Bipolar disorder, also known as bipolar affective disorder or bipolar syndrome, previously known as manic depression, is a mood disorder in which sufferers fluctuate between ‘manic episodes’ characterised by excitement, euphoria, impulsivity and an unusual sense of well-being, and ‘depressive episodes’ characterised by profound low mood, despondency, sadness, fatigue and self-reproach, with a certain degree of cyclicality.

These mood swings may affect patients’ daily lives, work and interpersonal relationships.

The exact causes of bipolar disorder are not yet fully understood, but it is generally believed to be linked to genetic, environmental and lifestyle factors; prolonged excessive stress and childhood abuse may both trigger the condition.

Bipolar disorder is classified into three types: Bipolar I Disorder, Bipolar II Disorder and Cyclothymic Disorder.

Bipolar I disorder refers to a condition in which, during an episode, manic and depressive phases occur simultaneously or alternate rapidly within a short period, with the episode lasting for two weeks or more.

Bipolar II disorder is characterised by prolonged manic and depressive episodes, with manic episodes lasting more than one week and depressive episodes lasting more than two weeks, alternating with one another.

Cyclothymic disorder is characterised by long-term emotional instability, with the patient exhibiting numerous episodes of depression and hypomania during the course of the illness; however, the symptoms are not severe, and there are also periods of normal mood, with these cycles recurring.

During manic episodes, patients are classified as either manic or hypomanic depending on the severity of their symptoms. Patients with mania experience more severe symptoms during episodes, which cause significant disruption to their daily lives and interpersonal relationships, and usually require hospitalisation.

Whether experiencing mania or hypomania, patients will exhibit three or more of the following symptoms during an episode:

• Extremely elevated mood

• Abnormal talkativeness and rapid speech

• Reduced need for sleep

• Excessive energy

• Irritability

• Reckless and impulsive behaviour, such as compulsive shopping or reckless investments

• Increased nervousness or tension

• Feelings of abnormal happiness and self-confidence

• Inability to maintain concentration

• Rapid, disorganised thinking

• Hallucinations and delusions

During depressive episodes, patients commonly exhibit the following:

• Feeling depressed and lacking motivation in life

• Reluctance to speak

• Loss of interest in all or almost all activities

• Insomnia or excessive sleep

• Loss of self-worth

• Suicidal thoughts, and a possible tendency to act on them

• Feelings of helplessness and crying

• Significant changes in weight without dieting

• Slowed movements

Current common treatments for bipolar disorder include psychotherapy, medication, or a combination of both. The aim of treatment is to reduce or eliminate symptoms, help patients regain normal functioning in their daily lives and at work, prevent relapse, and improve their quality of life.

In terms of psychotherapy, cognitive behavioural therapy (CBT) is the most commonly used approach. It aims to alleviate the symptoms of bipolar disorder by helping patients identify and change negative thought and behaviour patterns. This form of therapy teaches patients how to cope with negative emotions such as anxiety, depression and self-blame, whilst also teaching them how to take proactive steps to change these emotions.

Treatment for bipolar disorder typically involves the following three approaches:

1. Expressive therapy: This approach encourages patients to describe their feelings and experiences through writing or art, thereby enhancing self-awareness and the ability to express emotions.

2. Social rhythm therapy: Social rhythm therapy is a specific treatment for patients with bipolar disorder; it helps them maintain a stable circadian rhythm and mental health by adjusting their sleep, diet and daily activity schedules.

3. Psychodynamic therapy: This approach explores the patient’s unconscious conflicts and the impact of past experiences on current issues, with the aim of increasing self-awareness and understanding.

It is important to note that the choice of psychotherapy must be tailored to the patient’s specific circumstances and condition; it may be combined with medication to achieve better treatment outcomes. 

Furthermore, throughout the treatment process, patients and their families should maintain a good collaborative relationship with the treating practitioner and actively cooperate with the doctor’s treatment plan and recommendations, as this is essential for the treatment to be as effective as possible.

If you have a friend who is living with manic depression or bipolar disorder, here are some ways you can help them:

• Offer support and understanding: Try to understand their condition and how they feel as much as possible, and let them know you are there for them; this can help alleviate their feelings of loneliness and anxiety.

• Encourage them to seek professional treatment: Manic depression is a mental health condition that cannot resolve itself and requires professional treatment. As a friend, you should encourage them to consult a psychologist or psychiatrist for treatment.

• Help them maintain a stable daily routine: People with bipolar disorder often have irregular circadian rhythms, so they need to maintain a regular daily routine and sleep schedule.

• Avoid letting them feel isolated: People with bipolar disorder often feel lonely and despondent. As a friend, you can stay in regular contact with them, keep them company by chatting, watching films, or taking part in enjoyable activities together.

• Avoid triggers: People with bipolar disorder are often emotionally sensitive, so it is important to avoid provocative topics or events that might trigger emotional fluctuations.

In summary, helping someone with bipolar disorder requires patience, understanding and support. If you have any questions about how to help your friend, you can seek advice from a professional psychologist.

What exactly is the difference between bipolar disorder and depression?

Both bipolar disorder and depression are common mood disorders, but they differ in the following ways:

• In terms of mood changes: People with depression experience a persistently low mood, feeling despondent, helpless and hopeless, whereas those with bipolar disorder experience extreme mood swings, sometimes exhibiting extreme excitement and excessive self-confidence, and at other times feeling despondent, hopeless and self-reproachful.

• In terms of symptoms: Symptoms in people with bipolar disorder typically involve emotional, cognitive and behavioural aspects, including excessive excitement, impulsivity, high energy levels, disregard for danger, rapid speech and reduced sleep. People with depression, on the other hand, often exhibit symptoms such as sadness, boredom, reduced willpower, loss of interest, difficulty concentrating, and disturbances in appetite and sleep.

• Treatment: Depression is usually treated with antidepressants and psychotherapy, whilst bipolar disorder is typically managed with mood stabilisers and other medications, alongside psychotherapy and behavioural therapy.