Serotonin is an important neurotransmitter that plays a prominent role in depression and sleep. Environmental factors also play a role, since not all cases of bipolar disorder are associated with a family history of the disease. No single cause may ever been found for this complex disease. When inherited, the disease may increase in severity in subsequent generations, so affected people may wish to seek genetic counseling. However, there are no genetic tests available for bipolar disorder, and such counseling should be used for guidance, education, and reassurance about available treatments.
Bipolar disorder can be severe and long-term, or it can be mild with infrequent episodes.
Even with therapy, one or more relapses occur in most patients. In addition, treatment does not always prevent continuing problems in social and psychological functioning, particularly in patients with dysfunctional families or social groups. One center reported that recovery was more likely and improvement faster in patients having an illness of shorter duration, in those coming from a higher social class, and in those complying with treatment. Although a small percentage of bipolar patients demonstrate heightened productivity or creativity during manic phases, more often the distorted thinking and impaired judgment that are characteristic of manic episodes can lead to dangerous behavior. In a manic stage, for example, a person may spend money with abandon, financially ruining himself and his family.