Bipolar disorder - causes, signs and therapy

Bipolar disorder - causes, signs and therapy

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Manic depressive

Bipolar means opposite. People under one bipolar disorder suffer, experience their moods between storm surge and low tide. Joylessness changes with elation. They are extremely active in the euphoria.

Everyone's feelings change: A person has slept badly, nagging his partner at breakfast, after a coffee he feels good again and apologizes. Bipolar-disturbed people experience these changes to the extreme.

Signs of manic depression

Both high mood (mania) and depression can be at the forefront of bipolar disorder. If the following symptoms occur over a long period of time, such a disorder may be present:

  • Mood changes: Affected people change from one mood extreme to another, i.e. from a manic to a depressive phase and vice versa.
  • Manic phase: Upscale mood, euphoria, increased irritability, little sleep, those affected are energetic, lack of concentration, high need for speech, tendency to waste money, self-esteem and even megalomania.
  • Depressive phase: Lack of energy, lack of drive, feeling of worthlessness and inability, self-doubt, feelings of guilt, loss of interests, isolation, felt sadness, melancholy or complete lack of emotion, thoughts of suicide.

The hypomania

Hypomaniacs are hyperactive or irritable for at least four days. They are restless, speak continuously without listening, cannot concentrate, sleep, are lustful, take risks uncontrollably and need company. They develop a surplus of ideas and sometimes they do an extraordinary amount. Hypomania usually does not lead to social problems.

The mania

The mania is more violent than the hypomania. The elation lasts for at least a week; those affected get massive problems at work, in public and in everyday life.

In the manic phase, those affected are initially far more efficient than usual. The unusual behavior manifests itself as a flow of speech without any context, the ideas roll over, the thoughts race, social taboos play no role; Manic people overestimate themselves, are easily distracted, their actions change constantly; they are ruthless and sexually driven. They hardly eat and sleep little. They lose their distance from the environment as well as their self-criticism.

In the irritable variant, the disturbed act extremely aggressively: they constantly feel provoked, insult, and they attack other people - physically and verbally. One trigger is that others don't take their castles in the air seriously. Severe manias turn into a psychosis: those affected have delusions.

The future shimmers in the brightest colors. There are no social norms. They break down all borders and slide into disaster: they destroy relationships, they end up in financial ruin, and they lose their jobs.

They address strangers without any distance - the topics are often beyond social acceptance. Manic don't care about the needs of others. They make sexual advances in the presence of the partner, they expose the (real or supposed) problems of strangers in public, they take what they need at the moment. Non-manic people are familiar with such behavior in alcohol or cocaine highs.

In an ascending mania, others are sometimes enthusiastic, sometimes confused. The manicist finds his audience in the appropriate milieu: young people like breaking his taboo, sometimes he is sexually successful in clubs, shy people are amazed at his conversationalism. The manicist cannot be stopped. If the people present set limits, he insults them. Manicures almost inevitably cause conflicts.

Sometimes they are lucky because outsiders notice that "something is wrong with them" and therefore they do not become palpable, or friends distract the manic. But often manic get involved in fights. They fly out of pubs and they end up at the police station.

Manicans often behave completely alien to their "normal personality". This is extremely stressful for her friends, and the attacks destroy bonds - including years of friendship. Those affected slip ever deeper into social isolation.

Sex addiction

The mania increases lust. A person affected says about himself: "I am not only manic, but also nymphomaniac." Every cashier in the supermarket, every person waiting at the bus stop becomes a "dream woman" for the manic. Limits such as age or non-sexual friendship are overridden. Affected people behave sexually suggestive, even abusive. The megalomania also extends to one's own attractiveness: Every partner you want to have sex with - in the imagination of the manic. He does not calculate his passion like the "classic gigolo", because secret meetings with frustrated wives are not his thing. The affront combines with the irritability: the manic approaches a woman who lives in a stable relationship; the partner intervenes and a gang war breaks out in the district in the manic imagination.

Those affected not only invent their sexual constructs during acute mania, but sometimes defend them for months. Old friends and therapists can recognize the condition of the person affected by the reality and the number: Does he only say that he finds the new neighbor erotically interesting, does he claim that she will jump into bed with him this evening or is he already running into the door?

