Bipolar disorder: description, detection, causes

Bipolar disorder: description, detection, causes

A bipolar disorder is a serious mental illness. People who suffer from it experience a constant up and down of emotions. At times, those affected feel very depressed, then again they are euphoric, hyperactive and overestimate themselves. Read here how to recognize a bipolar disorder and how to treat it.

Brief overview

Symptoms: Alternation between depressive symptoms and phases of exaggerated high spirits, risk behaviour, megalomania, occasional hallucinations

Causes: strong genetic predisposition, disturbance of the messenger balance in the brain, stress, certain drugs

Diagnosis: Diagnosis based on the symptoms, often confused with classic depression or schizophrenia

Treatment: medication, psychotherapy, waking therapy, electroconvulsive therapy, therapy often difficult due to lack of understanding of the illness

Prognosis: hardly curable, can be stabilised by medication, high risk of suicide, therefore early therapy is important

Bipolar disorder: Description

Like depression, bipolar disorder belongs to the so-called affective disorders. This means that it has an effect on the feelings of those affected. They experience severe mood swings for which there is usually no external trigger. Manic phases with great euphoria, energy and overestimation of one’s own abilities suddenly turn into depressive phases in which those affected are depressed and lack drive. This is why bipolar disorder is still often colloquially referred to as manic depression.

Bipolar disorder: the different forms

In bipolar disorder, phases of mania and depression alternate. In some patients, however, there can be several months or even years between depressive and manic episodes. In between, their mood is balanced. About 20 percent of those affected experience exclusively manic phases and no depressive phases at all.

Bipolar disorder is divided into the following forms:

  • Bipolar I disorder: alternating depressive and manic phases
  • Bipolar II disorder: alternating depressive and only slightly manic (hypomanic) phases
  • Cyclothymia: alternating depressive and manic phases in a strongly attenuated form

Bipolar disorder: Symptoms

In more than half of the manic-depressive patients the disease begins with a depressive phase. It is only in the further course of time that manic or hypomanic (slightly manic) phases occur.

Symptoms in the depressive phase

In the depressive phases the clinical picture is similar to depression. The main symptoms then include

  • Depressed mood
  • Loss of interest and joy
  • Loss of drive
  • Sleep disturbances, especially under sleep through in the second half of the night
  • Concentration and thinking disorders
  • Feelings of guilt
  • Self-doubt
  • Suicidal thoughts

External symptoms

Facial expressions tend to be rigid and expressionless during a depressive episode. Those affected usually speak softly and their answers come delayed.

Physical symptoms

In the depressive phase physical symptoms may also occur. The appetite decreases and many of those affected lose a lot of weight. Some feel pain in different parts of the body. Common complaints are shortness of breath, heart problems, stomach and intestinal problems as well as dizziness, headaches and erectile dysfunction.

Bipolar disorder: symptoms in the manic phase

In phases of mania, the previously depressive mood changes completely. This phase is not always easy to recognise at the beginning. Often those affected are initially only more active and positive than in the depressive phase. It can also remain with this weakened form of mania. It’s called hypomania.


The good mood can also take on extreme dimensions. Without cause, manic-depressives are exuberantly cheerful or even irritable. Typical signs are also overactivity, a reduced need for sleep and an increased urge to talk.

Overconfidence and carelessness

The dangerous thing about mania is that those affected lose touch with reality. They tend to overestimate themselves and to behave recklessly. They spend money without hesitation and start oversized projects that can get them into financial and legal problems.

It is also problematic that social inhibitions are lost. Those affected then arbitrarily address strangers and tend to a more open flirt and sexual behaviour.

Delusions of grandeur

If the exaggerated self-confidence turns into megalomania and hallucinations occur, it is a mania with psychotic symptoms. Those affected then believe they have great abilities, for example, to become famous or to be able to change the world.

Creative potential

People with bipolar disorder are often very creative. Today it is assumed that Vincent van Gogh and musician Händel, among others, were manic-depressive.

