Bipolar disorder

Expert reviewer, Dr Rahul Bhattacharya, Consultant Psychiatrist
Next review due August 2023

Bipolar disorder is a mental health condition that may cause repeated, severe mood swings and changes in behaviour. At different times your mood can vary from feeling emotionally high with lots of energy, to feeling emotionally very low with depression and despair.

These moods are different from the normal ups and downs that everyone has from time to time. Bipolar disorder can be a lifelong and sometimes serious condition that can have a big effect on your day-to-day life. Bipolar disorder is also sometimes called manic depression, or bipolar affective disorder.

A man sitting at a table with a drink and looking out of a window

What is bipolar disorder?

When you have bipolar disorder, you may have alternating periods of time where you feel emotionally very high (mania) and then emotionally very low (depression) or vice versa. These periods are called episodes. You’ll also have periods in between when you feel well (in remission), and these periods can last for months.

Some people have hypomania, which is when you feel emotionally high, but it’s not as intense as with mania and you’re more able to get on with day-to-day life. Sometimes people can also have mixed episodes, experiencing both low and high moods quickly, one after another or almost at the same time.

Between episodes of mood disturbances, you may not have any symptoms at all and be able to live life almost as normal.

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

If you have bipolar disorder, you’re also more likely to have other conditions such as anxiety and attention deficit hyperactivity disorder (ADHD). Having bipolar disorder is also linked to some physical conditions such as heart disease, high blood pressure and type 2 diabetes.

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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 has the more severe symptoms of the two types with a fully manic episode and sometimes severe depression. The mania may trigger a loss from reality (psychosis). The symptoms can often be bad enough to lead to admission to hospital for treatment.
  • Bipolar disorder II. The symptoms of this type are usually less severe. You may be diagnosed as having bipolar II if you’ve had at least one episode of depression and an episode of hypomania.

Cyclothymia is where you have similar symptoms to bipolar disorder, but they aren’t as severe. You may have many episodes of depression and elevated mood over a long period of time. Rapid cycling bipolar disorder is when you have four or more depressive, manic, hypomanic, or mixed episodes in a year.

Living with bipolar disorder

Andrew shares his experience of living with bipolar disorder and how it has affected him

Symptoms of bipolar disorder

The symptoms of bipolar disorder come and go as episodes that can last for weeks or months in total. Everyone is different and how long or how often the episodes happen can vary. Symptoms can also vary from day to day or within the same day.

Mania symptoms

  • Feeling very confident about yourself and your abilities and being extravagant. A belief that you have a special talent or power – this can lead to loss of reality and is referred to as grandiose ideas or delusions.
  • Having lots of energy and not needing much sleep.
  • Being more talkative than usual or feeling like you must keep talking. You might not make much sense to other people.
  • Having lots of ideas one after another and feeling like your thoughts are racing.
  • Easily distracted, irritable or agitated.
  • Feeling extremely happy or euphoric.
  • Taking risks that you usually wouldn’t, such as taking drugs, investing money poorly or having unprotected sex.
  • Having symptoms of psychosis, such as seeing or hearing things that aren’t there (hallucinations) or delusions such as paranoia.

The symptoms of hypomania can be similar but less severe. So, you may feel happy and have a bit more energy or be more talkative or sociable. You won’t have symptoms of psychosis, though.

Symptoms of depression

  • Feelings of sadness and very low mood that don’t get any better.
  • Low energy levels.
  • Losing interest in the things you usually enjoy, such as hobbies or spending time with friends and family.
  • Sleeping a lot more or less than usual.
  • Changes in appetite.
  • Feelings of guilt, low self-esteem and despair, which there may not be any reason for.

Diagnosis of bipolar disorder

If you think you have symptoms of bipolar disorder, or you think someone else may, speak to your GP as a first step. It can help if you keep a diary of your moods and what you’re thinking and feeling. Some of the mental health charities have diaries and mood scales you can use.

