Bipolar Alternating Depressed

The bipolar affective disorder is characterized by alternating depressed (depressive) and euphoric (manic) moods – hence the formerly common term “manic-depressive illness”. These manic phases are one of the reasons why the disease differs from depression. The mood changes typical of the disease are also often described with the winged word “sky-high cheering, saddened to death” from Goethe’s “Egmont”.

Signs of a manic episode are overactivity, reduced need for sleep, unrestrained behaviour or exaggerated self-assessment. Depressive episodes are characterized by a depressed mood, feelings of guilt or a lack of joy and lust.

In contrast to mentally healthy people, the mood changes described in bipolar patients are often not more closely related to external living conditions and are increased in duration and intensity.

Who is affected by the bipolar disorder?

In Europe, about 3% of the population suffer from a classic manic-depressive disorder (so-called bipolar I disorder) in the course of their lives. If other minor forms of bipolar affective disorder are also included, the proportion of people affected increases to up to 5%.

This makes the disease one of the more frequent in the psychiatric field. Since a bipolar affective disorder is often not recognized, it usually takes many years from the first episode of the disease to the correct diagnosis.

The bipolar affective disorder, or bipolar disorder for short, usually begins before the age of 25 and thus on average more than ten years earlier than a “pure” depression (unipolar depression).

Men and women are affected about equally frequently, with one exception: women suffer twice to three times as often from so-called rapid cycling, a special form of the disease in which manic and depressive phases often alternate (four or more phases per year). Young people can also suffer from a bipolar effective disorder.

How does a bipolar disorder develop?

It is not exactly clear how the disease develops. It is assumed that there is an interplay between various factors that ultimately lead to disorders in the brain metabolism. To put it simply, the bipolar disorder leads to an imbalance of various carriers in the brain, so-called neurotransmitters. The neurotransmitter noradrenaline in particular is likely to play a decisive role in the development of the disease.

The manic-depressive disease, which is characterised by manic, depressive and mixed phases, breaks out at a relatively young age, occurs similarly often in different cultures and occurs more frequently in families.

First-degree relatives of bipolar patients have a tenfold higher risk of developing bipolar affective disorders than the general population. If both parents suffer from a bipolar disorder, the risk of their children contracting the disease even increases to 50%.

Symptoms of a bipolar disorder

Typical for the bipolar affective disorder are fluctuations of the basic mood in both directions; phases of euphoria and depression alternate. In between there are also phases of balanced mood.

As with unipolar, i.e. “pure” depression, bipolar disorder affects not only mood but also other areas such as drive, thinking and biorhythm.

Disease episodes and course of a bipolar disorder

The frequency of the disease episodes and the course of the bipolar disorder vary greatly from person to person.

The following disease states are distinguished:


The manic episode is characterized by an elevated mood that does not correspond to the circumstances. This can vary between carefree cheerfulness and uncontrollable excitement. Those affected are restless, overactive and feel a constant urge to move.

They think they have unlimited physical and mental energy and do not feel psychologically ill in any way. Dealing with other people is often without distance, the affected people typically speak a lot, quickly and uninhibitedly.

Concentration and attention are impaired, there is an increased ability to distract, often one thought chases the other. It is practically impossible to practise a profession in this state. Those affected, for example, start unrealisable projects or spend a lot of money recklessly.

Characteristic of mania is a reduced need for sleep, and sexual desire (libido) can also be increased. Very severe manic episodes can sometimes lead to delusions (delusions of grandeur, persecution).


Hypomania is characterized by a disease pattern similar to mania, but it is more pronounced and usually lasts shorter. The symptoms do not reach such an extent that the patients are significantly impaired in their lifestyle, i.e. can no longer pursue their profession or meet with massive social rejection.

Even in a hypomaniac episode, those affected usually do not perceive any changes worthy of disease; on the contrary, they usually feel particularly healthy, vital, attractive, creative, sociable, talkative and efficient. This is why relatives of people with a bipolar disorder should be particularly attentive and seek medical help at the first sign of an elevated mood or increased drive. Because often a hypomania turns into a mania.


In a depressive episode, bipolar patients show the same symptoms as people with a unipolar depression, i.e. depressed mood, lack of drive, joy and interest. Self-reproaches and feelings of guilt can arise, which sometimes refer to the consequences of manic excesses (e.g. loss of friends, debts).

Those affected show inhibited facial expressions, gestures and language and withdraw socially. In addition, appetite and sexual activity can decrease. Typical are also sleep disorders with early awakening. Depressive episodes usually last a little longer than manic episodes.