Bipolar disorder (bipolarism): symptoms and treatment

By Cristiano Antonino On Feb 16, 2023

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What is bipolarism? Bipolar disorder (or bipolar depression or bipolarism), although not particularly frequent, is a serious and disabling problem

It deserves clinical attention and sufferers are often unaware of it.

Sufferers tend to alternate between depressive phases followed by hypomanic or manic phases (bipolarism).

In general, the depressive phases of bipolar depression tend to last longer than the manic or hypomanic phases.

They usually last from a few weeks to a few months, whereas the manic or hypomanic phases last one to two weeks.

Sometimes, in bipolar disorder, the transition from one phase to the other is rapid and immediate.

Other times, however, it is interspersed with a period of normal (euthymic) mood.

Sometimes the phase transition in bipolarism is slow and subtle, while at other times it can be abrupt and sudden.

The depressive phase of bipolarism

The depressive phases in bipolar disorder (or bipolar depression) are characterised by a very low mood, a feeling that nothing can give pleasure any more and a general sadness for most of the day.

In principle, the depressive phases do not differ from the depressive episodes of unipolar major depression.

During these phases of bipolarism, therefore, sleep and appetite may be easily disturbed; the ability to concentrate and memory may be much less.

Sometimes, also during the depressive phases, people with bipolar disorder recurrently think about suicide.

The manic phase

The manic phases in bipolar disorder are, in some cases, generally described as the exact opposite of the depressive phases.

That is, characterised by a somewhat elevated mood, a feeling of omnipotence and excessive optimism.

In these phases, thoughts follow each other very rapidly in the mind of the patient suffering from bipolar depression or bipolar disorder to such an extent that they become so fast that it is difficult to follow them.

Behaviour can be hyperactive, chaotic, to the point of making the patient inconclusive.

The energy of the bipolar patient in the manic (or hypomanic) phase is so great that the subject often feels no need to eat or sleep.

He thinks he can do anything, to the point of engaging in impulsive behaviour, such as excessive spending or dangerous actions, losing the ability to properly assess their consequences.

True impulse control disorders are frequent (gambling addiction, compulsive shopping, etc.).

The dysphoric phase in bipolarism

In many cases, however, the (hypo)manic phase of bipolar disorder (bipolarism) is not characterised by an excess of euphoria and grandiosity.

Instead, a dysphoric mood is evident, characterised primarily by a constant sense of anger and injustice suffered.

This results in irritability and intolerance and often in expressed aggression, always without correctly assessing the consequences of one’s behaviour.

Bipolar disorders include Type I Bipolar Disorder, Type II Bipolar Disorder, Cyclothymic Disorder, and the so-called Not Otherwise Specified Bipolar Disorder, a diagnostic category that brings together all those individuals with insufficient symptoms to make the diagnosis of one of the above-mentioned disorders.

Bipolar disorder symptoms

Let’s look at the symptoms of bipolar disorder.

To make a definite diagnosis of mania, there must be a distinct period of abnormal and persistent elevation of mood, with characteristics of expansiveness or irritability.

The mood disturbance must be severe enough to impair study or work activities or social skills.

Manic symptoms

During a manic episode, several of the following symptoms of bipolar disorder are present:

Increased self-esteem or grandiosity
Reduced need for sleep
Increased verbal production with difficulty in restraining it
Fickleness in changing opinions (the patient does not realise that his thoughts change easily)
Easy distractibility (the patient may pay attention to insignificant details while ignoring important elements
Increased purposeful activity
Mental or physical agitation
Increased involvement in activities that may have dangerous consequences (e.g. spending a lot of money or engaging in sexual activities that are unusual for the person)

Depressive symptoms

A period of at least two weeks with loss of interest or pleasure in all or most activities is required for the diagnosis of depression.

Bipolar depression must be severe enough to produce a change in appetite, body weight, sleep or ability to concentrate as well as feelings of guilt, inadequacy or hopelessness.

Thoughts of death or suicide may also be present.

During a depressive episode, several of the following symptoms of bipolar disorder are present

Constant depression of mood or despair
Severe reduction of interest or pleasure in all or most activities
Loss or increase in body weight or appetite
Increased or decreased sleep
Agitation or slowing down
Fatigue or loss of energy
Feelings of inadequacy, guilt and/or loss of self-esteem
Inability to concentrate and make decisions
Thoughts of death or suicide

Bipolarism, mood instability and other disorders

Sometimes a person suffering from bipolar depression (or bipolarism) may experience only episodes of mania or only episodes of depression alternating with periods of normal mood.

When only mania is present, the illness is still called bipolar disorder.

Conversely, if only depression is present, the illness is usually called major depression.

It should be borne in mind, however, that the mood instability typical of bipolarism can also be found in many personality disorders, especially in borderline disorder.

The differential diagnosis is therefore very delicate and it is not enough to find alternating mood phases to be certain that one is dealing with a genuine bipolar disorder.

We also recommend reading this article on the differences between bipolar disorder and borderline personality disorder.

Bipolar disorder, treatment

The treatment of bipolar disorder is mainly centred on pharmacotherapy, based on mood stabilising drugs and antidepressants (tricyclics or SSRIs), under careful and continuous medical supervision.

Among stabilisers, lithium is often used in the treatment of mania in the acute phase, but its main indication is for the prevention of both manic and depressive crises.

Valproic acid and carbamazepine are also used in the treatment of bipolar disorder in the acute phase of mania as well as in relapse prevention.

Antipsychotics or neuroleptics are used in the treatment of mania in the acute phase and less so in the maintenance phase.

Other drugs such as benzodiazepines are also used in the acute treatment of mania.

Antidepressants are used in the depressive phases to treat bipolar depression: it is always important to remember that antidepressants generally take 2 to 6 weeks to be effective. In some cases antidepressants can induce a turn from the depressive phase to the manic phase and this naturally requires special attention.

Unfortunately, for some patients it may take some time before they find the therapy effective.

Importance of psychotherapy in bipolar disorder

Scientific research has shown that, in order to achieve greater mood stability, it is necessary to combine pharmacological treatment (which remains essential) with psychotherapy, preferably of a cognitive-behavioural orientation.

The latter is then indispensable in the treatment of bipolarism if it is secondary to a personality disorder.

Psychotherapeutic protocols for bipolar disorder usually involve several points of intervention and action:

helping the person to follow the drug therapy; indeed, it has been shown that, if they are not followed, people tend to ‘forget’ to take the therapy. The person’s motivation to take the therapy must be maintained and increased;
help the person to recognise the initial symptoms of the two phases quickly, so that he or she knows how to behave and how to prevent the situation from precipitating;
learn how to discuss and modify irrational and dysfunctional thinking styles;
learn more effective strategies for dealing with everyday difficulties, such as managing one’s anger, or improving one’s communication skills;
working specifically on the depressive phase, in a manner typical of cognitive behavioural therapy.