal for controlling and stabilizing the disturbance over time. In most cases, bipolar disorder responds better to continuous, rather than intermittent treatments. Sometimes, however, without interruption of treatment, mood changes may occur, which should be reported to your doctor immediately.

The important concept for treating this disease is that the episode should not be treated (depressive or manic), but the disease must be treated. Bipolar disorder is, in fact, with drugs, mood tone stabilizers, which avoid the recurrence of mood swings. The best one today is lithium carbonate, especially for the treatment of mania.

Anti-convulsants are also used that have the effect of stabilizing the mood:

  • Sodium valproate (Depakin, Depamag), effective in treating mania and mixed states;
  • Carbamazepine (Tegretol), effective in treating mania;
  • Lamotrigine (Lamictal), effective in preventing depression.
  • Even atypical antipsychotics have a tremendous effect on mood stabilization; Among these are: olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel) and clozapine (Leponex).

More and more specialists tend to avoid antidepressants to those suffering from bipolar disorder to prevent switches in the maniacal state or iatrogenic damage.

In addition to pharmacological therapy, psychotherapy can be of great help to those who suffer from this disorder. It is good to point out that psychotherapy can not replace drugs and is not effective alone in preventing relapses and treating the disorder. However, many studies have indicated that psychological interventions can improve mood stability, reduce hospitalization, and improve functioning.

Cognitive-behavioral treatment

Cognitive-behavioral psychotherapy is among the most commonly used treatments and it is very effective in treating this disorder. Psychotherapeutic interventions are designed to help the patient know better about their functioning and to accept it, to distinguish themselves and their personality from illness, improve stress management and indirectly, thus reducing the risk of relapse risk.

The cognitive-behavioral protocol also provides for a systematic compilation of a table of daily symptoms of mood, quantity and quality of sleep and pharmacological treatment taken by the subject. This tool can be helpful both to the patient to increase awareness and the ability to manage their own disorder, and to the physician to better understand the progression of the symptoms and to set up a more effective treatment.

Psychotherapy is an important part of the treatment of bipolar disorder. You may have the perception that “psychotherapy” means lying on a couch in a dark room while a bearded analyst poses different questions about your childhood. But the fact is that psychotherapy is usually something much more (and better) than that. For the most part, it means simply sitting down with a therapist, either individually or in a group, talking about his condition and how to handle it. You often talk about psychotherapy as “call therapy”.

Psychotherapy plays a crucial role in dealing with bipolar disorder and is often used in combination with medication. The goal of therapy is to ensure that once you have control of the symptoms, you should have tools and strategies to master your condition and make arrangements for your life. Psychotherapy can help you handle your mood, handle the issues that trigger your symptoms and build an environment that is good for living with the disease you have. The therapy will also focus on some of the “life skills” you need to settle on your life once you have started your journey towards recovery.

There are a number of therapy methods that are practiced in a few different ways. You can therefore choose the method and therapist you feel most comfortable with. Your care team will guide you to the right method for you. Or, you can get contact information through professional organizations for therapists or through support associations for bipolar disorder.

There are several types of psychotherapy used to treat bipolar disorder:

  1. Family-Focused Therapy. This form of therapy focuses on how bipolar disorder can affect the entire family, not just the individual individual in the family. The family gets to learn techniques that help them communicate better with each other, handle difficult situations and support each other. The goal is to reduce the stress level in the family (which can exacerbate disease symptoms) and build a supportive environment that contributes to the patient’s recovery.
  2. Cognitive Behavioral Therapy (CBT). This is a structured treatment that aims to help you identify and change unhealthy thinking patterns and destructive behaviors. The method can be of great help in the management of depression.
  3. Other psychotherapies. There are a number of other therapies that can often help people with bipolar disorder. For example, there are art therapy and music therapy. Some of these therapies may be more helpful than others. It is possible that some may even interfere with the treatment plan your care team is working for. Therefore, it is important to tell your doctor or therapist about any other methods you have tried or tested.

Finally, the cognitive-behavioral approach provides psycho-educational treatment for the patient and his / her family members to better understand the phases of the disease. Oftentimes,, cure for bipolar disorder includes psychiatric and psychotherapeutic treatment with constant availability of a healthcare provider and / or a substitute.

Bipolar disorder and relationships

Bipolar disorder is not easy to live with. People suffering from bipolar disorder usually have a series of tormenting relationships, and often they can not break them but keep them in time. Those are people who have difficulty with managing breakups, who tend to never end relationships, and they avoid closing them, so they just ‘ghost out’. They cannot have a constructive confrontation in the relationship, nor can they cope with the pain of separation.