Bipolar disorder: symptoms of the mixed phase

We speak of the mixed phase of bipolar disorder when depressive and manic symptoms occur simultaneously or within a very short time. The mood then changes from deeply sad to euphoric and cheerful or vice versa. This rollercoaster of emotions is difficult to bear. In a bipolar disorder, the mood fluctuates greatly between mania and depression during the various phases of the illness

Suicide risk

This form of bipolar disorder is associated with great suffering. The danger of suicide is great: negative thoughts and feelings make those affected despair, while at the same time manic energy drives them on. This dangerous constellation can cause them to put their suicidal thoughts into action out of an impulse.

Bipolar disorder: accompanying mental disorders

Frequently, other psychological problems occur in parallel to the bipolar disorder. Manic-depressives most frequently suffer from anxiety disorders or a personality disorder.

Many patients are substance dependent. The consumption of alcohol or drugs worsens the course of the disease. The treatment of such concomitant diseases is necessary for a successful therapy of bipolar disorder. Otherwise, symptoms of the concomitant diseases can have an unfavourable influence on the course of the disease.

Bipolar disorder: causes and risk factors

Bipolar disorder is caused by both biological and psychosocial factors. Previous studies suggest that a complicated interaction of several genes with various environmental factors promotes the disease.

Bipolar disorder: Genetic causes

Family and twin studies have shown that genetic factors are involved in the development of bipolar disorder. For example, children of an ill parent are ten percent likely to become manic-depressive as well. If bipolar disorder is present in both parents, the likelihood of the disease even increases to up to 50 percent.

So far, however, no specific gene for manic-depressive illness has been found. Presumably several genes are involved in a bipolar disorder.

Bipolar disorder: influence of neurotransmitters

There is much to suggest that in bipolar disorder the distribution and regulation of important messenger substances (neurotransmitters) in the brain is disturbed. Neurotransmitters are endogenous substances that cause certain reactions in the body and brain. Examples are serotonin, noradrenaline or dopamine.

Depressed people have been diagnosed with a lack of norepinephrine and serotonin. In manic phases, however, the concentration of dopamine and norepinephrine is increased. In bipolar disorder, the imbalance of the various messenger substances may therefore play an important role. The drug therapy of bipolar disorder therefore aims at achieving a controlled release of these signal substances.

Bipolar disorder: psychosocial causes

In addition to biological influences, individual living conditions are also involved in a bipolar disorder. Stress in particular seems to be a trigger for manic-depressive episodes.

Serious illnesses, bullying or separations, but also some phases of life such as puberty mean a longer period of stress. How stress is felt and processed depends on the individual person. Some people have developed good strategies for dealing with stress, while others are quickly overwhelmed.

Stress can be a bad childhood event, a recent divorce or the death of a loved one. Such stress-inducing factors increase the probability of developing bipolar disorder.

Bipolar disorder: Drug-related causes

Some medications can also change the mood and in extreme cases trigger a bipolar disorder. These include preparations containing cortisone, methylphenidate, certain antiparkinson and epilepsy drugs, but also drugs such as alcohol, LSD, marijuana and cocaine. There are also individual case reports according to which bipolar disorders have occurred after brain injuries.

Bipolar disorder: examinations and diagnosis

Bipolar disorder is not easy to diagnose because it can be confused with other mental disorders such as classic depression or schizophrenia. Since the manic phase is often interpreted by relatives and affected persons as merely a high-spirited mood, it often takes years before a correct diagnosis is made.

Especially the bipolar II disorder and cyclothymia are difficult to detect, as the symptoms are less pronounced here than in the bipolar I disorder. It is therefore particularly important to describe in detail the experiences, moods and feelings of the patient to the doctor or therapist.

If a bipolar disorder is suspected, the family doctor can be contacted first. However, due to the difficulty of diagnosis and the increased risk of suicide, it is advisable to contact a clinic or consult a psychiatric specialist immediately. Often, however, those affected see no need for medical help – especially during their manic phase.

If they can be persuaded to see a doctor, it is advisable to ask the relatives as well. If the person affected has no insight into the disease, the observations of close relatives are very helpful for the diagnosis “bipolar disorder”. Thus, relatives are often able to assess the different mood phases well.

