Written by Dr. Ioannis G. Malliaris

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"A soul that sways like a ship, sometimes sinking into stormy waves, and other times rising defiantly and boldly above the surface."
— A. Plevris, 2008

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1. A Few Words About Bipolar Disorder

Bipolar disorder (or manic-depressive illness) is one of the most severe mood disorders. It is characterized by episodes (phases) of mania and depression, often accompanied by psychotic symptoms.

While the prevalence of the disorder in the general population is relatively low (1% or 1 in 100 people), milder forms of the illness (such as cyclothymia) are believed to have a much higher frequency (about 5%).

The causes of bipolar disorder remain unknown, but most evidence points to a significant genetic component (it runs in families). However, the course of the illness is strongly influenced by psychosocial factors. The illness is marked by recurring episodes with periods of recovery (though not necessarily full remission). Clinically, even when a person is not in an episode, depression remains the dominant symptom, with significant mood fluctuations over time.

Although there is no known cure for bipolar disorder, mood stabilizers and anticonvulsants (medications used to stabilize mood) provide the best outcomes. These medications are often combined with modern psychotherapeutic methods that are educational and behaviorally oriented. With the right treatment and long-term support, people with bipolar disorder can have a good quality of life and function well in professional and social settings (bipolar disorder has, in fact, contributed significantly to artistic, political, and scientific achievements).

2. A Few Words About Diagnosing Bipolar Disorder

Bipolar disorder is diagnosed by a qualified psychiatrist or clinical psychologist. Like most mental illnesses, there are no laboratory or biological tests to make a definitive diagnosis. Diagnosis relies on reviewing the patient’s history (or current condition) and examining their symptoms on three levels:

1. Emotion (what the patient reports feeling).
2. Thoughts (what and how they think).
3. Behavior (what they do and how they act).

Although diagnosing bipolar disorder is relatively straightforward (compared to other mental illnesses), it still requires care and expertise. It’s essential to examine the patient and their behavior over time, rather than basing the diagnosis on a single observation during a difficult period.

Quick diagnostic practices can easily lead to misdiagnosis, such as schizophrenia (when psychotic symptoms are present) or depression (when only depressive symptoms are seen without considering past episodes of mania or hypomania).

However, the presence of even one manic episode (not due to substance use or another medical condition) is sufficient for diagnosing the disorder.

3. Symptoms of Episodes

1. Manic/Hypomanic Episode (According to DSM-IV)
Lasting at least one week (or requiring hospitalization), the following symptoms are present:

• Elevated (or irritable) mood.
• Inflated self-esteem or grandiosity.
• Reduced need for sleep.
• Excessive talking or pressure to speak.
• Racing thoughts or difficulty concentrating.
• Increased energy/activity or sociability.
• Increased involvement in risky or excessive activities (e.g., spending sprees, sexual indiscretions) with a lack of self-control.
• Impaired functioning in work, social, or family settings.

(Hypomanic episodes can last a shorter period—about four days—and feature the same symptoms, though in a milder form).

2. Depressive Episode (According to DSM-IV)
Lasting at least two weeks with the following symptoms:

• Low, depressed mood or feelings of sadness.
• Loss of interest or anhedonia (reduced pleasure in activities).
• Appetite or weight changes (decrease or increase).
• Sleep disturbances (insomnia or excessive sleep).
• Psychomotor agitation or retardation (increased or decreased activity).
• Fatigue or loss of energy.
• Difficulty concentrating.
• Feelings of guilt or low self-esteem.
• Thoughts or attempts of suicide.

Both manic and depressive symptoms should not be caused by substance use or another medical condition.

4. Types of Bipolar Disorder

There are two main diagnostic types of bipolar disorder: Bipolar I and Bipolar II.

1. Bipolar I Disorder (Bipolar I)
This is the more classic and well-known type, characterized by the presence of at least one manic episode. The patient may also experience depressive and hypomanic episodes, as well as psychotic symptoms.

2. Bipolar II Disorder (Bipolar II)
This is the lesser-known type, often mistakenly considered milder. It is marked by at least one hypomanic episode (a milder form of mania that does not require hospitalization) and predominantly depressive episodes. These patients are often misdiagnosed with unipolar depression (major depression).

5. Treatment for Bipolar Disorder

The primary treatment for bipolar disorder is medication, particularly during acute phases of mania, depression, or psychosis. Medication remains the first line of treatment.

However, the majority of patients continue to experience high rates of relapse, even when taking medication. The limitations of pharmacotherapy to maintain long-term stability, along with high rates of non-adherence to medication, have led to the development of specialized psychological therapies that work alongside medications.

The most effective treatment approach combines medication with structured cognitive-behavioral therapy (CBT). Family therapy is equally important, as it focuses on the specific issues related to bipolar disorder. These therapies teach patients and their families the skills necessary to manage the disorder effectively and prevent future episodes.

For patients who have suffered significant declines in functioning, intensive day programs are recommended, providing comprehensive, multidisciplinary care from teams of mental health professionals.

Despite being considered a serious mental illness, bipolar disorder is no longer seen as a chronic, untreatable condition thanks to the development of specialized therapies. Timely, systematic treatment interventions now enable patients to live normal, productive, and creative lives.

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For more information, visit ManioKatathlipsi.gr, where you can read specialized articles and watch an introductory online seminar about bipolar disorder.

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Dr. Yanni Malliaris, BSc., PhD.
Doctor of Clinical Psychology, University of London
Institute of Psychiatry, King’s College London

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