What is bipolar disorder?

Bipolar disorder is a mental health condition that mainly affects your mood. Its main symptoms include significant mood swings which include feeling extremely high to feeling very low (manic and depressive episodes). Bipolar disorder affects millions of people worldwide, both those who’ve been diagnosed and their loved ones.

We’ll be exploring bipolar disorder, helping you to understand the causes, symptoms and how to manage it if you’ve been diagnosed.

Understanding bipolar disorder

The word bipolar has two parts:

• Bi meaning two
• Polar meaning completely opposite

The term bipolar refers to the way your mood can shift from two very different states – manic highs to depressive lows, often disrupting both personal and professional lives. These changes can affect your mood, energy, activity levels and the ability to carry out day-to-day tasks.

The terms manic highs and depressive lows can be confusing. Some people think that this means that you’d only have mood swings from mania to depression, but bipolar disorder is more complex than this.

If you have bipolar disorder, mood swings can range from severe depression to severe mania and everything in between. Some episodes may feel stable and some episodes may feel intense. Some people may never even experience certain moods.

You might even hear of bipolar disorder being called bipolar affective disorder. The use of the word affective means that it relates to your mood or emotions.

What causes bipolar disorder?

The exact cause of bipolar disorder isn’t yet fully understood, but people believe that it might be due to a combination of various factors. These are thought to be a complex mix of physical, environmental and social influences.

Genetics

Bipolar disorder appears to have a genetic element, as it tends to run in families. If a close relative, like parents or siblings, have bipolar disorder, the risk of developing it is higher. It’s important to know that no single gene is responsible; instead, a combination of genetic and environmental triggers might be involved.

Triggers

Stressful situations often trigger bipolar disorder symptoms. These include:

• A relationship breakdown
• The loss of a close family member or loved one
• Physical, sexual or emotional abuse

These significant life events can also lead to episodes of depression. Other potential triggers for bipolar disorder include:

• Physical illness
• Disturbances with sleep
• Overwhelming problems in daily life like money troubles, work or relationship issues

Chemical imbalances in the brain

There’s some evidence that suggests that bipolar disorder may be linked to chemical imbalances in the brain. Neurotransmitters, like noradrenaline, serotonin and dopamine might play a key role in regulating brain functions. An imbalance in these chemicals may contribute to symptoms of bipolar disorder.

For example, high levels of noradrenaline might be linked with manic episodes, while low levels could lead to depressive episodes.

What are the symptoms of bipolar disorder?

We all experience changes in our mood, but for people with bipolar disorder, these changes can be distressing. You might find that the highs and lows are extreme and overwhelming, which might make you feel and behave very differently. This can be confusing and difficult to manage.

If you have bipolar disorder, you may experience:

• Manic or hypomanic episodes – where you feel extremely high
• Depressive episodes – where you feel very low
• Possible psychotic symptoms during episodes

The different experiences are often called mood episodes or states. Everyone experiences them differently and they can last for varying amounts of time. Your doctor might diagnose you with a specific type of bipolar disorder based on your mood experiences and how they affect you.

Manic & hypomanic episodes

Manic and hypomanic episodes both involve feeling very high, but they can differ in how severe they are and how they affect you. Manic episodes can be severe and require hospital treatment, while hypomanic episodes are less intense (but are still noticeable). Manic episodes might completely disrupt daily activities whereas hypomanic episodes might still allow you to work or socialise with people.

Experiencing mania or hypomania can be challenging, and it’s always okay to seek support if you’re unsure of what you’re experiencing.

