Bipolar affective disorder (bipolar disorder) is a long-term mental health condition characterised by episodes of mania or less severe hypomania and episodes of depression. It was previously known as “manic depression”. During an episode, a person may experience marked changes in mood, energy, activity, sleep, thinking, and everyday functioning. Periods of remission may occur between episodes, although some people continue to experience residual symptoms, difficulty concentrating, or reduced ability to manage work and daily tasks.
Symptoms of mania and hypomania
- an unusually high level of energy and activity;
- an elevated, euphoric, or irritable mood;
- numerous plans and ideas, some of which may be unrealistic or impractical;
- a reduced need for sleep;
- increased irritability or agitation;
- impulsive decisions, including excessive spending;
- rapid or excessive speech with frequent changes of topic.
Mania is more severe than hypomania. It can substantially disrupt daily life, impair judgement, include psychotic symptoms, or require treatment in hospital.
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Symptoms of a depressive episode
- low energy and motivation;
- withdrawal and avoidance of social contact;
- a persistently low mood or sadness;
- pessimistic thoughts and feelings of helplessness or hopelessness;
- loss of interest in activities that were previously enjoyable;
- changes in sleep and difficulty processing information;
- changes in appetite;
- thoughts of death, self-harm, or suicide.
If a person may harm themselves or someone else, has lost contact with reality, or is severely agitated or confused, seek emergency help immediately. A routine online consultation is not a substitute for emergency medical care.
Diagnosis of bipolar disorder
A psychiatrist makes the diagnosis based on a clinical assessment. The doctor discusses current and previous episodes, their duration and effect on everyday life, takes a medical and mental health history, and assesses symptoms of depression, mania, hypomania, or mixed states. With the patient’s consent, information from someone close to them may help clarify changes in mood and behaviour.
There is no single blood test, psychological questionnaire, MRI scan, or other examination that confirms bipolar disorder on its own. Laboratory or imaging tests may be recommended when clinically indicated to rule out physical conditions, medication effects, or other causes of similar symptoms. Online questionnaires cannot replace professional assessment.
Bipolar disorder affects people of different sexes and often first appears during adolescence or early adulthood, although it can begin later in life.
Expert opinion
“Bipolar disorder is a long-term condition, so treatment aims not only to reduce current symptoms but also to prevent future episodes. Manic and depressive episodes can vary greatly in duration and severity. A psychiatrist selects medication according to the type and phase of the disorder; psychotherapy and psychoeducation may also be recommended. Prescribed medication should not be started, stopped, or changed without consulting the doctor,” says Khrystyna Zhyvago, PhD MD, psychiatrist and head of Dr.Zhyvago Clinic.
Types and phases of bipolar disorder
- Bipolar I disorder involves at least one manic episode. Depressive episodes are common but are not required for the diagnosis.
- Bipolar II disorder involves hypomanic episodes and major depressive episodes, without a history of a manic episode.
- During episodes with mixed features, symptoms of elevated and depressed mood may occur at the same time.
The duration, frequency, and severity of episodes vary from person to person. Some people mainly experience depressive episodes, while others have more frequent manic, hypomanic, or mixed states. Regular follow-up helps identify changes early and allows treatment to be adjusted when necessary.
Causes and risk factors
Bipolar disorder has multiple contributing factors. Genetic and other biological factors can affect a person’s likelihood of developing the condition. Stress, chronic strain, disrupted sleep, bereavement, and other difficult events are not considered the sole cause of bipolar disorder, but in a person who is vulnerable they may be associated with the onset or recurrence of an episode.
In most cases, the cause cannot be reduced to a single factor. During an assessment, the doctor considers family history, previous episodes, physical health, sleep, substance use, and other relevant circumstances.
Seasonal patterns
Some people notice a seasonal pattern, with manic or hypomanic episodes occurring more often in spring or summer and depressive episodes in autumn or winter. This pattern does not occur in everyone. Between episodes, a person may feel well or may continue to experience some symptoms.
Bipolar disorder in adults and adolescents
Adults
Bipolar disorder can occur alongside anxiety disorders, panic attacks, post-traumatic stress disorder, obsessive-compulsive disorder, or eating disorders. Alcohol and other substance use can worsen the course of the condition and make treatment more difficult.
To support someone with bipolar disorder, listen without judgement, avoid dismissing their experience, and encourage them to seek professional help. If there are signs of immediate danger, arrange emergency help rather than trying to manage the situation alone.
Adolescents
In children and adolescents, mood changes may appear as irritability, apathy, sleep disturbance, declining school performance, conflict, or risky behaviour. These signs are not specific to bipolar disorder, so a careful assessment by a child psychiatrist is required, taking account of the young person’s development, family circumstances, and possible coexisting conditions.
Talk of suicide, self-harm, psychotic symptoms, or dangerous behaviour requires immediate professional help.
Treatment of bipolar disorder
Treatment may be provided on an outpatient basis or in hospital. The appropriate setting depends on the phase and severity of the condition, the person’s ability to care for themselves, and any risk to their safety. Hospital treatment may be necessary during severe mania or depression, psychotic symptoms, or suicidal risk.
An individual treatment plan may include:
- medication to stabilise mood and manage particular symptoms;
- psychotherapy and psychoeducation;
- a regular sleep schedule and daily routine;
- monitoring for early signs of a new episode;
- support for the patient and their family.
The duration of inpatient and outpatient treatment is determined individually. After the condition has stabilised, continued follow-up remains important, and any changes in symptoms or side effects should be discussed with the doctor. Do not change prescribed medication without consulting a psychiatrist.
Confidentiality and continuing support
The clinic handles information confidentially in accordance with applicable law and the professional duties of healthcare specialists. Confidentiality has limits defined by law, including situations involving an immediate risk to the safety of the patient or another person. Treatment and follow-up plans are developed individually.
About the clinic
Dr.Zhyvago is a psychiatry and psychotherapy clinic that has operated since 2013. The clinic provides psychiatric assessment, individual treatment planning, psychotherapy, and follow-up support. Appointments are available in person in Kyiv and online when a remote format is clinically appropriate.