Understanding Bipolar Disorder AccuratelySymptoms, Treatment, Systems, and Misconceptions

Prerequisites for understanding bipolar disorder

In recent Japanese clinical documents, bipolar disorder is also referred to as "bipolar spectrum disorder" (sokyokusho). It is a disease that not only causes depression, but also periodic fluctuations in mood, activity level, sleep, speed of thinking, self-evaluation, and impulsivity. It's not just a matter of being moody or having periods of energy and periods of tiredness. It is a medical condition that affects the person's life, work, interpersonal relationships, financial management, health, and even life safety, and requires long-term follow-up observation for diagnosis and treatment.

What makes this disease difficult to understand is that symptoms appear in waves rather than in one direction. There are periods when he appears to be depressed, and then there are periods when he is very energetic, talks quickly, and can function without sleep. To those around them, a depressed person may appear to have recovered. I also feel that my health has returned to normal. However, medically speaking, this energy may not be a recovery but a manic or hypomanic state. The difficulty in maintaining illness awareness, or the ability to recognize one's own condition as a disease, is deeply related to this structure.

The World Health Organization estimates that as of 2021, there are approximately 37 million people with bipolar disorder worldwide. This is approximately 1 in 200 people. According to statistics from the National Institute of Mental Health, the lifetime prevalence among American adults is 4.4%, and the past year prevalence is 2.8%. On the other hand, the 2023 edition of the Japanese Depression Association's clinical practice guidelines states that the prevalence is approximately 0.1-0.4% based on epidemiological surveys in Japan. The differences in numbers between countries and survey methods are due to differences in diagnostic standards, survey interview methods, ease of detecting hypomania, and rates of consultation at medical institutions.

Bipolar disorder is less often talked about accurately in everyday conversation than schizophrenia or depression. Although it is not well known, it has a great influence on people's lives. In a place like the Pocho Research Institute, where mental illness and diverse ways of living are treated as knowledge, it makes sense to use bipolar disorder as the first subject. Understanding does not mean completely sharing the other person's pain. However, just knowing the symptoms, treatment, system, and points that are easily misunderstood will give you more information to make a decision. This will be a gateway to viewing mental illness not as a story of a distant world, but as a concrete problem of the human brain and social life.

History of disease names

The idea that mania and depression are linked as a single disease is not unique to modern times. The ancient Greek and Roman physician Aretaeus is said to have mentioned the possibility that mania and melancholia were different aspects of the same illness. Of course, the medical science of the time differed from modern neuroscience and diagnostic standards, but the observation that extreme mood swings and low moods are not separate but cyclically linked has existed for a long time.

An important turning point in modern medicine occurred in France in the 19th century. In the 1850s, psychiatrist Jean-Pierre Falret described alternating periods of elation and depression as a cyclic illness. Around the same time, Jules Baillarger also reported a biphasic condition of mania and depression. At this point, a framework began to be formed that viewed it as a psychiatric illness with a course, rather than just a problem of personality or morality.

From the end of the 19th century to the beginning of the 20th century, German psychiatrist Emil Kraepelin broadly grouped recurrent mood disorders including mania and depression as manic-depressive disorder. Kraepelin was also a person who emphasized the distinction between schizophrenia and its predecessor concept, early-onset dementia. His classification created the basis of modern psychiatry, which classifies mental illnesses not by the moment of their symptoms, but by age of onset, course, and prognosis.

It took further research in the second half of the 20th century to arrive at the current concept of bipolar disorder. In the 1950s and 1960s, Karl Leonhardt, Jules Angst, Carlo Peris, and George Winokur conducted research to distinguish between unipolar depression and bipolar disorder. Unipolar depression refers to a state in which there are mainly depressive episodes without mania or hypomania. Bipolar disorder has episodes of mania or hypomania as well as depression. DSM-III, published in 1980, further clarified diagnostic criteria and placed bipolar disorder within the modern classification.

Knowing this history shows that the disease name bipolar disorder is not a buzzword that was suddenly coined. Ancient observations, 19th century clinical descriptions, Kraepelin's progression classification, late 20th century epidemiological studies, and the diagnostic systems of the DSM and ICD have all accumulated to form our current understanding. Although the name of the disease has changed, the phenomenon of waves of mania and depression affecting one's life has long been observed.

Difference from depression

The difference between bipolar disorder and depression is not determined solely by the severity of the depression. The biggest difference is whether the person has had past or present manic or hypomanic episodes. People with depression may also experience profound despair, sleep disturbance, appetite changes, poor concentration, and suicidal ideation. Similar depression occurs in people with bipolar disorder. Looking only at the symptoms, it is difficult to distinguish between the two based on the period of depression.

