At what age does bipolar disorder develop?

What is Bipolar Disorder?

Bipolar affective psychosis is a disorder characterized by repeated (i.e. at least two) episodes in which the patient's mood and activity are clearly disturbed. In this disorder, phases of mania or hypomania (see below) occur alongside depressive phases. Complete improvement between the episodes is characteristic. The lifetime risk of the disease is 1-2%. 20% of patients who develop depressive disorder for the first time develop bipolar disorder. After two depressive episodes the probability is only 10%, after the 3rd depressive episode the probability of developing a bipolar affective disorder is very low.

Manic episodes usually start abruptly and last between 2 weeks and 5 months. Depression is of longer duration (on average about 6 months), especially in older people it often lasts longer than 1 year. Both types of episodes often follow a stressful life event or other psychological trauma. The first episode (manic or depressive) can occur at any age, from childhood to old age. With increasing age, the symptom-free intervals become shorter, depressive episodes occur more frequently and last longer.

In mania, the mood is inappropriately elevated and can fluctuate between carefree cheerfulness and almost uncontrollable excitement. The elevated mood is associated with increased drive and usually leads to overactivity, the urge to talk and a reduced need for sleep. Usual social inhibitions are lost and attention can no longer be sustained. Instead, there is often strong distractibility, the self-assessment is excessive. Ideas of size and excessive optimism are common. Patients can embark on a variety of unrealisable projects, spend money recklessly, or become aggressive, in love, or joking on completely inappropriate occasions. In some patients, the mood is irritable and suspicious rather than elated. A manic episode lasts at least a week and is so severe that it affects professional and social functioning.

Hypomania is a mild form of mania. In addition to a slightly elevated mood that lasts for several days (well beyond normal mood changes), there is an increased drive and increased activity with subjective well-being and supposed physical and mental performance. Increased sociability, talkativeness, excessive confidentiality, increased libido, and decreased need for sleep are common, but not so pronounced that they lead to discontinuation of work or social activities. Concentration and attention can be impaired, and with it the ability to pursue work, to relax or to recover. This does not prevent interest in new activities or excessive spending.

Bipolar I disorder occurs when manic episodes occur in addition to depressive phases; One speaks of a bipolar II disorder when, in addition to depressive phases, only hypomanic episodes occur. About 10% of patients get sick more than three times in the course of a year: so-called "rapid cycling". 80-90% of patients with rapid cycling are women; Patients with bipolar II disorder are more frequently affected than patients with bipolar I disease. 50% of the patients with bipolar affective disorder suffer from psychotic symptoms, the suicide rate is with 15-30% of the patients even higher than with unipolar depression.


What are the causes of bipolar disorder?

As with depression, genetic and biochemical changes as well as important development-related events (such as separation experiences) create a predisposition (disposition) for the disease, the so-called vulnerability. The manifestation (“outbreak”) of the disorder is then caused by additional stressors such as loss events, damage to the brain (central nervous lesions) such as circulatory disorders or the influence of medication.

There are also effective therapeutic options for bipolar disorders, but these can only be used if the diagnosis has been confirmed.

As with depression, the earlier the diagnosis is made, the sooner and more promisingly the therapy can be started.


Who can help?

The first point of contact should be your family doctor. He can perform a range of examinations and also initiate therapy or refer you to a specialist or a center specializing in the treatment of mental illness in old age. Of course, you can also contact us yourself and make an appointment (see contact).