Bipolar Disorder

Bipolar disorder is a long-term condition in which mood, energy and activity swing between distinct episodes. There are periods of elevated or irritable mood with markedly increased energy and reduced need for sleep, and separate periods of sustained low mood and loss of drive. Between episodes many people are entirely well, and it is the episodic course that distinguishes the condition from depression alone.

It is one of the most strongly heritable conditions in medicine, and it usually declares itself between the late teens and the early thirties. Genetics set the vulnerability; what tends to trigger an individual episode is disrupted sleep, night shifts, long-haul travel, alcohol or stimulant use, some prescribed medicines, and the weeks after childbirth.

The elevated episodes are the harder part to recognise from inside, because energy, confidence and productivity feel like recovery instead of illness. Damage to finances, work and relationships is usually done during those weeks, and an account from someone close to you carries real weight in the assessment for that reason.

The diagnosis rests on the history of episodes over time, and it is often made years after the first one. Your psychiatrist is asking about past stretches of at least several days in which you slept far less without feeling tired, talked and moved faster, spent heavily, took risks you would not usually take, or felt unusually powerful or irritable.

An account from a spouse, parent or sibling is genuinely valuable here, because elevated episodes feel normal or good from the inside and are remembered as good weeks. Bring someone who has known you through them.

Your doctor will ask about family history, since it carries real weight, and about alcohol, cannabis and stimulants, which can both trigger episodes and imitate them. Thyroid function and basic blood tests are checked before starting long-term treatment, because some of the medicines used require kidney and thyroid monitoring afterwards. The distinction being drawn is between recurrent depression and a bipolar course, and getting it right changes what is prescribed.

An individual episode, treated, usually settles over four to twelve weeks. Severe episodes may need a period in hospital, most often one to three weeks, and that is arranged for safety while things are brought under control.

Time away from work during an episode is typically measured in weeks, with a phased return afterwards. Between episodes most people work, study and raise families without restriction.

The treatment itself is long-term and is continued while you are well. This is the part people most often stop, usually in the first good year, and it is the commonest reason an episode returns. Reviews are frequent at first and then every few months, with blood tests on a schedule for some medicines. Regular sleep and wake times, moderation with alcohol, and learning to recognise your own early warning signs do as much work as anything prescribed. Pregnancy plans should be discussed before conceiving, since treatment is adjusted in advance.