Hustle and its shadow: Understanding signs, triggers & treatment of bipolar disorder

At 2.30 am, the lights in Karan’s tony apartment in Whitefield were still on. His laptop glowed on the dining table. Half-finished plans for a start-up deck sat open across six tabs. He had not slept more than three hours a night for nearly a week, but he did not feel tired. If anything, he felt better than tired. He felt unstoppable.

He had called three friends after midnight with ‘brilliant’ ideas, signed up for an expensive online course he did not need, and messaged his manager promising he could take on two extra projects because he was ‘finally operating at full capacity’.

By morning, he was at work, talking faster than usual, jumping from one idea to another, unusually charming and unusually impatient. Colleagues said he seemed ‘on fire’. A friend joked that this was peak start-up energy. Another said this was what ambition looked like in the city.

A few weeks later, that fire went out.

Karan stopped answering calls. He lay in bed staring at the ceiling, unable to begin simple tasks. Bathing felt effortful. Food lost its taste. He was ashamed of the money he had spent, embarrassed by what he had said, and frightened by how quickly his mind had changed. What had first looked like drive and confidence had turned into something darker and harder to name.

Stories like this are one reason we need to talk about bipolar disorder now, especially in cities like Bengaluru, where long hours, poor sleep, relentless comparison, financial pressure, and a culture that rewards overwork can blur the line between high performance and distress. Many readers will know someone who seems to swing between periods of unusual energy and heavy withdrawal. Some may recognise parts of themselves. Bipolar disorder is not rare, not a moral weakness, and not simply moodiness. It is a serious but treatable mental health condition, and spotting it early can change the course of a life.

Not just mood swings

Bipolar disorder is a condition in which a person experiences significant shifts in mood, energy, activity, and functioning. These shifts are more intense than the usual ups and downs of life.

At one end may be depression: anhedonia, low mood, hopelessness, slowed thinking, loss of interest, fatigue, guilt, poor concentration, and sometimes thoughts of death or self-harm. At the other end may be mania or hypomania: an unusually elevated or irritable mood, increased energy, reduced need for sleep, racing thoughts, impulsive decisions, inflated confidence, and behaviour that is out of character.

That last point matters. Many people think mania simply means being very happy. It does not. A manic episode can include grand plans, excessive spending, risky behaviour, anger, restlessness, sexual disinhibition, or a level of confidence that cuts a person off from caution and reality. Hypomania is a milder form, but it can still disrupt judgement and relationships.

Bipolar disorder is often misunderstood because many people seek help only when they are depressed. The earlier high-energy phase may not look like an illness to them or to those around them. It may look like success. In a culture that praises hustle, speed, boldness, and constant availability, reduced sleep and nonstop productivity can even be admired, at least until things begin to fall apart.

The invisible early signs

The early signs are often easy to miss because they do not always arrive dramatically. Sometimes the first clues are subtle. A person who usually needs seven hours of sleep suddenly feels fine on three or four and insists they are functioning perfectly. Someone who is normally careful with money starts making impulsive purchases or risky investments. A quiet professional becomes unusually talkative, distractible, irritable, or socially overconfident.

A college student who was merely driven now seems unable to switch off. Someone starts too many projects, writes long, late-night messages, speaks rapidly, becomes argumentative, or begins to believe they have special insight that others are too slow to understand.

Families often notice the change before the person does. “You’re not yourself,” they may say. But because these shifts can initially look positive, more energy, more ideas, more sociability, warning signs are brushed aside.

Depression, too, can hide in plain sight. In urban settings, it is often written off as burnout, disappointment, laziness, a bad breakup, or just stress. But when sadness deepens into emptiness, when functioning drops, when sleep and appetite change, when a person feels slowed down, or life begins to feel pointless, it deserves attention. The key question is not whether someone is having a rough week. It is whether there is a clear, sustained change in mood, sleep, behaviour, and functioning.

Misdiagnosis and stigma

Bipolar disorder is often missed for several reasons.

First, people usually seek help during a depressive phase, not during a high-energy one. When someone presents with weeks of low mood, exhaustion, guilt, and inability to function, the immediate concern is depression. But unless a careful history is taken, including past periods of increased energy, decreased sleep, overspending, irritability, overconfidence, or reckless behaviour, bipolar disorder can be mistaken for unipolar depression.

Second, stigma remains powerful. Many patients and families are more willing to describe stress or tension than symptoms that may sound socially embarrassing. They may not volunteer information about risky behaviour, grand ideas, sexual impulsivity, aggression, or episodes that led to conflict at home or work. Shame edits the story, and that can delay a correct diagnosis.

Third, the social environment can reward the very behaviours that may signal trouble. In fast-paced metros, where work often spills into nights and weekends, sleeping less can look like dedication. Talking quickly can be mistaken for brilliance. Taking on too much can be framed as leadership. Spending freely can be read as confidence. What should raise concern may instead earn admiration, at least initially.

The result is that bipolar disorder may be identified late, after damage has already accumulated: strained relationships, debt, lost jobs, broken trust, academic decline, or severe depression. A person may be called dramatic, unstable, difficult, irresponsible, or weak before anyone asks a more useful question: could this be a treatable condition?

