Amit doesn’t want to get off his “high”. Professionally, the 31-year-old senior marketing executive at an advertising firm feels on top of the world. In private life, too, he is going through a gratifying phase. He spends lavishly and enjoys the way he presents himself on social occasions. Recently married to an old girlfriend, he is seen to be full of energy and enthusiasm.

But lately, his colleagues and family members have been noticing an obstinate streak in him. He chides his junior colleagues so sharply that they end up complaining to seniors. His wife is overwhelmed by his growing demand for sex. When denied, he becomes abusive. His troubled family members have now sought professional help.

Amit is not very different from Simran Kaur, a 27-year-old south Delhi homemaker, who has also been demonstrating personality changes. The mother of two — otherwise quiet and soft spoken — has suddenly become very talkative. She talked almost incessantly for two weeks, mainly about films and her favourite actors. She wouldn’t eat and sleep — prompting her husband to take her to a psychiatrist.

Both Amit and Simran are suffering from bipolar mood disorder. The ailment had led an anonymous patient to famously declare: “If I’m ill, it is the most beautiful illness I’ve ever had.”

Bipolar mood disorders are a kind of psychiatric illness that takes patients on an emotional roller-coaster ride. As the name suggests, they fluctuate between two distinct moods — a manic phase, which is characterised by euphoria, increased talkativeness, reduced need for sleep, and depression that induces thoughts of suicide and loss of appetite and a “down in the dumps” feeling. The switch from one mood to another can happen immediately, or months and years later.

Early this month, a team of researchers from Switzerland and Germany showed that a gene called NCAN is linked to the manic part of the disorder. The study in The American Journal of Psychiatry states that scientists removed a normal version of the NCAN gene from healthy mice. When the gene wasn’t present, the mice started showing manic traits including hyperactivity. When the rodents were subsequently fed with lithium — a drug commonly used for treating bipolar disorders in humans — their hyperactive behaviour vanished. The scientists concluded that the gene had some association with manic episodes.

Discoveries like this are important because they may help scientists ascertain whether a person is prone to bipolar disorders much before the illness manifests itself.

People who suffer a manic episode, like Amit and Simran, do not know they are unwell. “Instead, they think that they are perfectly fine and others around them have a problem,” says Rajesh Sagar, a psychiatrist at the All India Institute of Medical Sciences (Aiims), New Delhi.

Bipolar mood disorders, previously called manic depressive illness, have been around for some time. But, like most other psychiatric illnesses, it is highly under-diagnosed in India.

“We do not have exact figures on people suffering from bipolar disorders. But we have no reason to believe that the number is any less than what is seen in other countries,” says Sagar. If that is the case, one per cent or more of the Indian population runs the risk of suffering from a severe form of bipolar disorder — bipolar disorder I. There is also a spectrum of milder bipolar disorders, which includes bipolar disorder II, where the manic state is at sub-threshold levels. Such a condition is called hypomania, and is often overlooked as the symptoms are mild.

“It is estimated that another 5-6 per cent of the population could be suffering from milder forms including bipolar disorder II,” says Subho Chakraborty, a psychiatrist at the Postgraduate Institute of Medical Education and Research, Chandigarh.

More often than not, professional help is sought only for patients suffering from severe manic episodes, points out Om Prakash, associate professor of psychiatry, Institute of Human Behaviour and Allied Sciences, New Delhi. “They may appear pleasant and cheerful, but at times they will be demanding, impulsive and destructive. Colleagues and family members wouldn’t know how to handle them.”

Sagar points out that in a manic phase, patients have a feeling of grandeur. “They are highly energetic and have a strong libido. There is an increased tendency to indulge in alcohol or drug abuse. They even exhibit risky sexual behaviours, such as unprotected sex with partners as well as others,” he says. They also tend to eat less and do not feel the need for sleep. In some cases, if left untreated, they may die of kidney failure precipitated by sheer physical exhaustion, he warns.

The psychiatrists say that diagnosing bipolar disorder in patients during a manic phase is not difficult. But cases of bipolar depression are difficult to spot as the symptoms are quite similar to what they call unipolar depression or normal depressive disorders. “Treating a bipolar patient with conventional anti-depressants such as prozac is dangerous. He or she may switch to the manic phase,” says Chakraborty.

Sanjeev Jain, professor of psychiatry, National Institute of Mental Health and Neurosciences (Nimhans), Bangalore, goes a step further. He believes that wrong treatment with antidepressants can even trigger the disorder in many dormant cases.

“This is a serious problem considering that with the incidence of depression becoming rampant, nearly 10 per cent of the population has taken antidepressants at least once in their lifetime,” Jain says.

While the symptoms are very similar, there is a key difference between unipolar and bipolar depression. One of the major triggers for unipolar depression is factors around the patient’s surrounding such as the death of someone close and loss of job. But bipolar depression is caused largely by biological reasons.

It runs in the family, Sagar of Aiims explains. “Making the right diagnosis is critically important in bipolar disorders and psychiatrists generally do this by involving the patient’s family members and probing whether the patient had bouts of other extreme states before,” he says.

“The illness does not necessarily follow a clear pattern. In other words, it is not necessary that a patient who experienced an episode of mania will next experience depression. A patient can experience two manic phases one after the other or can have a hypomanic or depressive phase following the manic phase,” says Prakash.

The experts stress that the disorder is “extremely” treatable. “Three or four drugs can take care of nearly three-fourths of the cases. These drugs, used for treating epilepsy, have been around for many decades and are quite cheap,” Jain stresses.

Sagar says it is important for patients to comply with medication. Then they can lead an almost normal life. Constant expert monitoring is required as most of these drugs have side effects, some of which can be serious.

In a study conducted a few years ago, Jain and scientists from the Delhi-based Institute of Genomics and Integrative Biology identified a gene in an Indian family that increases the risk of bipolar disorder along with schizophrenia. But they failed to pinpoint the same genetic variation in a larger population. Subsequently, though, a team of Chinese scientists confirmed that the gene variation could be related to bipolar disorders.

Studies, including one by Jain’s team at Nimhans, have shown that bipolar disorders in tropical countries and countries in the northern hemisphere follow different patterns. In tropical countries patients suffer more manic episodes than depression and vice versa in the West. “As per what we have seen for every 10 episodes of manic attacks, there is one episode of depression in countries like India,” observes Jain. He hastens to add that these are mere observations and need to be scientifically corroborated.

What’s clear, though, is that bipolar disorder, if unchecked, can take a life. According to a 2011 British Psychological Society publication, people with a diagnosis of bipolar disorder are at a higher risk of suicide. It is estimated that 10-15 per cent of people admitted to hospital with the diagnosis will eventually kill themselves.

As the anonymous patient declares, the illness can be beautiful. But when it’s ugly, it can’t get any worse.