Flight of ideas

Manicures chase from one idea to another. If the mania begins, those affected wander off the topic and have problems finding their way back. In a "full-blown" mania, on the other hand, thoughts run amok. The disturbed person cannot answer any further questions because he does not know the beginning of his statements. However, individual thoughts can logically follow one another. His words roll over so that others hardly understand what he is saying. The irritable sees this lack of understanding as an attack and strikes - verbally or non-verbally.

This flight of ideas is also evident in the creative achievements. Manic painters, for example, get more and more into their picture, repaint over and over again until the structures lose the overall context. The fragments can be ordered. A cafe operator, who buys a friend's affected pictures, says: "I literally tear them out of his hand, otherwise he would destroy them."

Delusion and waste

The ego breaks through all the limits of reality in mania. Some sufferers continue to hold delusions when the manic phase is long gone and are otherwise considered stable. For example, one affected person ended up in an acute phase in psychiatry; he claimed that conspirators were targeting him - including members of a karate club. Years later, he had had no more manic flare-ups, he was considered healthy, but still said, “The karate club has nothing to do with mania. They were really after me. "

Those affected fixate themselves on the pleasant - to the point of excess. Personal hygiene is at the back, sleep disturbs, and eating prevents them from getting intoxicated. They throw money around, give away valuable things, "make the dolls dance"; some even go into debt. When the intoxication, the mania, is over, they are ashamed.

The Depression

The depressive follows the manic phase. The "happier" feel oppressed, the heavier sufferers worthless. They lose interest in hobbies, are very tired, restless inside and cannot sleep. You have chest, stomach, head and heart pain; they feel dizzy; they decrease. The thoughts circle into the negative. You cannot make the simplest decisions. You lose weight; Sex doesn't matter anymore. You feel guilty and ashamed. They imagine diseases. They don't trust themselves anymore. You think of death and suicide; many try to kill themselves. So the exact opposite of mania - both phases have in common that they cause massive problems in work and relationships.

Bipolar disorder: causes

Many studies suggest that bipolar disorders are brain disorders. Brain metabolism and the neurotransmitters dopamine, norepinephrine, serotonin and GABA function abnormally in those affected. Biological causes such as disorders in the brain's messenger substances or changed hormones trigger the disease as well as social factors: stress, separations, trauma and abuse. These psychological stresses can spark the bipolar surge in a drastic event.

Both go hand in hand. The "chemistry" in the brain triggers the disorder - so that's physical. The behavior of the manic-depressive, however, refers to their social environment and their experiences. The mania is often the potential of suppressed desires, the depression of her prison. Those affected could never develop the normality in between as a fulfilling structure. Bipolar effects on "average people" are immature even in very advanced age - like teenagers who have aged, and specifically also outside the pathological phases. For example, those affected play the “story uncle” in the youth center or make a “name” as an enfant terrible in a small town.

A typical case is a victim who came from a strictly Catholic home, worked as an altar boy at thirteen, and had internalized the catechism; in puberty he entered the political left and got to know free sexuality. It was then that he had his first manic flare-ups. On the one hand he ran through his hometown and said that he was St. Francis, on the other hand he questioned the church. At 40, he wrote a letter about finally leaving God now. His disorder appears like an attempt to free himself from the prison of his dogma and environment, which is doomed to failure as a manic, i.e. unconscious outbreak and therefore ends up in depression.

A psychotherapist talks to a patient intensively to see if there is a bipolar disorder. Relatives should be there, because they have a different view of what the person concerned describes.

Blood tests (and other tests) rule out that it is another disease.

Bipolar disorder: treatment

For a long time, bipolarity was not controllable by those affected. We know better today; Patients can use their own behavior to balance the swing of the pendulum between sky flight and decline much better than previously thought.

Psychotherapy works very well. Relatives should be involved, the therapist must know the situation in the family very well, because it is often the trigger for mania and depression. Medicinal and psychotherapeutic treatment complement each other.

Unfortunately, many people with acute mania do not show any insight into the problem. Then only a compulsory admission to psychiatry on the basis of a judicially confirmed personal and external risk helps. Psychiatry is primarily intended to shield the sick from stimuli.

However, some sufferers also reflect their problem in mania and compensate for it with extreme productivity. You need appropriate medication and a balanced life structure - especially adequate sleep.

Bipolar disorder medication

Three types of drugs are used in bipolar disorders: mood stabilizers, antidepressants and atypical antipsychotics. Mood stabilizers are mostly used for long-term use. They have an effect on both the manic and the depressive episode and are intended to prevent further illness episodes. Lithium salts and anticonvulsants such as valproate, lamotrigine and carbamazepine are among the mood stabilizers. In acute depressive phases, an antidepressant is often used in combination with quetiapine. In manic episodes, an atypical antipsychotic such as risperidone, olanzapine or aripiprazole with a temporary sedative such as diazepam, lorazepam or alprazolam is prescribed.