Mania is a state in which a person not only has an abnormally high or irritable mood, but also becomes hyperactive, can tolerate little sleep, overestimates one's abilities, talks continuously, has racing thoughts, and can lead to overspending, reckless investing, sexual deviance, fighting, excessive planning, and dangerous driving. According to the DSM-5, mania is defined as a state that lasts for more than a week and is severe enough to significantly interfere with social and occupational life, or to require hospitalization. It may also be accompanied by hallucinations and delusions.

Hypomania is milder than mania, but it is different from just being in a good mood. Changes in mood and activity level have lasted for at least 4 days, and the person appears to be in a different state than usual even to those around him. However, it is not severe enough to cause significant functional impairment or require hospitalization. Hypomania may be accompanied by feelings of pleasure for the individual. My work progresses, I come up with ideas, I can talk to people, and I feel okay even if I don't sleep. Therefore, it is difficult to report it as a disease. The reason bipolar II disorder tends to be treated as depression for a long time is because this hypomanic state is overlooked.

Bipolar I disorder is diagnosed when a person experiences distinct manic episodes. Bipolar II disorder is diagnosed when a person experiences periods of hypomania (less than mania) and depression. Bipolar II does not necessarily lead to a lighter life. In fact, depression can last for a long time, tend to become chronic, and increase the risk of suicide. A mixed state of depression and depression, which is less visible, may cause the person to suffer for a longer period of time than the flamboyant mania that is easy to see in daily life.

The difference from depression is important because the treatment changes. Antidepressants are sometimes used to treat general depression, but for bipolar disorder, treatment with antidepressants alone can lead to manic transitions and rapid deterioration. Manic transition is a switch from a depressive state to mania or hypomania. Rapid alternation refers to a process in which a person experiences four or more mood episodes in a year. Of course, the choice of drug varies from person to person, and the attending physician will make a decision based on past medical history, family history, current symptoms, and side effects. However, the main difference between treatment for bipolar disorder and depression is that it focuses on mood stabilizers and some antipsychotics.

Why don't we hear much about mania?

In everyday language, we often hear the word depression. On the other hand, the word mania is rarely heard. There is a change in the diagnostic system here. In modern psychiatry, mania is often treated as a component of bipolar disorder rather than as an independent disease. Once a person has had a clear manic episode, it is considered bipolar I disorder, even if depression is not evident at the time. Although some studies have examined the concept of unipolar mania, which includes only mania, current standard DSM and ICD practice understands mania within the context of bipolar disorder.

However, in drug package inserts and old clinical contexts, the terms mania and manic-depressive states may still be used. This is because the history and institutional notation of disease names overlap, and the wording is not exactly the same as modern clinical understanding. In the package insert for Rimath (lithium carbonate), the expressions `mania'' and `manic depression'' are also used as indications or effects. In other words, the word mania has not disappeared, but is now placed within the broader concept of bipolar disorder.

Another important point is when symptoms similar to mania occur due to other causes. Hyperthyroidism, brain disease, drugs, steroids, stimulants, sleep deprivation, and developmental hyperactivity can all lead to a manic-like state. The guidelines of the Japan Depression Society also state that if a manic state first appears after the age of 40, or if the course is atypical, it is necessary to consider secondary mania caused by a physical illness or medication. The reason why it cannot be dismissed simply with the word mania is due to the difficulty in making a diagnosis.

How many people are affected

When considering the frequency of bipolar disorder, it is difficult to settle on a single number. The World Health Organization estimates it to be approximately 1 in 200 people, and a U.S. study puts the lifetime prevalence among adults at 4.4%. In Japan, estimates are as low as 0.1 to 0.4%, while some Internet surveys have reported that the rate for bipolar type I and type II cases is around 0.6%. The reason why the numbers vary is that it depends on the degree to which you can pick up on hypomania.

People with bipolar disorder are more likely to seek medical attention when they are depressed. When a person is in a hypomanic state, the person is often not in trouble.In fact, they often feel better than usual. Your work progresses, you become more sociable, you sleep less, and your ideas increase. The people around me accept that I am temporarily feeling better. As a result, patients may be diagnosed with depression during a medical examination, only to later discover that they have had past hypomania.

