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Bipolar Disorder: Multiple Mood Episodes, but where is the Solution?

Written by
Dr. Alok Vinod Kulkarni
and medically reviewed by iCliniq medical review team.

Published on May 04, 2015 and last reviewed on Sep 07, 2018   -  3 min read



Bipolar Disorder is characterized by bouts of depression and spells of intense happiness. This article focuses on the clinical features of this disorder and the available treatment options.

Bipolar Disorder: Multiple Mood Episodes, but where is the Solution?

Bipolar disorder was previously called Manic-Depressive Psychosis, or MDP. There has been a paradigm shift in the understanding of this complex brain disorder.

Inheritance and Perpetuation of Manic episodes

Those afflicted with this disorder are prone to a lot many mood changes, sometimes on a day to day basis. This disorder runs in families and research has identified many loci for its inheritance.

The various facets of this disorder include hypomania, mania and depression. Each of these phases can be debilitating. Majority of those suffering from bipolar disorder spend their time being depressed, rather than in mania or hypomania.

  • The maximum duration that a depressive spell or an episode can last is for 9 to 12 months, while a manic episode will remit within 3 to 6 months. However, this is not the rule in every case, but the maximum time period that a mood episode can last. Following this, there will be spontaneous remission, what is called ''the natural course'' of the disorder.
  • Spontaneous remission of the mood episode (depression/mania/hypomania) is not seen in all cases, and there are quite a few number of chronic mania patients as well.
  • Rather than severity or duration of manic symptoms, factors associated with chronicity in mania are the presence of psychotic symptoms and issues related to social and occupational functioning.

Diagnosis of Bipolar Disorder

  • Bipolar disorder is diagnosed using criteria, either from the Diagnostic and Statistical Manual-5 (DSM-5) or the International Classification of Diseases (ICD-10). More often than not, it is common for clinicians to miss a previous mood episode which altogether changes the diagnosis.
  • Bipolar disorder is a clinical diagnosis and there is no investigation which will effectively point to the diagnosis as of now.
  • Research is going on to find reliable bio-markers, as in the case of cancer, for the diagnosis of bipolar disorder.

Behavioral Disturbances

Mood episodes are intense and people are prone to have behavioral disturbances during such episodes. It is imperative to seek professional help from a psychiatrist.

If left untreated, there will be serious socioeconomic implications with resultant loss of functioning capacity, quality of life, pay and absence from work.

Symptoms of People with a Manic Episode

  • They may feel very ''up'' or ''high'', feel ''jumpy'' or ''wired''.
  • They talk really fast with difficulty in interrupting them.
  • They will be agitated and restless.
  • They are unable to sit at one place, indulge in high-risk behaviors like having reckless and unprotected sex, or spend a lot of money.
  • Their sleep goes for a toss, and they will be found to be pacing in their homes, right through the night. Even with such less sleep, they will feel refreshed, and display high energy levels.

Symptoms of People Having a Depressive Spell

On the other hand, those having a depressive spell will experience symptoms that are poles apart from that of a manic episode.

  • Depressed individuals will feel ''down'', worry a lot, cannot concentrate on things at hand.
  • They keep forgetting a lot of stuff.
  • They become disinterested in day to day living.
  • They experience difficulty in falling asleep.
  • They keep getting thoughts about death and suicide.
  • Coupled with this, they also experience a lot of fatigue, and become less active.

How is Bipolar Disorder Treated?

A host of options exist for the treatment of bipolar disorder. The current philosophy of treating bipolar disorder lies in symptom control and prophylaxis.

Risk for recurrent episodes exists through out one's life, and one school of thought says that prophylaxis should be for a lifetime. Again, there are differing schools of thought, as there is no one-size-fits-all treatment.


These are referred to as mood stabilizers. Those with euphoric (intense sense of happiness) mania are treated with Lithium, and those with dysphoric or irritable mania are treated with Valproate.

Those who have a preponderance for repeated depressive spells in their course of this disorder, are treated with Olanzapine-Fluoxetine combination, Quetiapine or Lamotrigine. All atypical anti-psychotics serve as anti-manic agents.


''Talk'' therapy can help clients to change their behavior and manage their lives. Therapy should also include family members, and they should be educated about the illness, its natural course, prognosis and treatment options.

A specialized form of therapy, called Interpersonal and Social Rhythm Therapy (IPSRT), exists for clients with bipolar disorder. All psychiatrists undergo training to administer this form of therapy.

To bring a marked difference to the quality of life of the patients, it is vital to seek help from a psychiatrist online --> https://www.icliniq.com/ask-a-doctor-online/psychiatrist


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Last reviewed at:
07 Sep 2018  -  3 min read


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