Bipolar disorder is diagnosed by means of special clinical questionnaires. The doctor or therapist could ask the following questions in an initial consultation:

  • Have you felt depressed or a lack of drive in the last few weeks?
  • Did you have trouble getting up in the morning?
  • Did you have trouble sleeping through the night?
  • Did you have a good appetite?
  • What are your thoughts right now? What’s on your mind?
  • Do you sometimes think about death or about taking your own life?
  • Have you been unusually agitated in the last few weeks?
  • Did you feel like you were under the gun?
  • Did you have the impression that you talked more and faster than usual?
  • Was your need for sleep reduced?
  • Were you very active and did many things in a very short time?
  • Has your mood been erratic lately?

Due to the great genetic influence, a family anamnesis is very useful in the case of manic-depressive illness. This enables the therapist to find out if other members of the family suffer from bipolar disorder.

Bipolar disorder: treatment

The diagnosis “bipolar disorder” urgently requires the taking of medication. The drugs not only reduce the depressive and manic phases, they also reduce the risk of suicide.

Psychotherapeutic treatment is as important as drug therapy. It can positively influence the course of bipolar disorder. Above all, however, it is decisive for the insight into the disease and the will to be treated. This so-called compliance is often lacking in people with bipolar disorder, as they feel particularly well in the manic phases and are reluctant to give it up. Manic-depressive patients usually have to be treated for the rest of their lives, as this is the only way to keep their mood stable. If patients discontinue treatment, there is a high risk of relapse.

Bipolar disorder: phases of treatment

The treatment itself consists of an acute treatment, the stabilization phase and relapse prophylaxis.

Acute phase

In the acute phase, drugs are mainly used to treat the mania or depression that has occurred.

For psychological support, therapeutic discussions are offered in individual or group therapy. Some clinics also use waking and electroconvulsive therapies to normalize the mood.

Stabilisation phase

It may take several weeks or even months before a significant improvement in symptoms occurs. Then the stabilisation phase begins. The drugs are adjusted in this phase until the patient receives the optimal dosage for him/her.

Relapse prophylaxis

If the affected person is then largely symptom-free, an attempt is made to maintain this condition in the long term. For this purpose, it is necessary that the patient continues to take medication. In addition, during therapy he learns to recognise the warning signs of mania or depression at an early stage and can thus take countermeasures.

Bipolar disorder: Drug treatment

The therapy of a bipolar disorder is mainly based on mood-stabilising drugs such as lithium, antiepileptic drugs and atypical neuroleptics. Since both the manic and depressive phases must be treated, doctors often use different drugs.

If the mood-stabilising active ingredients are not sufficient for acute treatment, the doctor or therapist will additionally prescribe sedatives and antidepressants. Commonly used medications are the following:


Active substance Application Common side effects

(e.g. Quilonum)

  • natural salt
  • used frequently
  • works against both manic and depressive phases
  • reduces suicidal thoughts
  • Tremor
  • Stomach complaints
  • severe thirst
  • Fatigue
  • Fake
  • Muscle weakness
  • Weight gain
  • Thyroid gland problems
  • Kidney problems
  • Skin problems

(e.g. Tegretal, Timonil)

  • Anti-epileptic drug
  • Effect similar to lithium
  • very effective especially in the mixed form
  • Fatigue
  • Fake
  • Headache
  • Nausea
  • Skin problems
  • reduces the effect of the contraceptive pill
Valproic acid (e.g. Ergenyl, Orfiril)
  • Fatty acid
  • for the treatment of the manic phase and the mixed form
  • Nausea
  • Vomiting
  • Diarrhoea
  • Fatigue
  • Fake
  • Tremor
Tricyclic antidepressants (e.g. Sarotene)
  • for the treatment of the acute depressive phase
  • only short-term
  • Dry mouth
  • Problems with urination
  • can trigger manic phase
Selective serotonin reuptake inhibitors (e.g. Cipramil)
  • Antidepressants
  • for the treatment of the acute depressive phase
  • drive-increasing
  • Gastrointestinal complaints
  • Headache
  • Unrest


The effect of the mentioned drugs often only sets in after a few weeks. Those affected must initially be patient until the improvement is noticeable.

It is important to follow the precise instructions of the doctor when taking the medication. An independent increase of the dose is very dangerous and can cause severe side effects. Under no circumstances should the medication be discontinued suddenly and without consulting the doctor. This usually causes a new relapse of the manic-depressive illness.

