Bipolar disorder
Introduction
Bipolar disorder, formerly known as manic depression, is a condition that affects your moods, which can swing from one extreme to another.
People with bipolar disorder have periods or episodes of:
- depression – feeling very low and lethargic
- mania – feeling very high and overactive (less severe mania is known as hypomania)
Symptoms of bipolar disorder depend on which mood you’re experiencing. Unlike simple mood swings, each extreme episode of bipolar disorder can last for several weeks (or even longer), and some people may not experience a “normal” mood very often.
Depression
You may initially be diagnosed with clinical depression before having a future manic episode (sometimes years later), after which you may be diagnosed with bipolar disorder.
During an episode of depression, you may have overwhelming feelings of worthlessness, which can potentially lead to thoughts of suicide.
If you’re feeling suicidal or having severe depressive symptoms, contact your GP, care co-ordinator or local mental health emergency services as soon as possible.
If you want to talk to someone confidentially, call the Samaritans, free of charge, on 116 123. You can talk to them 24 hours a day, 7 days a week. Alternatively, visit the Samaritans website.
Mania
During a manic phase of bipolar disorder, you may feel very happy and have lots of energy, ambitious plans and ideas. You may spend large amounts of money on things you can’t afford and wouldn’t normally want.
Not feeling like eating or sleeping, talking quickly and becoming annoyed easily are also common characteristics of this phase.
You may feel very creative and view the manic phase of bipolar as a positive experience. However, you may also experience symptoms of psychosis, where you see or hear things that aren’t there or become convinced of things that aren’t true.
Living with bipolar disorder
The high and low phases of bipolar disorder are often so extreme that they interfere with everyday life.
However, there are several options for treating bipolar disorder that can make a difference. They aim to control the effects of an episode and help someone with bipolar disorder live life as normally as possible.
The following treatment options are available:
- medication to prevent episodes of mania, hypomania (less severe mania) and depression – these are known as mood stabilisers and are taken every day on a long-term basis
- medication to treat the main symptoms of depression and mania when they occur
- learning to recognise the triggers and signs of an episode of depression or mania
- psychological treatment – such as talking therapy, which can help you deal with depression, and provides advice about how to improve your relationships
- lifestyle advice – such as doing regular exercise, planning activities you enjoy that give you a sense of achievement, as well as advice on improving your diet and getting more sleep
It’s thought using a combination of different treatment methods is the best way to control bipolar disorder.
Help and advice for people with a long-term condition or their carers is also available from charities, support groups and associations.
This includes self-help and self-management advice, and learning to deal with the practical aspects of a long-term condition.
Find out more about living with bipolar disorder
Bipolar disorder and pregnancy
Bipolar disorder, like all other mental health problems, can get worse during pregnancy. However, specialist help is available if you need it.
What causes bipolar disorder?
The exact cause of bipolar disorder is unknown, although it’s believed a number of things can trigger an episode. Extreme stress, overwhelming problems and life-changing events are thought to contribute, as well as genetic and chemical factors.
Who’s affected?
Bipolar disorder is fairly common and one in every 100 adults will be diagnosed with the condition at some point in their life.
Bipolar disorder can occur at any age, although it often develops between the ages of 15 and 19 and rarely develops after 40. Men and women from all backgrounds are equally likely to develop bipolar disorder.
The pattern of mood swings in bipolar disorder varies widely between people. For example, some people only have a couple of bipolar episodes in their lifetime and are stable in between, while others have many episodes.
Symptoms
Bipolar disorder is characterised by extreme mood swings. These can range from extreme highs (mania) to extreme lows (depression).
Episodes of mania and depression often last for several weeks or months.
Depression
During a period of depression, your symptoms may include:
- feeling sad, hopeless or irritable most of the time
- lacking energy
- difficulty concentrating and remembering things
- loss of interest in everyday activities
- feelings of emptiness or worthlessness
- feelings of guilt and despair
- feeling pessimistic about everything
- self-doubt
- being delusional, having hallucinations and disturbed or illogical thinking
- lack of appetite
- difficulty sleeping
- waking up early
- suicidal thoughts
Mania
The manic phase of bipolar disorder may include:
- feeling very happy, elated or overjoyed
- talking very quickly
- feeling full of energy
- feeling self-important
- feeling full of great new ideas and having important plans
- being easily distracted
- being easily irritated or agitated
- being delusional, having hallucinations and disturbed or illogical thinking
- not feeling like sleeping
- not eating
- doing things that often have disastrous consequences – such as spending large sums of money on expensive and sometimes unaffordable items
- making decisions or saying things that are out of character and that others see as being risky or harmful
Patterns of depression and mania
If you have bipolar disorder, you may have episodes of depression more regularly than episodes of mania, or vice versa.
