Bipolar disorder: the highs and lows

A renewed global interest in research on mental health disorders has been sparked, as the number of individuals suffering from mental or behavioural disorders now amounts to approximately 450 million. Additionally, the World Health Organisation (WHO) estimates that one million people suffering from mental health issues die by suicide each year. Bipolar disorder (BD) is a chronic mental illness defined by repeated episodes of depressive and manic episodes that impact patients’ overall health, including daily functioning and quality of life. BD commonly presents in adolescence or early adulthood, and is further divided into Bipolar I, dominated by manic episodes, and Bipolar II, dominated by hypomanic episodes. Current practice guidelines and detailed algorithms used for the diagnosis and management of BD are not user friendly and require a skilled team to navigate. This results in underdiagnosis of BD, leaving many patients undertreated. Symptom complexity, duration, and intensity make reaching a conclusive diagnosis for manic, hypomanic, and depressive states challenging. While there is no single unifying theory that encompasses the genetic, pharmacological, biochemical, and anatomical components of BD’s pathophysiology, an array of categorical theories currently exists. After accurately confirming a BD diagnosis, identifying appropriate treatment is crucial, as symptomatic improvement generally takes one to four weeks. Currently, pharmacologic treatments include mood stabilisers, antidepressants, and atypical antipsychotics. Unfortunately, lifetime management of BD is extremely challenging due to its dynamic and fluctuating nature. The WHO has called on regional governments to identify the current barriers to mental health and well-being, as this is a crucial step towards improving the morbidity and mortality associated with mental illnesses on a global scale. This review aims to dissect the complexity of BD from diagnosis to management, including the prevailing theories, diagnostic methods, and pharmacologic therapies.