Bipolar disorder: Waking therapy

A so-called waking therapy can also improve the depressive symptoms. For this purpose the patient abstains from sleep for one night. Surprisingly, this stabilizes the state of mind. If this method shows a good effect, the sleep deprivation can be repeated.

This form of therapy must be carried out under medical supervision, as sleep deprivation can also trigger a manic phase. However, this risk can be reduced by combining it with medication.

Bipolar disorder: electroconvulsive therapy

Electroconvulsive therapy is effective for both depressive and manic symptoms. In this therapy, electrodes are applied to the patient which, under general anaesthesia, produce a brief cramping seizure. This may sound scary, but it is actually harmless.

For one thing, patients under general anaesthesia do not notice any of this. On the other hand, this procedure has significantly fewer side effects than most drugs. It is mainly used when those affected suffer severely from the bipolar disorder or when there is a high risk of suicide.

While the effect of the drugs only sets in after a few weeks, electroconvulsive therapy works immediately. Before the procedure, the doctor checks for existing risks, such as heart disease. Electroconvulsive therapy cannot be used during pregnancy or at an advanced age.

Bipolar disorder: Psychotherapeutic treatment

Interpersonal and Social Rhythm Therapy (IPSRT) and Family-Focused Therapy (FFT) have proven to be particularly effective therapeutic treatments for bipolar disorder. Often clinics also offer cognitive behavioural therapy.

Cognitive behavioral therapy

In addition to reducing personal difficulties, IPSRT is about stabilizing the rhythm of life. Regular and adequate sleep reduces the risk of a manic or depressive phase. In the therapeutic sessions, patients are informed about the bipolar disorder and learn how they can better structure their everyday life.

The family-focused therapy is preferred especially for younger patients. Important caregivers such as the parents or partner are involved in the therapy.

The advantage of this method is that reference persons are also informed in detail about the bipolar disorder. In addition, possibilities are worked out together as to how a normal everyday life can take place despite the illness. A communication and problem solving training should reduce existing conflicts.

Behavioral therapy helps the patient to recognize the early warning signs of bipolar disorder. Stress reduction is also an important part of the therapy, as stress plays a decisive role in the flare-up of pathological phases. The patient also learns a conscientious approach to medication and learns strategies for dealing with manic and depressive symptoms.

Living with the disease

A bipolar disorder often accompanies patients throughout their lives. It is therefore important for them to learn how to deal with this disease in order to achieve a good quality of life. The psychotherapeutic treatment also helps the persons concerned to integrate into their social and professional environment.

Bipolar disorder: course of disease and prognosis

Is bipolar disorder curable? This is a question that both those affected and their relatives ask themselves. In fact, in a good third of patients, the mood swings disappear permanently. However, the majority of those affected are accompanied by bipolar disorder for the rest of their lives.


A bipolar disorder has a very different course from one individual to another. The course of the disease also depends on the type of bipolar disorder. In the classic form, the bipolar I disorder, manic and depressive phases alternate – sometimes at close intervals.

In the bipolar II disorder, the depressive phases predominate and only so-called hypomanic phases occur. In cyclothymia both the manic and depressive phases are only weakly developed.

However, this does not mean that those affected by a bipolar II disorder or cyclothymia have a lower level of suffering. This is because in these forms of bipolar disorder, the manic or depressive episodes often occur more frequently than in bipolar I disorder.

Intermittent mood swings

The depressive and manic phases usually last between eight and twelve weeks. Between these episodes, affected persons can be symptom-free for a long time. In the special form called “rapid cycling”, at least four phases of mania or depression occur throughout the year.

Early disease, unfavourable course

Bipolar disorder usually first occurs between the ages of 15 and 25 years. The earlier the bipolar disorder occurs, the more unfavorable the course is usually.

According to studies, there is a higher suicidal tendency among young patients and further mental disorders often occur. Experts estimate the rate of suicides among bipolar patients to be about 15 percent.

Early diagnosis important

It is important that a bipolar disorder is diagnosed as soon as possible. Untreated, the manic and depressive phases occur more and more often. The more manic or depressive episodes a patient has gone through, the worse the treatment usually works. Conversely, however, this means that timely drug therapy can significantly improve the course.

Unfortunately, relapses cannot be ruled out even then. However, the symptoms of bipolar disorder and thus the level of suffering can be significantly reduced by the medication.

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