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Bipolar disorder

Bipolar disorder is a mental health condition that causes repeated, severe mood swings. At different times your mood can vary from excitement and elation, called mania, to depression and despair.

Bipolar disorder is also known as manic depression, or sometimes bipolar affective disorder. It affects your mood and behaviour, causing extremes of emotion. These moods are different from the normal ups and downs that everyone goes through from time to time.

A man thinking

What is bipolar disorder?

When you have bipolar disorder, you may have distinct lengths of time when you feel extremely low (depression) or times when you feel very high (mania). Each of these periods of time would last for longer than two weeks. Sometimes people can also have mixed emotions, experiencing both low and high moods at the same time.

The symptoms of bipolar disorder usually appear for a set length of time (an episode). Each episode lasts for more than two weeks. The time an episode lasts for can vary and may be several months, but this depends on the person affected. The time from the start of one episode to the next also varies. Some people with bipolar disorder have only a few episodes during their life. Other people may have them more regularly. Between episodes of mood disturbances, you may not have any symptoms at all.

About one in 100 people get bipolar disorder at some point in their life. You’re most likely to develop bipolar disorder for the first time in your mid teens to your mid 20s. Both men and women develop it in pretty much equal numbers.

Personal experience: Andrew's story

Sometimes hearing from someone who has experienced a condition can help you to understand it better. Here, Andrew shares his experience of living with bipolar disorder and how it has affected him.

“I was originally diagnosed with severe clinical depression. It took almost a decade before I was properly diagnosed with bipolar disorder.

“As part of the bipolar disorder, I have experienced periods of mania as well. When manic, my mood would either be falsely elated or very irritable. I would become extremely focused and goal-oriented around one interest at the expense of all else. I have amassed a wealth of knowledge and built up large collections of guitars, obscure music and Land Rovers in the past. I would become very poor at managing my money (usually spending it on amassing collections). I would need very little sleep and would usually devote all my time to work at the expense of my family.

“Knowing that I have bipolar disorder means that I’ve had to learn to build a toolbox of behaviours, which help me to manage the condition and keep within a safe range of mood fluctuation (everyone gets sad sometimes). I take regular daily medication that helps in the moderation of my moods, but just as important as the medication are the lifestyle changes and psychological interventions. For me, this includes having a consistent sleep pattern every day, limiting how much alcohol I drink and keeping a mood diary.

“My advice to anyone going through the same situation is to not be ashamed of your illness. Bipolar disorder (or any mental health condition) is just as real an illness as diabetes or a broken limb."

As Andrew suggests, there can sometimes be a delay in bipolar disorder being diagnosed. Many people who see their GP are going through an episode of depression. But it’s also important to make your doctor aware of the fluctuations in your mood so that they know about all of your symptoms. See our section on Diagnosis for more information.

Types of bipolar disorder

In the UK, bipolar disorder is usually described using two main types: bipolar disorder I and bipolar disorder II.

Bipolar disorder I

This is the more severe of the two types. You have at least one ‘fully manic’ episode, where you have a very elevated mood. You may also have episodes when you feel depressed, or when you feel more mildly manic (this milder mania is called hypomania).

Bipolar disorder II

This is when you have one or more episodes of feeling really depressed. You also have at least one episode of hypomania.

Related disorders

Cylothymia is where your mood disturbances aren’t as bad as full bipolar disorder, but they last longer. You may have episodes of mild depression and mild elevated mood. Your symptoms may disappear for a while or even forever. But they can also develop into a full bipolar disorder.

If you have more than four episodes of mood disturbance in a year, this would be called rapid cycling bipolar disorder. This affects around one in every 10 people with bipolar disorder. Your mood changes from feeling manic to depressed very quickly and then back again. Sometimes your mood can change over days or even hours.

Symptoms of bipolar disorder

If you have bipolar disorder, you’ll have noticeable mood disturbances. Your mood will alternate between periods of feeling low (depression) and of feeling high (mania). These periods usually last several weeks or even several months. The symptoms vary from one person to another, and between one episode and the next. Your symptoms may vary from day to day and even during the day. They may disappear between episodes.