During a manic or hypomanic episode, you might feel:

• Extremely happy or euphoric
• Very excited and energetic
• Like you can’t talk or move fast enough
• Irritable or agitated
• Distracted or like you can’t concentrate
• Confident or adventurous
• Untouchable or invincible (this is more likely in mania)
• Like you need less sleep
• Very focused on specific tasks

You might:

• Be more active than usual
• Talk a lot and very quickly
• Be unusually friendly or inappropriate
• Sleep very little
• Act rudely or aggressively
• Misuse drugs or alcohol
• Spend money excessively
• Take risks with your safety

After a manic or hypomanic episode, you might:

• Feel unhappy or ashamed about your behaviour
• Have taken on responsibilities that now feel unmanageable
• Have few clear memories of the episode
• Feel very tired and need a lot of rest

Depressive episodes

Depressive episodes involve feeling low for at least two weeks but can last much longer. They can severely disrupt everyday life, sometimes requiring medication or hospital treatment.

Some find depressive episodes harder to deal with than manic episodes, especially due to the stark contrast between high and low moods. During a depressive episode, you might feel:

• Down, upset or tearful
• Tired or sluggish
• Uninterested in things you usually enjoy
• Low self-esteem
• Guilty, worthless or hopeless
• Agitated and tense
• Unable to concentrate
• Suicidal

You might:

• Avoid things you usually enjoy
• Have trouble sleeping or sleep too much
• Eat too little or too much
• Misuse drugs or alcohol
• Withdraw from social situations
• Spend a lot of time thinking about upsetting things
• Avoid contacting people
• Be less physically active
• Try to self-harm or attempt suicide

If you’re experiencing a mental health crisis or are at risk of harming yourself or others, please call 111, speak to the Samaritans on 116 123, text Shout on 85258 or speak to your GP.

Mixed episodes

A mixed episode involves experiencing symptoms of both depression and mania or hypomania simultaneously. This can be particularly difficult as it may be hard to identify what help you need.

Psychotic symptoms

Some people with bipolar disorder experience psychosis, which can include delusions or hallucinations. These symptoms can be more common during manic episodes but can also occur during depressive episodes.

Stable or neutral periods

Between episodes, it's common to experience stable or neutral periods where you're not experiencing mania, hypomania, or depression. These periods can feel like a relief but also challenging as you might worry about becoming unwell again or feel unsure about continuing medication.

Frequency of bipolar episodes

The frequency of bipolar episodes varies from person to person and can depend on factors like your specific diagnosis, how well you're managing symptoms, and triggers like lack of sleep or stress. Episodes can last from a few weeks to much longer, and what’s normal for you may change over time.

Diagnosing bipolar disorder

If your GP thinks you might have bipolar disorder, they might refer you to a psychiatrist (a specialist in mental health). If there’s a risk of self-harm, your GP will plan for an immediate appointment.

Assessments

During your appointment, the psychiatrist will conduct an assessment to determine if you have bipolar disorder and to identify the most suitable treatments. They’ll ask about your symptoms and when they first appeared. You’ll also discuss how you feel before and during episodes of mania or depression, and whether you have thoughts of self-harm.

The psychiatrist will want to know about your medical history and family background, particularly if any relatives have had bipolar disorder.

Depending on your symptoms, you might need additional tests to rule out physical problems, such as thyroid issues. Regular visits to your GP for physical and mental health reviews will be necessary if you’re diagnosed with bipolar disorder.

Advanced directives

It's important to be involved in decisions about your treatment and care. However, there may be times when severe symptoms prevent you from making informed decisions. In such cases, an advance statement can be helpful. This is a set of written instructions outlining the treatments you prefer or wish to avoid, should you be unable to communicate your decisions later.

Your GP or psychiatrist can provide more guidance and support on creating an advance statement and managing your care effectively.

Treating bipolar disorder

Without treatment, episodes of mania in bipolar disorder can last between three and six months, while depressive episodes often last longer, typically six to 12 months. However, with effective treatment, these episodes can improve significantly.

Most people with bipolar disorder can be treated with a combination of different approaches.

Medications

Mood stabilisers are taken daily on a long-term basis to prevent episodes of mania and depression. Additional medications can be prescribed to treat the main symptoms of depression and mania when they occur.

Recognising triggers

Learning to identify the triggers and early signs of depressive or manic episodes can help you manage it.

