How Bipolar Disorder Affects Physical Health

Bipolar disorder, characterised by extreme mood swings between mania and depression, impacts not only mental but also physical health. Research has shown how it increases risks of metabolic syndrome, cardiovascular issues, musculoskeletal problems, and sleep disturbances. Effective treatment often combines medication, therapy, lifestyle changes, and support for patients and caregivers.

What is bipolar disorder?

Bipolar disorder, also known as Bipolar Affective disorder (BPAD), is a mental health condition defined by intense changes in mood, behaviour, thought, and energy. People who struggle with this condition often report experiencing extreme swings between moods — depression (lows) and mania (highs). These swings are quite different from daily ups and downs, severely impacting functioning when the symptoms present themselves. 

Episodes can be typically defined by phases of mania which include an elevated mood, energy, and activity, depression with low mood and low energy, and an overall drop in activity levels.

In severe cases, there might be an element of psychosis– those affected may feel they can hear, smell, see, and hear things that are not real (hallucinations) and have false beliefs (delusions). 

Also read what are the types of Bipolar Disorder

Bipolar disorder and physical health

With the onset of an episode, you might experience mania, depression, or a mixed episode. In a manic episode, you may experience irritability, lowered inhibitions, risk-taking behaviour, euphoria, and overall increased activity and energy. 

With depressive episodes, symptoms may include little interest in usual activities, persistent pervasive low mood, loss of interest or pleasure, and reduced energy, along with other symptoms such as difficulty concentrating, excessive guilt, hopelessness and worthlessness, recurrent thoughts of death/suicide, and changes in sleep and appetite. A mixed episode may include several depressive and manic symptoms that can also occur alternately — within the same day or from day to day — or simultaneously; throughout the disorder, mixed or manic episodes may alternate with depressive episodes. 

BPAD is quite common in India, often present in those aged 20-30, and the current lifetime prevalence is estimated at 0.3% (Narula et al., 2024). BPAD is also affected by gender differences in diagnosis — usually, more men than women are affected. The diagnosed women may have more depressive episodes, and men may have more manic episodes (Narayana Health, n.d.)

The risk factors of bipolar disorder vary greatly– from genetic predisposition to family members living with a mood disorder or other mental health conditions, stressful and sudden life events, trauma, adverse childhood experiences, and excessive substance abuse. 

Also read how does bipolar disorder impact everyday life

Health risks of bipolar disorder

Similar to how good mental health has a positive impact on physical health, mental illness can negatively impact physical health. Emerging evidence even says that cardiovascular diseases and severe mental illness share several biological, behavioural, and genetic mechanisms, with the mortality rate being twice that of the general population (Coello et al., 2019). 

1. Metabolic Syndrome (MetS) consists of a cluster of cardiovascular risk factors that include high blood pressure, diabetes, abdominal obesity, and elevated cholesterol and fat levels in the blood. The presence of metS doubles the risk of mortality linked to cardiovascular causes (Reese et al., 2024). 
2. In those diagnosed with BPAD, high rates of Type 2 diabetes are also observed; a co-modbird diagnosis may cause the person to experience increased cardiovascular morbidity and mortality, and worsening long-term glucose control. Research also suggests that BPAD and type 2 diabetes have shared underlying mechanisms and risk factors. 
3. Similarly, hypertension levels observed in those diagnosed with bipolar are also much higher, which could be linked to the increased cardiovascular risk. Other factors like lack of exercise, sedentary lifestyle, increased carbohydrate intake, bipolar depressive symptoms, genetic factors, and side effects of medication can also affect the metabolism of glucose. 
4. Sleep disturbances are also common in those with BPAD– manic episodes may reduce a need for sleep, whereas depressive episodes, insomnia, or insomnia can be experienced. Parasomnia, which is frequent arousal during sleep, is also common. 

Additionally, depressive phases and the end of manic phases are also associated with fatigue and weakness, worsened by a lack of adequate sleep and diet. Some patients report increased clumsiness during the manic phase or its end. 

Treatment and care for bipolar disorder

Bipolar disorder is challenging but manageable with appropriate care;

Medication:

• Mood stabilisers like lithium, sodium valproate, and carbamazepine control manic episodes.
• Antipsychotics and benzodiazepines can be used for severe symptoms.
• Side effects (e.g., nausea, fatigue, dizziness) can be promptly discussed with a doctor for a dose adjustment.