The age of onset is said to be between the late teens and early 20s. This is a time when school life, going on to higher education, finding employment, love, becoming independent, and disrupting sleep rhythms tend to overlap. Twin studies have estimated the heritability of bipolar disorder to be as high as 70-90%. However, this does not mean that it is always inherited from parent to child. Heritability is a statistic that shows how much genetic factors are involved in the difference in susceptibility to a disease within a group. The actual onset of the disease is related to sleep, stress, drugs, physical illness, living environment, and psychosocial factors.

Bipolar disorder is not so rare that it is exceptional, but not so common that everyone has accurate, practical knowledge close at hand. This in-between frequency itself makes understanding difficult. A relatively large number of people have heard of schizophrenia and depression.Many people know the term bipolar disorder, yet their understanding often stops at a rough image of alternating highs and lows. In reality, mania, hypomania, depression, mixed states, and remission combine differently over time from person to person.

Difficulty in understanding pathology

Awareness of the illness is a major theme in the treatment of bipolar disorder. Illness awareness is the ability to recognize that one's condition is changing due to illness. When a person is depressed, they are more likely to be aware of their suffering. This is because the pain of not being able to sleep, not being able to move, wanting to die, and not being able to enjoy anything is so strong. On the other hand, in hypomanic or manic states, it is difficult to feel that one is sick. In fact, I sometimes feel like I have returned to my true self, that my abilities have blossomed, and that I can do anything now.

At this time, the perception of the surroundings becomes misaligned. Family members and co-workers notice when you can't stop talking, aren't sleeping, get angry, suddenly make a big purchase, or take on too much work. The person may feel that those around him or her are bothering him or her. Decreased awareness of illness is not a flaw in one's personality, but is linked to the symptoms of the disease itself. Particularly in manic states, inflated self-evaluation, impaired judgment, and impulsivity occur simultaneously, making it difficult to accept the need for treatment.

In diagnosing bipolar disorder, it is necessary to carefully listen not only to the person's current mood but also to their past history. At what age did you start having waves? Was there ever a time when you didn't need to sleep? Have you ever been told that you look like a different person? Are you experiencing periodic overspending, job changes, starting a business, love affairs, interpersonal problems, excessive self-confidence, or irritability? Do you have a family history? This information is difficult to obtain in a single consultation. Mood records, sleep records, and information from family members often help with diagnosis and treatment.

The reason for the delay in diagnosis also lies on the doctor's side. Non-specialist doctors and pharmacists may not be able to immediately make the connection between lithium carbonate and bipolar disorder. Psychiatric drugs cover multiple areas such as epilepsy, migraines, neuralgia, sleep, and mood disorders, so it is difficult to immediately determine the disease name based on the drug name alone. That's why there are times when the person himself or herself doesn't want to answer. Information on mental illness is deeply related to privacy. Although it is important to have knowledge, it is also necessary to be considerate in not forcing explanations on the other person.

Suicide risk and mixed conditions

One of the most serious problems with bipolar disorder is the risk of suicide. The Japan Depression Association's clinical practice guidelines state that the suicide rate for people with bipolar disorder is 20 to 30 times higher than the general population. The World Health Organization also points out that bipolar disorder can coexist with suicide risk, anxiety disorders, and substance use disorders. These are not numbers meant to stir up fear. These numbers indicate the need for appropriate treatment, sleep management, understanding of those around you, and a crisis response plan.

Suicide does not simply occur during the most severe moments of depression. In deep depression, even if you feel like dying, you may not be able to move. Afterwards, when one's activity returns a little, the strength to act may return even though the feeling of hopelessness remains. Although this explanation is often used in clinical settings, it does not explain all cases. In bipolar disorder, mixed states can be particularly dangerous.

A mixed state is a state in which the suffering of depression and manic activity and irritability coexist. I feel depressed, but my mind won't stop, I can't sleep, I'm irritable, and I can't sit still. The combination of feelings of hopelessness, agitation, and impulsivity can easily lead to suicide attempts. To those around you, the condition may appear more restless and aggressive than simple depression. However, inside him, extreme pain and uncontrollable energy are running at the same time.

High-risk periods include immediately after being discharged from the hospital, after discontinuing medication, when sleep is disrupted, significant loss of work or relationships, alcohol or drug use, past suicide attempts, and the manifestation of severe insomnia, agitation, and suicidal thoughts. In times like these, enthusiasm and persuasion alone are not enough. Priority is given to connecting with your doctor, family, emergency services, and local consultation centers. The risk of suicide in bipolar disorder needs to be understood not as a weakness of the individual, but as a result of a combination of the disease process, impulsivity, sleep, and feelings of hopelessness.