Mania and mild mania (hypomania)

If you get mania, you may:

  • feel incredibly happy and have an unusually elevated mood
  • have more energy than usual
  • be irritable and sometimes aggressive
  • be more talkative, and talk very fast
  • be easily distracted
  • have poor judgement
  • not need much sleep
  • have more interest in sex
  • take part in activities that may be unwise, such as gambling, dangerous sports or risky business schemes

You would usually expect a manic episode to last for at least a week. Hypomania is a milder form and would normally be expected to last for more than four days. During an episode of mania, you may not be aware of any changes in your behaviour. It’s more likely that it’ll be your friends, family or colleagues who notice these changes.

Depression

If you get depression, you may:

  • feel sad and negative about life
  • lose interest in people and activities
  • feel worthless and lose confidence in yourself
  • feel unable to make decisions
  • have difficulty sleeping
  • have less energy, and feel unusually tired
  • isolate yourself from your friends
  • think of suicide
  • feel guilty
  • eat more or less than usual so you gain or lose weight

Mixed

You may have feelings of mania and depression at the same time or rapidly switch between them (within a few hours). So you may feel sad but also have lots of energy.

Psychosis

If an episode of mania or depression is very severe, you may develop psychosis. This is where your thoughts and emotions are so affected that you lose sense of reality. You may imagine seeing or hearing things (hallucinations) or have illogical beliefs (delusions). It can be hard to communicate with people during this time. If you are depressed or in a mixed state of depression and mania, you may have feelings of guilt and worthlessness or suicidal thoughts. If you have suicidal thoughts, you need to see your GP or go to A&E. You can also call Samaritans on 116 123 for support.

Diagnosis of bipolar disorder

If you think you have symptoms of bipolar disorder, speak to your GP. It’s important to get diagnosed so you can change your lifestyle and get treatment to control your episodes as much as possible. A friend or relative may realise you have bipolar disorder before you do. They may be more aware of changes in your behaviour.

Your GP will ask about your symptoms and talk to you about your medical history and how you’re feeling. Many people who see their GP are going through an episode of depression, which can include thoughts of suicide. If you do have suicidal thoughts, it’s important to seek help from your GP. You can also call Samaritans on 116 123 for support.

It’s important that bipolar disorder is treated as a whole, including any mania episodes. So, your GP will ask whether you’ve noticed any mania symptoms lasting for four or more days at a time. They may refer you to see a psychiatrist (a doctor who specialises in mental health) or a specialist mental health service. Your GP may suggest some tests to rule out other conditions, such as problems with your thyroid gland, which can affect your behaviour.

Treating bipolar disorder

Bipolar disorder is a long-term illness and often lasts for the rest of your life. Although there isn’t currently a cure for bipolar disorder, there are things you can try to keep your mood constant and control your symptoms.

The right treatment for you will depend on your symptoms and their severity. It will also depend on your medical history. Your doctor may recommend a mixture of self-help measures, medicines and talking therapies.

If your symptoms are very severe, you may need to go into hospital for a while.

Self-help for bipolar disorder

You may find it helpful to track your moods by recording them in a diary or using a diary app. This may highlight anything in your life that helps your mood disturbances and anything that makes them worse. If you know what helps and what doesn’t, you may be able to prevent future episodes. It may also help you recognise when things are getting out of control. Learning to recognise the start of a mood disturbance may mean you can get help early on. Then you may be able to avoid a full-blown episode or hospital admission.

Sticking to a regular daily routine may help to control your symptoms. Make sure you have a good sleep routine, going to bed and getting up at the same time each day. Avoid stress as much as possible and make sure you have time to relax every day. Try listening to relaxing music or join a local relaxation class.

Doing some regular exercise may help to keep your mood stable. Choose a fun, but reasonably intense, activity that you enjoy, ideally for 20 minutes on three days every week.