Between episodes of depression and mania, you may sometimes have periods where you have a “normal” mood.
The patterns aren’t always the same and some people may experience:
- rapid cycling – where a person with bipolar disorder repeatedly swings from a high to low phase quickly without having a “normal” period in between
- mixed state – where a person with bipolar disorder experiences symptoms of depression and mania together; for example, overactivity with a depressed mood
If your mood swings last a long time but aren’t severe enough to be classed as bipolar disorder, you may be diagnosed with cyclothymia (a mild form of bipolar disorder).
Living with bipolar disorder
Bipolar disorder is a condition of extremes. A person with the condition may be unaware they’re in the manic phase.
After the episode is over, they may be shocked at their behaviour. However, at the time, they may believe other people are being negative or unhelpful.
Some people with bipolar disorder have more frequent and severe episodes than others. The extreme nature of the condition means staying in a job may be difficult and relationships may become strained. There’s also an increased risk of suicide.
During episodes of mania and depression, someone with bipolar disorder may experience strange sensations, such as seeing, hearing or smelling things that aren’t there (hallucinations).
They may also believe things that seem irrational to other people (delusions). These types of symptoms are known as psychosis or a psychotic episode.
Read more about living with bipolar disorder
Causes
The exact cause of bipolar disorder is unknown. Experts believe there are a number of factors that work together to make a person more likely to develop the condition.
These are thought to be a complex mix of physical, environmental and social factors.
Chemical imbalance in the brain
Bipolar disorder is widely believed to be the result of chemical imbalances in the brain.
The chemicals responsible for controlling the brain’s functions are called neurotransmitters and include noradrenaline, serotonin and dopamine.
There’s some evidence that if there’s an imbalance in the levels of one or more neurotransmitters, a person may develop some symptoms of bipolar disorder.
For example, there’s evidence that episodes of mania may occur when levels of noradrenaline are too high, and episodes of depression may be the result of noradrenaline levels becoming too low.
Genetics
It’s also thought bipolar disorder is linked to genetics, as the condition seems to run in families. The family members of a person with the condition have an increased risk of developing it themselves.
However, no single gene is responsible for bipolar disorder. Instead, a number of genetic and environmental factors are thought to act as triggers.
Triggers
A stressful circumstance or situation often triggers the symptoms of bipolar disorder. Examples of stressful triggers include:
- the breakdown of a relationship
- physical, sexual or emotional abuse
- the death of a close family member or loved one
These types of life-altering events can cause episodes of depression at any time in a person’s life.
Bipolar disorder may also be triggered by:
- physical illness
- sleep disturbances
- overwhelming problems in everyday life – such as problems with money, work or relationships
Diagnosis
If your GP thinks you may have bipolar disorder, they’ll usually refer you to a psychiatrist (a medically qualified mental health specialist).
If your illness puts you at risk of harming yourself, your GP will arrange an appointment immediately.
Specialist assessment
You’ll be assessed by the psychiatrist at your appointment. They’ll ask you a few questions to determine if you have bipolar disorder. If you do, they’ll decide what treatments are most suitable.
During the assessment, you’ll be asked about your symptoms and when you first experienced them. The psychiatrist will also ask about how you feel leading up to and during an episode of mania or depression, and if you have thoughts about harming yourself.
The psychiatrist will also want to know about your medical background and family history, especially whether any of your relatives have had bipolar disorder.
If someone else in your family has the condition, the psychiatrist may want to talk to them. However, they’ll ask for your agreement before doing so.
Other tests
Depending on your symptoms, you may also need tests to see whether you have a physical problem, such as an underactive thyroid or an overactive thyroid.
If you have bipolar disorder, you’ll need to visit your GP regularly for a physical health check.
Treatment
Treatment for bipolar disorder aims to reduce the severity and number of episodes of depression and mania to allow as normal a life as possible.
Treatment options for bipolar disorder
Treatment for bipolar disorder aims to reduce the length and severity of episodes. In some cases treatment can prevent bipolar episodes.