Getting into relationships for people with bipolar disorder is complicated, complex and painful on both sides. Bipolar disorder is never about meeting halfways or offering transitions. One of the characteristics of this kind of people is boredom: they often get bored of routine and stable things. You have to be multifaceted to entertain a bipolar person for a long time. A person with bipolar disorder always feels misunderstood because misunderstanding begins with themselves, they do not understand. A person with bipolar disorder is sad or cheerful but does not know why; they love you or does not love you and does not know why; is bored or not but does not know why. A person with bipolar disorder is never consistent, but cannot be held liable to it, since they are not in touch with their own feelings.

From a relational point of view, to help a person with bipolar disorder one needs to stimulate contact because they tend to isolate themselves while establishing links that help them like dancing, hugging, kissing, satisfying sexual relations, buying a dog. We talk of contact because they have difficulty in establishing contact with other human beings, so buying a dog is really a good idea. It is also important to foster relationships and contacts with people, even helping other people because a person with bipolar disorder needs to deal with anything other than themselves and automatically begin to improve. All this implies a personal job that the person has to be willing to face. The patient has to focus on this therapeutic work. Many, however, prefer not to be held responsible for their situation at first, preferring to believe that since their illness is organic and that there is nothing to do. Bipolarity is not necessarily a misfortune. Paradoxically, bipolar people can be good therapists because they are very empathic about understanding what is happening to others. Great therapists of the past century like Freud and Jung were bipolar.

The disease often puts a tremendous pressure on your relationships. If you are in the middle of a manic or depressive period, you may not be aware of the injuries your friendship and family relationships face. When you start recovering, you may find that life has become quite lonely.

Caring for someone with bipolar disorder can also mean that relationships with friends, colleagues and family are subjected to great strains. It’s in times like these you find out who your real friends are. You may find that people who you thought were friends fade out into the background when you experience difficult periods. Even family members may be more distant. Already existing tensions in your close relationships can begin to come to the surface. There are no ready answers to address these issues.

But there are some practical steps you can take to make things easier:

  • Learn more about bipolar disorder and explain to your friends and family – they will have a better understanding of your behavior if they know what’s happening and why
  • Continue to talk – even if things are difficult, try to keep up with those you care about and those care about you
  • Be honest – when it comes to your fears, your hopes, your future plans
  • Set boundaries – tell your nearest ones what you want them to do for you and, more importantly, what you do not want them to do
  • Try to trust your close friends and family. Be aware that they want what is best for you
  • Do not be ashamed – bipolar disorder is not your fault
  • Take lessons from others – in support associations there are members who have gone through the same things; they can help you, accept their help.

Bipolar disorder self-help: making the most out of your life

quick fact:
Some say that the symptoms of bipolar disorder and also other mental illnesses are due to some form of weakness or lack of character in those who are affected. This is not true. Bipolar disorder occurs when something goes wrong in the brain. The disease is to blame, not the patient. For most, the disease is something you can live with throughout your life. Sometimes it decreases and comes back only after several months or even years.

Living with bipolar disorder is difficult. This applies equally to relatives, friends and close relatives as for the people who themselves have the disease.

The disease causes severe changes in emotional state, from deep, intense depression to energetic euphoria or to mixed moods where restless energy occurs simultaneously with emotions of desperate sorrow. Psychiatrists use the word “depression” or “depressive episode” to describe the periods when the predominant feeling in the disease is mood and “mania” or “manic episode” to describe the periods of euphoria. There is also a lighter form of mania called “hypomania”.

These mood modes can last for several weeks or even months and are significantly more difficult than the fluctuations that can be considered normal. The result often are a dysfunctional behavior, injured relationships, and severe limitations in performance at school or at work. Unfortunately, the disease also brings a stigma that can lead to unfair discrimination and isolation. All of this reduces the quality of life significantly.

At the same time, many negative consequences can be addressed and alleviated once you have received the diagnosis and treatment. Effective treatment can control the mood and the severe mood swings caused by the disease. This can in turn give patients and people in their area the opportunity to get back to normal life again. There are a variety of techniques and strategies that you can use to manage your emotional life and protect yourself from the effects of your illness

Deal with stress.

Stress is a big bow in the drama when it comes to triggering bipolar disorder and it is unfortunately almost impossible to avoid completely. However, it is possible to reduce the effects the stress has on your life. The first step when dealing with stress is to be aware when and how it affects you. There are a number of warning signs (see the table below).

Warning Signs Of Stress.

In the way you think In the way your body feels
Circular thinking – worrying ‘for the sake of it’


Feeling scared

Feeling lack of control

Feel like something terrible will happen

Numb hands and sweating

Dry mouth and throat

The heart beats too fast

Pressure over the chest


Stitches in the fingers



Learn to relax.

It may be easy to say but not as easy to do, especially if you already feel stressed. Here are some strategies you can try. If you feel that a situation is stressful, withdraw yourself gradually. If you escape the situation dynamically, it may feel stressful in itself. Avoid alcohol, drugs, tea, coffee and soda or energy drinks with caffeine in. They can increase the anxiety and worry.

