How to survive a manic episode

Course of bipolar disorder

How does bipolar disorder work?

Since bipolar disorders are not a uniform clinical picture, the disease can develop very differently. Basically, it runs in phases or, as the experts say, in manic or depressive episodes. The duration of the episodes of illness can vary between a few days, several months and - this is very rare - a few years. On average, a disease episode lasts between four and twelve months in untreated patients. Manic and depressive episodes can occur individually or merge into one another. Some of the patients experience more manic episodes, others more depressive episodes. It is also possible to switch from manic to depressive episodes within an episode of illness. Finally, there are also so-called mixed states: Symptoms of depression and mania occur to different degrees at the same time.
There can be intervals of several months or years between the individual episodes of illness, during which the patient is completely symptom-free or has a stable mood. During these times, patients are usually fully productive and able to meet the demands of daily life. On average, patients with bipolar disorder are symptom-free for two to three years between the individual episodes of the illness. In addition, there are individually different numbers of episodes of illness. Some patients only have one or two episodes in their lifetime, while others get the disease significantly more often. On average, people with bipolar disorder suffer around four episodes of illness within the first ten years of illness. According to the nature of the episodes of illness and the severity, bipolar disorders are divided according to the following scheme:

Bipolar I disorder

Bipolar I disorder is when the person affected has had at least one manic episode lasting more than 14 days and at least one depressive episode.

Bipolar II disorder

Bipolar II disorder is when the person affected has had at least one depressive episode lasting more than 14 days and at least one hypomanic (milder form of mania) episode.

Cyclothymic disorder

One speaks of a cyclothymic disorder when those affected have constant slight manic and depressive mood swings for a period of at least two years, whereby the individual episodes do not meet all criteria of mania or depression. However, this disorder is rarely diagnosed today and is sometimes confused with the historical term "cyclothymia", which used to be a synonym for all bipolar disorders.

Although the classification given may seem confusing at first glance, it is of great importance for the treatment strategy and the choice of appropriate medication. While patients with bipolar I and II disorders often have to be treated with medication, in patients with cyclothymic disorders it depends on the personal level of suffering whether appropriate therapy must be initiated.

Special Risks in Bipolar Disorders

People with bipolar diseases have an average life expectancy that is nine years shorter and they lose an average of 12 healthy years of life compared to the general population. The effects on social and family aspects of life can be just as serious: On average, people with bipolar disease lose 14 years of normal professional and family activity.