Psychological treatment

Talking therapies, such as cognitive-behavioural therapy (CBT), can help you manage depression and improve relationships.

Most people with bipolar disorder receive their treatment on an outpatient basis, meaning they don’t need to stay in the hospital. However, if symptoms are severe, or if there's a risk of self-harm or harm to others, hospital treatment may be needed. In some cases, treatment can be provided in a day hospital, allowing you to return home at night.

By combining these treatment methods, people with bipolar disorder may be able to achieve better stability and improve their quality of life. If you have bipolar disorder, working closely with your healthcare team can help ensure you receive the best possible care that’s tailored to your needs.

Living with bipolar disorder

Although bipolar disorder is a long-term condition, treatments and self-help techniques can help to reduce its impact on your daily life.

Regular exercise, engaging in enjoyable activities, having a healthy, balanced diet and getting enough sleep are all important lifestyle adjustments that can support your treatment. Speaking about your condition with family, friends and support groups can also be very helpful.

Avoid drugs & alcohol

Steer clear of alcohol and illegal drugs, as they can make your symptoms worse and aren’t a substitute for treatment. Effective treatment can help reduce substance misuse.

Money worries

Managing daily stresses, including work-related stress, is important. If you work, your employer is required to make reasonable adjustments for employees with bipolar disorder. Various benefits are available if you can’t work due to your condition.

Living with or caring for someone with bipolar disorder

Caring for someone with bipolar disorder can be challenging. Support groups and specialist relationship counsellors can offer valuable help. If necessary, social services can provide additional support.

Bipolar disorder & pregnancy

If you have bipolar disorder, it’s important to let your GP or midwife know as soon as you find out you’re pregnant. They’ll refer you to a specialist perinatal mental health team or community mental health team.

Don’t stop taking your medication without speaking to your doctor to help you avoid withdrawal symptoms and making your symptoms worse. Most women with bipolar disorder have healthy pregnancies, but the condition can increase the risk of postnatal depression and postpartum psychosis. There’s also a chance of relapse during pregnancy or after birth, especially if you or close relatives have experienced postpartum psychosis.

Managing bipolar disorder during pregnancy

Your care plan

Your healthcare team, including doctors, midwives, your GP and health visitors, will help create a care plan for your mental health during pregnancy, birth, and afterwards. This plan includes a list of symptoms to watch for and how to get help. You should share your care plan with your family to help them support you.

Medication

You should speak to your mental health specialist before making any changes to your medication. They may suggest staying on your current medication, switching to another or adjusting the dose. Some medications have specific risks during pregnancy and breastfeeding. The risks and benefits can be discussed with your doctor.

If you’re currently taking sodium valproate, you should avoid getting pregnant due to health risks for the baby. If you do become pregnant while on this medication, make sure to speak to a doctor immediately.

Talking therapy

Talking therapies, such as CBT and interpersonal therapy, can reduce the chances of bipolar episodes during and after pregnancy, especially if medication is changed or stopped.

Depression & mania

You should contact a perinatal psychiatrist immediately if you experience extreme highs or lows. They may adjust your medication or suggest alternative treatments.

Social services

Most parents with mental illnesses aren’t referred to social services unless extra support is needed to care for the baby. Social services aim to help families care for their children at home.

We’ve put together some self-help tips for if you have bipolar disorder and you’re pregnant:

• Maintain a healthy diet and exercise regularly
• Track your mood with a diary
• Continue taking your medication unless advised otherwise by your doctor
• Ensure your close family and friends understand your condition and know how to help

Having a baby can disrupt your sleep and routine. Making sure to get practical help from family and friends can help you to get enough rest. If you’re struggling, talk to your doctor or health visitor. It’s important to make sure your care plan includes contacts for extra help after the baby is born.

Asking for help when you need it is always a good idea. With the right knowledge and support, living a fulfilling life can be possible. Remember you’re not alone if you’re dealing with bipolar disorder.