Bipolar Disorders and Relationships

Mania and depression double burden friends and relatives. Partners are in danger of becoming co-bipolar. The closer you are to a person with this disorder, the more urgently you need professional information.

Lay people do not know how to deal with the disease. Relatives are injured by the attacks and at the same time have to deal with the fact that these attacks are part of the disease. In an acute mania, the relatives have to ensure that the person concerned does not make any money transactions, does not come to "hot spots" like mass events, so ideally rages through the forest for a week - under supervision, of course.

In stable times, relatives and those affected can set a framework to prevent the worst consequences of the mania. For example, the person concerned can only carry an EC card with them to an account with low credit, and can deposit the card for their big money with a confidant who refuses to give it to them in a manic phase.

Friends and relatives should also establish rules for their stable phases with those affected. You can support them or even exhort them to implement what they cannot do during the ascent and descent - be it to take up ideas that they had in the mania or to exercise personal responsibility. Some bipolar people go into their illness as a "that's the way it is". In mania, no one can be convinced of "banal things" like paying the electricity bill or doing the laundry. In the more stable phase, however, it can.

In the phases of bipolar disorder, other people have to learn when and how they react. When is the person concerned still responsible, when is it no longer? When to turn to it, when to define it? The relatives are not only overworked, they are also angry. They must not neglect their own needs, they must make room for themselves and are well advised to seek out self-help groups.

Friends should set limits to those affected in their stable phases - if necessary rigorously. People with mental disorders often circle around their problems in their thoughts. Some sufferers think much of their stable phase about how manic, hypomanic, depressed or “normal” they are. Friendships then take on a therapeutic character. First of all, friends must make it clear that they respect the person concerned and confirm that they are currently accountable. Secondly, this means that someone who uses the energy of others to revolve around himself is acting self-centered, so please leave his friends alone.

Some sufferers feel ashamed of what they are doing in mania in a stable phase. Then friends help them, telling them that they are not to blame for the mania. Others see mania as a potential that can be developed. This can have a positive effect if you convert this power into art, for example; many artists are bipolar.

Still others create a special status of freedom of the fool from their disturbance. Friends have to show them clear boundaries. For example, a victim scratched past a fight three times in one evening only because the people he insulted regarded him as mentally ill. The next day, when he "came down", he said, as if by a feat, that he was confusing people and that idiots were walking around on this street. His friends behaved rightly: Instead of giving the audience for his "exciting experience", they told him that it was not an honor to escape even provoked fights only because fellow human beings act prudently and because one is considered "someone." Bang ". The bipolar, now in a decongestant mania, roared: "Do you want to pathologize me?" His friends replied: "Either, others treat you as normal and therefore accountable, or they see you as irresponsible. However, if they treat you as normal, you would be right to have a black eye because of anti-social behavior. You don't get the benefits of both together. "

Friends are also required not to support the patients with their wrong ideas out of friendship. This is often difficult if those affected are still largely accountable. A victim rang a scientist friend out of bed at 6:00 a.m. on Sunday in an impending mania and roared for minutes until the awakened man understood that he should write a positive report to the bipolar for an application. It was about the position of a team group leader in a development aid project. The scientist read aloud the requirement: "Increased self-discipline even in extreme situations" and said: "I cannot write an expert opinion on this." His friend roared, even louder than before: "What do I have friends for?" The doorbell rang The neighbor stood at the door and complained about the noise. "The manic roared in her face:" Yes, she too. You too ”and provided proof that the rejection of the report was correct.

In depression, relatives should not overwhelm the sick. He can't do anything - it's not about wanting. If the person concerned says "I don't want to live anymore", the relatives should inform a doctor. The suicide rate of bipolar people in depression is 20-30 times higher than that of the general population.

Self-help for bipolar disorders

Many bipolar people lead a regulated life - however, this includes the insight that it is a disorder, taking medication and long-term psychotherapy. Bipolar almost always remain restricted throughout their lives.

Bipolar can reduce triggers by falling asleep and getting up at fixed times, keeping your hands off alcohol and other drugs, especially cocaine. Cannabis, on the other hand, stabilizes moods - according to reports by those affected. Mood diaries help the bipolar to manage itself.

