A complex and varied condition: why bipolar disorder demands individualised care

Globally, bipolar disorder affects an estimated 40 million people, according to the World Health Organization (WHO). Yet, despite its prevalence, clinicians say its diagnosis and management remain far from straightforward, often requiring highly individualised care.

Subtle, episodic,and often misread

Bipolar disorder rarely begins in a way that is immediately recognisable. Instead, early symptoms are often mistaken for personality traits or even positive behavioural changes.

Doctors note that patients frequently present with reduced need for sleep, increased energy, excessive talkativeness, irritability, and impulsive decision-making. “These phases are often seen as productivity or ambition rather than warning signs,” says D. Archanaa, consultant psychiatrist, Apollo Hospitals, Chennai, adding that early symptoms may even be signs like hyperactivity and unusual enthusiasm and that patients may feel well during these episodes, with families noticing changes first.

Mithun Prasad, consultant psychiatrist at SIMS Hospital, Chennai, points to hyperthymia or cyclothymia (chronic mood disorders) as a commonly missed phase. “There is a misconception that bipolar disorder begins dramatically. In reality, patients may simply appear more confident, take on multiple tasks, or sleep less,” he explains. These phases are often appreciated or overlooked until they progress into full-blown mania.

Dr. Archanaa, adds that early symptoms may even be signs like over enthusiasm, excessive spending, and risk-taking. “Families may interpret these as positive changes until they begin to disrupt functioning,” she says.

At the same time, depressive episodes though more easily recognised can present with mixed features such as agitation and restlessness, often misinterpreted as anxiety.

Gender and life stages

Hormonal and life-stage transitions add to the complexity of bipolar disorder. In adolescence, symptoms often present as irritability or mixed states, leading to misdiagnosis as behavioural issues. In women, phases such as pregnancy, the postpartum period, and menopause are associated with increased vulnerability.

Dr. Kapil points to the increased risk of episodes during these transitions, including postpartum associated health issues, which require urgent medical attention. He adds that some women initially diagnosed with postpartum depression may later be identified as having bipolar disorder.

“These are not just biological shifts but periods of emotional and environmental change as well,” notes Dr. Archanaa. Medication choices during pregnancy and breastfeeding require careful risk assessment, while menopause may necessitate changes therapy.

Clinical experiences highlight the long-term, evolving nature of the condition. Doctors describe patients who remain stable for years with treatment but relapse due to triggers such as sleep disruption, substance use, or stress underscoring the need for continuous monitoring.

Comorbidities,diagnosis and care

A key reason bipolar disorder resists standardised treatment is its tendency to coexist with other conditions. “Bipolar disorder does not usually exist on its own,” says Vivian Kapil, consultant psychiatrist, SRM Prime Hospital, Chennai, pointing to anxiety, substance misuse, ADHD, and physical conditions such as thyroid or metabolic disorders. These can both mimic and exacerbate mood symptoms, complicating diagnosis.

Dr. Prasad notes that many patients initially present with substance use, anxiety, or behavioural addictions, with bipolar disorder becoming evident only later. In some cases, treating depressive symptoms without recognising underlying bipolarity can trigger manic episodes, a phenomenon known as antidepressant-induced switching.

Treatment adherence is another challenge . “During depressive phases, patients may neglect treatment, while in manic phases, they may deny illness altogether,” says Dr. Archanaa. Co-existing medical conditions such as diabetes or cardiac illness further influence both symptom patterns and medication choices.

Experts say that a fragmented approach — treating one condition in isolation — often leads to poor outcomes. What is needed, they say, is a holistic strategy addressing all comorbidities .

Patient-centred, preventive care

Early recognition and sustained, preventive care are crucial.

Patient-centred care, doctors say, rests on a combination of education, regular follow-up, adherence to medication, and structured daily routines particularly around sleep. As early warning signs are often first noticed at home, family involvement plays an important role.

Additionally, Dr. Kapil points to early intervention models, such as those implemented in the United Kingdom, where dedicated teams focus on identifying and managing conditions like bipolar disorder at an early stage, significantly improving long-term outcomes.

This approach is in sync with World Health Organization guidelines, which emphasises a combination of pharmacological and psychosocial interventions. Mood stabilisers, including lithium and certain anticonvulsants along with antipsychotic medications are recommended to manage acute episodes as well as for long-term relapse prevention.

Continuity of care is crucial. Other important steps are reducing stigma, integrating mental health services into primary healthcare systems, particularly in low- and middle-income countries reinforcing the shift from episodic care to long-term management. “Many people delay seeking help due to stigma, which worsens the condition,” says Dr. Kapil.

Workplaces, too, have a role to play in offering flexibility and mental health support. Experts emphasise that healthcare systems must prioritise sustained follow-up over intermittent care.

Published – April 01, 2026 06:22 pm IST