This is why public understanding matters. Bipolar disorder is not a bad temperament. It is not a poor character. And it is not something people can simply snap out of.

Learning the illness pattern

The good news is that bipolar disorder can be treated, and many people live full, productive, meaningful lives with the right care.

Treatment usually involves a combination of medication, regular follow-up, psychoeducation, and lifestyle stabilisation. Medication may be needed to control acute symptoms and reduce the risk of future episodes. The exact plan differs from person to person.

But treatment is not only about medicines. A large part of management is learning the illness pattern: recognising early warning signs, understanding triggers, observing how sleep affects mood, and acting quickly when symptoms begin to build. Psychoeducation becomes crucial here. Patients and families who understand bipolar disorder are better able to recognise change early, seek help sooner, stay consistent with treatment, and reduce relapse risk.

Routine matters more than many expect. Regular sleep and wake times, avoiding all-night work, reducing alcohol or substance use, keeping appointments, and building structure into the day are not minor add-ons. They are part of treatment.

Continuity matters just as much. Many people stop treatment when they begin to feel better, especially after a high-energy phase that felt powerful or productive. But feeling well is not the same as being protected from the next episode. Bipolar disorder usually requires ongoing monitoring, even during stable periods.

Urban triggers and lifestyle factors

Urban life can make symptoms harder to spot and harder to manage.

Sleep disruption is one of the biggest challenges. Late-night work, international meetings, nightlife, screens in bed, endless scrolling, and irregular routines can all disturb the body clock. For someone vulnerable to bipolar disorder, sleep loss is not trivial. It can become a warning sign or even a trigger.

Then there is overstimulation: constant noise, traffic, crowded commutes, social comparison, financial strain, job insecurity, and the pressure to seem successful all the time. Bengaluru’s work culture, especially in technology and corporate sectors, often normalises long hours, multitasking, blurred home-work boundaries, and permanent mental overdrive.

Substance use can further complicate the picture. Alcohol may be used to switch off; stimulants and excessive caffeine to keep going. Neither is a sustainable answer. Both can worsen mood instability, sleep problems, and judgement.

Social media adds another layer. During high-energy phases, it may amplify impulsivity, spending, grand plans, oversharing, or conflict. During depression, it can intensify comparison and shame. Digital life does not create bipolar disorder, but it can become part of the storm.

Family support is crucial

Bipolar disorder rarely affects only one person. It shapes households.

Families often move between worry, confusion, anger, and helplessness. During mania or hypomania, the person may resist help, deny illness, spend excessively, behave rudely, or make decisions that damage trust. During depression, they may withdraw, become dependent, or seem unreachable. Caregivers may feel exhausted and unprepared. Yet family support can be one of the strongest protective factors.

A family that learns to notice early signs, less sleep, more irritability, sudden grand plans, unexplained spending, social overactivity, or withdrawal, can help bring the person to care before a full episode develops. A calm, informed response works better than blame. “We are noticing changes. Let us act early” is more useful than accusation.
Families also need support for themselves. They need space to ask questions, voice frustration, and understand that relapse does not always mean failure. Recovery is often not linear. It is a process of learning patterns, building safeguards, and staying engaged with treatment.

Unfortunately, not all families respond with care. Some minimise symptoms. Some interpret them as stubbornness, lack of discipline, or moral weakness. Some delay psychiatric consultation because they fear labels, marriage concerns, or social judgement. This can cost precious time.

If there is one message families in urban India need to hear, it is this: early help is not an overreaction.

Bipolar disorder often hides behind labels that urban India celebrates or excuses: ambition, intensity, drive, burnout, temper, sensitivity, or “just stress”. In high-pressure cities, symptoms can be normalised until harm becomes impossible to ignore.

Bipolar disorder is treatable, but delay has consequences. The sooner a person and family understand what they are dealing with, the better the chances of stability, safety, and recovery. This is not only a story about illness. It is also a story about recognition: learning when not to applaud distress, when not to dismiss suffering, and when to reach out before a crisis.

The point is not to diagnose every energetic person or every low mood as bipolar disorder. The point is to take sustained changes in mood, energy, activity, sleep, judgement, and functioning seriously, especially in a world that rarely tells people to slow down.

Where to seek help

* NIMHANS helpline:080-46110007

* Tele-MANAS:14416 or 1-800-891-4416 - Government of India’s 24/7 mental health support helpline, available in multiple languages. 

A checklist for families

* Keep a note of early warning signs.

* Encourage regular sleep and treatment follow-up.

* Do not argue with the person in the middle of a severe episode; focus on getting help.

* Remove easy access to means of self-harm if risk is present.

* Remember that support is not the same as doing nothing. Seek professional psychiatric help early.

The author is a Bipolar Disorder expert at the Manas Institute of Mental Health and Neurosciences, Hubballi. In 2023, he was awarded the IMH Marshall Mood Disorders Fellowship by the University of British Columbia, Vancouver, Canada.