  • Learn some relaxation techniques
  • Listen to music
  • Take a bath
  • Take a walk
  • Read a book or newspaper
  • Meditate or practice yoga
  • Talk to someone. Problems are often easier to deal with if you have ventilated them with someone
  • Try to create a routine of regular exercise and think about starting at a gym or in a sports team

Once you know you have bipolar disorder, it is advisable to avoid stressful situations that can trigger manic or depressive periods.

Below you will find a few tips:

  • Write down what situations you feel most stressful. If you can not avoid them, is there anything you can do to make them less stressful?
  • Learn to say “no”. Do not take too much into your work or in your social life
  • Talk to the occupational health center at your job. Are there less stressful tasks you could change?
  • Avoid night shift work. It can interfere with your sleep quality and aggravate your condition
  • Plan your day. Make a schedule of your goals and stick to it
  • Solve conflicts. Some conflicts can be avoided completely. If it does not go well, ask someone outside to join. This can help solve the situation
  • Use cognitive aids

Bipolar disorder can affect your thinking which can make you easily confused or forgetful. Sometimes it can be difficult with the organization even by the simple tasks of the supervision. To get help with such things, there are a number of tools. It can range from simple diaries, calendars, and lists to more sophisticated smartphones, computers, ball and chain characters. These tools can be used to gain control even when things are chaotic.


In order to feel better, it is important to understand your mood and your feelings. Many people with bipolar disorder learn to predict and recognize when a manic or depressive period is in the process. By keeping a polling diary, you can check if any particular event patterns or feelings usually occur before a period. It can make it possible for you to take preventive measures. To handle low mood modes. ask your doctor for help. Rest; often a good night’s sleep can make a big difference. Cheer yourself up, engaging in a pleasurable activity: chronic sadness is something that can easily trigger depression. But do not be too active. Do not let things go the way so that you feel they take over your life. Visit a friend or relative. It often helps to talk to someone.

Strengthen your confidence. When we feel good, we usually just want to go on with our lives. We do not think so much about things we are doing well. If we feel down, however, it is easy to focus only on the negative things in life. It makes us feel even worse. Next time you feel satisfied with yourself or proud of something, take a minute and think about why. Write down all the things you like about your life. What are the top five things with your life right now?

As example:

  1. My family loves me
  2. I love taking a stroll outside
  3. I have joined gym
  4. I meet new people in my support group
  5. It\s soon summer

Although support and interest associations can be extremely helpful to those living with bipolar disorder, it is important not only to deal with people from the “bipolar world”. Try to stay in touch with friends and family. And, as far as possible, continue to pursue various leisure activities.

Join a support club. Living with bipolar disorder can be lonely. You may find that you have to tackle unacceptable problems and that you have no one to turn around who can help you. Then a support group can be a great support to move on with your life. There are a number of different support and interest associations, both for people with bipolar disorder and for relatives. These groups work and work at local, national and international levels and can help people with bipolar disorder in a variety of ways.

In the support society you can meet people who have similar experiences as yourself. By meeting, talking about problems or just hanging out with people who really know how to live with bipolar disorder, you can get new perspectives and more easily solve your own problems.

Benefits that support associations can provide may be:

Shared experiences

Most support and interest associations have been started by people who themselves have bipolar disorder or lived close to people with the disease. It can be a huge relief just to sit down in a safe and relaxed environment and talk to someone who really knows what you are talking about. It can help you express your feelings more openly and solve some of the confusing feeling that often surrounds people with bipolar disorder. If you feel angry or frustrated about your situation or the care you receive, it is easier to express feelings and opinions to someone who has been in the same situation than the healthcare professional.

Information and expertise

The only real experts in living with bipolar disorder are those who actually do it. Therefore, most support associations are full of people who can share stories about how they have managed the disease and continued their lives. It is very possible to meet someone who can answer your questions yourself or who knows where to turn to find answers. Many support associations have used these expertise to make good information material such as brochures, films and web pages.

Support for legal issues

People who have or are affected by bipolar disorder may sometimes conflict with the law. These may involve economic problems, conflict with benefit systems or discrimination in the workplace. On such occasions it is much easier to stand up for their rights if you have a strong, well-informed union behind them.


Many support and associations have extensive links with groups that focus on other forms of mental health. By working together, these groups can run campaigns with a wide range of issues affecting people with bipolar disorder. It also gives them the opportunity to participate in consultation meetings that may influence the creation of new laws.

Fight ignorance and prejudice

It is not just people with bipolar disorder who need to know more about the disease. People in general often have poor knowledge of the disease. This can lead to misconceptions, prejudice and abuse. Many support and interest groups meet this lack of knowledge with knowledge dissemination and education campaigns.

The bottom line is, bipolar disorder is a serious organic condition that can be both alleviated and cured with the right approach. You do not have to face this condition alone. Family, friends, doctors, therapists and social services all can be employed to provide the required assistance.