Actor Anupam Kher’s recent recollection of being diagnosed with “manic depression” has drawn attention to an older term for what is now medically known as bipolar disorder. Kher has spoken about pushing himself despite getting very little sleep and recalled being told by a psychiatrist that he was manic depressive.“Manic depressive psychosis was an older term for bipolar disorder,” said Dr Santosh Bangar, senior consultant psychiatrist, Gleneagles Hospital, Parel.Bipolar disorder is characterised by distinct episodes of changes in mood, energy, sleep and behaviour. Dr Bangar said recent Indian studies suggest that about three in 1,000 adults have bipolar disorder, while around five in 1,000 have experienced symptoms of the condition.Diagnosis can nevertheless be delayed, particularly when a person initially seeks help for depression.“Delayed or missed diagnosis could be because of lack of awareness of symptoms and stigma of mental illness in the community. The symptoms of bipolar are typical and diagnosis is made by a detailed assessment by a psychiatrist,” Dr Bangar said.Unlike the everyday highs and lows of mood, bipolar disorder involves episodes that represent a marked change from a person’s usual functioning and can affect relationships, work and daily life.When high energy is a warning signMania is one of the defining features of bipolar disorder. Common symptoms include an unusually elevated or irritable mood, increased energy despite little sleep, grandiose thoughts, excessive talking, impulsive spending and other risky or reckless behaviour. “These are some of the common symptoms of mania, which must be present for at least a week,” Dr Bangar said.Hypomania involves similar symptoms but is less severe. Because some features may overlap with an individual’s usual personality or temperament, recognising a clinically significant episode can sometimes be difficult. However, psychiatrists use established diagnostic criteria to distinguish mania and hypomania from normal variations in behaviour.Story continues below this adWhy sleep mattersOne symptom that deserves particular attention is a reduced need for sleep — which is different from simply being unable to sleep. “Reduced need of sleep rather than insomnia is more specific to mania or hypomania. It could be an early symptom and also a risk factor for a relapse,” Dr Bangar said.The distinction is important. A person with insomnia may feel tired but remain unable to sleep. Someone experiencing mania or hypomania may sleep substantially less and nevertheless feel unusually energetic or refreshed. Dr Bangar added that seven to eight hours of restful sleep are important for healthy mental and physical functioning.It can begin earlyPsychologist and psychotherapist Dhara Ghuntla, an independent practitioner affiliated with Sujay Hospital, 7 Hills Hospital and CritiCare Hospital, said bipolar disorder commonly begins in late adolescence or early adulthood, although symptoms can emerge earlier.In children and adolescents, the condition may not resemble the classic adult presentation. “In children and adolescents, it may present differently, with pronounced irritability, rapid changes in mood, sleep disturbance, increased activity or impulsive behaviour rather than the more typical adult pattern of clear manic and depressive episodes,” she said.Story continues below this adThis is one reason the condition needs to be distinguished from ordinary mood fluctuations, depression, anxiety or simply being energetic and optimistic. “Bipolar disorder involves distinct episodes of significant changes in mood, energy, sleep and behaviour that are different from the person’s usual functioning,” Ghuntla said.Mania or hypomania may involve reduced need for sleep, increased activity, rapid speech, impulsivity or grandiosity. Depression, meanwhile, involves persistent low mood or loss of interest, accompanied by cognitive, physical and functional changes.Stress and disrupted routinesLifestyle and environmental factors may influence the course of bipolar disorder, although they do not necessarily cause the condition. “These factors do not necessarily cause bipolar disorder, but they can trigger or worsen episodes in someone who is already vulnerable. Sleep deprivation, prolonged stress, substance use and major disruptions in routine can affect circadian rhythms and emotional regulation, increasing the risk of mood episodes,” Ghuntla said.There is also insufficient evidence to conclude that bipolar disorder is more common in metropolitan cities. Ghuntla noted that better access to mental-health services in urban areas may simply mean that more cases are recognised and diagnosed. In smaller cities and rural areas, stigma, limited access to services and under-recognition can contribute to delays in diagnosis.Story continues below this adWhy treatment mattersUntreated bipolar disorder can affect several areas of life. “Untreated bipolar disorder can significantly affect relationships, work, finances and overall functioning, and severe episodes can be associated with substance use and increased suicide risk,” Ghuntla said.Long-term management may include mood-stabilising medication, psychotherapy, psychoeducation and regular psychiatric follow-up. Maintaining regular sleep patterns, monitoring changes in mood and recognising early warning signs can also help reduce the risk of relapse.For someone experiencing persistent or marked changes in mood, sleep, energy or behaviour, a psychiatric assessment can help determine whether these are part of a mental health condition or reflect something else.