OVERVIEW

What is Bipolar Disorder?

Bipolar disorder, commonly known as "manic-depressive illness," is a prevalent mental disorder characterized by episodes of mania or hypomania alternating with depressive episodes.

The onset of bipolar disorder typically occurs at a relatively young age, with a high incidence before the age of 30 ^[1]. Many patients initially seek treatment for depressive episodes, often leading to misdiagnosis as major depressive disorder, which directly results in unsatisfactory treatment outcomes.

Currently, the primary treatments for bipolar disorder are mood stabilizers and antipsychotic medications. Drug therapy can effectively control symptoms, and patients with stable medication management during maintenance phases can participate normally in daily activities.

The progression of bipolar disorder is influenced by factors such as age of onset, duration of illness, and timing of treatment initiation. The disorder also carries a certain degree of disability, with many patients experiencing prominent depressive symptoms during severe episodes, which is a leading cause of self-harm ^[1].

If depression is like a black dog, the mind of someone with bipolar disorder contains not only the black dog but also a raging dragon. If you are diagnosed with bipolar disorder, it is crucial to seek active treatment. If a friend or family member is diagnosed, offer them patience, encouragement, and care to support their recovery.

Is Bipolar Disorder Common?

The global lifetime prevalence of bipolar disorder rose to 5.5%–7.8% after the 1990s, meaning 5 to 8 out of every 100 people with the condition may experience it lifelong without a complete cure ^[1]. In 2004, the WHO listed it as one of the most common moderate-to-severe disabling diseases across all age groups, ranking 12th ^[3].

What Are the Types of Bipolar Disorder?

Bipolar disorder can be classified into the following three types ^[1]:

1. Bipolar I Disorder: Primarily marked by acute or chronic mania, with fewer depressive episodes.

2. Bipolar II Disorder: Characterized by recurrent depressive episodes and hypomanic episodes, with depression being dominant.

3. Cyclothymic Disorder: Involves alternating periods of elevated and low mood but does not meet the full criteria for depressive or manic episodes.

Is Bipolar Disorder a "Genius Disease"?

Bipolar disorder is not a "genius disease" but an intermittently occurring mental illness with no direct correlation to intelligence.

During remission periods, patients may behave similarly to unaffected individuals, while episodes can involve extreme mood swings. Most patients experience impulsivity and difficulty sustaining focus during manic/hypomanic phases, leading to chaotic subjective experiences. Excessive physical exertion can also negatively impact health.

The term "genius disease" usually refers to Asperger's syndrome, a condition within the autism spectrum or pervasive developmental disorders, typically without significant language or intellectual impairments ^[4].

Which Department Should You Visit for Bipolar Disorder?

For emotional abnormalities, consult the psychiatric or psychological department. Some specialized mental health hospitals have "Depression/Bipolar Disorder Clinics" for targeted care.

Like physical illnesses, many mental health conditions can be treated effectively. Do not hesitate due to stigma. If apprehensive about seeking help, consider bringing a trusted family member or friend for support.

SYMPTOMS

What are the symptoms and manifestations of bipolar disorder?

Bipolar disorder generally presents in three forms of episodes: depressive episodes, manic episodes, and mixed depressive-manic episodes. The episodes occur frequently within a year, at least four times^[1].

1. Depressive episodes:

   • Patients experience low mood, slowed thinking, reduced volitional behavior, and may also exhibit cognitive decline and physical symptoms (such as pain, insomnia, etc.).
   • They often feel unhappy and gloomy all day, with some showing a distinct pattern of worse mood in the morning and improvement in the evening. Their reactions are sluggish, thought processes slow, and they may have pessimistic or hopeless thoughts. Their activities or behaviors slow down, such as staying indoors all day, neglecting personal hygiene, appearing disheveled, and avoiding social interactions.

2. Manic episodes:

   • Patients exhibit typical symptoms of elevated mood, racing thoughts, and increased volitional behavior.
   • They may appear cheerful, optimistic, and exuberant, with infectious energy, though sometimes they may become irritable (easily agitated). They may also talk incessantly, speaking faster and more than usual, with rapid associative thinking and shifting topics. In severe cases, brief auditory hallucinations, delusions, loose associations, illusions, or hallucinations may occur. Patients struggle to stay still, engage in excessive activity, and display reckless behavior without considering consequences.

3. Mixed depressive-manic episodes:
   Depressive and manic symptoms may appear simultaneously or be prominent for most of the time, with short intervals between them.

