Understanding bipolar disorder
Bipolar disorder is characterised by episodes of mania (or hypomania) and depression. During manic episodes, individuals may experience elevated mood, increased energy, reduced need for sleep, rapid thinking, impulsivity, and risky behaviour. Depressive episodes mirror major depression with low mood, fatigue, and loss of interest. Bipolar I involves full manic episodes (lasting at least 7 days or requiring hospitalisation); bipolar II involves hypomanic episodes alternating with depression.
Accurate diagnosis is critical because the wrong treatment (e.g., antidepressants alone without mood stabilisation) can worsen cycling. Bipolar disorder is often misdiagnosed as unipolar depression because depressive episodes are typically more frequent and distressing than manic episodes. A thorough psychiatric evaluation including detailed mood history is essential.
- Bipolar I: full manic episodes lasting 7+ days or requiring hospitalisation
- Bipolar II: hypomania alternating with major depression
- Episodes affect mood, energy, sleep, thinking, and behaviour
- Accurate diagnosis requires detailed mood history
- Wrong treatment can worsen cycling
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Treatment and management
Long-term mood stabilisation is the cornerstone of bipolar treatment. Mood stabilisers (such as lithium or valproate) and atypical antipsychotics are used to prevent episode recurrence. Acute mania and acute depression are treated with specific medication combinations. Psychoeducation — understanding the condition, recognising early warning signs, maintaining regular sleep, and adhering to medication — is equally important.
Dr. Shrestha provides longitudinal management, monitoring medication effectiveness, side effects, and mood stability over time. CBT adapted for bipolar disorder helps with adherence, identifying triggers, and developing coping strategies for both manic and depressive episodes. Regular follow-up appointments ensure that the treatment plan remains appropriate as your condition evolves.
| Phase | Treatment focus | Key interventions |
|---|---|---|
| Acute mania | Reduce mania severity | Mood stabiliser/antipsychotic, sleep hygiene, reduce stimulation |
| Acute depression | Treat depressive episode | Mood stabiliser ± adjunct, CBT, safety planning |
| Maintenance | Prevent relapse | Ongoing mood stabiliser, psychoeducation, regular monitoring |
Living well with bipolar disorder
Consistency is key: regular sleep schedules, medication adherence, stress management, and avoiding alcohol or substance use all help maintain stability. Keeping a mood diary can help identify early warning signs of an approaching episode — such as reduced sleep needs (sign of mania) or persistent low mood and withdrawal (sign of depression).
Family involvement is valuable. Educating family members about bipolar disorder helps them recognise early signs, support medication adherence, and respond appropriately during episodes. Dr. Shrestha encourages family participation in treatment planning where appropriate.
- Maintain regular sleep—wake cycles
- Take medication as prescribed, even when feeling well
- Avoid alcohol and recreational substances
- Keep a mood diary to track patterns and warning signs
- Involve trusted family members in education and support