Beyond the Highs and Lows: Understanding Bipolar Disorder

We have all heard someone say, “Ugh, today my mood is so bipolar.” But bipolar disorder is not a personality trait or a passing mood. It is a serious mental health condition that affects millions of people globally and in India, yet most of us know little about it.

What Is Bipolar Disorder?

At its core, bipolar disorder is a condition that causes extreme shifts in mood, energy, and the ability to function. These are not your everyday ups and downs; they are intense episodes that can last for days or even weeks.

According to the World Health Organisation, bipolar disorder is characterised by alternating episodes of mania (or hypomania) and depression. There are two main types. In Bipolar I, the person experiences at least one full-blown manic episode. In Bipolar II, the manic phases are milder (hypomania), but the depressive episodes can be long and debilitating (World Health Organisation, 2025).

Think of it this way: if the normal mood is a gentle wave, bipolar disorder may feel like a tsunami: unpredictable, powerful, and impossible to ignore.

Its Prevalence and Causes

There is no single cause. Research points to a mix of genetics (it runs strongly in families), brain chemistry imbalances, and environmental triggers like severe stress, trauma, or sleep disruption. It is not anyone’s fault, and it is not caused by “weak or no control over emotions”, a misconception that is still far too common in Indian households.

So how many people in India live with this condition? A multi-site population study titled Bipolar affective disorder in India found that the lifetime prevalence of bipolar disorder in India is 0.5 to 1 percent. That means anywhere from 7 to 14 million Indians may be affected. The study also found that men and women are affected equally, and the most common age of onset is between 15 and 25 years, right when young Indians are finishing school, starting college, or entering the workforce (Vajawat et al., 2023).

Adding to that Clinical characteristics, sociodemographic profile, and treatment pattern of bipolar disorder - A multicentre study from India, found that the average delay between first symptoms and getting proper psychiatric help in India is over four years. Four years of suffering, misunderstanding, and often being told it is just “nerves” or “tension” (Reddy et al., 2022).

The Symptoms: More Than Just Mood

A manic episode is not just feeling happy. It is feeling invincible, it may be sleeping only two hours a night and feeling fully rested, talking so fast that no one can keep up, making grand plans or reckless decisions like emptying a bank account or starting three businesses in a week. Some people develop grandiose delusions, believing they have special powers or a mission to save the world.

On the other side, a depressive episode is a crushing weight, it may indicate loss of interest in everything, overwhelming fatigue, feelings of worthlessness, and sometimes suicidal thoughts. Many people with bipolar disorder spend far more time in depression than in mania, which is why they are often misdiagnosed with regular depression.

The key difference between bipolar disorder and normal mood swings comes down to three things: intensity, duration, and impairment. Normal mood swings are triggered by events, last a few hours, and do not stop you from working or maintaining relationships. Bipolar episodes can come out of nowhere, last for weeks, and completely derail your life. That is not a mood swing; that is a medical scenario.

Understanding Bipolar Disorder with the International Classification of Disorders ICD-10

The ICD-10 classifies mental health conditions under the codes of F01-F99, covering a wide range of mental, behavioural, and neurodevelopmental conditions. Bipolar disorder with its various episodes under F31. According to ICD-10, Bipolar affective disorder is characterized by repeated (i.e. at least two) episodes in which the patient’s mood and activity levels are significantly disturbed, this disturbance consisting of some occasions of an elevation of mood and increased energy and activity (mania or hypomania), and on others of a lowering of mood and decreased energy and activity (depression). Characteristically, recovery is usually complete between episodes, and the incidence in the two sexes is more equal than in other mood disorders. As patients who suffer only from repeated episodes of mania are comparatively rare, and resemble (in their family history, premorbid personality, age of onset, and long-term prognosis) those who also have at least occasional episodes of depression, such patients are classified as bipolar. Manic episodes usually begin abruptly and last for between 2 weeks and 4-5 months (median duration about 4 months). Depressions tend to last longer (median length about 6 months), though rarely for more than a year, except in the elderly. Episodes of both kinds often follow stressful life events or other mental trauma, but the presence of such stress is not essential for the diagnosis. The first episode may occur at any age from childhood to old age. The frequency of episodes and the pattern of remissions and relapses are both very variable, though remissions tend to get shorter as time goes on and depressions to become commoner and longer lasting after middle age.

Treatment: Yes, it is Manageable

Bipolar disorder is one treatable mental illness. The cornerstone of treatment is mood stabilisers, with lithium being the gold standard that has been used for decades. Atypical antipsychotics and certain anticonvulsants are also effective. Antidepressants are used carefully because they can trigger mania if given without a mood stabiliser.

