When the Mind Swings: Understanding Bipolar Disorder in the Indian Context

Imagine this: a loved one- a parent, your partner, a good friend, has everything going their way for a month. They're full of energy, barely sleeping, making big plans, spending money recklessly, and talking fast. Everyone around them says, "Finally, they seem to be doing well."

Then they crash. They don't want to get out of bed. They stop eating. They say things like "What's the point?" or "I'm a burden to everyone." Their family lost, tired, scared, and torn between "it's just a phase" and "something serious is happening here."

That's how lives of individuals with bipolar disorder and their families might look like.

Bipolar disorder is not a personality flaw. It is not "just moodiness" or "being overly emotional." It's a medical condition of the brain, serious, but treatable, and fully explained by science. This blog aims to help educate people about this illness through individual conversations.

What is Bipolar Disorder?

Bipolar Disorder is a form of mood disorder characterised by significant changes in mood and energy level. These fluctuations can be so severe as to make it difficult for an individual to function in their day-to-day life. There will always be some degree of fluctuation from one mood to another in every individual but those experiencing bipolar disorder will have much greater mood swings than we consider typical emotional highs and lows.

When referring to bipolar disorder, the term bipolar indicates the two extremes of mood that exist when an individual experiences this illness - mania (or hypomania), at one end; depression, at the other. An individual experiencing bipolar disorder will move back and forth between mania and depression (and/or periods of normal mood) depending upon whether or not there are breaks between episodes of mania or depression.

Types of Bipolar Disorders 

Identifying these types can be helpful in identifying the condition sooner: 

Bipolar I Disorder includes having at least one full manic episode - an abnormal, elevated, expansive or irritable state that lasts at least seven days (might require hospitalisation), while depressive episodes occur frequently, though are not required for diagnosing.
This is the more extreme version.

Bipolar II Disorder has depressive episodes and episodes of hypomania, a milder state than mania and does not cause the same degree of functional impairment. Many people who have Bipolar II are diagnosed incorrectly as simply being depressed, since they appear to be during the down cycle and may not recognise when they are experiencing hypomanic episodes as problematic.

Cyclothymic Disorder, also known as Cyclothymia, is the mildest, longest version of the disease and represents those who experience a long time (at least two years) with numerous periods of hypomanic and depressive states that are not severe enough to qualify for either of these states. 
It is often dismissed as "that's just the way this person is". 

These are things you should watch out for: 

Signs of a Manic Episode 

• An unusual elevation or irritability that is ‘unusual for you’

• Reduction in the need for sleep (you may only sleep 2 - 3 hours and still feel well-rested) 

• Rapid racing thoughts and rapid pressured speech - speaking quickly and shifting from idea to idea quickly 

• Excessive self-esteem or unrealistic belief in your own ability (also known as, Grandiosity)  

• Impulsive behaviour like making unwise, dangerous and financially irresponsible choices. 

• Distractibility or difficulty focusing on anything. 

• Aggression, paranoia or even psychotic behaviours such as hearing voices (in very rare situations) 
  

Signs of a Depressive Episode 

• Feeling sad, empty or hopeless nearly all of the time 

• Loss of interest in things you used to enjoy 

• Low energy and feeling tired a lot 

• Changes in eating habits (eating too little or too much) 

• Problems with sleep (either too much or too little) 

• Slowed thinking, poor concentration or decision-making skills 

• Feelings of worthlessness or excessive guilt 

• Severe cases: Thoughts of death or suicide

Common Misunderstandings Regarding Bipolar Disorder

“Bipolar disorder is characterised solely by extremes of mood."
That isn't true. Everyone experiences mood swings at some point. A bipolar episode, typically spanning days to weeks, represents an abnormal deviation from one's typical behaviour patterns and is disruptive to the individual's function.

“Individuals with bipolar disorder are dangerous and unpredictable."
This misconception is damaging. Only a small number of individuals diagnosed with bipolar disorder are aggressive. They are simply coworkers, students, spouses, children, friends, teachers, bosses - people who live with a condition that may be managed successfully through treatment.

“Childhood trauma or difficult parenting style causes bipolar disorder."
The primary causal factors of bipolar disorder are genetic and neurobiological in origin. Although stressors may serve as triggers for episodes of mania, hypomania or depression, they do not cause the illness. Identifying the "problem" as either the family or the individual is both inaccurate and unproductive.

“When once you take medication, you will be permanently dependent upon it."
This perception of dependency is also misleading. Bipolar disorder is a long-term condition like diabetes or hypertension. Medication used to treat bipolar disorder does stabilise moods and prevent episodic occurrences. Abrupt discontinuation of medications intended to manage bipolar disorder poses significant risk for relapse.

“You can never treat bipolar disorder."
There is no truth to this statement. The appropriate management of bipolar disorder includes a combination of psychopharmacology and psychotherapy and most people with the diagnosis lead very fulfilling and successful lives.

When Should You Seek Help?

As soon as you or somebody you love shows signs of what was talked about earlier, don’t delay. If:

• Episodes of an unusual high mood, little need for restful sleep, and impulsive behaviour, even though it appeared okay or even great at the time of occurrence.

• Episodes of depression keep happening, regardless of how many times you try changing your lifestyle.

• Mood episodes are interfering with your job, your relationships, or daily living.

• You or someone you know thinks about harming yourself or dying by suicide

• One of your relatives has been diagnosed with bipolar (there’s a strong genetic link).

Early identification of this problem can greatly improve one’s long-term outcome. The sooner one finds out whether they have a specific type of mental health issue; the sooner they will be able to start working toward a solution.

