World Bipolar Disorder Day is observed on March 30 each year, the birthday of painter Vincent van Gogh—whose presumed bipolar disorder profoundly shaped his work and his life. This event aims to reduce the stigma associated with this serious psychiatric condition and to raise public awareness about its detection and treatment. Bipolar disorder affects approximately 2 to 3 % of the global population, across all forms, which amounts to several hundred thousand Quebecers. Despite its prevalence, it remains one of the psychiatric disorders most often diagnosed late—with an average delay of six to ten years between the first symptoms and a correct diagnosis.
This diagnostic delay can be partly explained by the fact that people with the condition most often seek medical care during depressive episodes, leading to an initial diagnosis of unipolar depression. Manic or hypomanic episodes can be experienced positively—increased energy, creativity, a sense of omnipotence—and do not always lead to a doctor’s visit. However, inadequate treatment of bipolar disorder—particularly with antidepressants alone without a mood stabilizer—can trigger manic episodes and worsen the course of the illness.
What Is Bipolar Disorder: Definition and Clinical Types
Bipolar disorder is a psychiatric condition characterized by marked and recurrent fluctuations in mood, energy, and behavior, alternating between episodes of depression and episodes of elevated mood—mania or hypomania. There are several clinically recognized subtypes in the DSM-5. Bipolar I disorder is defined by the presence of at least one full-blown manic episode—lasting at least one week and severe enough to impair functioning or require hospitalization. Depressive episodes are present in the vast majority of patients but are not required for diagnosis.
Bipolar II disorder is characterized by hypomanic episodes—a less intense form of mania lasting at least four days, without severe impairment in functioning or psychotic features—and depressive episodes. It is often underdiagnosed because hypomania can be difficult to distinguish from normal «energetic» functioning, and patients primarily seek treatment for depression. Cyclothymia refers to a milder form characterized by chronic mood fluctuations that fall short of the full diagnostic thresholds for mania or major depression.
Manic and hypomanic episodes: recognizing the signs
A manic episode is characterized by a marked elevation or expansiveness of mood—euphoria, intense irritability, or grandiosity—accompanied by a reduced need for sleep without fatigue, logorrhea, and rapid speech that is difficult to interrupt, a racing mind or accelerated thinking, increased distractibility, increased goal-directed activity, and impulsivity involving high-risk behaviors—reckless spending, risky sexual behavior, impulsive investments, and dangerous driving. In severe cases, psychotic symptoms may be present—delusions of grandeur, hallucinations.
Hypomania exhibits the same characteristics but to a lesser degree and without severe functional consequences. The person often feels at their best—productive, creative, sociable, and sleeping little without feeling tired. This is why these episodes are rarely spontaneously reported as problematic. It is often those around the person who notice the behavioral change. A history of hypomania, even a brief one, is crucial for diagnosing bipolar II disorder and radically changing the treatment strategy.
Bipolar depression: differences from unipolar depression
Bipolar depression shares many symptoms with unipolar depression: persistent depressed mood, anhedonia, fatigue, sleep and appetite disturbances, difficulty concentrating, negative thoughts, or suicidal ideation. However, certain characteristics are more common in bipolar depression and can guide the diagnosis: hypersomnia rather than insomnia, overeating rather than anorexia, marked psychomotor retardation, diurnal mood fluctuations with worsening in the morning, and a response to antidepressants that is often partial or unstable—or may even trigger a hypomanic or manic episode.
The risk of suicide is particularly high in bipolar disorder — studies indicate that 25 to 50 % of those affected attempt suicide at least once in their lifetime, and that the suicide death rate is twenty times higher than in the general population. This underscores the urgency of an accurate diagnosis and appropriate treatment.
How is bipolar disorder diagnosed?
The diagnosis of bipolar disorder is clinical—it is based on a thorough psychiatric interview, a longitudinal history of mood episodes, and the use of standardized assessment tools. There are no biomarkers or diagnostic laboratory tests. The medical history should explore not only current depressive episodes but also a history of episodes of elevated mood, even brief ones, and family history—bipolar disorder has one of the highest heritabilities in psychiatry, around 70 to 80 %. Several clinical scales help structure the evaluation, notably the MDQ (Mood Disorder Questionnaire) and the HCL-32 for detecting a history of hypomania.
A comprehensive medical evaluation is also necessary to rule out organic causes of mood instability—hyperthyroidism, neurological disorders, substance abuse—and to assess common comorbidities: anxiety, ADHD, and substance use disorders. These comorbidities are present in the majority of patients with bipolar disorder and must be incorporated into the treatment plan.
Available treatments: stabilizing mood and preventing relapses
The treatment of bipolar disorder has two complementary goals: treating acute episodes—depressive, manic, or mixed—and preventing long-term relapses. Mood stabilizers are the cornerstone of treatment: lithium remains the standard of care with the strongest evidence for preventing relapses and reducing suicide risk. It requires regular monitoring of blood levels and of kidney and thyroid function. Valproic acid—valproate—and lamotrigine are other mood stabilizers used depending on the predominant mood profile.
Certain atypical antipsychotics—quetiapine, olanzapine, aripiprazole, and lurasidone—have been shown to be effective both during acute episodes and as maintenance treatment. Psychoeducation—learning to recognize prodromal symptoms and triggers—is an essential component of treatment and significantly reduces the relapse rate. Regular sleep patterns, limiting alcohol and cannabis use, and stress management are particularly important lifestyle and dietary measures for this condition.
Frequently asked questions about bipolar disorder in Quebec
Les réponses aux questions les plus fréquentes sur ce sujet.
Normal mood fluctuations are part of the human experience. What distinguishes bipolar disorder is the intensity, duration, recurrence, and functional impact of the episodes. A hypomanic episode lasts at least four consecutive days and involves a change noticeable to those around the person; a manic episode lasts at least one week and significantly impairs functioning. If you have periods when you sleep much less without feeling tired, spend money recklessly, speak or think very quickly, or feel invincible—alternating with periods of depression—a medical evaluation is strongly recommended.
Antidepressants can be problematic in bipolar disorder when used alone, without the support of a mood stabilizer. They can trigger a manic or hypomanic episode, accelerate cycling—the alternation of episodes—or induce unstable mixed states. This is one of the reasons why it is crucial to distinguish bipolar depression from unipolar depression before prescribing treatment. When used in bipolar disorder, antidepressants are generally combined with a mood stabilizer and prescribed with caution. The decision rests with the physician following a comprehensive evaluation.
For the vast majority of people with bipolar disorder type I or II, medication is necessary to stabilize mood and prevent relapses. Untreated relapses have cumulative effects on the brain, social and occupational functioning, and increase the risk of suicide. That said, medication alone is rarely sufficient: psychoeducation, cognitive-behavioral therapy tailored to bipolar disorder, support groups, and lifestyle modifications are essential components of comprehensive care. Discontinuing medication without medical supervision is associated with a very high relapse rate.
Yes. At several of our locations in Quebec, a doctor can conduct an initial evaluation for bipolar disorder, make a diagnosis in clear-cut cases, initiate or adjust mood-stabilizing treatment, and provide regular follow-up care. For complex situations—such as treatment resistance, multiple psychiatric comorbidities, or high suicide risk—a referral to a psychiatrist will be arranged. A prompt medical evaluation helps prevent the years of misdiagnosis and inadequate treatment that all too often characterize the journey of people with bipolar disorder in Quebec.
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