Most people with bipolar disorder can be treated using a combination of different treatments. These can include one or more of the following:
- medication to prevent episodes of mania, hypomania (less severe mania) and depression – these are known as mood stabilisers and are taken every day on a long-term basis
- medication to treat the main symptoms of depression and mania when they occur
- learning to recognise the triggers and signs of an episode of depression or mania
- psychological treatment – like talking therapies, which help you deal with depression and provide advice on how to improve relationships
- lifestyle advice – such as doing regular exercise, planning activities you enjoy that give you a sense of achievement, and advice on improving your diet and getting more sleep
Read more about living with bipolar disorder.
Medication
Several medications are available to help stabilise mood swings. These are commonly referred to as mood stabilisers and include:
- lithium carbonate
- anticonvulsant medicines
- antipsychotic medicines
If you’re already taking medication for bipolar disorder and you develop depression, you should speak to your healthcare professional.
Learning to recognise triggers
If you have bipolar disorder, you can learn to recognise the warning signs of an approaching episode of mania or depression.
A community mental health worker, such as a psychiatric nurse, may be able to help you identify your early signs of relapse from your history.
This may mean making some changes to your treatment. Your healthcare professional can advise you on this.
Psychological treatment
Most people find psychological treatment helpful when used alongside medication in between episodes of mania or depression.
Pregnancy
You should speak to your healthcare professional if you have bipolar disorder if you’re trying to conceive or become pregnant.
The National Institute for Health and Care Excellence (NICE) recommends that specialist mental health services work closely with maternity services.
A written plan for managing the treatment of a pregnant woman with bipolar disorder should be developed as soon as possible.
The plan should be drawn up with the patient, her partner, her obstetrician (pregnancy specialist), midwife, GP and health visitor.
If you become pregnant while taking medication prescribed to treat bipolar disorder, it’s important that you don’t stop taking it until you’ve discussed it with your healthcare professional.
If medication is prescribed for bipolar disorder after the baby is born, it may also affect a mother’s decision to breastfeed her child. Your pharmacist, midwife or mental health team can give you advice based on your circumstances.
Living with bipolar disorder
Although it’s usually a long-term condition, effective treatments for bipolar disorder, combined with self-help techniques, can limit the condition’s impact on your everyday life.
Staying active and eating well
Eating well and keeping fit are important for everyone. Exercise can also help reduce the symptoms of bipolar disorder, particularly depressive symptoms.
It may also give you something to focus on and provide a routine, which is important for many people.
A healthy diet, combined with exercise, may also help limit weight gain, which is a common side effect of medical treatments for bipolar disorder.
Some treatments also increase the risk of developing diabetes, or worsen the illness in people that already have it. Maintaining a healthy weight and exercising are an important way of limiting that risk.
You should have a check-up at least once a year to monitor your risk of developing cardiovascular disease or diabetes.
This will include recording your weight, checking your blood pressure and having any appropriate blood tests.
Read more information about losing weight and improving fitness
Self-care and self-management
Self-care
Self-care is an essential part of daily life. It involves taking responsibility for your own health and wellbeing with support from the people involved in your care.
It includes:
- staying fit and maintaining good physical and mental health
- preventing illness or accidents
- caring more effectively for minor ailments and long-term conditions
People with long-term conditions can benefit enormously from being helped with self-care. They can live longer, have less pain, anxiety, depression and fatigue, have a better quality of life, and be more active and independent.
Self-management programmes
Self-management programmes aim to help people with bipolar disorder take an active part in their own recovery so they’re not controlled by their condition.
One course run by Bipolar UK aims to teach people with bipolar disorder how to manage their illness. The programme includes information about:
- triggers and warning signs
- coping strategies and self-medication
- support networks and action plans
- maintaining a healthy lifestyle
- drawing up an advance decision
- complementary therapies
- action plans
There are other courses, such as those run by Self Management UK, for mild to moderate mental health conditions.
Courses such as these help people who may feel distressed and uncertain about their bipolar disorder improve their own lives.
Talking about it
Some people with bipolar disorder find it easy to talk to family and friends about their condition and its effects. Other people find it easier to turn to charities and support groups.
Many organisations run self-help groups that can put you in touch with other people with the condition. This enables people to share helpful ideas and helps them realise they’re not alone in feeling the way they do. These organisations also provide online support in forums and blogs.
Some useful charities, support groups and associations include:
Talking therapies are useful for managing bipolar disorder, particularly during periods of stability.
