Bipolar Disorder: Myths and Facts About the Illness, Its Treatment and Living With It

What Bipolar Disorder Really Is

In ICD-10, bipolar affective disorder is coded F31. Its essence is recurring episodes of disturbed mood and activity: elevation (mania or hypomania) and depression, and sometimes mixed states, when features of both poles are present at the same time. Between episodes, many people experience remission, a period when mood and functioning return to normal.

According to DSM-5 criteria, mania is a period of abnormally elevated, expansive or irritable mood and increased energy that lasts at least a week or requires hospitalization. The person sleeps little without feeling tired, talks a lot, makes grandiose plans, spends money and takes risks. Hypomania is a milder form that lasts at least four days and does not cause serious impairment in functioning. Depressive episodes in bipolar disorder resemble ordinary depression but require a different approach to treatment.

Types of bipolar disorder

In bipolar I disorder, there is at least one manic episode. In bipolar II, there are hypomanic episodes and major depressive episodes, but no full-blown mania. Cyclothymia is a milder, chronic fluctuation of mood that does not reach the level of full episodes but persists for years.

Myth 1: Bipolar Disorder Means Your Mood Swings a Lot

This is the most widespread myth. In everyday speech, the word "bipolar" is often applied to anyone with a changeable mood. But bipolar disorder involves prolonged episodes: mania lasts a week or longer, hypomania at least four days, and depression at least two weeks. Mood changes together with sleep, energy, speed of thinking and behavior.

Frequent, sudden changes in emotion throughout the day that are linked to events and relationships are more typical of other conditions, such as emotionally unstable (borderline) personality disorder, anxiety disorders or stress reactions. Sometimes a person has both, which is why the diagnosis should be made by a psychiatrist after a thorough assessment, not by an online test.

Myth 2: Mania Is Just a Really Good Mood

From the outside, hypomania can look like a surge of energy and inspiration, and many people do not see it as a problem. But mania is a state in which the ability to judge the consequences of one's actions is impaired. In just a few days, a person may spend all their savings, take out loans, quit their job, enter into risky relationships or drive while in a dangerous state. Often, irritability and a tendency toward conflict predominate instead of euphoria.

A manic episode is often followed by depression, and the consequences of decisions made while elevated can take months to sort out. That is why recognizing hypomania and mania at an early stage is one of the most important tasks of treatment. Loved ones often notice the changes before the person does.

• A sharply reduced need for sleep without feeling tired
• Rapid speech that is hard to interrupt
• Racing thoughts and a flood of ideas and plans
• Inflated self-esteem and a sense of special abilities
• Impulsive spending and risky decisions
• Irritability and conflict when contradicted

Myth 3: People With Bipolar Disorder Are Dangerous

The overwhelming majority of people with bipolar disorder are no more dangerous than anyone else. The stereotype of "unpredictable and aggressive" patients is fueled by films and the news but does not reflect reality. Far more often, they are the victims: of stigma, of discrimination at work and of financial exploitation during mania.

The real and serious risk in bipolar disorder is the risk to the person themselves. During depressive and especially mixed episodes, the risk of suicidal thoughts and actions increases. That is why it is important not to leave a person alone during a severe phase, to know the danger signs and to have an action plan. This is not a reason to be afraid, but a reason for attentive support.

Myth 4: Treatment Turns a Person Into a "Zombie"

Treatment for bipolar disorder is based on mood stabilizers and, when indicated, certain antipsychotic medications and other drugs chosen by a psychiatrist. The aim of therapy is not to suppress the personality but to prevent new episodes and maintain stability. Side effects are possible, especially at the beginning, but in most cases they can be reduced by changing the dose or the drug.

It is important to understand that some people miss the feelings of hypomania and perceive stability as "dullness." This is a common reason for stopping treatment on one's own, which significantly increases the risk of relapse. If you feel that your treatment is getting in the way of your life, discuss it with your doctor: there is almost always a solution, but the regimen needs to be changed together with a specialist.

Why antidepressants are not prescribed on their own

In bipolar depression, antidepressants without a mood stabilizer can trigger a switch into mania or more frequent episodes. That is why the correct diagnosis is so important: a person with bipolar disorder who is treated as if they had ordinary depression may feel worse.

The role of psychoeducation and psychotherapy

In addition to medication, the guidelines of NICE and international societies include psychoeducation, cognitive behavioral therapy, family therapy and work on daily routines. The person learns to recognize the early signs of an episode, maintain stable sleep and a regular daily rhythm, and see a doctor in good time.

Myth 5: With Bipolar Disorder You Cannot Work or Have a Family

With stable treatment and regular follow-up, most people with bipolar disorder work, study, build careers, start families and raise children. The key factors are timely diagnosis, ongoing treatment, a stable sleep schedule, avoiding alcohol and drugs, and support from loved ones. Many creative and successful people live with this diagnosis.

Planning a pregnancy with bipolar disorder requires special attention: some medications need to be replaced in advance, and the postpartum period is a time of increased risk of episodes. This is not a prohibition but a reason to plan together with a psychiatrist and an obstetrician-gynecologist. A genetic predisposition exists, but having a parent with bipolar disorder does not mean a child will necessarily develop it.

How Bipolar Disorder Is Diagnosed and Treated

The diagnosis is made by a psychiatrist based on a detailed interview, the history of episodes, observations from loved ones and, if necessary, tests to rule out other causes, such as thyroid disease or the effects of psychoactive substances. Years often pass between the first episode and the correct diagnosis, because people seek help only when depressed and do not consider hypomania an illness. Keeping a mood diary helps reveal patterns.

Treatment is long-term and includes maintenance therapy even during periods of stable mood. At Psychiatry Online, an online psychiatrist can carry out an initial assessment, choose and adjust treatment, monitor your progress and spot the signs of a new episode in time. Acute mania, severe depression with a risk to life and psychotic symptoms require in-person care and sometimes hospitalization.

When to see a doctor

• Periods of low mood alternate with periods of unusual elevation with little sleep
• Antidepressants have made you agitated, sleepless or "too good" in mood
• Loved ones notice that you periodically become a different person: talkative and impulsive
• During elevated periods you made decisions you later regretted: spending, loans, quitting your job
• Blood relatives have had bipolar disorder, and you have had severe depression
• You are already in treatment but notice early signs of a new episode

Questions and answers

Reviewed by

Assel Omarova, MDPsychiatrist and addiction specialist

Addiction combined with depression and anxiety, crisis states, online consultations for families.