What is the difference between bipolar disorder and schizophrenia?

1. Mood: Bipolar disorder is a mood-related mental disorder, where a patient's behavior fluctuates with mood changes. In contrast, schizophrenia patients do not exhibit this feature; their emotional symptoms are secondary, appearing odd, withdrawn, or even inexplicable.

2. Course of illness: Bipolar disorder often follows an intermittent course, with episodes alternating with periods of normalcy. Schizophrenia tends to be progressive or continuous in its episodes^[1].

What is the difference between bipolar disorder and depression?

When bipolar disorder is in a depressive episode, it can easily be confused with depression.

The depressive episodes of bipolar disorder are intermittent and do not last for extended periods, whereas depression involves persistent and prolonged depressive symptoms.

CAUSES

What Causes Bipolar Disorder?

Current research suggests that bipolar disorder arises from the interaction of multiple factors, including genetic, biological, and psychosocial influences^[1-3].

1. Genetic Factors: These are the primary risk factors for the condition. Bipolar disorder shows significant familial aggregation, with higher prevalence rates among closer blood relatives of diagnosed individuals.

2. Biological Factors: Bipolar disorder is also linked to abnormal central neurotransmitter function, involving serotonin, norepinephrine, dopamine, acetylcholine, glutamate, and GABA. Additionally, it is associated with neuroendocrine changes, circadian rhythm disruptions, neuroimmune dysfunction, and structural brain abnormalities.

3. Psychosocial Factors: Stressors (such as sudden psychological or physical trauma) and prolonged psychological suppression can also trigger bipolar disorder.

Is Bipolar Disorder Hereditary?

Yes, it is hereditary. As a polygenic genetic disorder, bipolar disorder has a heritability rate as high as 85%^[1-3].

DIAGNOSIS

Suspected of having bipolar disorder, what should I do?

To diagnose bipolar disorder, you must visit the psychiatry department of a formal hospital and be evaluated by a professional psychiatrist. The psychiatrist will conduct a comprehensive assessment based on your medical history and scale tests to provide a psychiatric diagnosis. If necessary, hormone tests may also be required to rule out endocrine disorders.

Please note that there are many "self-assessment scales" online, but these scales cannot diagnose the condition. If the test results are abnormal, seek medical attention promptly instead of trying to self-diagnose.

TREATMENT

Can Bipolar Disorder Heal Itself?

Bipolar disorder has a certain degree of self-limiting nature. If symptoms resolve spontaneously without treatment within the first year after the initial episode, the likelihood of recurrence is relatively low. However, if symptoms persist, the recurrence rate can reach 90% or even higher^[1].

Those who experience spontaneous remission often do not realize they are ill and do not seek medical attention. However, once diagnosed with bipolar disorder, it is essential to follow the doctor's treatment plan. Receiving a diagnosis may be difficult to accept, but regardless, adhering to medical advice and actively pursuing treatment can lead to improvement.

When Does Bipolar Disorder Require Hospitalization?

The primary treatment principle for bipolar disorder is ensuring patient safety.

During acute episodes, some patients may exhibit aggression, impulsive behavior due to manic episodes, or self-harm or suicidal thoughts and actions due to depressive episodes, all of which necessitate hospitalization.

How Is Bipolar Disorder Treated?

Bipolar disorder is treated through several methods, with approaches varying by individual. Strict adherence to medical advice is crucial. If medication side effects occur, consult a doctor to adjust the treatment plan^[1-3].

1. Medication: Mood stabilizers are the primary treatment, with lithium, carbamazepine, and valproate being first-line options. Other medications include antipsychotics (e.g., olanzapine, risperidone) and antidepressants (e.g., fluoxetine, fluvoxamine). Common side effects include gastrointestinal issues (nausea, vomiting, constipation). These drugs are suitable for those who tolerate them without allergies.

2. Physical Therapy: Used for acute manic or severe depressive episodes, including repetitive transcranial magnetic stimulation (rTMS) and electroconvulsive therapy (ECT) or modified ECT, which involves electrical stimulation of brain nerves.

3. Psychological Intervention: Essential for addressing stigma and negative self-perception, which can worsen depressive symptoms^[5]. Approaches include psychoeducation, cognitive behavioral therapy (CBT), and family therapy. Mental health professionals help manage symptoms, such as calming agitation or uplifting low moods.

Treatment typically combines medication, physical therapy, and psychological intervention.

