Bipolar Disorder: What It Is and What It Is Not

This article is general information published by the practice of Dr. Sholeh Toobaei, Specialist Psychiatrist, Dubai. It has not yet been individually reviewed by a clinician and is not a substitute for personal medical advice. Published: 1 September 2026.

Scope: This article is general information about bipolar disorder. It is not a diagnosis and cannot tell you whether you or someone you know has bipolar disorder. Only a proper clinical assessment can do that.

What is bipolar disorder, in plain terms?

Bipolar disorder is a condition where a person's mood, energy, and activity levels go through periods that are significantly above normal and significantly below normal. The "below" periods are indistinguishable from regular (unipolar) depression. The "above" periods are what make it different — they are not just "good moods." They are states of unusually elevated energy, reduced need for sleep, faster thinking and speech, and often poor judgement.

The word "bipolar" refers to these two poles — high and low. Between episodes, many people return to a normal baseline. Some experience mild symptoms between episodes. Some have periods of what is called hypomania — a milder form of the high state — and some have full mania, which can be severe enough to require hospitalisation.

The key point: bipolar disorder is not mood swings in the everyday sense. It is not getting upset when something goes wrong. The mood shifts in bipolar disorder are extreme, prolonged (days or weeks at a time), and they happen without a proportionate trigger.

What are the different types?

Bipolar I disorder involves at least one episode of full mania. The depressive episodes are common but not strictly required for the diagnosis — a single manic episode is enough. Mania is serious. It can involve behaviour that has serious consequences: reckless spending, risky sexual behaviour, impulsive business decisions, aggression. People in a manic episode often do not feel ill — they feel better than ever. That lack of insight is part of the condition.

Bipolar II disorder involves hypomania (the milder high) and major depression. Because the highs are less dramatic, bipolar II is often missed. A person presents with depression, is prescribed an antidepressant, gets worse, and nobody connects the dots. This is a known diagnostic challenge, and it is one of the reasons why psychiatrists spend extra time asking about periods of unusually high energy.

Cyclothymic disorder is a milder, chronic form where a person has numerous periods of hypomanic and depressive symptoms that do not meet the full criteria for episodes. The mood fluctuations are ongoing but less extreme. It still causes significant problems and still requires treatment.

How is bipolar disorder diagnosed?

By history. There is no blood test, no scan, no lab result for bipolar disorder. The diagnosis depends on the person's story — what their mood has been like, how long the episodes lasted, whether there were periods of unusually high energy, and what the family thinks. Family members often have valuable information about periods the person themselves does not recognise as unusual.

The most important question a psychiatrist will ask is: "Have you ever had a period where you needed much less sleep than usual and still had enormous energy?" If the answer is yes, and that period lasted at least a few days, the psychiatrist will think carefully about whether this could be bipolar disorder rather than simple depression. This matters because the treatment for bipolar disorder is different from the treatment for unipolar depression.

Misdiagnosis is common. People with bipolar disorder often see several doctors before getting the right diagnosis, because the depressive episodes are the ones that bring them in, and the manic or hypomanic periods can feel like recovery rather than illness. The average time from symptom onset to correct diagnosis is eight years. This is improving, but it is still a real gap.

What causes bipolar disorder?

Genetics play a very strong role. Bipolar disorder runs in families more than almost any other psychiatric condition. If a first-degree relative has bipolar disorder, the risk is substantially higher than average. But genes are not destiny — environmental triggers matter too. Sleep disruption is a particularly well-known trigger for manic episodes. Stress, major life changes, substance use, and even seasonal changes can all play a role.

The biological mechanism involves the brain's mood-regulating circuits — the same circuits involved in depression, but with an additional instability that pushes in both directions. This is why mood stabilisers, which smooth out the extremes in both directions, are the cornerstone of treatment.

What treatment looks like?

Medication is usually the foundation. Mood stabilisers — lithium, valproate, lamotrigine, and some newer agents — are designed to reduce the amplitude of the mood swings. They do not erase personality or make you feel numb. They reduce the risk of the next episode, and over time they protect the brain from the damage that repeated untreated episodes can cause.

Antipsychotic medications are also used, not because people with bipolar disorder are psychotic (though some can be during severe episodes), but because many of these medicines have proven mood-stabilising properties.

Psychotherapy, particularly cognitive behavioural therapy and interpersonal and social rhythm therapy, helps people recognise the early warning signs of episodes, manage stress, maintain regular sleep schedules, and stick with treatment.

The single most important thing a person with bipolar disorder can do for themselves is protect their sleep. Sleep disruption is the number one trigger for manic episodes. A regular sleep schedule is not a lifestyle suggestion — it is part of the treatment plan.

Can bipolar disorder be managed well?

Yes. Many people with bipolar disorder live full, productive, meaningful lives. The key is early diagnosis, consistent treatment, and knowing the early warning signs of your own episodes. Most people develop a sense of what their mania feels like before it becomes full-blown — a period of reduced sleep, increased confidence, more social activity than usual. Catching it early and adjusting treatment can prevent a full episode.

The condition is lifelong, but it is treatable. Accepting that and committing to the treatment plan is one of the hardest and most important steps a person can take.

When should I seek help?

If you are experiencing periods of unusually high energy, reduced need for sleep, racing thoughts, impulsive or reckless behaviour, or if you are depressed and have ever had periods of high energy, seek a professional assessment. Also seek help if a close friend or family member has noticed extreme mood changes in you. Seek urgent help — call 999 (police) or 998 (ambulance) in the UAE, or go to the nearest emergency department — if you are having thoughts of self-harm, if you are behaving in ways that put yourself or others at risk, or if you have stopped sleeping for several days and feel increasingly agitated. For non-urgent enquiries, use the appointment request form on this website. This practice does not operate a monitored telephone line, and a message sent through the form may not be read straight away.