Your GP will ask about the symptoms you have now and any you’ve had in the past. They will also talk to you about your medical history and how you’re feeling. There is a group of symptoms which together would show your GP that you may have mania. They will also be looking for signs or symptoms of hypomania and depression.

If they think you may have bipolar disorder, they will refer you to see a psychiatrist (a doctor who specialises in mental health) or a specialist mental health service. If your symptoms are severe or you’re at risk of hurting yourself or someone else, you’ll be referred as an emergency.

Your GP may suggest some blood tests to rule out other conditions, such as problems with your thyroid gland, which can affect your behaviour. Your doctor should also do a physical examination to check for health problems.

Self-help for bipolar disorder

There are many things that you can do to help yourself stay well and reduce the effects that bipolar disorder can have on your life. The following tips may help.

  • Medicines for bipolar disorder can cause you to put on weight and during episodes when you’re depressed you may not feel like exercising either. Do what you can to eat healthily and be as active as you can.
  • Avoid taking recreational (or unprescribed) drugs or drinking alcohol.
  • Recognise early warning signs of relapse.
  • Develop good relationships with the health professionals and others who support you. Work with them to develop emotional and social recovery goals and a crisis plan so you know what to do when you have the early warning signs of an episode. You can also work together to create a plan for your medicines so you know what to take and when and can check for side-effects.
  • Keep a record or a diary of how you’re feeling day-to-day, so you can manage your mood and spot any changes quickly.
  • Make use of self-help and support groups, telephone support and activities to reduce stress.

Treating bipolar disorder

Bipolar disorder is a lifelong mental illness which will always need treatment. The aim of your treatment is to have stable moods and manage your symptoms.

Treatment will depend on whether you’re having an episode or not, and if you are having an episode, what kind you’re having and how severe the symptoms are. Your doctor will work with you to create an individual treatment plan to help prevent episodes from happening or to reduce how often or how severe they are.

Your doctor may recommend a mix of self-help measures, medicines and talking therapies. If your symptoms are very severe, you may need hospital treatment for a while.

Medicines for bipolar disorder

There are three main types of medicines used to treat bipolar disorder. It’s likely you will be prescribed a combination of medicines.

  • Antidepressants. These may help when you’re having an episode with depression. It may help your recovery to have talking therapy, such as family therapy or cognitive behavioural therapy (CBT) alongside taking antidepressants. It’s important that you mention to your GP that you have bipolar disorder when seeking help and advice for episodes of depression. This is because taking antidepressant medicines on their own put you at risk of manic relapse.
  • Antipsychotics. These medicines are used to treat manic or hypomanic episodes. You might need to take more than one, or you may be asked to take them with a mood stabiliser as well.
  • Mood stabilisers. These can help to keep your mood stable in the long term as well as during an episode. They include lithium and valproate.

You’ll need to have regular check-ups, while you’re taking some medicines for bipolar disorder. If you’re taking an antipsychotic medicine, you’ll have your weight, blood pressure and pulse, blood sugar and cholesterol levels checked. If you’re taking lithium, you’ll need to have regular blood tests to check you’re having the right amount.

Drinking alcohol, smoking or taking drugs while you’re taking medicines for bipolar disorder can stop them working as well as they should and make your symptoms worse. Don’t stop taking any of the medicines suddenly. If you’re stopping any medicines, you’ll need to do it gradually over at least four weeks. It’s also important to know what to do if your symptoms start again.

Some medicines can affect how a baby develops in the womb. So, if you have bipolar disorder and aren’t planning a family, it’s important to use contraception. If you want to have a baby, it’s also important to plan your pregnancy if you can. Your doctor can give you advice about your medicines and tell you whether you need to stop or change any.

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

Talking therapies for bipolar disorder

Talking and thinking about your bipolar disorder with a counsellor or psychologist may help your symptoms and help to prevent a bipolar episode. 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.

Talking therapies include:

Treatment during a crisis

If you feel very unwell, if your symptoms are severe or they have been going on for a long time without getting better, you may need help and treatment quickly. This is called getting crisis support and it may mean going to accident and emergency or getting support from a crisis resolution and home treatment (CRHT) team.