Medicines for bipolar disorder

Self-help measures may help you track your mood, but you often still need to take some medicines to keep your symptoms under control. There are many medicines you can take to treat bipolar disorder. You may need to try out several of them before you find the ones that work best for you. It’s a good idea to track how well different medicines work for you in your diary. If your symptoms change or you notice any side-effects, your doctor may switch or add medicines to your treatment plan.

Antipsychotics

In the most serious cases of mood disturbance, your doctor may prescribe an antipsychotic medicine. If they think this is necessary, they will go through the possible side-effects and make sure they have your full consent before starting the medicine.

Your doctor will want to keep a close eye on you and do regular health checks after prescribing antipsychotics. You shouldn’t stop taking antipsychotic medicines without your doctor’s advice. If your doctor decides you need to stop taking them, you’ll do this slowly, reducing your dose over at least four weeks.

Mood stabilisers

To help prevent mood disturbances or treat a manic episode, your doctor may prescribe mood stabilising medicines. There are a number of different mood stabilisers, such as lithium – your doctor will decide on the most appropriate one for you based on your symptoms and history. You may be advised to take mood stabilisers on their own or with antipsychotic medicines. You’ll need to have blood tests to make sure you’re getting the right dose. It can take some time for these medicines to work properly (around six months for lithium).

As with all medications there can be side-effects when taking mood stabilisers. These can include either putting on or losing weight, tremors (shaking) and feeling thirsty. Your doctor will give you advice about taking mood stabilisers and tell you about possible side-effects you might experience.

It’s important to carry on taking your medicine and follow your doctor’s advice, even if you start to feel well. Don’t stop taking your medicine without speaking to your doctor first, as this may cause your symptoms to come back.

Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist or GP for advice.

Antidepressants

If you have depression, your doctor may recommend you take a short course of antidepressants. People with bipolar disorder usually take a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI), such as fluoxetine.

There’s a risk that you may switch from depressive to manic symptoms when taking these medicines. So, you’ll probably take them with antipsychotic medicines or mood stabilisers to stop this from happening. Side-effects of antidepressant medicines can include restlessness, increased anxiety and agitation.

Talking therapies for bipolar disorder

Talking and thinking about your bipolar disorder with a counsellor or psychologist may help your symptoms, especially if you feel depressed. This may prevent a relapse and the risk of hospitalisation. It can also help you stay well in the future. You can decide whether to see a counsellor on your own, in a group or with your family.

Cognitive behavioural therapy (CBT) is one type of talking treatment. It helps to change the way you think, feel and behave. You’ll usually have a course of CBT lasting for at least three months.

If your symptoms are really severe, your GP may worry that you won’t recover without going into hospital, as you need more care than is available in the community. They may be concerned about your safety, because your symptoms are so serious that you may hurt yourself or have conflicts with people around you. So, in this situation you may need to go into hospital for a while. You’ll be able to get the care you need there, and a specialist doctor will support you.

Because bipolar disorder can change your behaviour, you may not realise you’re unwell. This may mean you don’t want to have treatment. In this situation, the Mental Health Act gives doctors certain powers to keep you in hospital for treatment. Usually, this is only used if there’s a risk to your health or safety, or that of others.

Causes of bipolar disorder

Why some people develop bipolar disorder and others don’t isn’t yet fully understood. But there are some things that can make you more likely to develop it.

Having a close relative (such as a parent or sibling) with bipolar disorder means you’re five to 10 times more likely to get it.

Stressful events, such as the breakdown of a relationship, may trigger bipolar disorder episodes. Emotionally difficult experiences as a child, such as physical, sexual or emotional abuse, can also increase your risk of developing it.

Taking certain illegal drugs, such as cocaine and amphetamines, or alcohol may make bipolar disorder worse.

Pregnancy and bipolar disorder

Certain medicines for bipolar disorder, such as carbamazepine, can stop the contraceptive pill working properly. To avoid pregnancy, you may need to use barrier methods of contraception (such as condoms) instead. Speak to your GP for advice.

