Understanding Bipolar Disorder: A Brief Overview

Welcome to our newsletter providing information about Bipolar Mood Disorder, a chronic mental health condition affecting millions worldwide. As we bring attention to this disorder, in recognition of World Bipolar Day on March 30, 2025 it’s crucial to understand its characteristics, the varying degrees of intensity across different types, and how to offer support to those affected.

What is bipolar disorder?

Bipolar Disorder is characterised by extreme mood swings that range from emotional highs (mania or hypomania) to deep lows (depression). These are not typical mood fluctuations but are intense, long-lasting, and can significantly disrupt daily life.

Understanding it from a neuropsychiatrist’s perspective, this is when the brain’s limbic system (which regulates emotions) and prefrontal cortex (responsible for decision-making) are often out of sync in individuals with bipolar disorder. Research suggests that an imbalance in neurotransmitters like dopamine, serotonin, and norepinephrine plays a key role in mood instability.

Bipolar Disorder in South Africa

• Global Prevalence – Affects 0.5%–1% of the world’s population (~40 million people).
• South Africa – Estimated to affect 3%–4% of the population (~1.8 to 2.4 million people).

Recognising Mood Episodes:

Manic or Hypomanic Episode (Highs)

• Elevated or irritable mood.
• Increased energy, restlessness, or racing thoughts.
• Reduced need for sleep.
• Rapid speech and impulsive decisions.
• Engagement in risky behaviours (e.g., overspending, reckless driving),
• Severe cases (mania only): Grandiose thinking, hallucinations, or delusions.

Manic episodes are associated with hyperactivity in the brain’s reward system. The prefrontal cortex (responsible for impulse control) is underactive, leading to poor decision-making. This explains why individuals may engage in reckless behaviours without considering the consequences.

Depressive Episode (Lows)

• Prolonged sadness or hopelessness.
• Fatigue or low energy levels.
• Changes in appetite and sleep patterns.
• Difficulty concentrating.
• Loss of interest in usual activities Suicidal thoughts (in severe cases, seek help immediately).

Depressive episodes involve reduced activity in the prefrontal cortex and heightened stress responses in the amygdala. Low levels of serotonin and dopamine contribute to feelings of sadness and a lack of motivation.

Types of Bipolar Disorder

• Bipolar I Disorder – Characterized by at least one severe manic episode, often requiring hospitalization. Depressive episodes typically follow.
• Bipolar II Disorder – Involves recurring depressive episodes and hypomanic episodes, which are less severe than full mania.
• Cyclothymic Disorder (Cyclothymia) – Chronic mood swings lasting at least two years, but symptoms are less severe than Bipolar I or II.

When Does Bipolar Disorder Start?

Bipolar disorder typically begins between ages 15 and 25, though it can develop earlier or later in life. Early diagnosis and treatment significantly improve long-term management.

Adolescence and early adulthood are critical periods for brain development. The frontal lobes, responsible for decision-making and impulse control, are still maturing, which may explain why bipolar symptoms often emerge in this age range.

What Causes Bipolar Disorder?

There is no single cause, but several factors contribute:

• Genetics – Family history increases risk.
• Brain Chemistry – Imbalances in neurotransmitters impact mood regulation.
• Life Events & Trauma – Stressful experiences can trigger episodes.
• Sleep Disruptions – Poor sleep patterns can increase mood instability.

Genetic studies show that bipolar disorder has a strong hereditary component, with multiple genes influencing brain function. However, environmental factors, such as chronic stress or substance use, can activate the condition in predisposed individuals.

How Is Bipolar Disorder Treated?

While bipolar disorder is a lifelong condition, it is highly manageable with the right approach:

• Medication – Mood stabilisers, antipsychotics, and sometimes antidepressants.
• Therapy – Cognitive Behavioural Therapy (CBT) and psychoeducation for coping strategies.
• Lifestyle Adjustments – Consistent sleep, nutrition, exercise, and stress management.
• Support Systems – Family, friends, and peer networks play a crucial role.

Medication alone is not enough. The brain needs structure and stability to regulate mood. A combination of medication, therapy, and routine-based lifestyle habits helps stabilise brain function.

How to Support Someone with Bipolar Disorder

• Psychological Support – Encourage therapy, monitor mood changes, and promote medication adherence.
• Emotional Support – Be patient, listen without judgment, and validate their experiences.
• Practical Support – Assist with daily routines, minimise stimulation during manic episodes.
• Lifestyle Support – Encourage balanced sleep, diet, and structured activities.
• Crisis Support – Recognise severe warning signs and know emergency contacts.

Support systems play a critical role in reducing relapse rates. Patients with strong family and social support networks tend to experience fewer hospitalisations and better long-term stability.

Understanding and breaking the stigma around bipolar disorder is essential. If you or someone you know experiences these symptoms, seeking professional help is the first step toward effective management.

Let’s continue the conversation, raise awareness, and support those navigating this condition.