March 30, 2024

World Bipolar Day is commemorated each year on 30 March, the birthday of Vincent Van Gogh, who was diagnosed posthumously with bipolar.

This international initiative aims to raise awareness about bipolar disorder, fight stigma, and empower those living with the condition.

Let’s celebrate this year’s World Bipolar Day theme, #BipolarStrong, on March 30th!

Here are commonly asked questions about this condition!

What is bipolar disorder?
Bipolar disorder, previously known as manic depressive illness, is a mental disorder that is characterised by periods of depression and periods of abnormally elevated mood called mania.

How common is this disorder?
An estimated 4.4% of adults in western world experience bipolar disorder at some time in their lives. More than 2 million adults or 1 percent of the population age 18 or older in any given year have bipolar disorder. India has much lower, around 0.1%. But considering our population, even that becomes a very significant number.

How long are these episodes?
A typical manic phase lasts for approximately 4-6 months and depressive phase for 6-9 months.

What are the symptoms of mania?
The elevated phase is known as mania or hypomania, depending on its severity. During mania, an individual behaves or feels abnormally energetic, elated, or irritable. They are over confident, over groomed, over religious and over spend. Individuals often make poorly thought out decisions with little regard to the consequences. They may be hyper sexual and behave in a disinhibited manner. The need for sleep is usually reduced during manic phases. Patient wakes up much earlier than his usual time and over works himself to exhaustion. The symptoms of psychosis may be present. By psychosis it means that patient may believe he is special and has unusual powers known as delusion of grandeur. He may also report hearing voices praising him, singing or God talking to him.

What happens in depression?
Opposite happens during depression when they are gloomy for more than 2 weeks with sadness, lethargy, over-sleep and reduced interest in everything. They report extreme sadness and become slow and quiet. Patient becomes dejected and finds life hopeless. Patient may attempt suicide. This May last for approximately 6 months

Is there a risk of self-harm?
The risk of suicide among those with bipolar illness is high at greater than 6 percent over 20 years, while self-harm occurs in 30–40 percent of the patients. It is more in the depressive phase and under intoxication.

How is the course of the illness?
Patient may have the first episode in their third decade. The index episode may be depression or mania. There may be many years gap till the next episode. Subsequent episodes may happen more often and some patients have episodes every year, sometimes around the same time of the year. Over decades depressive episodes may become more prominent though initially manic episodes cause major disruptions.

Is bipolar illness familial?
Bipolar disorder runs in families. If one parent has bipolar disorder, there's an appropriately 10% chance that their child will develop the illness.

Are other comorbid psychiatric conditions also present with bipolar illness?
Other mental health issues such as anxiety including obsessive compulsive disorder are seen. Substance dependence is also a common comorbidity.

Case Study

Jennifer* had never felt depressed like this before in her 43 years of life. Why did her husband leave her? She would not be able to work, felt heavy and had become slow. She would find it difficult to have bath even. How should I die? She would think of Suicide often. Her sister reported that this must be her 10th episode with each lasting 3-4 months. In some episodes she would be an express train. She would wake up at 3 am and overwork. At that time she would talk non-stop and call relatives late in the night. She would go to neighbours house and talk about irrelevant things. She would scold her husband and in laws and all the wrong they have done to her. Then there would be episodes like this in which she would be totally opposite and behave meek and withdrawn. She had tried to take her life in the past during this phase. She would lie down most of the time and not talk. Her major problem was that she refused to take medication regularly especially during the high phase.

How is Bipolar Illness treated?
The aim of treating bipolar illness is to establish stability of mood. Mood stabilisers are the mainstay treatment. Lithium, sodium valproate, carbamazepine, oxcarbamazepine, topiramate, lamotrigene are the various options. Atypical antipsychotics such as quetiapine, olanzapine, risperidone, lurasidone are also prescribed. Antidepressants may be required for brief period during a severe depressive episode. ECT (Electro Convulsive Therapy) helps in violent and suicidal patients. It is a safe procedure.

Non- medication therapy are given side by side to ensure understanding of illness, drug compliance, regular sleep and consistent routine. Abstaining from alcohol improves outcome and helps to maintain remission.

Treatment is often required lifelong. Medication may sometimes be lowered in remission and have to be hiked during an acute episode. Comorbid drug abuse needs treatment.

Treatment helps. It improves quality of life. It reduces risk of suicide. It improves functionality and productivity.

Left untreated, patients eventually become dysfunctional, often suicidal in depressed phase and violent and disruptive in manic phase. They may lose their job, get divorced or separated from partner and meet with accidents due to rash driving.

Overall it is so much better to treat than not to. We may be helping the patient to remain a productive member of society.

Bipolar disorder is a form of severe mental illness which has an episodic life long course. Treatment consists of mood stabilisers which are required lifelong. Drug compliance reduces relapse and improves functioning and quality of life.

On this World Bipolar Day on March 30, I am doing my bit to spread awareness about this illness which is episodic, familial, lifelong and requires long term treatment.