What is bipolar disorder?

Le bipolar disorder is a serious mood disorder characterized by alternating phases of “high mood”, with increased energy and hyperactivity, and phases of low mood (depressive state).

These “manic-depressive” episodes are interspersed with periods during which the mood is normal and stable, for varying durations.¹.

During “manic” episodes, the person is irritable, hyperactive, feels little need to sleep, talks a lot, and often presents an exaggerated self-esteem, even a feeling of omnipotence. Conversely, during depressive episodes, his energy level is abnormally low, his mood is gloomy, sad, with a loss of interest in various activities and projects. 

It is one of the most frequent psychiatric illnesses, affecting 1 to 2,5% of the population. The disease usually appears in young adults (under 25) and becomes recurrent. The first episode is followed by other episodes of mood disorders in 90% of cases.

It is a disorder which causes many social, professional and emotional disabilities and which can frequently lead to suicide attempts. It has been recognized by the World Health Organization (WHO) as the seventh leading cause of disability per year of life among 15 to 44 year olds, among all diseases.

Evolution of bipolar disorders

Bipolar disorders are characterized by a succession of episodes and frequent relapses, even under treatment.

The risk of suicide remains the main fear associated with this disease. Moreover, for biological reasons which are still poorly understood, bipolar disorders are frequently associated with an increased cardiovascular risk, with metabolic and hormonal diseases.

Studies show that, for all these reasons, the life expectancy of patients with bipolar disorder is on average 10 to 11 years less than the life expectancy of the rest of the population.².

What are the symptoms of bipolar disorder? 

This disease, formerly called manic-depressive illness or manic depression, comes in many forms. Thus, bipolar disorder may or may not be accompanied by psychotic symptoms (such as hallucinations, delusions). They can be, according to the HAS3 :

• hypomanic (similar symptoms but less intense than during a so-called “manic” episode);
• maniacs without psychotic symptoms;
• maniacs with psychotic symptoms;
• mild or moderate depression;
• severely depressed without psychotic symptoms;
• severely depressed with psychotic symptoms
• mixed (mania and depression combined) without psychotic symptoms;
• mixed with psychotic symptoms.

The most recent version of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-V, published in 2014, proposes to categorize the different types of bipolar disorder as follows:

• type I bipolar disorder, characterized by the presence of at least one manic or mixed episode.
• bipolar disorder type II, characterized by the occurrence of one or more major depressive episodes and at least one episode of hypomania.
• bipolar disorder not specified.

While the course of the disease is characteristic enough, individual symptoms vary from person to person. In some, the symptoms of depression will take precedence over everything else, while in others restlessness, excess energy or even aggression will dominate.

The manic phase is characterized by an expansive mood, increased self-esteem, ideas of grandeur.

Usually, the person in the manic phase feels the need to talk constantly, to present his countless ideas, is full of energy and carries out several projects or activities at the same time. Her need for sleep is reduced (she feels rested after 3 or 4 hours of sleep) and she is easily irritated. This period lasts at least a week, is present throughout the day almost every day.

Hypomania is manifested by the same type of symptoms, with persistent high energy but more “normal”.

During phases of depression, there is a decrease in interest or pleasure in almost all daily activities, psychomotor slowing down (or, sometimes, restlessness), severe fatigue, and possibly guilt or excessive devaluation, decreased ability to concentrate. Thoughts of suicide can occur. According to some studies, the percentage of suicide attempts varies between 20 and 50% (HAS June 2014).

These symptoms are not necessarily all present, but the diagnostic criteria are based on the presence of a significant combination of several of them. In almost three quarters of people with bipolar disorder, there are other disorders such as anxiety, dependence on alcohol or other substances, etc.1.

Who can be affected by bipolar disorder?

The causes of bipolar disorder are still unknown. They are probably multifactorial, involving genetic and environmental factors.

From a biological point of view, it is known that there are abnormalities in the neurotransmitters in the brains of affected people. Thus, episodes of mania are associated with an abnormally high level of norepinephrine.

Genetic factors are also implicated: the risk of suffering from bipolar disorder is greater when someone in the family already has it4.

Finally, external elements can promote or trigger the disease. This is the case with traumatic events that occur early in life, as well as many other stressors or factors of change (seasons, pregnancies, hormonal fluctuations)5.