What Are the Phases of Bipolar Disorder Treatment?

Treatment is divided into acute, consolidation, and maintenance phases^[1].

1. Acute Phase: Lasts 6–8 weeks, focusing on safety and symptom relief.
2. Consolidation Phase: The 3 months following the acute phase, aimed at preventing relapse.
3. Maintenance Phase: Critical for long-term prevention of recurrence. Stopping medication without medical guidance can lead to frequent relapses.

Can Bipolar Disorder Be Cured? How Long Does Treatment Last?

Bipolar disorder is challenging to cure completely, but standardized treatment can significantly alleviate symptoms and restore normal life.

The global lifetime prevalence of bipolar disorder rose to 5.5%–7.8% post-1990s, meaning 5 to 8 out of 100 affected individuals may live with it lifelong^[1].

Due to the risk of recurrence, long-term maintenance treatment is necessary beyond acute symptom management. The duration depends on medical evaluation.

Does Bipolar Disorder Recur? What Are the Risk Factors for Relapse?

Recurrence rates are high, with 40%–50% relapsing within two years post-treatment^[6]. Risk factors include sleep disturbances, improper medication use, and excessive stress, all of which increase relapse likelihood.

DIET & LIFESTYLE

How to Care for Family and Friends with Bipolar Disorder?

1. First, ensure the patient's safety. Patients experiencing manic episodes may act impulsively, while those in depressive episodes may self-harm or attempt suicide. During acute episodes, hospitalization is the preferred option to protect both the patient and their family.

2. Confirm that the patient is receiving proper treatment and encourage them to take their medication daily to minimize fluctuations in drug concentration levels and stabilize their mood.

3. Family and friends should join the treatment alliance. Learn about the typical characteristics of manic, hypomanic, and depressive episodes to recognize mood changes promptly and seek medical help when necessary.

4. Treat the patient with a normal attitude—no need to be overly cautious in words or actions.

What Should Bipolar Disorder Patients Pay Attention to in Their Diet?

Making the right dietary choices can help maintain a healthy weight and a stable mood. These choices include:

1. Avoid foods high in saturated fats, trans fats, and simple carbohydrates, such as processed snacks. A diet low in saturated fats and carbohydrates benefits overall health but does not directly affect bipolar symptoms.

2. Choose protective, nutrient-rich foods. These include fresh fruits, vegetables, legumes, whole grains, lean meats, cold-water fish, eggs, low-fat dairy, soy products, and nuts. These foods provide essential nutrients for maintaining health and preventing disease.

3. Monitor calorie intake and exercise regularly. Some studies suggest that bipolar disorder patients are at higher risk of being overweight or obese. Discuss weight management strategies with a doctor if medication causes weight gain.

Can Bipolar Disorder Patients Get Married and Have Children?

1. Bipolar disorder patients can marry and have children. It is recommended to plan pregnancy after clinical recovery. If pregnancy occurs during medication, consult a doctor to switch to or select pregnancy-safe medications.

2. Bipolar disorder tends to run in families, and evidence suggests genetics play a role in its development. Currently, genetic testing can only estimate hereditary risk, but since the exact cause remains unclear, results are for reference only.

PREVENTION

Can Bipolar Disorder Be Prevented? How to Prevent Bipolar Disorder?

Bipolar disorder can be prevented to some extent by reducing risk factors, such as:

1. Maintaining good sleep quality: Long-term poor sleep, frequent dreams, easy awakening, or insomnia can lead to mental exhaustion and tension, increasing the risk of the disorder. Therefore, ensuring good sleep can effectively prevent the onset of mental illnesses. Methods like exercise (e.g., pre-sleep yoga) or therapies (e.g., head massage) can promote restful sleep.

2. Timely stress relief: Prolonged exposure to societal pressures from work or life can increase the risk of developing the disorder. Learning to manage stress and avoiding emotional buildup are effective preventive measures.

How to Prevent Relapse of Bipolar Disorder?

1. Medication prevention: Prophylactic treatment with lithium salts can effectively reduce relapse rates. However, dosages vary by individual and must be taken under professional medical supervision, with regular symptom monitoring ^[2].

2. Psychological prevention: Providing psychological counseling and addressing mental health issues promptly.

3. Environmental prevention: Ensuring support from family, work, and social environments, offering understanding and care, and encouraging patients to build confidence, reintegrate into society, and establish healthy interpersonal relationships.