Bipolar disorder
Your health expert: Dr Sammad Hashmi, Consultant Psychiatrist
Content editor review by Pippa Coulter, December 2022
Next review due, December 2025
Bipolar disorder is a mental health condition that causes severe mood swings from depression to elation. It’s sometimes called manic depression, or bipolar affective disorder. Bipolar disorder is a serious, long-term condition that can have a big effect on your day-to-day life. But treatment can help to keep your symptoms under control.
About bipolar disorder
When you have bipolar disorder, you have alternating periods of very high and very low moods. These periods are called episodes. They may include the following.
- Manic episodes. This is when you have an abnormally high mood, which makes it hard to go about your normal life.
- Hypomanic episode. This means you feel emotionally high, but it’s not as intense as with mania. You’ll feel more able to get on with day-to-day life.
- Depressive episodes. You’ll have a low mood and loss of interest or pleasure in your usual activities.
- Mixed episodes. This means you experience both low and high moods quickly, one after another or almost at the same time.
You can read more about how you feel during these episodes in our symptoms section.
Between episodes of mood disturbances, you may not have any symptoms at all and be able to live life almost as normal. This is called being in remission. These periods can last for months, or even years.
About two in 100 people get bipolar disorder at some point in their life. You’re most likely to develop it in your mid-teens to early twenties.
If you need help now
This page is designed to provide general health information. If you need help now, please use the following services.
- Samaritans. 116 123 (UK and ROI) - This helpline is free for you to call and talk to someone.
- NHS Services has a list of where to get urgent help for mental health.
- Mind website. Click the ‘Get help now’ button on the page. This is a tool that is designed to help you understand what’s happening to you and how you can help yourself.
If you think you might harm yourself or are worried someone else might come to immediate harm, call the emergency services on 999 or go to your local accident and emergency department.
Types of bipolar disorder
There are two main types of bipolar disorder, which are classed as follows.
- Bipolar disorder I. This is when you’ve had at least one, severe manic episode. You may also have severe depression, but it’s not always recognised.
- Bipolar disorder II. You may be diagnosed with this type if you’ve had at least one episode of severe depression and one episode of hypomania. You don’t have the more severe type of mania with this type.
If you have similar symptoms to bipolar disorder, but they aren’t as severe, you may be diagnosed with cyclothymia. With cyclothymia, you 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. You can have this with bipolar I or II.
Causes of bipolar disorder
It’s not fully understood why some people may develop bipolar disorder. But it’s thought to be down to a combination of genetic and environmental factors. These can include the following
- Family history of bipolar disorder. 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.
- Traumatic events or experiences as a child, such as abuse or death of a parent.
- Stressful life events, such as a relationship breakdown, bereavement or money worries. These can trigger an episode.
- Taking drugs, such as cannabis or cocaine. It’s unclear whether taking drugs causes bipolar disorder, or whether having bipolar disorder makes people more likely to take drugs.
Symptoms of bipolar disorder
Bipolar disorder symptoms come and go as episodes that can last for weeks or months at a time. Everyone is different, and how long the episodes last for or how often they happen can vary. Bipolar symptoms can also vary from day to day or within the same day.
Your symptoms will be different, depending on whether you are having a manic episode or a depressive episode.
Mania symptoms
- Feeling extremely happy or excited.
- Having lots of energy and not needing much sleep.
- Being more talkative than usual or feeling like you can’t stop talking. You might not make much sense to other people.
- Having lots of ideas one after another and feeling like your thoughts are racing.
- Being easily distracted and not being able to concentrate.
- Feeling irritable or agitated.
- Having a high sex drive.
- Having increased confidence and doing things that are more extravagant or risky than you’d normally do. For example, spending lots of money, taking drugs or having unprotected sex.
- Having symptoms of psychosis. These include seeing or hearing things that aren’t there (hallucinations). It also includes delusions, where you think you’re more powerful or important than you really are.
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.
Depression symptoms
- Feeling constantly down, low or tearful.
- Having 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, without any clear reason.
If you’re having symptoms of mania or depression, contact your GP for advice. It can help if you keep a diary of your moods and what you’re thinking and feeling. You can find mood diaries to download online (for example, see Bipolar UK in our further information section) or use apps to track how you’re feeling.
Diagnosis of bipolar disorder
Your GP will ask about your symptoms and whether you’ve had any episodes of depression or mania in the past. This may include questions about your mood, how you feel and your behaviour. Your GP may suggest some blood tests to rule out other conditions, such as problems with your thyroid gland, which can affect your behaviour.
If your GP thinks you could have bipolar disorder, they will refer you for a specialist mental health assessment. If your symptoms are severe or you’re at risk of hurting yourself or someone else, you may have an urgent referral.
The specialist will carry out a full assessment of your symptoms. This may include asking about:
- your mood changes
- changes in behaviour and any manic episodes
- anything that may have triggered your symptoms
- any family history
- how well you’re able to function in your daily life
- any other mental and physical problems you may have
- your general health, including any medicines you’re taking
You can usually bring a family member or carer to help describe the problems you’ve been having.
Treating bipolar disorder
You’ll usually need bipolar disorder treatment for life. The aim of bipolar treatment is to manage symptoms when you’re having episodes, and to help you maintain stable moods in the longer term.