Some medicines, such as lithium and valproic acid, can increase the risk of developmental problems in babies. Ask your GP for advice if you're considering getting pregnant. You may need to change your medicine or stop taking medicines altogether and use another treatment, such as a talking therapy, instead.

If you’re pregnant, tell your midwife you have bipolar disorder. Your local mental health service may ask to see you more often to monitor you and your baby more closely.

Living with bipolar disorder

Bipolar disorder is a lifelong condition. It can’t be cured, but you can keep your symptoms under control if you follow your management programme. Keeping a diary will help you track your mood disturbances and know when to seek help.

You may find you can get back to normal between mood disturbances. But sometimes you can still have mild depression or problems with thinking, even if you seem better. This can affect your work and relationships, so it’s important to get the help you need. Don’t stop taking your medicines when you feel well without speaking to your doctor first.

Your doctor or mental health service will create a personalised care plan with you. This plan will describe your treatment and the care you’d like if your symptoms suddenly get worse. It will include your early warning symptoms and anything that’s likely to trigger an episode.

Give your family and friends information about bipolar disorder so they know what to expect if you have an episode. They can help you develop your care plan with your doctor or mental health service. They can then help you reach your goals and stick to your treatment.

There may be times when you need urgent help or support or you may not be well enough to make your own decisions. Your care plan will include key clinical contacts for you in case of an emergency. It’s a good idea to give friends or family these details too.

Stressful situations can trigger an episode of mania or depression. Counselling and therapies can help you stay well. You can have counselling on your own, in a group or with family and friends. Bipolar disorder affects around one in every 100 people in the UK. It’s important to realise you’re not alone. By joining a local support group, you can meet other people with the same condition. You may benefit from hearing about their own experiences, as they may be similar to yours.

If you work, or want to work, you should be offered help and advice. This help could come from your local mental health service or mental health service. Supported employment programmes can help you stay in work or move to another job. They can also help you find work more quickly. If you struggle to find work, you may be offered a training programme.

If you’re taking medicines for bipolar disorder, such as lithium, you’ll need regular health checks to stay well. You should also have a physical health check at least once a year. Your doctor will check your weight and blood pressure and assess your risk of heart disease and diabetes using blood tests. Your doctor will look for any signs that you’re not well and take steps to address them.

Bipolar disorder may stop you driving for a while. For more information, see our FAQ on driving.

FAQ: How can I keep my symptoms under control?

Bipolar disorder affects people in different ways. You may recover completely between episodes. But once you’ve had one episode, there’s a chance you’ll have another one. The gap between episodes varies. About half of people who have a manic episode will have a further episode of bipolar disorder within a year.

Watch out for anything you know acts as a trigger or a sign that you’re about to have an episode. This may help you seek treatment early on and prevent an episode from developing into a major one. Keeping a diary of your daily life and your symptoms may help you do this. Sleep problems can trigger an episode, but may also be a sign that a manic episode is on its way.

Finding the best way to manage your condition can help to control your mood disturbances and ease your symptoms. You can try a range of different treatments, including medicines and talking therapies. Your doctor will help you find the best one for you. Keep taking your medicines as prescribed and watch out for any side- effects. Don’t stop taking your medicines suddenly, as this is likely to lead to another episode.

FAQ: Can I drive if I have bipolar disorder?

If you have bipolar disorder, legally you may not be allowed to drive. Tell the Driver and Vehicle Licensing Agency (DVLA) about your condition and they will let you know whether or not you can. Your symptoms can affect your ability to drive safely, putting you and others at risk.

Don’t drive during an episode as it isn’t safe. If it’s your first episode, you’ll usually be allowed to drive again if you:

  • don’t have another episode for at least three months
  • are having treatment for bipolar disorder
  • don’t have any side-effects from your medicines that may affect your driving
  • receive a medical report from your doctor saying you’re fit to drive

If you’ve had four or more mood disturbances within a year, don’t drive for at least six months or until your symptoms are under control. Speak to your doctor or the DVLA for more information and tell your insurance company about your condition.

