The two extremes of bipolar disorders are:

- Manic or hypomanic episodes (feeling high). You might experience optimism, euphoria and feelings of grandeur; rapid, racing thoughts and hyperactivity; a decreased need for sleep; increased irritability; impulsiveness and possibly reckless behavior.

- Depressive episodes (feeling low). You might experience constant pessimism, withdrawal from socializing; loss of interest in previously enjoyed hobbies; constant irritability or sadness; feelings of inadequacy and self-loathing.

Some people alternate between extreme episodes of mania and depression, but most are depressed more often than they are manic. Mania may also be so mild that it goes unrecognized. People with bipolar disorder can also go for long stretches without symptoms.

Some people experience psychotic symptoms during manic or depressed episodes. Symptoms of psychosis are false thoughts (delusions) or seeing or hearing things that are not there (hallucinations). These symptoms can occur with manic or depression episodes.

What are the causes of bipolar disorder?

No one knows exactly what causes bipolar disorder. But research suggests the causes may lie in genetics or biology of the brain. Many researchers also believe social aspects may play a part in causing episodes, such as difficult life events or experiencing trauma as a child.

Stressful circumstances or situations can trigger symptoms of bipolar disorder in a patient, for example a loss of a loved one or abuse.

Bipolar disorder symptoms may also be triggered by physical illness, sleep disturbances and overwhelming problems in everyday life, such as problems with money, work or relationships.

Difference in brain size

Scientists have found that brain size could lead to bipolar disorder. Particularly, the size of the frontal cortex (which is associated with decision-making and controlling impulsive behavior) in people with bipolar disorder is smaller than those who don’t have bipolar disorder.

Difference in function

People with bipolar disorder don’t seem to use the front part of their brains when making decisions under time pressure. This area of the brain is the medial prefrontal cortex.

Brain chemistry

Many studies have shown that brain chemistry is connected to mental illness, although no one knows for sure exactly what the connection is. Evidence shows that bipolar symptoms can be linked to chemicals called noradrenaline and serotonin.

(Read also: A look at the bipolar life)

Who is at risk of bipolar disorder?

Bipolar disorder can happen to anyone at any age. Factors that may increase the risk of developing bipolar disorder or act as a trigger for the first episode include:

Childhood trauma

Children who experience sexual or physical abuse, neglect, trauma or losing someone very close have an increased risk of developing bipolar disorder as adults.

This could be because experiencing trauma and distress as a child can have a big effect on the ability to regulate emotions.

Stressful life events

Even long-term, low-level stress can trigger bipolar disorder. Certain stressful life events can trigger bipolar disorder, such as a failed relationship (romantic or platonic), financial struggle or poverty, a traumatic loss.

Self-esteem problems

People with low self-esteem may develop depression. Manic episodes can be an escape from depression or very low self-esteem. It is possible that mania can boost self-esteem and help you cope with depression.

What are common signs and symptoms of bipolar disorder?

Bipolar disorder can look very different in different people. The symptoms vary widely in pattern, severity and frequency. There are four main types of mood episodes in bipolar disorder: 

Mania: People experiencing a manic episode often talk a mile a minute, sleep very little and are hyperactive.

Hypomania: Hypomania is very much the same as manic, but less severe. You may have a greater sense of well-being and productivity. However, hypomania is one step away from mania and can turn into a serious condition.

Depression: Most people with bipolar depression are not helped by antidepressants.

Mixed episode: Mixed episode is a period of switching between depression and mania/hypomania. Most of the time, people with bipolar disorder have depression more than mania.

What are the complications?

Bipolar disorder can happen with other conditions or as a result of these conditions. They include anxiety disorders, post-traumatic stress disorder (PTSD), attention-deficit/hyperactivity disorder (ADHD), addiction or substance abuse and physical health problems, such as heart disease, thyroid problems or obesity.

How is bipolar disorder diagnosed?

Currently, diagnosis is based on symptoms, course of illness and family history. Bipolar involves mood changes over time. Your doctor might want to observe you for a while before making a diagnosis.

Bipolar disorder also has some symptoms that are common in other mental health problems (such as depression, borderline personality disorder, schizoaffective disorder and schizophrenia), so your doctor may want to take care to diagnose you correctly. Moreover, your doctor or psychiatrist might request a brain scan or other tests to rule out other conditions, for example a brain tumor.

What are the treatments for bipolar disorder?

Treatment for bipolar disorder is focused on treating symptoms of mania/hypomania and depression. Your doctor will show you how to manage bipolar disorder by learning and recognizing triggers and signs, and give you advice for a better quality of life.

Treating bipolar is a long process and is more focused on using therapy and self-care than medication. You will need a lot of support from your family, friends and the community.

Bipolar disorder is treated and managed in several ways:

- Psychotherapy, such as cognitive behavioral therapy and family-focused therapy.

- Electroconvulsive therapy (ECT).

- Self-management strategies and education.

- Medication, such as mood stabilizers, antipsychotic medications and antidepressants.

- Complementary health approaches such as meditation, faith and prayer.

Bipolar disorder can be a challenge to treat. It is important to see your doctor regularly to keep your symptoms under control. Let your doctor know if you have any concerns or if you feel your symptoms are getting worse. (kes)