Services that can help
You may be involved with many different services during treatment for bipolar disorder. Some are accessed through referral from your GP, others through your local authority.
These services may include:
- Community mental health teams (CMHT) – these provide the main part of local specialist mental health services. They offer assessment, treatment and social care to people with bipolar disorder and other mental illnesses.
- Early intervention teams – these provide early identification and treatment for people who have the first symptoms of psychosis. Your GP may be able to refer you directly to an early intervention team.
- Crisis services – these allow people to be treated at home, instead of in hospital, for an acute episode. These are specialist mental health teams that deal with crises that occur outside normal office hours.
- Acute day hospital – these are an alternative to inpatient care in a hospital. You can visit every day or as often as you need.
- Assertive outreach teams – these deliver intensive treatment and rehabilitation in the community for people with severe mental health problems, providing rapid help in a crisis. Staff often visit people at home and liaise with other services, such as your GP or social services. They can also help with practical problems, such as helping to find housing and work, or doing your shopping and cooking.
Avoiding drugs and alcohol
Some people with bipolar disorder use alcohol or illegal drugs to try to take away their pain and distress. Both have well-known harmful physical and social effects and are not a substitute for effective treatment and good healthcare.
Some people with bipolar disorder find they can stop misusing alcohol and drugs once they’re using effective treatment.
Others may have separate but related problems of alcohol and drug abuse, which may need to be treated separately.
Avoiding alcohol and illegal drugs is an important part of recovery from episodes of manic, hypomanic or depressive symptoms, and can help you gain stability.
Read more about alcohol misuse
Money and benefits
It’s important to avoid too much stress, including work-related stress. If you’re employed, you may be able to work shorter hours or in a more flexible way, particularly if job pressure triggers your symptoms.
Under the Equality Act 2010, people are protected from discrimination in the workplace and in wider society. This can include people with a diagnosis of bipolar disorder or other mental illnesses.
A range of benefits is available to people with bipolar disorder who can’t work as a result of their mental illness. The Adult Disability Payment is managed by Social Security Scotland. Depending on your circumstances, you may qualify from non-devolved benefits from the UK Government.
Want to know more?
Living with or caring for someone with bipolar disorder
People living with or caring for someone with bipolar disorder can have a tough time. During episodes of illness, the personalities of people with bipolar disorder may change, and they may become abusive or even violent.
Sometimes social workers and the police may become involved. Relationships and family life are likely to feel the strain.
If you’re the Named Person (as defined by the Mental Health (Scotland) Act 2015) of a person with bipolar disorder, you have certain rights that can be used to protect the person’s interests.
These include requesting that the local social services authority asks an approved mental health professional to consider whether the person with bipolar disorder should be detained in hospital (also known as “sectioning”).
You may feel at a loss if you’re caring for someone with bipolar disorder. Finding a support group and talking to other people in a similar situation might help.
If you’re having relationship or marriage difficulties, you can contact specialist relationship counsellors, who can talk things through with you and your partner.
Want to know more?
Dealing with suicidal feelings
Having suicidal thoughts is a common depressive symptom of bipolar disorder. Without treatment, these thoughts may get stronger.
Some research has shown the risk of suicide for people with bipolar disorder is 15 to 20 times greater than the general population.
Studies have also shown that as many as 25-50% of people with bipolar disorder attempt suicide at least once.
The risk of suicide seems to be higher earlier in the illness, so early recognition and help may prevent it.
If you’re feeling suicidal or you’re having severe depressive symptoms, contact your GP, care co-ordinator or the local mental health emergency services as soon as possible.
If you can’t or don’t want to contact these people, contact the Samaritans on 116 123. You can call them 24 hours a day, seven days a week.
Alternatively, visit the Samaritans website or email jo@samaritans.org.
Self-harm
Self-harm (sometimes called self-injury) is often a symptom of mental health problems such as bipolar disorder.
For some people, self-harm is a way of gaining control over their lives or temporarily distracting themselves from mental distress. It may not be related to suicide or attempted suicide.
Want to know more?
Recommended communities
Online communities help you talk to people, share your experiences and learn from others.
The SANE Support Forum allows people to share their feelings and provide mutual support to anyone with mental health issues, as well as their friends and family.
Bipolar UK, a national charity, also runs an online discussion forum for people with bipolar disorder, their families and carers.
Last updated:
04 April 2024
