A Psychiatrist’s Message to Patients and Families from Nagpur

As a psychiatrist, one sentence I hear very often—especially during winter—is:

“Doctor, they are not sleeping, fighting with everyone, but they say nothing is wrong.”

Winter is usually associated with depression.
But what many families don’t realize is that mania and hypomania can also flare up during seasonal changes, including winter—especially in people living with Bipolar Disorder.

In Nagpur, where temperature drops suddenly, daylight hours change, routines get disturbed, and social stress increases, we often see a spike in mood instability.

This blog is not just information.
It is a message—from a psychiatrist to families who are silently struggling.

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Understanding Bipolar Disorder in Simple Words

Bipolar disorder is a brain-based mood disorder where a person swings between:

• Depression (low mood, low energy)
• Mania or Hypomania (high energy, irritability, less sleep, impulsive behavior)

Many patients do not accept or recognize mania—and that makes family members the first line of detection.

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What Is Mania and Hypomania?

Mania

• Severe mood elevation or irritability
• Significant impairment
• Often requires hospital admission

Hypomania

• Milder form
• Patient may still go to work
• But behavior becomes disruptive, argumentative, risky

❗ Important:
Patients often enjoy hypomania.
That’s why they deny anything is wrong.

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Why Winter Can Trigger Mania / Hypomania

1. Sleep–Wake Cycle Disturbance

• Shorter daylight hours
• Late nights, early mornings
• Disrupted circadian rhythm → mood instability

2. Sudden Temperature Changes in Nagpur

• Warm afternoons, cold nights
• Body clock confusion
• Stress hormones fluctuate

3. Increased Social & Financial Stress

• Year-end deadlines
• Exams, weddings, planning
• Pressure + less sleep = trigger

4. Medication Non-Compliance

• “I’m feeling fine, why continue medicines?”
• Very common before winter flare-ups

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Epidemiology (How Common Is This?)

• Bipolar disorder affects 1–2% of the population
• Seasonal relapse is seen in up to 25–30% of patients
• Mania is more common in patients with irregular sleep and routine
• In central India, October to February shows higher clinic visits for mood instability

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Pathogenesis (What Happens in the Brain?)

Mania and hypomania involve:

• Dysregulation of dopamine (reward, energy)
• Altered melatonin (sleep hormone)
• Overactivation of limbic system
• Reduced control from prefrontal cortex

In simple terms:

The emotional brain becomes louder,
the rational brain becomes quieter.

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Early Warning Signs Families Must NOT Ignore

These signs often appear before full mania:

Sleep Changes

• Sleeping only 3–4 hours
• Saying “I don’t feel sleepy”
• Waking others up at night

Irritability & Fights

• Frequent arguments
• Anger over small issues
• Shouting, abusive language (out of character)

Increased Talking & Ideas

• Not letting others speak
• Jumping topics
• Big plans with no practicality

Denial

• “You people are the problem”
• “I am better than before”
• “Doctors are unnecessary”

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Example 

Mr. A, 34, Nagpur

Every winter:

• Stops sleeping
• Becomes hyper-religious
• Picks fights with parents
• Spends impulsively
• Refuses medicines

Family waits… until aggression increases.
Finally, emergency admission is required, increasing stress and cost.

Early consultation could have prevented hospitalization.

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Why Patients Deny Their Illness

This is not stubbornness.
This is called lack of insight, a core symptom of mania.

So:

• Arguing doesn’t help
• Logical explanation fails
• Emotional reactions worsen the situation

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What Should Relatives Do?

1. Do NOT Confront Aggressively

Avoid:

• “You are mad”
• “Doctor said you are bipolar”
• “You are ruining the family”

2. Focus on Sleep First

Sleep loss is the strongest trigger.
Encourage:

• Fixed bedtime
• No late-night discussions
• Reduce phone use at night

3. Observe & Document

Note:

• Sleep hours
• Anger episodes
• Spending behavior
• Speech changes

This helps doctors immensely.

4. If Patient Is Not Willing – Family Can Visit the Clinic

Yes.
Family members can consult without the patient.

At Mind & Mood Clinic, Nagpur, we regularly guide families on:

• How to talk to the patient
• Medication strategies
• When admission becomes necessary

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When to Consult URGENTLY

🚨 Do not delay if you notice:

• Complete loss of sleep
• Physical aggression
• Suicidal or risky behavior
• Uncontrolled spending
• Delusional ideas (grandiosity, suspicion)
• Refusal of all medication

Delaying treatment may lead to:

• Emergency admission
• Higher treatment cost
• Occupational damage
• Relationship breakdown

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Why Early Treatment Matters

• Prevents hospitalization
• Reduces financial burden
• Protects dignity of the patient
• Keeps family peace intact

Bipolar disorder is manageable—
but only when treated early and consistently.

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Message from the Psychiatrist

As a psychiatrist, I want families to remember:

You are not weak.
You are not overreacting.
You are protecting someone who cannot see their illness right now.

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How to Reach Us

📍 Mind & Mood Clinic, Nagpur (India)
👨‍⚕️ Dr. Rameez Shaikh, MD
Psychiatrist & Counsellor
📞 Call / WhatsApp: +91-8208823738

Early consultation can prevent crisis.

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Medical Disclaimer

This blog is for educational purposes only and does not replace professional medical consultation. Diagnosis and treatment decisions should always be made in consultation with a qualified psychiatrist.