Bipolar disorder: symptoms, types and treatment

The word «bipolar» gets thrown around loosely, almost always wrongly, to describe someone whose mood changes over an afternoon. Real bipolar disorder is something else, and far more serious: a mood disorder in which spells of euphoria or acceleration alternate with spells of deep depression, with calmer periods in between. This guide covers what it is, which types there are, how it is recognised, why it develops and how it is treated, with one underlying idea: it is a chronic condition, yes, but a very manageable one when it is approached well.

One note before we start: this is information to understand the condition, not to diagnose anyone. Bipolar disorder is assessed by a mental health professional —of the kind bodies like the American Psychological Association represent— over time, not from a list of symptoms.

What bipolar disorder is

Bipolar disorder, once called manic-depressive illness, is a mood disorder marked by episodes at two opposite poles: on one hand, phases of elevated, expansive or irritable mood with high energy —what is called mania or, in its milder form, hypomania—; on the other, phases of depression. Between them there are usually periods of stability in which the person functions normally.

It affects around 1-2% of the population and usually appears in late adolescence or early adulthood. The important thing is to understand that it is not a matter of character or lack of willpower: it is a medical condition, with a biological basis, that disrupts mood regulation. And, as we will see, it has treatment that works.

Types of bipolar disorder

Not all bipolar disorders are the same. Three main forms are distinguished:

• Bipolar I. It involves at least one full manic episode —intense and clearly affecting life— almost always accompanied by depressive phases.
• Bipolar II. It involves episodes of hypomania (milder than mania) and depressive episodes, often more marked and persistent than in type I.
• Cyclothymia. Milder, chronic swings, with hypomanic and depressive symptoms that do not meet the criteria for full episodes but persist over time.

Telling the type apart is the professional's job, and it is no small matter: it guides treatment. It also needs to be told apart from other conditions it gets confused with, especially borderline personality disorder, where the mood changes are much faster and tied to relationships.

Symptoms of bipolar disorder

The symptoms of bipolar disorder are best understood by separating the two poles.

In the manic or hypomanic phase there is a euphoric or, at times, very irritable mood with overflowing energy. The person sleeps far less without feeling tired, talks non-stop, jumps from one idea to another, feels capable of anything and tends towards impulsivity: spending, rushed decisions or risky behaviour that weighs on them afterwards. In full mania, this interferes completely with life and may require hospitalisation.

In the depressive phase the picture flips: sadness, loss of interest in what used to be enjoyable, fatigue, changes in sleep and appetite, difficulty concentrating, guilt and, in the most severe cases, suicidal thoughts. Precisely because of that risk, it is best to have a crisis protocol in place when supporting these patients.

Why bipolar disorder develops

There is no single cause. Bipolar disorder has a strong genetic component —it is one of the most heritable mental disorders— and a neurobiological basis in the way the brain regulates mood and energy. On top of that predisposition act triggers that can set off an episode: intense stress, sleep disruption, seasonal changes or substance use.

It is worth saying plainly, because the stigma weighs heavily: a person with bipolar disorder does not choose to have episodes nor «do it for attention». Understanding that there is biology behind it does not remove responsibility for the treatment, but it does help to look at the problem without blame and to get involved in managing it.

Treatment of bipolar disorder

Here we have to be honest and orderly. The foundation of treatment for bipolar disorder is pharmacological: mood stabilisers —lithium is the best known— and, depending on the case, other medication, always prescribed and monitored by a psychiatrist. That is not negotiable or replaceable by psychology: it is the pillar that stabilises the episodes.

That said, psychotherapy is a complement with solid evidence, not an add-on. Psychoeducation —understanding the condition and recognising the early signs—, cognitive behavioral therapy, work on daily routines and rhythms and family-focused therapy greatly improve adherence and help with relapse prevention. In practice, bipolar disorder is best treated as a team, with the psychiatrist and the psychologist pulling together. Reference guidelines such as those from the UK's NICE and bodies like the National Institute of Mental Health agree on this combined approach. With it, the outlook is good.

Supporting bipolar disorder in your practice

Supporting bipolar disorder from psychology has a peculiarity: it is long-term work and very sensitive to continuity. You have to keep a stable follow-up, watch for the warning signs of relapse, sustain adherence and coordinate with the psychiatrist who handles the medication. And there is a clinical nuance: during phases of decompensation, missing appointments is part of the condition itself, not carelessness.

That is why good organisation is not a luxury. With practice management software you can schedule the follow-up as recurring appointments and turn on automatic reminders that cut no-shows exactly when they matter most. You can record the mood course, the warning signs and the crisis plan in an encrypted digital clinical record, and offer online sessions when travelling is hard. Fewer administrative barriers means, in a chronic condition like this, more continuity of care.

My Psico Agenda: logistics handled so you can support

Supporting long-term conditions like bipolar disorder takes consistency and coordination; the paperwork, the less the better. My Psico Agenda is practice management software that brings the calendar, the encrypted clinical record, WhatsApp reminders, the patient portal and VeriFactu invoicing into a single account, in the browser, on the phone and on the tablet, GDPR-compliant with servers in the European Union, and it treats the in-person and the online session the same.

It starts at €19.99/month with no lock-in if you work on your own with the calendar for self-employed psychologists, and if you are part of a team or coordinate a centre, the version for psychology centres brings several calendars, with their reports, together on one panel.