Bipolar Disorder | Why Do I Experience Such Extreme Emotional Highs and Lows?

A manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least one week. During this period, individuals often experience an inflated sense of self-esteem, a decreased need for sleep, increased talkativeness, and racing thoughts. This state is not simply feeling good; it is a significant deviation from a person's usual self and can lead to impaired judgment and risky behaviors. Neurologically, mania is associated with hyperactivity in brain circuits that regulate emotion and reward. Specifically, there is an excessive release and uptake of neurotransmitters, particularly dopamine, which is heavily involved in the brain's reward system. This surge in dopamine contributes to the feelings of euphoria, increased energy, and impulsivity characteristic of a manic state. Brain imaging studies show increased activity in areas like the prefrontal cortex and the amygdala, but the communication between these regions becomes dysregulated, leading to difficulties in controlling emotions and impulses.

A major depressive episode in the context of bipolar disorder involves a period of at least two weeks during which there is either a depressed mood or a loss of interest or pleasure in nearly all activities. This is accompanied by other symptoms, such as significant weight loss or gain, insomnia or hypersomnia, fatigue, feelings of worthlessness, and recurrent thoughts of death. Unlike unipolar depression, bipolar depression exists on a spectrum with mania. Brain function during a depressive episode is markedly different from that during a manic episode. There is often a reduction in the activity of key neurotransmitters, including serotonin, norepinephrine, and dopamine. Brain imaging reveals decreased activity in the prefrontal cortex, a region responsible for executive functions like decision-making and emotional regulation. Simultaneously, there can be heightened activity in the amygdala, the brain's fear center, which can contribute to feelings of anxiety and persistent low mood.

The transition between mania and depression in bipolar disorder reflects significant, yet reversible, changes in brain function. These shifts are driven by a dysregulation of neurotransmitters—the chemical messengers that transmit signals between nerve cells. During mania, there is an excess of dopamine and norepinephrine, leading to overstimulation of neural circuits. Conversely, during depression, the levels of these neurotransmitters, along with serotonin, are often depleted. Key brain structures, including the prefrontal cortex (for judgment), the amygdala (for emotion), and the hippocampus (for memory and emotion), show altered activity and connectivity. The core issue is a failure in the brain's ability to regulate these systems, leading to uncontrolled oscillations between extreme mood states.

Bipolar disorder is considered a chronic, lifelong medical condition that requires long-term management. While there is no cure, it is highly treatable. The goal of treatment is to stabilize mood and prevent the recurrence of manic and depressive episodes. This is typically achieved through a combination of medication, such as mood stabilizers, and psychotherapy. Consistent adherence to a treatment plan is crucial for managing symptoms and improving quality of life. Without ongoing treatment, the frequency and severity of mood episodes tend to increase over time. Therefore, continuous medical supervision and therapeutic support are essential components of managing the disorder effectively throughout an individual's life.

The distinction between bipolar disorder and normal mood swings lies in their intensity, duration, and impact on functioning. Everyday mood swings are typically reactions to life events, are relatively mild, and do not significantly impair a person's ability to work, study, or maintain relationships. In contrast, the mood episodes in bipolar disorder are extreme and persistent. A manic episode, for instance, must last at least one week (or less if hospitalization is required), and a depressive episode must last at least two weeks, according to diagnostic criteria like the DSM-5. These episodes represent a clear departure from a person's baseline and cause severe functional impairment, potentially leading to job loss, financial ruin, or damaged relationships. They are rooted in neurobiological dysfunction rather than being simple emotional reactions to daily life.