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Never stop medication for phase prophylaxis on your own — not even during stable times. A sudden stop, especially of Lithium, can trigger a new episode of the illness.
Bipolar disorder is a mental illness in which mood swings in phases far beyond the normal range — downwards into a depression and upwards into a mania or a milder form, hypomania. "Bipolar" means exactly that: two poles. Between the phases there are often weeks, months or years during which those affected feel completely healthy and balanced.
It is important to distinguish it from the normal mood swings that everyone knows. In bipolar disorder the phases are far more pronounced, last longer (days to months) and considerably impair everyday life, work and relationships. It is not about "sometimes in a good mood, sometimes bad", but about states that profoundly change thinking, drive, sleep and judgement.
You can picture the illness as a control system for mood and energy that has gone out of sync. In depression, drive, interest and self-worth are as if dimmed down; everyday things become a burden. In mania the opposite happens — energy, ideas and self-confidence shoot upwards, often combined with a dangerously reduced need for sleep and risky decisions. Both extremes can harm those affected and the people around them. Left untreated, the illness tends to make the phases more frequent and more intense over the years — which is why early, consistent treatment is so important.
Bipolar disorder is not a single, uniform illness — depending on how strong the high phases are, different forms are distinguished. The most important difference lies between a mania and a hypomania: both mean an elevated, overactive mood, but mania is much stronger, lasts longer and disrupts life massively — up to psychotic symptoms or a hospital stay.
| Form | High phase | Low phase |
|---|---|---|
| Bipolar I | At least one genuine mania (min. 7 days or hospital needed) | Usually depressive episodes, but not required for the diagnosis |
| Bipolar II | Hypomania (min. 4 days, without severe impairment) | At least one pronounced depressive episode |
| Cyclothymia | Persistent mild mood swings over at least 2 years | Alternating mild highs and lows, subthreshold |
| Rapid cycling | At least 4 illness phases per year — harder to treat | |
Put simply: in Bipolar I at least one severe mania is the central feature. In Bipolar II the depressive phases predominate, with milder high phases (hypomanias) in between that those affected often do not experience as pathological at all — on the contrary, they then feel especially capable and good. This is exactly what makes Bipolar II treacherous: because the highs stay inconspicuous and only the depressions are perceived as distressing, the illness is often misinterpreted as a "normal" depression.
The symptoms depend on which phase someone is in. Characteristic is the alternation between two very opposite states — often with long, symptom-free periods in between. Sometimes signs of both poles appear at the same time; this is called a mixed episode and it is particularly distressing.
During the manic or hypomanic phase, the following typically appear:
During the depressive phase, by contrast, the central features are:
The contrast is decisive: the same person who in depression can barely get out of bed in the morning may, weeks later in mania, work for days on end while losing all sense of proportion. Because many affected people do not feel ill precisely during the high phase, they usually only enter treatment during the depression — and the manic phases then go unmentioned. This is exactly why it is so important to ask actively about earlier high phases.
Bipolar disorder does not arise from a single cause, but from the interplay of several factors. The most important is the hereditary predisposition: the genetic component is more pronounced here than in almost any other mental illness. Anyone with close relatives who have a bipolar disorder carries a markedly increased risk. What is inherited, however, is not the illness itself, but an increased susceptibility.¹
One particular point: in bipolar disorder, sleep is not only a symptom but also a trigger. A single sleepless night can be the tipping point into a mania in sensitive people. This is why a regular sleep-wake rhythm and managing sleep disorders play such a large role in treatment. The predisposition cannot be changed — but many of the triggering factors can be influenced.
The diagnosis of a bipolar disorder is made by a psychiatric or psychotherapeutic specialist — and it takes time. There is no blood test and no scan that proves the illness. The decisive element is a detailed conversation about the previous course of the mood, supplemented by questionnaires and — with consent — often also the account of relatives.¹
The key to the diagnosis is evidence of at least one manic or hypomanic episode in the past. This is exactly where the great difficulty lies: those who seek help only during depression often do not remember or mention the earlier high phases — after all, they felt like "especially good times". On average, therefore, several years pass between the first symptoms and the correct diagnosis.
Distinguishing it from other illnesses is also part of the diagnosis: anxiety disorders, an attention disorder (ADHD), personality disorders or substance use can produce similar pictures or exist at the same time. A careful assessment is the foundation of every effective treatment.
The treatment of a bipolar disorder rests on several pillars: medication for phase prophylaxis, psychotherapy and psychoeducation, and a stable rhythm of life. None of these pillars replaces the others — only together do they unfold their full effect. The goal is not only to treat acute phases, but above all to prevent new ones.¹
A central, often underestimated building block is rhythm. Because irregular sleep and an everyday life that has gone out of sync can trigger phases, a regular daily routine is not a nice extra but effective protection. Fixed times for sleeping, getting up, eating and activity stabilise the internal clock — a principle known in the field as social rhythm therapy. The individual building blocks work together: those who combine sleep, structure and stress management noticeably lower their relapse risk.
Psychotherapy — above all cognitive behavioural approaches and the rhythm therapy mentioned — helps to cope with the illness, recognise triggers and interpret early warning signs. In cases of persistent inner restlessness or sleep problems it is an important complement to medical treatment.
The heart of long-term treatment is phase prophylaxis — an ongoing medication intended to prevent new highs and lows. It is usually continued even when you are doing well, because the stable state is precisely the result of the treatment. Alongside this there are medications for acute mania and for bipolar depression. Which active substance fits depends on the form, the previous course and tolerability.¹,²
No medication should be stopped on your own — with Lithium in particular, an abrupt stop can provoke a new phase. Side effects are no reason to quietly stop: often a dose adjustment or a change of preparation already helps. Interactions with other agents can be checked in advance; more on this in the guide Drug interactions.
brite reminds you of every tablet and documents mood and sleep seamlessly — ready for your next medical appointment.
Bipolar disorder is as a rule a lifelong illness that runs in phases. Between the episodes there are often long, stable periods. The goal of treatment is to make these stable phases as long as possible and to soften relapses or prevent them entirely. What this looks like in individual cases varies — which is why the therapy is tailored individually.¹
| Situation | Treatment goal | Note |
|---|---|---|
| Acute mania | Rapid calming, protection from harm | Often an antipsychotic, hospital if needed |
| Bipolar depression | Lift mood without triggering mania | Mood stabiliser preferred |
| Stable phase | Prevent relapses (prophylaxis) | Continue medication, keep the rhythm |
| Rapid cycling | Slow down the change of phases | Usually avoid antidepressants |
| Wish to have children | Safe choice of active substance | Avoid Valproate, plan with a specialist |
An effective tool in the stable phase is the personal crisis plan: a list, drawn up together with treaters and relatives, of your own early warning signs and the steps that help at the start of a phase. Those who know their typical first signs — such as less sleep, more spending, an irritable mood — can counteract early, often before a full episode develops. Regular check-up appointments and documenting mood and sleep are the best foundation for this.
Record your mood and sleep in brite and recognise beginning phases before they overwhelm you — ideal for your next medical appointment.
A large part of the treatment happens in everyday life. A few habits make the difference between stable and unstable phases:
Bipolar disorder is not treated in weeks but over years — often with several active substances. The therapy only protects if it runs reliably and mood, sleep and early warning signs stay in view. This is exactly where brite supports you.
