Bipolar Disorder: Symptoms, Causes, Diagnosis & Treatment

Bipolar disorder is a mental health problem which can characterised by excessive and overwhelming mood swings, just like riding a roller-coaster, shifting between mania (elevated mood) and depression.

What is bipolar disorder?

Bipolar disorder, also known as manic depression, is a mental condition which may cause extreme changes in emotions. It usually present in people 15 to 30 years old and less commonly in children and older adults. 

Patients usually experience two states: a manic episode whereby most people feel elated (hypomania presents with less severe symptoms), or a depressive episode during which you might feel lower in mood, tired or lose interest in things you used to enjoy. 

Common symptoms

In bipolar disorder, patients develop different symptoms depending on their mood.

Mania and Hypomania

Mania is more severe than hypomania and usually causes more problems in day-to-day life. 

• Increased activity or energy
• Extreme irritability or agitation
• Decreased need for sleep
• Feeling superior, full of special powers 
• Racing thoughts
• Short attention span
• Excessive talking
• Reckless decision-making, e.g. inappropriate spending sprees/ sexual activity

Major Depressive Episode

• Loss of energy, feeling weak and tired
• Feeling down, hopeless, worthless or despaired 
• Difficulty falling or staying asleep, or sleeping too much
• Losing interests and enjoyment in everything
• Having suicidal thoughts
• Significant unexplained weight loss
• Difficulty concentrating and making decision

What are the main types of bipolar disorder?

There are 3 major types:

• Bipolar I: At least one manic episode lasting longer than a week. It may be followed by a hypomanic or major depressive episode. It affects both genders equally. 
• Bipolar II: At least one major depressive episode and at least one hypomanic episode, but never a manic episode. More commonly seen in women.

Cyclothymic disorder: At least two years of mild elation and mild depression, not sufficiently severe or prolonged to make a diagnosis of bipolar I or II disorder.  

What are the main causes?

The exact cause is unclear. However, there are some possible factors that may contribute to this condition.

• Genetics: Someone whose family member is diagnosed with bipolar disorder has an increased risk.  For people who have first-degree relative with bipolar disorder, there is an increased 10-15% risk of them developing bipolar disorder themselves compared with people with no family history.  
• Brain: Bipolar disorder may be a result of chemical imbalance specifically with neurotransmitters (messenger chemicals) such as glutamate and noradrenaline. It is hypothesised that too much noradrenaline may lead to a manic episode while too little of it may cause depression. Hormonal imbalances may also be involved.
• Other triggers: Examples are stressful life events (e.g. relationship issues, financial needs), traumatic events (e.g. sexual abuse), physical illness and sleep disturbances. 

How is bipolar disorder diagnosed?

Currently, there are no blood tests or brain imaging to confirm a diagnosis of bipolar disorder. The diagnosis is made by a thorough mental health history taking and evaluation and the exclusion of any possible physical illnesses which may present with similar symptoms to that of bipolar disorder.

How is it treated?

Episodes of bipolar disorder show improvement in about 3 months with proper treatment. However, if left untreated, manic episodes can last for 3-6 months, while depressive episodes can last for up to a year.  Medication

1. Second-generation antipsychotics
   They are prescribed for mania irrespective of any psychotic symptoms, including olanzapine, risperidone, quetiapine and aripiprazole. Quetiapine is also licenced for bipolar depression.
2. Mood stabilizers 
   • Lithium
     It is the main medication used to control acute mania and prevent manic or depressive episodes of bipolar disorder.
     
     The dose of lithium has to be accurate to achieve its effect and to avoid possible toxicity such as nausea, vomiting, blurred vision, incoherent speech and ringing in the ears. Your doctor will monitor the lithium level in your blood, which will need to be checked every 3 months, at least. You will also need to attend check-ups on kidney and thyroid functions at least once a year. 
   • Anticonvulsants 
     Examples include sodium valproate, carbamazepine and lamotrigine. 
3. Antidepressants 
   Antidepressants are are rarely used alone in managing depressive episodes of bipolar disorder as they can provoke mania. Your doctor will prescribe you with antidepressants either with a mood stabilizer or an antipsychotic.
   
   Examples are fluoxetine, citalopram and sertraline.
   
   Psychotherapy  Also known as talk therapy to help you understand bipolar disorder, accept its existence and cope with its symptoms and impacts. You will also learn how to recognise early signs and symptoms and develop coping strategies to deal with them.

They include cognitive-behavioural therapy (CBT), interpersonal and social rhythm therapy (IPT/SRT) and family-focused therapy (FFT). These may enhance the treatment response and play a role in  preventing relapses.

What is the cost of bipolar disorder treatment in Hong Kong?

Treatment COSTS in Hong Kong’s Public Sector:

For eligible persons with a HKID card, the cost for psychiatric day hospital is $60 per attendance.

For non-eligible persons without a HKID card, the cost for psychiatric day hospital is $2,340 per attendance.

For details, call the Hospital Authority at 2300 6555.

Treatment COSTS in Hong Kong’s Private Sector:

Fees may vary significantly for different hospitals and clinics. It is best to first consult your doctor and discuss the options that best suit your situation. Our research found that the general consultation fee of visiting a psychiatrist ranges greatly, from about $600 to $3,000, excluding medication fees.

* All amounts are in HKD and were last updated in June 2020. No responsibility is accepted for any inaccuracies, errors, or omissions. It is always best to call ahead to make sure the information is still up-to-date.

Helpful Links

If you need instant support, here is a list of 24/7 Hotlines you can call:

Caritas Family Crisis Support Centre → 18288

Hotline Service (Family Crisis)

Hospital Authority → 2466 7350

Mental Health Direct

Social Welfare Department → 2343 2255

Hotline Service: 24 hours

Suicide Prevention Services → 2382 0000

Hotline Service: 24 hours

The Samaritan Befrienders Hong Kong → 2389 2222

Hotline Service: 24 hours

The Samaritans → 2896 0000

Multi-Lingual Suicide Prevention Hotline: 24 hours

For a list of other useful mental health services, please click here.

Useful Resources 

• Mind HK
• Bipolar Hong Kong 
• Institute of Mental Health
• The Mental Health Association of Hong Kong (Chinese only)

Dr. Frances Cheng is a Specialist in Psychiatry and is the Head of Mental Health at OT&P MindworX. She obtained her medical degree from the University of Hong Kong and her MSc. in Epidemiology at the London School of Hygiene & Tropical Medicine. She completed her specialist training in Psychiatry in Hong Kong and in the United Kingdom where she worked as an Academic Clinical Fellow at the University of Cambridge. She is a Member of the Royal College of Psychiatrists of the UK as well as a Fellow of the Hong Kong College of Psychiatrists. Prior to entering private practice, she was a Clinical Assistant Professor at the Department of Psychiatry at HKU. She is now an Honorary Assistant Professor at the same department.