How phases manifest themselves
The depressive phase is dominated by depression, loss of interest and pleasure, loss of strength, sleep and appetite disturbances, feelings of guilt, and difficulty concentrating. Mania is the opposite state: an elevated or irritable mood, a sharply reduced need for sleep, accelerated speech, a feeling of special abilities, impulsive decisions and spending. Hypomania is milder: a person feels unusually uplifted and productive, others notice a change, but there may be no serious consequences. This is why hypomania is rarely considered a problem and is not discussed with the doctor, making diagnosis difficult.
- Depressive phase - depression and loss of strength
- Manic phase - getting up, little sleep, impulsiveness
- Hypomania - a milder rise without pronounced consequences
- Mixed states with signs of both phases simultaneously
- Periods of remission between episodes
Causes and risk factors
Bipolar disorder is a biologically determined disease in the development of which hereditary predisposition plays a major role. People with sick close relatives have a significantly higher risk. But the mere presence of genes does not necessarily mean the development of the disease: it is triggered or aggravated by stress, lack of sleep, sudden changes in time zones, childbirth, alcohol and substance abuse, and sometimes taking antidepressants without the cover of a mood stabilizer. It is important to understand that the patient or family is not to blame for the disorder.
- Hereditary predisposition
- Sleep and routine disorders
- Severe stressful events
- Postpartum period
- Alcohol and psychoactive substances
- Taking antidepressants without mood stabilizers
- Somatic diseases and hormonal disorders
Diagnostics
The diagnosis is clinical: it is made by a psychiatrist based on a detailed conversation about the course of conditions over time. The key is to identify episodes of elation that the patient may not mention as periods of good performance. Therefore, the doctor often asks permission to talk with loved ones who notice changes from the outside. A mood and sleep diary is useful. Additionally, conditions that can mimic the phases are excluded: thyroid diseases, neurological diseases, side effects of medications, substance use.
- Detailed clinical conversation with a psychiatrist
- Assess the entire episode history, not just the current state
- Information from loved ones with the patient’s consent
- Mood and sleep diary
- Thyroid hormone tests
- General clinical tests before starting therapy
- Elimination of the influence of alcohol and psychoactive substances
Treatment
The basis of treatment is mood stabilizers, drugs that stabilize mood and prevent new episodes; they are taken for a long time, including during periods of good health. For severe mania or psychotic symptoms, drugs from other groups are added, sometimes requiring hospital treatment. Antidepressants are used with caution and only together with a stabilizer, because on their own they can provoke a transition to mania. Psychotherapy and psychoeducation help recognize early signs of the phase, adhere to the regimen, and maintain adherence to treatment.
- Long-term mood stabilizers
- Medications to relieve manic episodes
- Careful use of antidepressants only with a stabilizer
- Hospitalization for severe episodes
- Psychoeducation for the patient and family
- Cognitive-behavioral and family psychotherapy
- Regular monitoring of tests when taking certain medications
Living with a diagnosis and preventing exacerbations
Bipolar disorder is highly manageable, and many people with this diagnosis are successful in work, school, and family. The regularity of taking medications and a stable sleep schedule are crucial: lack of sleep is one of the most reliable provocateurs of the manic phase. It is useful to keep a mood diary and draw up an action plan with your doctor and loved ones in advance in case of early signs of exacerbation. Alcohol and psychoactive substances should be excluded. Stopping treatment on your own when you feel well is the most common reason for the return of symptoms.
- Strict sleep-wake schedule
- Regularly taking prescribed medications
- Mood diary and early recognition of phase signs
- Action plan for exacerbation, agreed upon with the doctor and family
- Quitting alcohol and psychoactive substances
- Planning pregnancy together with a psychiatrist
- Support for loved ones and self-help groups