But medication alone is not enough. Psychotherapy, especially psychoeducation, cognitive behavioural therapy, and social rhythm therapy helps people recognise early warning signs, stick with their medication, and maintain stable daily routines. In India, where family involvement is central to life, family-focused therapy can be particularly powerful.

The challenge is access. Research on bipolar disorders: an update on critical aspects highlighted that the treatment gap for bipolar disorder remains staggeringly high. Most psychiatrists are in cities, medications can be costly, and stigma keeps families from seeking help. The study called for integrating mental health into primary care and using digital tools to reach more people and a practical solution within a country (Olivia et al., 2025).

A paper on Stigma in Bipolar Affective Disorder, reveals that stigma remains one of the most significant barriers to treatment and recovery in India. The paper notes that people with bipolar disorder in India face both public stigma - negative attitudes, discrimination, and social distancing from the community - and self-stigma, where individuals internalise these negative beliefs, leading to shame, secrecy, and reluctance to seek help. The review found that stigma is deeply rooted in cultural factors, including family honour, marriage prospects, and the widespread misconception that mental illness is a sign of personal weakness or a result of past karma (Pal, Saxena & Avinash, 2021). This is especially damaging in the Indian context, where family involvement in care is high, and a diagnosis of bipolar disorder can affect not just the individual but their entire family’s social standing. The paper emphasises that addressing stigma through culturally sensitive psychoeducation, community awareness programmes, and involving families in treatment is critical to improving outcomes for people with bipolar disorder in India.

Bipolar Disorder in Indian Cinema and Pop Culture

While Bollywood has not yet given us a film that centres on bipolar disorder with full accuracy, there have been small but meaningful steps toward representation. The 2018 film Manto, based on the life of legendary Urdu writer Saadat Hasan Manto, touches on his struggles with alcoholism, Depression, Post Traumatic Stress Disorder - highlighting the partition and what many mental health professionals have retrospectively identified as possible bipolar traits - his periods of frenetic creative energy followed by crushing despair. It is not a clinical portrayal, but it opened conversations about how mood extremes have shaped some of India’s greatest artistic minds.

A Celebrity Who Opened Up: Deepika Padukone

One of India’s biggest film stars, Deepika Padukone, went public in 2015 about her struggle with depression and later spoke about experiencing bipolar tendencies during a difficult phase of her life. She did not just talk, she founded The Live Love Laugh Foundation, which works to destigmatise mental illness across India. Even pop singers like Jasmine Sandlas and Honey Singh have talked about bipolar tendencies, though it was not confirmed that they have a diagnosis of it which also highlights how important professional assessments are and how self-diagnosing can be confusing. When a celebrity of their stature says, “I went to therapy, I took medication, and I got better,” it reaches millions of people who might otherwise never hear that message. Her openness has been credited with encouraging more young Indians to seek help for mood disorders without shame.

The above discussed research and understandings, point to the same conclusion: early detection saves lives, and proper treatment allows people with bipolar disorder to lead full, productive lives. The difference between a mood swing and bipolar disorder is not subtle -it is the difference between a passing rain shower and a cyclone. And the more we talk about it openly, through films, web series, celebrities speaking up, and honest conversations at the dinner table; the sooner that treatment gap will close.

If you or someone you know is showing signs of bipolar disorder, please reach out to us or your nearest psychologist or psychiatrist. It is not a weakness. It is the bravest thing you can do.

References

• Olivia, V., Fico, G., Frisco, M. D., & Gonda, X. (2025). Bipolar Disorders: An update on Critical aspects. The Lancet Regional Health, 48, 101135. https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(24)00304-1/fulltext.
• Pal, A., Saxena, V., & Avinash, P. (2021). Stigma in Bipolar Affective Disorder: A Systematic Quantitative Literature Review of Indian Studies. Indian Journal of Psychological Medicine, 43(3), 187–194. https://doi.org/10.1177/0253717621996618.
• Reddy, Rao, G. P., Kumar, S., Seshadri, V., & Prasant, P. (2022). Clinical characteristics, sociodemographic profile, and treatment pattern of bipolar disorder - A multicentre study from India. Psychiatry Research Communications, 2(2), 100039. https://doi.org/10.1016/j.psycom.2022.100039.
• Vajawat, B., Suhas, S., Moirangthem, S., Kumar, C. N., Varghese, M., Gururaj, G., Benegal, V., Rao, G. N., & Group, N. N. C. (2023). Bipolar Affective Disorder in India: a multi-site population-based cross-sectional study. Indian Journal of Psychiatry, 65(12), 1230–1237. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_838_23.
• World Health Organization: WHO. (2025, September 8). Bipolar disorder. https://www.who.int/news-room/fact-sheets/detail/bipolar-disorder.