Center of drug therapy

Pharmacological treatment for bipolar disorder focuses on mood stabilizers and some antipsychotics. Typical mood stabilizers include lithium carbonate, sodium valproate, carbamazepine, and lamotrigine. Antipsychotic drugs such as aripiprazole, olanzapine, quetiapine, and lurasidone are used depending on the disease phase, such as mania, depression in bipolar disorder, and prevention of relapse. Which drug is suitable for you will depend on factors such as how strong your mania is, whether you have been depressed for a long time, whether you have a mixed condition, your fertility, kidney function, liver function, weight gain, sleepiness, and hand tremors.

Rimath is lithium carbonate; it is not valproate. Depakene and Depakene R are sodium valproate. In 1949, Australian psychiatrist John Cade reported that lithium carbonate was effective against manic states, and its effectiveness was subsequently verified by research by Denmark's Mogens Shaw and colleagues. Lithium is a classic and important drug in psychiatry and has long been studied for the treatment of mania, prevention of relapse, and reduction of suicide risk.

A feature of lithium carbonate is that control of blood concentration is extremely important. According to the guidelines of the Japan Depression Society, the effective blood concentration of lithium is 0.5 to 1.0 mEq/L. The package insert requires blood concentration measurements to be performed approximately once a week at the start of treatment or when increasing the dose, and approximately once every 2 to 3 months during the maintenance phase. If the concentration is too low, it will not be effective, and if the concentration is too high, there is a risk of poisoning. Lithium poisoning can cause nausea, diarrhea, lightheadedness, hand tremors, loss of consciousness, and convulsions. Dehydration, fever, diarrhea, diuretics, nonsteroidal anti-inflammatory drugs, and some antihypertensive drugs can affect blood levels.

Based on NDB data on new lithium prescriptions from 2010 to 2023, PMDA has issued a warning stating that serum lithium concentration measurements may not have been confirmed in 54.12% of approximately 500,000 prescriptions. This does not mean that lithium is a dangerous drug and should not be used. Rather, it means that it is a drug that exhibits its value when used with appropriate measurements. In the treatment of bipolar disorder, a mechanism for safely continuing medication is as important as administering the medication.

Generic drugs include products with the generic name on the front, such as lithium carbonate tablets 100mg and lithium carbonate tablets 200mg. Examples that can be confirmed as of 2026 include lithium carbonate tablets 100mg and 200mg "Fujinaga". In the past, there were products with different brand names, but the supply and transitional arrangements change. Even if the drug dispensed at a pharmacy is labeled by the generic name lithium carbonate rather than the brand name Rimath, the active ingredient is the same. However, the method of taking the drug, the number of tablets, blood concentration, and changes in physical condition must be confirmed under the supervision of a prescribing physician and pharmacist.

Depakene and Depakene R are sodium valproate. Originally known as an antiepileptic drug, it is also used to suppress the onset of migraine attacks. In bipolar disorder, it is sometimes used for manic and mixed states. According to the guidelines of the Japan Depression Society, the effective blood concentration of valproic acid is 50 to 100 μg/mL. Hepatic dysfunction, hyperammonemia, thrombocytopenia, drowsiness, weight gain, etc. require attention, and regular blood tests are performed.

Regarding valproic acid, it is not accurate to simply say that it is a drug that does not work. There are studies showing its effectiveness in treating mania, and it is also used clinically. However, the Japanese package insert cautions that no clear evidence has been obtained in domestic or international clinical trials for long-term use of the drug for more than three weeks for mania and manic-depressive symptoms. For this reason, it is necessary to consider separately its role as a drug for suppressing mania in the acute phase and its role in preventing relapse in the long term. The decision to use lithium, valproic acid, lamotrigine, or antipsychotics is based on the phase of the illness and the risk of side effects.

Valproic acid should be treated with particular caution in people of childbearing potential. The World Health Organization also warns against using it during pregnancy, breastfeeding, or those who may become pregnant, as the effects on the fetus are a concern. This should not be treated as an issue only for women. Treatment options, pregnancy plans, side effects, and risk of recurrence need to be considered together with the patient's life plan.

Treating the structure of life, not just drugs

Treatment of bipolar disorder is not limited to medication alone. Medicine is an important pillar of reducing the waves and preventing recurrence. However, sleep, daily rhythm, stress, interpersonal relationships, workload, alcohol, caffeine, staying up late, and seasonal changes affect the disease phase. Sleep is especially important. Even if a person feels fine without sleeping, it can be a gateway to mania or hypomania.

