“Ajith was a 36 year old businessman. He recently suffered heavy losses in business as he had given huge loans to friends. He derives great pleasure in giving off his money and is boastful about it. He has sudden bouts of heavy spending and gambling. He also has had affairs during those episodes which resulted in marital conflicts.

Since a few days, he has been keeping dull and not interacting much with anyone. He even contemplated suicide. Since an year, he has left home and has been staying in a hotel spending lakhs of rupees, just to escape the tensions around him.

The stigma to meet a psychiatrist and not able to accept that he is suffering with a mental illness led to delay in initiation of his treatment, the result being strained marital relationship, bankruptcy and a confused and unhappy life.”


bipolar disorder

Mood fluctuations are common in many of us. We need to differentiate it from what we call as Bipolar affective disorder or BPAD.

General description of anyone who exhibits rage or fluctuations of mood should not be termed as bipolar and made fun of. It demeans the individual who actually has the disorder. It is similar to making fun of someone who has diabetes or cancer.

Increased awareness would identify the disorder early and early intervention would improve the prognosis.

The disorder is characterised by episodes of depression alternating with episodes of irritable or elevated mood. During episodes of mania, the individual exhibits elevated, happy or irritable mood, boastful/ grandiose talk, disinhibited behavior, high risk behavior, decreased need for sleep, excess spending, talking excessively etc. Psychotic features like delusions and hallucinations can also be witnessed which further complicate the situation.


Risk of self harm increases during these episodes. There can be fluctuations even within a day which we call ultrarapid cycling and frequent number of episodes in a single year as rapid cycling.

Bipolar hand

In our case scenario, Ajith had episodes of mania when he had given huge loans to friends and spent excessively. During these manic episodes, he had sexual advances and high risk behavior which threatened his marital relationship. He resorted to alcohol at those times and sudden depressive moods led him to go back to his shell. During the depressive episodes, he had suicidal ideas.

He had similar episodes even prior to marriage, but as it never caused any disturbance in his functionality, he did not find the need to seek help.

Genetic causes can contribute to the occurence of bipolar disorder. Any stressful situation can trigger an episode. Substance abuse increases during manic episodes.

The disorder itself should not trigger panic in people, but if not treated, can have grave consequences to the individual and the family.

There are medications like antipsychotics and mood stabilisers which bring the person out of the episodes and aid in speedy recovery. Sometimes a person may have to use the medications for prolonged periods of time but in the interest of the person who is suffering, the medications benefit him more than doing harm. Psychotherapy sessions can be arranged during his depressive episodes and also to bring insight into his condition and to encourage better compliance with medications.

Bipolar disorder is a treatable mental condition. Society should rise above the stigma and labelling and contribute to better identification and encourage treatment of individual suffering with this condition.

Balance is an idealistic term. Mood fluctuations are common in many of us. Only when it crosses the line and affects functionality, the problem arises and one must be able to accept it and seek treatment. Negligence in taking care of the symptoms could cost a life at times. on march 30, world bipolar day, Let us all start helping people around us with such fluctuations and create a better world to live in.Bipolar

Dr Jyothirmayi is a Psychiatrist

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