Treatment: What does Recovery look like?

Treatment of bipolar disorder is usually a combination of different treatments that meet the needs of each patient.

Medications typically form the basis of a treatment program. Medications called mood stabilisers (such as Lithium, Valproate, Lamotrigine) can stop episodes from occurring again. Antipsychotic medications (atypical ones) or other antidepressant medications may be used in addition to mood stabiliser medications. It could take several attempts before finding the right combination of medicines; and developing this combination will require ongoing communication with your psychiatrist.

Psychotherapy is also very helpful alongside medication. Cognitive Behavioural Therapy (CBT) can help you learn to recognise thought patterns that trigger episodes. Interpersonal & Social Rhythm Therapy (IPSRT) can help stabilise your day-to-day routines - especially in managing bipolar disorder. Family-Focused Therapy can help educate and support your whole household in learning to deal with and understand the effects of bipolar disorder.

For both patients and their families, psychoeducation is one of the strongest tools we currently have. Education on the potential triggers and signs of an episode will give patients more control over their lives.

Hospitalisation for bipolar disorder occurs when episodes become so intense that a patient cannot safely manage themselves. This includes when patients become unsafe to themselves or others, when patients are unable to provide for their own basic needs, or when patients’ conditions worsen while taking medication and require around-the-clock psychiatric observation. Hospitalised patients receive 24 hour-a-day psychiatric care, a strict daily routine, and a safe place to recover until their conditions can be managed by an outpatient team.

The use of healthy practices that promote stabilisation of moods, including maintaining a consistent sleep cycle, limiting consumption of alcoholic beverages, minimising stress, and maintaining contact with friends and family - all through the structure of a treatment plan.

Life With Bipolar Disorder: Recovery Is Possible

A very important point needs to be said here as well. A diagnosis of bipolar disorder does not represent an inevitable lifelong sentence of suffering. Many people diagnosed with this illness lead active, healthy, fulfilling and productive lives through appropriate management and support.

Recovery from bipolar disorder can often look like a roller coaster ride of ups and downs. Relapse can occur. Medication side effects and changes may need to be adjusted. Difficult conversations about how to manage symptoms will arise. However, if you surround yourself with a solid, supportive medical and mental health care team; if you have access to accurate information regarding your options for managing your symptoms; and if you build a solid social support system, then achieving long term stability is possible and much more common than many people realise due to the lack of open discussion surrounding mental illnesses in our society.

The reason many Indian families do not take advantage of the available help systems (and therefore suffer) is not because there aren't resources available to them. It is simply because they don't talk openly about their struggles. We hope that by writing this article, we have helped make the first steps toward creating those open discussions a little bit less difficult.

Frequently Asked Questions (FAQs)

Question: Does Bipolar Disorder occur in adults as well as young people?
While Bipolar Disorder most commonly begins in late adolescence/early adulthood (ages 15-25), it can begin at any time. The high rate of misdiagnosis is largely due to clinicians attributing the symptoms to stress, hormonal changes, etc. 

Question: Is Bipolar Disorder inherited? Will my children also develop it if I do?
While there is a genetic role to developing bipolar disorder, it is not a guaranteed outcome. Individuals with biological parent having bipolar disorder are at a higher risk than the general population. Many family members of individuals diagnosed with bipolar disorder will never develop the condition themselves and, conversely, some individuals diagnosed with bipolar disorder report having no known family history. 

Question: How is Borderline Personality Disorder different from Bipolar Disorder?
Borderline Personality Disorder and Bipolar Disorder share some similar characteristics such as mood instability and impulsivity, so it is easy to confuse the two disorders. However, in individuals diagnosed with bipolar disorder, mood episodes tend to be discrete, prolonged and episodic. In contrast, emotional dysregulation in individuals with Borderline Personality Disorder tends to be more reactive, shorter duration and tied to interpersonal events. A comprehensive psychiatric evaluation by a psychiatrist is necessary to accurately diagnose either disorder. While both disorders can be effectively treated, each treatment approach differs. 

Question: Once an individual feels "stable", can they simply stop taking their medications?
This is perhaps one of the most Important Questions and one of the Most Common Reasons for Relapses in individuals with bipolar disorder. It is quite common for individuals with Bipolar Disorder to feel "stable" while on medication. The feeling of stability is often directly related to the fact that the medications being taken are effective. Abrupt cessation of medications or discontinuation thereof without proper medical supervision greatly increases the likelihood of another episode occurring. All decisions regarding medications should be done in conjunction with a psychiatrist. 

Question: Under what circumstances would Bipolar Disorder require inpatient treatment?

Inpatient psychiatric care is required for those who are at risk for their own safety or others, for individuals who cannot provide for themselves in the way they need to, when less intensive treatments have failed to stabilize a person's condition, or if they require an extensive and closely monitored assessment of their medications. Many people find their first opportunity to become stabilized within the structure provided by the inpatient unit.

If you are experiencing symptoms that could be associated with bipolar disorder or if a loved one is displaying these signs, you need to know that there is hope and that there is assistance available. At Adayu, located in Sector 38, we offer every kind of mental health support including consultations, in-patient stabilization as well as ongoing outpatient services. Please reach us at Adayu to discuss which type of service will work best for you. You don't have to go through this process by yourself.

📍 Adayu — Psychiatric Hospital; Sector 38; Gurugram

This article is intended for educational purposes only. It should never be used in place of a clinical evaluation or treatment provided by a licensed psychiatrist.