Bipolar disorder: 8 myths debunked

Bipolar disorder is one of the most misunderstood psychiatric conditions. Contrary to popular belief, it is not simply about mood swings — it is a group of chronic, complex disorders (bipolar I disorder and bipolar II disorder) that can reduce both quality of life and life expectancy.

In this article, I examine eight of the most widespread misconceptions and compare them with the scientific evidence.

Myth 1: “Bipolar disorder is rare”

It is often said that bipolar disorder is an uncommon condition. In reality, epidemiological estimates indicate a lifetime global prevalence of 0.6–1.0% for bipolar I disorder and 0.4–1.1% for bipolar II. To put this in perspective, approximately one million people in Italy live with bipolar disorder.

Myth 2: “It’s just mood swings”

Bipolar disorder cannot be reduced to sudden changes in mood throughout the day (something we can all experience). Rather, it involves discrete episodes - manic, hypomanic, depressive, or mixed - lasting days, weeks, or months and causing marked changes in cognitive functioning, sleep, energy, and behaviour. Mania, for example, can present with uncontrollable euphoria or irritability, reduced need for sleep, increased goal-directed activity (doing things with a purpose), and impulsive behaviours with potentially serious consequences (excessive spending, risky sexual conduct, reckless decisions). Bipolar depression, on the other hand, dominates the longitudinal course of the illness (especially in bipolar II disorder) and represents the main source of disability, increased cardiovascular risk, and suicide risk.

Myth 3: “It always starts in adulthood”

Although the average age of onset in Europe is around 27, more than half of people with bipolar disorder show signs and symptoms before the age of 25. In many cases, the first episodes are depressive and are initially diagnosed as major (unipolar) depression. This contributes to an average diagnostic delay of 5–10 years, a period during which the person may receive inadequate treatments - such as antidepressant monotherapy - that can worsen the course of the illness by destabilising mood. Recognising the early signs of bipolar disorder is essential for starting appropriate treatment from the outset.

Myth 4: “It’s a purely psychological illness”

Bipolar disorder has an estimated heritability of around 70%, meaning that genetic factors play a central role in determining vulnerability to the condition. At the neurobiological level, research has identified alterations in monoaminergic circuits, neuronal and glial plasticity, inflammatory processes, cellular metabolism, and mitochondrial function. Bipolar I disorder also shares genetic risk alleles with schizophrenia, while bipolar II shows greater genetic overlap with major depressive disorder.

Myth 5: “People with bipolar disorder can’t lead productive lives”

The scientific literature extensively documents the association between bipolar disorder and creativity, professional achievement, and leadership. Many people with bipolar disorder achieve high levels of functioning and satisfaction in their professional, artistic, social, and personal lives. That said, it is true that the condition can impair functioning across multiple domains if left untreated, particularly during episodes, but also during the periods between episodes.

Myth 6: “Lithium is an outdated and dangerous drug”

Lithium has been used in psychiatry since 1950, and this very longevity sometimes leads people to consider it obsolete. Lithium has endured because it is a medicine that works. It is effective in treating acute mania, in preventing manic and depressive relapses (and recent evidence suggests it may reduce the risk of dementia). Lithium certainly requires regular medical monitoring, but this does not make it more “dangerous” than other medications widely promoted by the pharmaceutical industry (lithium, being a natural element, cannot be branded in the way synthetic molecules can).

So, if you had to choose between a medication backed by over 70 years of clinical data supporting its safety and efficacy, or a “new generation” drug that has been on the market for less than 10 years with data derived almost exclusively from industry-sponsored trials, what would you choose?

Myth 7: “Just take an antidepressant”

Antidepressants are widely prescribed in bipolar disorder despite the lack of convincing evidence of their efficacy in both the short and long term. Worse still, antidepressant use in bipolar disorder is associated in many cases with mood destabilisation and rapid cycling (more than 4 illness episodes per year). For bipolar depression, the evidence supports the use of other medications such as quetiapine or lithium. The pharmacological treatment of bipolar disorder is complex and requires specific expertise: applying the same strategies used for unipolar depression can prove not only ineffective, but harmful.

Myth 8: “Bipolar disorder doesn’t affect physical health”

This last myth is perhaps the most dangerous. People with bipolar disorder have a life expectancy reduced by 10–20 years compared to the general population. The main cause of this gap is not suicide, as one might assume, but cardiovascular disease. Medical comorbidity is the rule rather than the exception: obesity, type 2 diabetes, metabolic syndrome, and cardiovascular disease are significantly more common in people with bipolar disorder. These findings underscore the importance of a therapeutic approach that goes beyond managing psychiatric symptoms to include monitoring and preventing medical comorbidities, engaging caregivers, and integrating psychosocial interventions.

Conclusion

The myths surrounding bipolar disorder - from its supposed rarity to its allegedly “temperamental” nature, from the dangers of lithium to the irrelevance of physical health consequences - are not merely inaccuracies: they can contribute to stigma, diagnostic delay, and the choice of inadequate treatments. Understanding the scientific reality is the first step towards combating these prejudices and ensuring that people with bipolar disorder (and the people who love them) receive the care and respect they deserve.

Myth 1: “Bipolar disorder is rare”#

Myth 2: “It’s just mood swings”#

Myth 3: “It always starts in adulthood”#

Myth 4: “It’s a purely psychological illness”#

Myth 5: “People with bipolar disorder can’t lead productive lives”#

Myth 6: “Lithium is an outdated and dangerous drug”#

Myth 7: “Just take an antidepressant”#

Myth 8: “Bipolar disorder doesn’t affect physical health”#

Conclusion#

Further reading#