Bipolar disorder: highs and lows

We all have moments of joy when we’re really happy, but equally we experience times of sadness. And sometimes we don’t know why we feel good or bad. However, some people experience mood swings that go beyond the usual ups and downs. “People with bipolar disorder experience extreme highs in manic episodes. They are creative, full of energy, and believe they can achieve anything. As a result, they may overestimate their abilities, make risky decisions or act carelessly,” says Gregor Hasler, professor of psychiatry at the University of Fribourg and President of the Swiss Society for Bipolar Disorders.

Manic phases can also be characterised by unusual sociability, reckless sex or spending sprees. Some sufferers barely sleep because they have so much energy. In severe cases, the mania can lead to psychotic symptoms such as delusions or hallucinations.

The other extreme is the depressive phase, during which the person has feelings of sustained listlessness, fatigue and despondence. They have little energy, lose interest in their hobbies and withdraw socially. These episodes may also be accompanied by physical complaints such as sleep disorders, headaches or digestive problems. Feelings of guilt, hopelessness and suicidal thoughts are also possible. The depressive episodes may last longer and occur more often than the manic phases.  

At what stage is an illness classed as a bipolar disorder?

Bipolar disorder is fairly common, with around 3 in 100 people being diagnosed with it at some point in their life, often starting in adolescence. “It is a common misconception that bipolar disorder is characterised by rapid mood swings. In actual fact, the ups and downs usually last for several weeks (or even longer),” explains Gregor Hasler.

According to the World Health Organisation’s ICD-10 classification system, to be diagnosed with bipolar disorder, a person must have experienced at least two episodes that have significantly affected their mood or level of activity. One of these episodes must be a depressive phase, while the other is characterised by the symptoms of mania or hypomania (a milder form of mania with less extreme symptoms).

There are two main types of bipolar disorder:

• Bipolar I disorder: This is the most severe form of bipolar disorder, involving manic and depressive phases. In the manic phase, those affected are full of energy, euphoric and impulsive, while the depressive phase is plagued by low spirits, listlessness and negative thoughts.
• Bipolar II disorder: People with this form experience hypomanic episodes with less severe symptoms. But the depressive phases are similar to those of bipolar I disorder.

Causes of bipolar disorders still unclear

Experts believe that a complex mix of genetic and psychosocial factors increase the risk of developing a bipolar disorder. It often seems to run in families. Changes in specific genes that influence the functionality of neurotransmitters in the brain could play a role.

Gregor Hasler adds that environmental factors, especially stress, can also play a role in the development of a bipolar disorder. Life changes, such as the loss of a loved one, but also positive events, such as a wedding, can trigger such stress.

A study by researchers at the University of Reykjavik in Iceland has also highlighted a genetic link between creativity and certain psychological disorders. Scientists analysed the genetic make-up of over 150,000 people and found that people in creative professions such as acting, music or writing often carry risk genes that are also associated with mental illnesses such as bipolar disorder. The study therefore suggests that creativity and mental instability may have common genetic roots.  

Difficulty diagnosing bipolar disorders

If you or a family member has severe mood swings, it may be a good idea to make an appointment with your family doctor or a psychiatrist. Those affected are more likely to report depressive phases rather than manic episodes, because they tend to feel full of energy or euphoric during a high and don’t perceive the symptoms as problematic.

It is easy to confuse bipolar disorder with other mental illnesses. Addictive disorders, schizophrenia or borderline personality disorder present with similar symptoms. And people with bipolar disorder can also suffer from other psychological disorders, such as anxiety, eating disorders or ADHD. “It is not uncommon for people being treated for burn-out to be diagnosed with a bipolar disorder,” says professor Hasler. That’s why it can also take time for bipolar disorders to be diagnosed correctly.  

Manias are harmful for the brain

Although bipolar disorders can’t be treated, early diagnosis and treatment are still important. “During a manic phase, the brain “runs hot”. This can cause severe neurological damage, which intensifies the next manic phase and increases the risk of dementia,” says Hasler. Without treatment, patients are also more likely to suffer from physical illnesses, particularly cardiovascular diseases.

However, people with a bipolar disorder often find it difficult to accept their condition, particularly when they are experiencing a manic phase. Even after diagnosis and during treatment, many of those affected are unwilling to accept that they have a problem. Gregor Hasler explains: “It’s hard to understand that a state that feels so good is actually bad for them.”  

How can friends and relatives help?

Hasler explains that this defensive attitude can also be hard for loved ones. They often don’t know how to handle it. In a manic phase, it’s often better to avoid conflict and discuss any problems afterwards. It is important to keep those affected calm, make sure they get enough sleep and contact a doctor if necessary. During a depressive phase, there’s little point in trying to cheer them up. Offering a clear daily schedule and practical support are more helpful. If they experience suicidal thoughts, it is essential to address the situation openly and seek professional help.

Bipolar disorder: no cure but effective treatment

Although there is no cure for bipolar disorder, it can be treated effectively. “Treatment usually involves medication and psychotherapy,” says Hasler. The medication aims to minimise mood swings and reduce the severity and number of episodes. Drug treatment is combined with psychotherapy, particularly cognitive behavioural therapy.

This helps those affected manage their symptoms and recognise triggers. Other psychotherapeutic approaches, such as family-focused therapy or interpersonal and social rhythm therapy, can also support the treatment of bipolar disorder with medication. “Long-term treatment can help many people with bipolar disorder live a normal and successful life,” explains professor Hasler.