“There are times when my mood suddenly soars and I can stay active without sleep.” “Then I crash into a depressive state where I can’t do anything.” “My family says I become like a completely different person.” — If you’re struggling with extreme mood swings like these, they may be signs of bipolar disorder.
Bipolar disorder is a different condition from depression, and it requires a different treatment approach. If you continue taking only antidepressants under the assumption that you have depression, improvement is unlikely — which is why an accurate diagnosis is so important.
Keldsen Family Clinic is a family-oriented clinic offering both Psychosomatic Medicine and Internal Medicine, a 1-minute walk from ‘Oizumi Yubinkyoku’ bus stop, accessible by Seibu Bus from Oizumi-Gakuen Station. We are open on weekends and holidays and also offer telemedicine. “Going to a clinic feels a little scary” — we’d love to help you take that first step.
About Mood Disorders
Mood disorders are a group of conditions in which mood fluctuations exceed a normal range and persist long enough to interfere with daily life. The two most well-known examples are depression and bipolar disorder.
Mood disorders are not a matter of willpower or personality — they involve imbalances in neurotransmitters that affect how the brain functions. Even though the depressive states may look similar, the choice of medication for depression and bipolar disorder is entirely different, making an accurate diagnosis the key to recovery.
The depressive phase of bipolar disorder, in particular, can be very difficult to distinguish from depression at first glance, and it is not uncommon for a correct diagnosis to take several years. Carefully reviewing past episodes of feeling “a little high” can be an important step toward an accurate diagnosis.
If treatment is continued with antidepressants alone, there is a risk of triggering a hypomanic or manic episode. For this reason, information from family members and daily life records — not just the patient’s own account — are valuable clues in determining the right treatment plan. Bipolar disorder is a condition where the goal of treatment is to “reduce the size of the waves” through long-term management.
What Is Bipolar Disorder?
Bipolar disorder is a condition characterized by alternating episodes of elevated mood (“manic state”) and depressed mood (“depressive state”). In Japan, the prevalence is reported to be approximately 0.4–0.7%, with onset most commonly occurring in people in their 20s and 30s.
There are two main types of bipolar disorder:
- Bipolar I: Involves severe manic episodes alternating with depressive episodes. During a manic episode, symptoms such as elevated mood, increased activity, and reduced need for sleep persist for a week or more.
- Bipolar II: Involves mild manic episodes (hypomania) alternating with depressive episodes. Hypomanic episodes last four days or more, and because the person often feels they are simply “in a good period,” it can be difficult to recognize as an illness.
Type II is especially likely to be mistaken for depression, often leading to delayed diagnosis. Observations from family and friends — such as “you seemed like a different person during that period” — can sometimes provide important diagnostic clues.
During a manic episode, the person’s judgment may be impaired, leading to excessive spending, interpersonal conflicts, and professional setbacks. This is why early treatment and continued treatment for relapse prevention are especially important for this condition.
It is known that genetic factors can play a role in the onset of bipolar disorder. If a family member has a mood disorder, it is worth being aware — not because it means you will necessarily develop the condition, but because early recognition allows for early intervention.
At Keldsen Family Clinic, we carefully assess each case based on the patient’s own account as well as information from family members.
Characteristics and Symptoms of Bipolar Disorder
The symptoms of bipolar disorder change significantly across three phases: manic state, depressive state, and the interval (euthymic period).
Specific Symptom Examples
Manic and Hypomanic Symptoms
- Abnormally elevated mood
- Ability to stay active with little or no sleep
- Talking continuously; rapid flow of ideas
- Inflated self-confidence and grandiose plans
- Impulsive spending, investments, or travel
- Increased irritability or aggressive behavior
- Interpersonal conflicts
Depressive Symptoms
- Persistent low mood throughout the day
- Loss of interest or pleasure in everything
- Insomnia or excessive sleeping
- Decreased appetite or overeating
- Fatigue and difficulty moving
- Inability to concentrate or make decisions
- Thoughts of wanting to disappear
Interval (Euthymic Period)
- Relatively stable mood and functioning
- Symptoms may be completely absent
- Discontinuing treatment on one’s own increases the risk of relapse
Because the person tends to perceive manic or hypomanic episodes as “feeling good,” it can be difficult to recognize the condition as an illness. Reflecting on past episodes and gathering information from those around the person can be valuable for diagnosis.
Treatment and Management of Bipolar Disorder
Treatment for bipolar disorder is centered on mood stabilizers as the primary pharmacotherapy. Because the choice of medication differs from that used for depression, treatment with antidepressants alone typically does not produce adequate results.
1. Pharmacotherapy
The mainstays of bipolar disorder treatment are mood stabilizers and atypical antipsychotics.
- Lithium (Lithobid): One of the most widely used mood stabilizers worldwide with a long history. It is effective for both manic and depressive episodes and helps prevent relapse.
- Valproate (Depakote): Originally developed as an antiepileptic medication, it is also approved for its mood-stabilizing effects.
- Lamotrigine (Lamictal): Considered effective for preventing depressive episodes.
- Atypical antipsychotics (olanzapine, aripiprazole, quetiapine, risperidone, etc.): Used for treating manic and mixed episodes as well as for relapse prevention.
For moderate to severe manic episodes, a combination of lithium and an atypical antipsychotic is generally recommended.
Discontinuing medication on one’s own can easily lead to relapse — this is a hallmark of bipolar disorder. Even when symptoms have subsided, continuing medication for relapse prevention is essential.
2. Psychosocial Support
- Psychoeducation: Learning about how the condition works, warning signs of relapse, and how treatment progresses
- Cognitive behavioral therapy (CBT): Examining the relationship between mood swings, behavior, and thought patterns
- Interpersonal and social rhythm therapy: Stabilizing daily routines to help prevent relapse
- Family therapy: Helping family members develop a deeper understanding of the condition
At Keldsen Family Clinic, we listen carefully during consultations and provide guidance on psychotherapy approaches as needed.
3. Strategies for Work and School
- When early signs of a manic episode appear, consult your doctor or family promptly
- Avoid sleep deprivation and excessive overtime
- Discuss major decisions (job changes, contracts, large purchases, etc.) with your doctor first
- Consider taking medical leave from work or school when necessary
A medical certificate can serve as an important tool for communicating your situation to your workplace or school.
4. Strategies for Home Life
- Watch for early signs of a manic episode (decreased sleep, increased talkativeness, expanding plans, etc.)
- Rather than blaming the person, calmly encourage them to seek medical care and rest
- Encourage postponement of major decisions
- Make sure family members also have access to their own support and resources
Family support is a powerful force in preventing relapse.
5. General Self-Care
- Sleep schedule: Maintaining the same sleep and wake times every day is the most important factor. A decrease in sleep may be a sign of a shift toward mania.
- Mood tracking: Briefly recording your mood and sleep each day can help you notice early warning signs
- Exercise: Regular light exercise can help stabilize mood
- Limiting caffeine and alcohol: These can amplify mood swings
- Knowing your relapse warning signs: Common examples include “feeling fine with less sleep,” “a sudden urge to make plans,” and “increased shopping”
Bipolar disorder is a condition that can be kept stable over the long term with ongoing treatment and lifestyle adjustments. You don’t have to face it alone — please feel free to reach out to Keldsen Family Clinic. We are a 1-minute walk from ‘Oizumi Yubinkyoku’ bus stop, accessible by Seibu Bus from Oizumi-Gakuen Station, open on weekends and holidays, and telemedicine is also available.