Psychoeducation has great significance in the treatment of bipolar disorder. Psychoeducation means that the patient and their family learn about the mechanism of the disease, signs of recurrence, the role of medications, sleep management, and stress management. Cognitive behavioral therapy, family therapy, and interpersonal/social rhythm therapy have also been studied. Interpersonal relationship/social rhythm therapy is based on the idea that daily rhythms and interpersonal stress affect mood episodes. Stabilizing daily wake-up times, bedtimes, meals, starting work, and social contacts may be subtle but related to relapse prevention.

This does not mean that people with bipolar disorder cannot have a social life. In fact, when the waves become smaller through appropriate treatment, many people are able to use their abilities, concentration, responsibility, and creativity in a stable manner. The important thing is not to think too much that your true ability lies only in times of high tension. Although the momentum of hypomania may seem appealing, it can be accompanied by sleep deprivation, poor judgment, friction with those around you, and the repercussions of depression later on. Stability is not boring; it is the foundation for continuing to work for a long time.

The question of whether it is curable or not requires a careful answer. Bipolar disorder is a recurrent illness, and it is more realistic to think of it as an illness that will be with you for a long time than to think that it will disappear completely and never be associated with it again. However, this does not mean there is no hope. It is possible to remain in remission, meaning that the symptoms have subsided, and to continue working, home, creating, and studying. The World Health Organization also explains that symptoms can come back, but recovery can occur between episodes. Bipolar disorder is not a disease that can be cured or given up on, but rather a disease that requires predicting its waves, intervening early, and designing a lifestyle.

Japan's medical system and independence support

In Japan, treatment for bipolar disorder is carried out in psychiatry, mental clinics, psychosomatic medicine, etc. However, psychosomatic medicine is originally a field that deals with diseases that involve physical symptoms and psychological factors, and psychiatric expertise is important when diagnosing bipolar disorder and adjusting medications. The actual signboards vary by region, so it is important to connect with a doctor who can continue to treat mood disorders.

If you need to go to the hospital for a long period of time, you may be able to use outpatient psychiatric care as an independence support medical treatment in Japan. This system is designed to reduce the out-of-pocket burden of ongoing outpatient treatment for mental illnesses. Even if people pay 30% out-of-pocket under normal public medical insurance, if they become eligible for independence support medical care, they will generally have to pay 10%, and a monthly limit is set depending on their income category. Targets include schizophrenia, mood disorders, epilepsy, anxiety disorders, developmental disorders, etc., and bipolar disorder is also treated as a mood disorder.

Target areas include outpatient medical treatment, outpatient medicine, day care, and home-visit nursing. Inpatient medical care and medical care not directly related to mental illness will not be covered. Applications must be made at the municipal office and will require a medical certificate, insurance card, and income verification documents. In principle, the validity period of a beneficiary certificate is one year or less, and it must be renewed for continuation. Because this system is used at designated medical institutions and pharmacies, procedures may be required when changing hospitals or pharmacies.

The system is not designed to show people the severity of the disease. This is the foundation for long hospital visits, continued medication, and prevention of recurrence. People with bipolar disorder may find themselves wanting to stop going to the hospital or stop taking medication when their symptoms subside. If the cost burden is heavy, interruptions are likely to occur. The system to lower medical costs is not just financial support, but also a mechanism to prevent recurrence.

Creativity and bipolar disorder

The relationship between bipolar disorder and creativity needs to be treated with caution. Psychiatrist and psychologist Kay Redfield Jamison has published her experiences with bipolar disorder and has researched and written about the relationship between mood disorders and artistic temperament. Her writings gave many people an inside look at bipolar disorder. On the other hand, it does not follow that just because mania breeds creativity, it is better not to treat it.

In a hypomanic state, people can associate more quickly, become more confident, become more active, and may find it easier to create or plan projects. Some writers, musicians, painters, actors, and entrepreneurs talk about mood waves as a source of creative energy. Examples that he has publicly spoken about include Kay Redfield Jamison, actor and author Carrie Fisher, singer Mariah Carey, and actor Catherine Zeta-Jones, who have spoken out about bipolar disorder and bipolar II disorder. These announcements show that illness does not mean incompetence.

However, it is dangerous to conclude that historical figures or famous artists had bipolar disorder using modern diagnostic criteria. Although people such as Van Gogh, Hemingway, Schumann, and Churchill are often talked about in relation to mood disorders, they have not been evaluated by modern psychiatric examinations. Although we can make inferences based on diaries, letters, and biographies, this is different from a medical diagnosis. The same goes for military commanders from the Sengoku period and politicians of the past, and it is not possible to determine that someone has bipolar disorder based solely on their fierce determination or passion.