Your doctor will work with you to create an individual care plan. This should give you recovery goals to work towards and information on treatments to manage your symptoms and moods. You should also have a crisis plan, so you know what to do if you have early warning signs of an episode.
Your doctor may recommend a mix of medicines and talking therapies, as well as suggesting things you can do to help yourself. If your bipolar symptoms are very severe, you may need hospital treatment for a while.
Medicines for bipolar disorder
Types of medicine
If you have bipolar disorder, it’s likely you will be prescribed a combination of medicines. Medicines that help to stop and prevent mood swings are called mood stabilisers. They include the following.
- Antipsychotics, such as haloperidol, olanzapine, quetiapine and risperidone. These medicines are used to treat manic episodes or hypomanic episodes. You might need to try different types before you find one that works for you.
- Lithium. This can help to keep your mood stable in the long term as well as during an episode of mania or depression.
- Valproate, carbamazepine and lamotrigine. These are medicines usually used to treat epilepsy. But they can also help with bipolar disorder. Your doctor may prescribe one of these if treatment with lithium isn’t helping or you don’t get on with it.
Your doctor may also prescribe an antidepressant called fluoxetine if you’re having an episode of depression. You’ll usually need to take this in addition to one of the medicines above. Antidepressants can sometimes trigger an episode of mania, so they’re not always used for depression in bipolar disorder. You may need to stop taking it if you develop an episode of mania.
Check-ups
You’ll need to have regular check-ups while you’re taking some medicines for bipolar disorder. If you’re taking an antipsychotic medicine, your doctor will want to monitor you. This may include checks on your weight, blood pressure and pulse, blood sugar and cholesterol levels. If you’re taking lithium, you’ll need to have regular blood tests to check you’re taking the right amount.
Taking your medicines
There are some important points to be aware of if you’re taking medicines for bipolar disorder.Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your doctor or pharmacist for advice.
Talking therapies for bipolar disorder
Your doctor may also recommend you try a talking therapy to help with your bipolar symptoms. This can help if you’re having an episode of depression, and can also help you manage your bipolar disorder in the long term.
Talking therapy involves talking to a trained counsellor or therapist about your thoughts, feelings and behaviour. It can help you to understand why you think or act in a certain way, and how you might be able to change this. Some talking therapies for bipolar disorder you do on your own, and others you do in a group, or with your partner or family.
Talking therapies for bipolar disorder include:
cognitive behavioural therapy (CBT) – which looks at how you feel and think affects your behaviour
- family therapy – where you work as a family to look at problems and how to overcome them
- interpersonal therapy – which looks at how your relationships with others affect you
- behavioural couples therapy – which focuses on problems you may have with a partner
- group psychoeducation – where you work together with a group of people who have had similar experiences
Treatment during a crisis
Sometimes you may need help and treatment quickly. This is called getting crisis support. You may need this if:
- you’re feeling very unwell with severe symptoms
- the mania or depressive episode has been going on for a long time
- your usual treatment isn’t helping
Crisis support may mean getting urgent specialist assessment and support from a community mental health service or crisis resolution and home treatment (CRHT) team.
If you’re in danger of harming yourself or others, the specialist may recommend that you’re admitted to hospital. Doctors will always aim for this to be your choice. But in some circumstances, your doctor may need to give treatment without your agreement. In this situation, the Mental Health Act gives doctors certain powers to admit you to hospital for treatment.
Living with 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.
- Use a diary or an app to track how you’re feeling day-to-day. This may help you to manage your mood and spot any changes quickly.
- Get to know what triggers an episode or makes one more likely and what the warning signs are. For example, lack of sleep might be a trigger. But changes to your sleeping patterns might be a sign that you’re having 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. This includes support from family and friends but might also include support groups, where you can meet other people who have had similar experiences.
- Make sure you have a plan in place for a crisis or an episode. Know what you’ll do and when and who can help you.
- Think about ways you can manage stress, as this can be a trigger for manic or depressive episodes.
- Look after yourself physically. Try to get enough sleep, eat a healthy diet and keep active. This can make you feel better generally. It may also be important if you’re taking antipsychotic medicine, as weight gain can be a side-effect.
- Avoid taking drugs, smoking and drinking alcohol. These may trigger episodes.
Looking for mental health support?
We’re committed to helping people improve their mental health, which is why we’ve created lots of useful information about mental health and wellbeing. Anyone can use it, even if you don't have health insurance with us.
To enquire about health insurance for future conditions, call us on 0808 115 6779∧
Remembering to take your medicines as prescribed is one of the most important things you can do to keep symptoms under control. It’s also important to stick to a good, daily routine, like making sure you get enough sleep. See our treatment and living with sections to find out more.
If you have bipolar disorder, you'll switch between feeling very high and very low. In the high periods (mania) you may feel excited or happy, full of energy and find it difficult to concentrate. In the low periods (depression) you may feel down, have no energy and lose interest in things. Read more in our symptoms section.
You can develop bipolar disorder at any age. But it’s most common for it to start between your mid-teens and early 20s. You’ll usually have periods of months or years between episodes of very high or very low mood. See our about section to find out more
Depression
Antidepressants
Antidepressants are a type of drug that can be used to treat depression and other disorders.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) is a type of talking therapy. It helps you change how you think, feel and behave.
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