If you’re in danger of harming yourself or others, sometimes your doctor may need to give treatment without your agreement. In this situation, the Mental Health Act gives doctors certain powers to keep you in hospital for treatment.

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. These are some of the main ones.

  • Bipolar disease is in your family. Having a close relative such as a parent or sibling with bipolar disorder means you’re at least five times more likely to get it.
  • Very stressful events or experiences as a child, such as abuse or neglect or the death of your mum when you’re very young.
  • Stressful life events which can be a trigger for the first episode or episodes in the future.
  • Taking drugs such as cannabis or cocaine for long periods of time is linked to bipolar disorder. Doctors don’t know whether drug taking causes bipolar disorder or whether having bipolar disorder leads to taking drugs.

Living with bipolar disorder

Bipolar disorder is a lifelong condition and sometimes it can be hard to live with. Everyone has mood swings, but with bipolar disorder these can be extreme and can have a big impact on all areas of your life. It might feel as if you have very little control, but there are things you can do that will help you to manage symptoms and feel as well as you can.

Mind, the mental health charity, has these suggestions.

  • Know and keep an eye on your moods – using a diary is sometimes helpful.
  • Get to know what triggers an episode or makes one more likely and what the warning signs are. So, late nights might be a trigger and changes to your sleeping patterns might be a sign of an episode.
  • Stick to a routine that includes set times for medicines, meals and sleep as well as times for relaxation and activities you enjoy. Get support, from your family and friends but also from others with bipolar disorder. There are organisations that can help, and you can find details of these in the helpful websites section below.
  • Plan ahead for a crisis or an episode. Know what you’ll do and when and who can help you.
  • Manage your stress, as it can trigger a manic or a depressive episode.

Travel, long-haul flights and changes in time zones can trigger episodes. Make sure you plan ahead and discuss any concerns with your GP. It can help to:

  • travel with someone you trust
  • leave plenty of time to arrive before departure
  • consider low-stress destinations
  • book direct flights or routes

Frequently asked questions

  • Bipolar disorder affects people in different ways. You may recover completely between episodes or you may carry on having milder symptoms. But once you’ve had one episode, there’s a chance you’ll have another one. Most people find that the start of their next episode will be with mania if the last episode ended with depression and vice versa. The gap between episodes varies. About half of people will have a further episode of bipolar disorder within a year of the first.

    Watch out for anything you know acts as a trigger or a sign that you’re about to have an episode. This can 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.

    When you’re trying to recover from an episode, try to avoid things that you know are likely to trigger strong, negative emotions. That might include staying away from drugs and alcohol or making changes to your job, relationships or living arrangements. Friends and family members who support you are invaluable in helping you to feel less isolated and picking up signs that an episode might be in its way.

    Remembering to take your medicines as prescribed is one of the most important things you can do. Medication reminders or pill boxes can help you organise yourself, so you don’t miss any medicines.

  • You must tell the Driver and Vehicle Licensing Agency (DVLA) You must tell the Driver and Vehicle Licensing Agency (DVLA) about your condition and they will tell you whether you can carry on driving. 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 and it’s against the law. After an 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, you won’t be able to drive for at least six months. Speak to your doctor or the DVLA for more information and tell your insurance company about your condition.

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Related information

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    • Bipolar disorder. Patient – Professional Reference., last edited May 2016
    • Mood [affective] disorders. ICD-10 Version: 2016., published 2016
    • Bipolar disorder. BMJ Best Practice., last updated September 2018
    • Bipolar disorder – definition. NICE Clinical Knowledge Summaries., last revised June 2019
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    • Bipolar Disorders. MSD Manuals., last reviewed March 2020
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    • Bipolar disorder. Mind., published May 2018
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  • Reviewed by Sarah Smith, Freelance Health Editor and Alice Windsor, Specialist Health Editor, Bupa Health Content Team, August 2020
    Expert reviewer, Dr Rahul Bhattacharya, Consultant Psychiatrist
    Next review due August 2023