Bipolar disorder is difficult yet manageable with early detection.

• Major depressive disorder and bipolar disorder are the most common mood disorders in India.

• Major depressive disorder is characterized by persistent sadness, anhedonia, easy fatigability, cognitive difficulties, hopelessness, worthlessness, inappropriate guilt, and crying spells.

• Bipolar disorder is characterized by mania, an elevated, expansive or irritable mood, higher energy levels, inflated selfesteem, decreased need for sleep, pressured speech, subjective experience that thoughts are racing, being easily distracted, increased goal-directed activity, unrestrained buying sprees, and sexual indiscretions.

Causes of Mood Disorders

• The genesis of mood disorders is complex and multifactorial, with onset during development and manifesting as individuals mature.

• Environmental factors play a crucial role in precipitating the affliction.

• Proximal stressors include adverse childhood experiences such as abuse, loss, neglect, and domestic violence.

• Distal stressors seen in adulthood include a life-threatening illness, financial difficulties, unemployment, bereavement, violence, and trauma.

• Chronic stress is associated with dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, which is disrupted by chronic stress.

• Bipolar disorder is highly heritable, with 60-85% of the affliction attributed to genetic factors.

Diagnostic Challenges

• Bipolar disorder often begins with periods of depression, and sometimes a decade may elapse before the onset of hypomanic or manic episodes.

• The average time from the onset of symptoms to the first diagnosis of bipolar disorder ranges from six to 10 years.

• Clinicians keep an eye out for symptoms or tendencies of bipolar disorder in patients with early-onset of multiple brief periods of depression, a family history of bipolar disorder, attention deficit and hyperactivity disorder, substance misuse, abrupt onset and offset of depression, and who don’t respond as expected to antidepressants.