Details

  • Other helpful websites Other helpful websites

    Further information

    Bipolar UK Bipolar UK is a charity specifically for people with the condition offering not only information but also details of local support groups. This page gives answers to some of the questions that are most commonly asked about bipolar disorder.
    Mental Health Foundation The Mental Health Foundation is a charity that carries out research and offers information about many areas of mental health. They have a helpful overview of bipolar disorder.
    Mind The charity Mind has information to support people with a mental health condition and those who care for them. This page on bipolar disorder has a video of people who have it talking about what it’s like living with the condition. There are also personal accounts written by people with bipolar disorder about their experiences.
      This page has information about mania and hypomania. You can get these on their own, as well as with the periods of depression that characterise bipolar disorder.
     Rethink This charity has support groups, runs campaigns and can direct you to local mental health services, as well as providing information. Their factsheet on bipolar disorder [PDF] explains some of the key guidelines around treatment that apply to you so you can get what’s right for you.
     CALM CALM (Campaign Against Living Miserably) is a charity that exists primarily to prevent male suicide. Through their confidential helpline and website, they offer support for all men when things go wrong. Their information about bipolar disorder has first-person accounts from people living with the condition.

    Sources

    • Bipolar disorder: Background. Clinical Knowledge Summaries. cks.nice.org.uk, last revised October 2015
    • Bipolar disorders. The MSD Manuals. www.msdmanuals.com, last full review/revision August 2016
    • Bipolar illness. Oxford Handbook of Psychiatry (online). Oxford Medicine Online. oxfordmedicine.com, published online March 2013
    • Bipolar disorder. Royal College of Psychiatrists. www.rcpsych.ac.uk, published April 2015
    • Bipolar disorder: assessment and management. National Institute for Health and Care Excellence (NICE). Clinical Guidelines CG185. www.nice.org.uk, last updated February 2016
    • Bipolar disorder. PatientPlus. patient.info, last checked may 2016
    • Bipolar disorder in adults. Definition. BMJ Best Practice. bestpractice.bmj.com, last updated February 2017
    • Bipolar disorder in adults. National Institute for Health and Care Excellence (NICE). Quality Standard QS95. www.nice.org.uk, published July 2015
    • Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Journal of Psychopharmacology. Association for Psychopharmacology. www.bap.org.uk, 2016
    • Drug treatment of bipolar disorders. The MSD Manuals. www.msdmanuals.com, last full review/revision August 2016
    • Drugs for mania and hypomania. NICE British National Formulary. bnf.nice.org.uk, last updated June 2017
    • Olanzapine. NICE British National Formulary. bnf.nice.org.uk, last updated June 2017
    • Lithium carbonate. NICE British National Formulary. bnf.nice.org.uk, last updated June 2017
    • Valproic acid. NICE British National Formulary. bnf.nice.org.uk, last updated June 2017
    • Fluoxetine. NICE British National Formulary. bnf.nice.org.uk, last updated June 2017
    • Cognitive and behavioural therapies. PatientPlus. patient.info, reviewed 2 April 2014
    • Bipolar disorder: Scenario: Managing relapse. Clinical Knowledge Summaries. cks.nice.org.uk, last revised October 2015
    • Bipolar disorder: Causes. Clinical Knowledge Summaries. cks.nice.org.uk, last revised October 2015
    • Combined oral contraceptive pill: follow up and common problems. PatientPlus. patient.info, last checked November 2014
    • Antenatal and postnatal mental health: clinical management and service guidance. NICE Clinical Guidelines CG192. www.nice.org.uk, last updated June 2015
    • Medical conditions, disabilities and driving. Driver & Vehicle Licensing Agency (DVLA). www.gov.uk, accessed August 2017
    • Assessing fitness to drive a guide for medical professionals. Driver & Vehicle Licensing Agency (DVLA). www.gov.uk, June 2017
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    Reviewed by Graham Pembrey, Lead Health Editor, Bupa Health Content Team, September 2017
    Expert reviewer, Dr Gabrielle Pendlebury, Consultant Psychiatrist
    Next review due September 2017 

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