If those affected know themselves better and better, they can see their specialist at the first signs of a mania, increase the medication, sleep a lot and avoid stress or stimuli to prevent the outbreak.

But this only works if they understand the mania as a disorder. Mania is a phase of illness that those affected experience positively. Some speak of their first manic experience as of a religious revival; they "fall in love" with them like a heroin rush. This is especially true for bipolar people who are afraid of depression.

Those affected must understand “averageness” as something positive. This helps them to understand their manic potential as part of themselves. Those affected usually have enthusiasm even before the onset of the first mania.

Famous bipolar

“Without the manic-depressive component in the population, our culture would be very poor. It would be almost bleak. ”Jules fear

Bipolar does not necessarily mean a social case. Inclusion here means including people with mental disorders rather than excluding them. However, those affected are not or only partially suitable for many professions; To make this clear to them is just as little to discriminate against them as it is to discriminate against someone who cannot drive a car because they need a driver's license for a job.

Someone who throws local rounds in a manic high is unsuitable as a treasurer, and someone whose structure is constantly changing is not an administrator. 3-tier services are problematic because they provide triggers for mania; Stress jobs should be avoided, for example in the catering trade.

Some people who did great things were bipolar: Elias Canetti suffered from it as well as his wife Veza; Andrew Delbanco wrote about Hermann Melville, the author of Moby Dick: "Depression often followed his moments of happiness". So he was able to develop Captain Ahab, who manically pursues the white whale - until the ship ends at the end (like the soul in depression).

Or the manic-depressive Ernest Hemmingway, who shot himself, probably in a depression? His "old man and the sea" is just the model of a literary implementation of bipolar disorder. An old man goes to sea again, catches a fish giant in a superhuman wrestling, takes him to the beach under obstacles. Once there, sharks have eaten their catch down to the skeleton - nothing remains, after the mania comes the depression.

Lord Byron was affected as was Virginia Woolf. She killed herself and wrote to her husband in her farewell letter: “Dearest, I have the sure feeling that I will go crazy again. I feel that we cannot go through these terrible times again. And this time I will not recover I start hearing voices and can't concentrate. So I will do what seems to do the best. You gave me the greatest possible happiness. "

The ill Kurt Cobain also committed suicide in a depression. He shared his illness with Marilyn Monroe and the singer Falco. Gauguin suffered just as much as his roommate Van Gogh, who cut off his ear in a mania - and later Pablo Picasso. Brahms, Mozart and Tchaikovsky suffered, Churchill as well as Nixon.

Edgar Allan Poe, the master of fear of death stories, suffered from the disorder. Poe's main motif is - probably not by accident - the double side of perception. Imaginations, thoughts and feelings turn into their opposite. A doppelganger lurks in the unconscious. Poe's characters are often normal people who go mad, like in "Spirit of Perversity" or "Black Cat", where a decent husband becomes addicted to alcohol, kills his cat and later kills his wife with an ax.

Friedrich Nietzsche also fought against these fluctuating moods. Niezsche's most important quote is: “Whoever fights monsters should be careful not to become a monster himself. Because whenever you look into an abyss, the abyss also looks into you. ”He knew what he was writing about. (Dr. Utz Anhalt)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.


  • German Society for Bipolar Disorders e.V.: Bipolar Disorders - A disease with two faces, information leaflet, as of 2016, dgbs.de
  • Professional associations and specialist societies for psychiatry, child and adolescent psychiatry, psychotherapy, psychosomatics, neurology and neurology from Germany and Switzerland: What is bipolar disease? (Accessed: 26.08.2019), neurologen-und-psychiater-im-netz.org
  • Merck and Co., Inc .: Bipolar Disorder in Children and Adolescents (Manic-Depressive Disease) (accessed: August 26, 2019), msdmanuals.com
  • German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN): S3 guideline for diagnosis and therapy of bipolar disorders, as of March 2019, detailed view of guidelines
  • Swiss Society for Bipolar Disorders: Bipolar Disorders (accessed: August 26, 2019), swiss-bipolar.ch
  • Robert Koch Institute (RKI): Federal Health Reporting, Issue 51, Depressive Diseases, as of: 2010, rki.de
  • Mayo Clinic: Bipolar disorder (accessed: August 26, 2019), mayoclinic.org

ICD codes for this disease: F31ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.

Video: 5 misunderstandings about Bipolar Disorder (July 2022).


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