UNDERSTANDING BIPOLAR DISORDER
In bipolar disorder, phases of extreme elation or restlessness alternate with deep depression. They often last weeks or months and usually come without an obvious reason. In between, there can be long stable periods. The illness is treatable, but usually stays with people for life.
Bipolar disorder is an illness of mood and energy. 'Bipolar' means 'two poles': people affected go through phases in which they are extremely wound up or irritable, and phases of deep low mood. It used to be called 'manic depression'.
It has nothing to do with moodiness or weak character. The illness comes from a predisposition; triggers such as stress or lack of sleep can set off individual phases. It usually starts in young adulthood.
Hardly any sleep needed and still full of energy. Thoughts race, plans keep getting bigger, decisions riskier – such as expensive purchases or quitting a job on the spot. Some people mainly become irritable.
The milder form is called hypomania. It often feels good – and is therefore rarely recognised as part of the illness.
Lack of energy, hopelessness, sleep problems, withdrawal. Everyday things become a huge effort.
60 to 80% of bipolar disorders begin with a depression.1 That's why the illness is often only correctly recognised late.
Both can also happen at the same time. Professionals then speak of mixed states.
Simplified illustration – every course is different.
Mood and energy rise or fall over days or weeks. A phase is often announced by small changes, such as less sleep. Afterwards, mood usually returns to a balanced range. However, a manic phase is often followed by a depressive one. In some people, phases change very quickly, four times a year or more. Professionals then speak of rapid cycling.
At least 80% of people affected can name one or more warning signs. The most common early sign of mania is changed sleep. Manic warning signs last more than 20 days on average.2
In a third to half of people with bipolar I disorder, mania is followed by depression within a few weeks.3
If four or more phases occur within twelve months, this is called rapid cycling. It affects some of the people affected, often only for a certain time.4
At least one pronounced manic phase. Usually there are depressive phases as well.
Depressive phases and milder highs (hypomania), but no full mania. The depressive phases are often in the foreground – so this form is not milder.
Milder mood swings up and down that recur over a long time, without reaching the full extent of mania or depression.
Bipolar disorder doesn't only affect mood. It can reach into every area of life – even at times when people seem to be doing well.
The World Health Organization counts bipolar disorder among the ten illnesses that most often lead to long-term disability worldwide.1 At the same time: with the right treatment, many people affected stay stable for a long time. What matters is recognising changes early.
Treatment usually rests on two pillars that complement each other.
Treatment is usually based on mood stabilisers such as lithium, often combined with other psychiatric medication. Many people affected take several medications at the same time.13 Finding the right combination takes patience: doses are adjusted, substances changed, blood levels checked. Side effects such as tiredness, weight gain or tremor can be very burdensome.
Important: never stop medication on your own. Always discuss changes with your clinicians.
In addition, the German S3 guideline recommends psychoeducation and psychotherapy, for example cognitive behavioural therapy.14 There, people affected learn to recognise their personal early warning signs, create a crisis plan and stabilise their daily routine and sleep-wake rhythm. Family and friends can be involved too.
Early warning signs are different for everyone, and over months it is easy to lose track. Even with good treatment, about half of people affected have a new phase within two years.8 Is the new dose working? Since when has someone been sleeping worse? PHASE makes exactly this information visible – as a basis for the conversation with clinicians.
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DiGA (apps on prescription in Germany) are aimed at mental illnesses.
As of September 2026
Information, self-help groups and advice for people affected and their family and friends (in German).
dgbs.deEmergency (Germany) 112Medical on-call service (Germany) 116 117TelefonSeelsorge crisis line (Germany) 0800 111 0 111 (free, 24/7)
This page does not replace medical or psychotherapeutic advice. As of September 2026