When thinking about creativity, it is important not to glorify illness. A manic state can produce works, or it can destroy one's life. It is associated with sleep deprivation, wasteful spending, interpersonal problems, dependence, impulsive decisions, accidents, and suicide risk. Creative people do not become mediocre through therapy. Treatment can save you the time, body, and trusting relationships you need to continue creating. Stability is necessary in order to accumulate work over a long period of time, rather than in the moment of intense waves.

A little fun fact: before lithium is a drug, it's also an element. It is an alkali metal with atomic number 3 on the periodic table, and is one of the light elements that existed in the early universe. Lithium in batteries and lithium carbonate in medicine are used in different ways and forms, but the same element name appears in both the modern energy industry and psychiatry. This coincidence is easily remembered as a trivia when discussing the treatment of bipolar disorder.

Reducing misunderstandings

A common misconception about bipolar disorder is that it is simply a person who experiences mood swings. In fact, not only mood, but also sleep, activity level, judgment, impulsivity, cognition, interpersonal relationships, and bodily rhythms change. Another misconception is that mania is less of a problem because it seems fun. During a manic episode, it may be difficult to see the person's distress, but it can later have a major impact on work, debt, relationships, credit, and health.

Another misconception is the idea that if you take drugs, your personality will disappear. Medication side effects can include drowsiness, sluggishness, hand tremors, and weight gain. It is true that there are some drugs that are not suitable for you. However, the purpose of medicine is not to erase a person's personality, but to reduce the wave of illness and make it easier to use the power that the person originally has. When adjusting medication, not only symptoms but also quality of life are important. Telling your doctor specifically about your side effects and concerns will improve the accuracy of your treatment.

What those around you can do is not make a random diagnosis. It is important to share the facts of changes such as sudden inability to sleep, inability to stop talking, increased waste of money, increased aggression, inability to move for long periods, desire to die, quitting drugs, increased alcohol use, etc., as facts rather than blaming them. For people with bipolar disorder, stable relationships can help detect relapse early. However, it is not necessary for a family member or friend to become a therapist. The focus will be on practical support, such as connecting patients to medical care, not leaving them alone in an emergency, protecting their sleep, and stopping money and contracts from spiraling out of control.

Bipolar disorder is not an illness for which the person is not making efforts. It's not a disease that can be cured through effort alone. The brain, genetics, sleep, lifestyle, stress, medicine, and social environment are involved. That is why the patient's self-understanding, knowledge of those around him, use of the system, and continuity of medical care need to overlap. Knowing about mental illness does not mean giving special treatment to the other person. It becomes the basis for understanding the differences concretely and distinguishing between necessary consideration and unnecessary prejudice.

Position as a summary

Bipolar disorder is a recurrent mood disorder with periods of depression, similar to depression, and periods of mania or hypomania. The frequency varies depending on the survey, but it is said to be approximately 1 in 200 people in the world and 0.1 to 0.4% in Japan. Onset often occurs between the late teens and early 20s, and while genetics are a major factor, sleep, stress, lifestyle, drugs, and the environment also play a role. In diagnosis, it is important to detect past mania or hypomania, which may be overlooked as depression for a long time.

The mainstays of treatment include lithium carbonate, sodium valproate, lamotrigine, carbamazepine, and some antipsychotics. Rimath is lithium carbonate, and Depakene and Depakene R are sodium valproate. Lithium is a drug that is used while measuring blood levels, and proper management can help prevent recurrence and lower the risk of suicide. Valproic acid is sometimes used for manic symptoms, but careful judgment is required, including the rationale for long-term use and the effect on fertility.

Bipolar disorder does not have to be treated as a life-destroying illness. At the same time, there is no need to glorify it as a source of talent. With medicine and lifestyle changes, we can reduce the waves and create a sustainable form of creativity and passion for work. It's not that people get sick because they're incompetent, but even capable and socially successful people can suffer greatly from mood swings.

The meaning of knowing about this disease is not to memorize its classification name. It is important to understand that there may be a medical reason behind your depression and energy. Don't pretend to know everything about the other person, but don't ignore them ignorantly either. In between is a sense of distance based on knowledge. Accurately understanding bipolar disorder is a step toward a more concrete understanding of the diversity surrounding mental illness, rather than an abstract and kind understanding.