Mood swings are perfectly normal throughout the day, weeks, months. Sometimes we are happy, sometimes sad, there are moments when we are calm and then something makes us anxious or angry. Or vice versa. This is natural and has nothing to do with the mood swings associated with bipolar disorder.

Bipolar disorder is a psychiatric illness characterized by very marked mood swings in which the patient alternates periods of clinical depression with periods of elevated mood and increased energy (mania or hypomania) so great that they become dysfunctional.

Mania, explains the psychiatrist and psychotherapist Cláudio Moraes Sarmento, is characterized by a high state of mind “with euphoria, lack of inhibition, lack of respect for social norms, risk behaviors —great lack of sexual inhibition and spending more money than usual, for example—, or talking excessively and uninterruptedly with speech generally in a high pitched and accelerated tone. There is also increased activity and excess energy: “People with this may not sleep for days and may not feel tired.”

Mania implies a great increase in self-esteem that, in the worst case, “can reach psychotic proportions, with delusions of grandiosity”, in which the person loses contact with reality. Other symptoms are “acceleration of mental activity, distractibility, difficulty distinguishing between relevant and irrelevant thoughts, and a generally heightened perception of stimuli (visual, olfactory, auditory)”.

The onset of a manic episode is usually sudden, with rapid progression over a few days. “Hospitalization is often necessary to protect yourself from certain risks, such as financial ruin, job loss, and assault.”

Hypomania is characterized by symptoms very similar to those of mania, but with less intensity. “Self-esteem, for example, can increase, but it does not reach a delusional dimension, thinking is more organized and, in general, it does not imply hospitalization.”

“There are subtypes I and II”, clarifies the psychiatrist Cláudio Moraes Sarmento. “In type I the patient has episodes of mania and major depression and in type II there is at least one hypomanic episode, one major depressive episode and no manic episodes.”

Depressive symptoms are more frequent than those of mania or hypomania, and there are also mixed episodes, in which mania, hypomania, or depression are accompanied by symptoms of the opposite pole, such as hypomania with symptoms of major depression, for example.

Crises can last days, weeks or months. The frequency, duration, and interval between them vary greatly, but proper medication and psychiatric and psychotherapy follow-up generally make them more spaced, less intense, and lasting. Once the crisis is controlled, the patient usually returns to his usual state, however, many times there are serious sequelae, since there may be behaviors that compromise family, professional and economic stability, with marital conflicts, professional defaults or excessive indebtedness. . In addition, psychotic episodes can have an impact on cognitive abilities in the long term.

It is not possible to predict the occurrence of crises. “And the only way to prevent them is to carry out a maintenance treatment, which can prevent or reduce their outbreak,” says Cláudio Moraes Sarmento. However, with patient and family information and education, it is possible to identify early warning symptoms for ongoing decompensation. “Over time, many patients learn to spot some relapse symptoms early, whether it’s depression or euphoria. [elevação] humor and go to the treating psychiatrist in a timely manner.”

Diagnosis is clinical, based on symptoms, and there is no specific test or analysis to detect bipolar disorder. Despite this, it is necessary to exclude other medical conditions, “for example, endocrine and neurological conditions that could cause symptoms of bipolarity.” For this reason, the initial evaluation of the doctor, in addition to the clinical and psychiatric history, the interview with the relatives and the assessment of the mental and physical state, also includes “laboratory tests, such as thyroid function, blood count and urine and, eventually, screening of taking drugs.”

The diagnostic process requires great care to distinguish the illness from others that can cause similar symptoms, “such as unipolar major depression, schizophrenia and borderline personality disorder.”

They are still unknown, although it is known that biological, psychological and social factors may be involved. “Changes can be found in the structure and functioning of the brain, but it is not clear if these changes precede the onset of the disease or are a consequence of it,” says Cláudio Moraes Sarmento.

The doctor explains that there are proven hereditary factors, knowing, for example, “that the risk of bipolar disorder in the general population is 1 to 3%, but having a first-degree relative with the disease is 5 to 10% and in a twin is 40-70%.”

In addition, and according to some studies, “life events such as abandonment and abuse in childhood may be associated with the onset of bipolar disorder and its greater severity.”

At first, the acute phase that occurs is treated, whether it is mania, hypomania or major depression. In some situations, the psychiatrist explains, hospitalization may be justified, especially in manic episodes, to protect the patient himself. “Then, you have to do the maintenance treatment, to delay or prevent a new episode, and the combined treatment of pharmacotherapy [medicação] and psychotherapy is the best option: psychotherapy is essential for maintenance and adherence to treatment.”

The medication used often includes mood stabilizers (such as lithium), which “reduce the risk of relapse by 30% and are especially effective in preventing manic relapse.” It may also include antidepressants, antipsychotics, and somatic treatments such as electroconvulsive therapy, which involves electrical stimulation of the brain, with the aim of eliciting a seizure for therapeutic purposes.

Bipolar disorder is considered a chronic disorder, so there is no talk of a cure. “Symptom severity varies from patient to patient and throughout the life cycle,” explains the doctor.

However, in many cases there is complete remission of symptoms, that is, there are patients who, with psychotherapy and adequate medication, remain without symptoms of the disease.