Psychotherapy:

• Cognitive Behavioral Therapy (CBT) helps identify triggers and develop healthier coping mechanisms.
• Interpersonal and Social Rhythm Therapy stabilises daily routines for mood regulation. This is a structured, evidence-based psychotherapy designed to help people with mood disorders, particularly bipolar disorder, manage their symptoms and reduce the risk of recurrence. It focuses on two main aspects; improving interpersonal relationships and stabilising daily routines.
• Family-focused therapy improves communication and support systems. FFT is a specialised psychotherapy designed to support individuals with mood disorders by strengthening family communication, reducing conflict, and fostering a supportive environment.

Brain-Stimulation Therapies:

• Electroconvulsive Therapy (ECT) is highly effective for severe, treatment-resistant cases, offering rapid relief by altering brain chemistry.
• Repetitive Transcranial Magnetic Stimulation (rTMS) uses magnetic pulses to stimulate brain activity and improve symptoms.

Lifestyle Changes:

• A balanced diet, regular exercise, and avoiding alcohol or substances reduce the risk of metabolic and cardiovascular complications.
• Adequate sleep and stress management are crucial for long-term health.

Also read what are effective treatments for bipolar disorder

Supporting Loved Ones with Bipolar Disorder

Caring for someone with bipolar disorder can be challenging but you can take certain steps to make sure your loved one feels cared for.. Here are some ways to help:

• Encourage them to stick to their treatment plan and have regular check-ins with healthcare providers.
• Listen patiently, understand mood swings, and provide reassurance.
• Participate in activities they enjoy to help them stay socially engaged.
• Seek professional help during acute episodes or emergencies.
• Take care of your mental health too—support groups or counselling can provide relief and guidance.

Conclusion

Bipolar disorder, while difficult and having adverse effects on your physical health, can still be a condition that can be well managed and help with leading a more fulfilled, better life. If you suspect someone may have bipolar disorder, approach conversations with them with compassion and clarity. A proper diagnosis and treatment plan can pave the way for a healthier, more balanced life.

FAQs

1. What causes bipolar disorder?

Bipolar disorder can be caused by a complex interplay of biological, genetic and environmental reasons. A family history of bipolar disorder or any other mood disorder can increase the risk, as genetic predisposition plays a key role. Brain structure and function can also contribute to this, especially with irregularities in mood regulation and imbalances in neurotransmitters like serotonin and dopamine. Environmental stressors like trauma, significant life changes, or chronic stress can lead to episodes. While no singular cause has been identified, the disorder can happen due to a combination of these reasons. 

2. What are bipolar disorder symptoms in females?

The symptoms of bipolar disorder in women are similar to those in men but can often vary in presentation and intensity due to hormonal influences and social factors, where symptoms of mania and depression can occur simultaneously. During manic episodes, symptoms include increased energy, impulsivity, decreased need for sleep, and irritability and euphoria. During the depressive episodes, symptoms can range from sadness, low self-worth, difficulty concentrating to sadness. Hormonal changes during pregnancy, menstruation, pregnancy or menopause may make mood symptoms worse, and women are also at a higher risk of developing comorbid conditions like anxiety or thyroid disorders. 

3. What are the types of bipolar disorder?

There are three main kinds of bipolar disorder; bipolar 1 disorder involves at least one manic episode lasting at least seven days or severe enough to require hospitalization, often interspersed with depressive episodes. Bipolar II featured at least one major depressive episode and one hypomanic episode (a less severe form of mania) but no full-blown manic episodes. The third kind, cyclothymic disorder is characterised by chronic mood swings, with periods of hypomania and depressive symptoms that don’t meet the parameters of mania or major depression, lasting for at least two years. All the types require professional diagnosis and a treatment plan.

4. Is bipolar disorder curable?

While not entirely curable, it is highly treatable and manageable with the right approach. It’s a lifelong condition characterized by recurrent mood swings, but many people live a fulfilling life through a combination of treatments. These include mood-stabilizing medications, psychotherapy, lifestyle adjustments, and robust support systems of family and friends. Regular monitoring and treatment adjustments are crucial to managing symptoms and preventing relapses. While the condition cannot be eradicated, long-term remission and improved quality of life are possible with proper care adherence and treatment plans.