Bipolar affective disorder

Your health expert:
Dr Sammad Hashmi, Consultant Psychiatrist

Bipolar affective disorder (bipolar disorder) is a mental health condition that causes severe mood swings from depression to elation. It’s sometimes called manic depression. Bipolar disorder is a serious, long-term condition that can have a big impact on your day-to-day life. But effective treatments can help to keep your symptoms under control.

About bipolar affective disorder

If you have bipolar disorder, you’ll have alternating periods of very high and very low mood. 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 episodes. This means you feel emotionally high, but it’s not as intense as a manic episode. 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 remission 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.

Types of bipolar affective disorder

There are two main types of bipolar disorder.

• Bipolar disorder I. If you have bipolar affective disorder type 1, it’s when you’ve had at least one severe manic episode. You may also have severe depression.
• Bipolar disorder II. You may be diagnosed with bipolar affective disorder type 2 if you’ve had at least one episode of severe depression and one episode of hypomania. You don’t have severe mania with bipolar disorder II.

If you have similar symptoms to bipolar disorder, but the depression isn’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 disorder I or II.

Causes of bipolar affective disorder

It’s not fully understood exactly what causes bipolar disorder. But doctors and researchers think a combination of genetic and environmental factors may be the cause. These factors can include the following.

• Family history of bipolar disorder. If you have a close relative such as a parent or sibling with bipolar disorder, you’re at least five times more likely to get it.
• Traumatic events or experiences as a child – for example, child abuse or the death of a parent.
• Stressful life events such as a relationship breakdown, a bereavement or money worries can trigger an episode.
• Taking drugs such as cannabis or cocaine. It’s unclear if taking drugs causes bipolar disorder or if having bipolar disorder makes people more likely to take drugs.

Symptoms of bipolar affective disorder

Bipolar affective 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 or how often they happen can vary. Bipolar affective disorder symptoms can also vary from day to day or within the same day.

Your bipolar disorder symptoms will depend on whether you’re 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.

Hypomania symptoms

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 section on further information. You can also use apps to track how you’re feeling.

Diagnosis of bipolar affective disorder

Your GP will ask about your symptoms and if you’ve had any episodes of depression or mania in the past. They may ask about your mood, how you feel and your behaviour. You may need blood tests to rule out other conditions such as problems with your thyroid gland because these can affect your behaviour.

If your GP thinks you could have bipolar disorder, they’ll 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 and may ask about:

• your mood changes
• how well you sleep
• changes in behaviour and any manic episodes
• anything that may have triggered your symptoms
• your 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, friend or carer to help describe the problems you’re having.

Self-help for bipolar affective disorder

There are things that you can do to help yourself stay well and reduce the effects that bipolar disorder has on your life.

• 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. 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 to relax 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.
• Have a plan ready 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 because this can be a trigger for manic or depressive episodes.
• Look after yourself physically. 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 because weight gain can be a side-effect.
• Don’t take illegal drugs, smoke or drink alcohol. These may trigger episodes.

Treatment of bipolar affective disorder

You’ll usually need bipolar affective disorder treatment for life. The aim of this treatment is to manage symptoms during 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 notice early warning signs of an episode.

Your doctor may recommend a mix of medicines, talking therapies, and things you can do to help yourself (see our section on self-help). If your bipolar symptoms are very severe, you may need hospital treatment.

Medicines for bipolar affective disorder

Types of medicine

If you have bipolar disorder, your doctor will usually prescribe 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 treat manic episodes or hypomanic episodes. You might need to try different ones 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. Your doctor may prescribe one of these if treatment with lithium doesn’t help or you have severe side-effects.

Your doctor may also prescribe an antidepressant such as 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 antidepressants if you develop 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 monitor 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 take medicines for bipolar disorder.

• Don’t drink alcohol, smoke or take illegal drugs. These can stop your medicines working as well as they should and make your symptoms worse.
• Don’t stop taking any of the medicines suddenly. If you want to come off your medicine, talk to your doctor first. You’ll usually need to stop your medicine gradually over at least four weeks.
• Tell your doctor if you’re pregnant or trying for a baby. You may need to stop or change your medicine. People who can get pregnant won’t usually be prescribed valproate unless they’re on a pregnancy prevention programme. This is because valproate has a high risk of causing birth defects.

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 affective disorder

Your doctor may also recommend a talking therapy for 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, others you do in a group or with your partner or family.

Talking therapies for bipolar disorder include the following.

• Cognitive behavioural therapy (CBT). This looks at how you feel and think and how it affects your behaviour.
• Family therapy. Here you work as a family to look at problems and how to overcome them.
• Interpersonal therapy. This looks at how your relationships with others affect you.
• Behavioural couples therapy. This focuses on problems you may have with a partner.
• Group psychoeducation. This is 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, which is called 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. This may be from emergency services such as your local accident and emergency or the crisis resolution and home treatment (CRHT) team.

If you’re in danger of harming yourself or others, the specialist may recommend you go into 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.

Other helpful websites

• Mind
• Bipolar UK

Discover other helpful health information websites