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Bipolar disorder

Bipolar disorder, also called bipolar affective disorder or manic depression, is a mental illness characterized by extreme shifts in mood and energy levels, most commonly between depression and mania.

What is bipolar disorder?

A depressive episode of bipolar disorder is similar to depression, with low mood, a lack of energy, feelings of worthlessness, and difficulty with day-to-day activities. In bipolar, depression can be more severe than usual and harder to treat. Manic states in bipolar disorder are largely experienced as the opposite: high mood, high energy, and high levels of activity. This can bring such things as sleeplessness, reckless behaviour, unrealistic plans and ideas, irritability, and rage.

An individual with bipolar disorder may experience hypomania rather than mania, where the feelings are similar but less intense.

People with bipolar disorder may not regularly experience a ‘normal’ or steady mood at all. Bipolar can have harmful effects on all areas of life and be very difficult to cope with, particularly without treatment or support. Shifting between moods in bipolar can happen abruptly, over hours or days, or more gradually over several weeks. An episode - either depressive or manic - may last for days, weeks, or months.

“I get triggered easily and have very severe mood swings. Socially it is awkward, and I get intimidated and paranoid. Family life is difficult, and they do not understand”

HealthUnlocked bipolar survey response, 2018

How common is bipolar disorder?

Bipolar disorder affects up to 2.6% of adults in the US; it’s less common in the UK, affecting 2% of adults. Bipolar usually develops between the ages of 15-19. It can develop later, though rarely in people over 40. Men and women are affected by bipolar disorder equally.

The different types of bipolar disorder

Bipolar disorder is categorized into several main types:

Bipolar I:
  • Manic episodes are clearly recognizable

  • To be diagnosed as Type I, the individual must experience manic episodes. Though most individuals with Type I also have depressive episodes, these are not required for the Type I diagnosis

  • An untreated manic episode will usually last around 3-6 months

  • A depressive episode is longer, usually lasting 6-12 months unless treated

Bipolar II:
  • More common than bipolar I and less clearly recognizable

  • Characterized by less severe episodes of mania than bipolar I. Those with bipolar II experience hypomania rather than mania

Rapid cycling:
  • Four or more mood state changes over 12 months would be described as rapid cycling. This can happen with both Type I and Type II bipolar disorder and affects around 1 in 10 people with bipolar
  • Low and high moods are not as severe as in bipolar I and II and don’t result in major depression or mania. However, the mood swings can disrupt daily life and affect personal relationships at home, school, or work. People with cyclothymia are at risk of developing bipolar I or II
Bipolar disorder not otherwise specified:
  • When someone displays traits of bipolar disorder, but there is not enough evidence to make a diagnosis of type I, II, or cyclothymia, they may be diagnosed as having a ‘bipolar disorder not otherwise specified’, or ‘NOS’

Symptoms of bipolar disorder

The pattern of depressive and manic episodes varies considerably between people. In general, however, for most with bipolar disorder symptoms will include:

  • Lack of energy

  • Low self-esteem

  • Feelings of worthlessness

  • Withdrawing from friends or family

  • Difficulty concentrating

  • Self-harming behaviour

  • Suicidal thoughts

As a depressive episode will often follow a manic episode, the contrast between the two can make the depression seem even harder to deal with.

  • Increased energy

  • High self-esteem

  • Excitement

  • Restlessness

  • Reduced need for sleep

  • Impulsive behaviour

  • Engaging in uncharacteristic behaviour, such as spending lots of money, taking drugs, or being sexually promiscuous

  • Agitation

  • Delusions

After a manic episode, an individual may feel distressed or ashamed of their behaviour. They might be overwhelmed, having taken on too many responsibilities or projects that now seem unachievable. People may also have few or confused memories of what they did during a manic state.

Sometimes, rather than being distinctly depressive or manic, a mood state can include symptoms of both extremes. This is referred to as an episode with mixed features.

There is the potential for psychosis during either manic or depressed episodes. This can come in the form of hallucinations (hearing or seeing things that are not there) or delusions (believing things that are not true).

Sleep patterns and appetite are often affected in both depressive and manic states. In mania people often sleep very little and lose interest in eating. In depression, oversleeping is common.

Diagnosis of bipolar disorder

Unless someone has severe mania, bipolar disorder may be difficult to diagnose. The UK National Institute for Health and Care Excellence reports that on average bipolar is misdiagnosed 3.5 times before the correct diagnosis is reached.

With the less severe hypomania, people are likely to have more energy and confidence – many enjoy the feeling if it doesn’t bring negative side effects, and so don’t seek help. It is more likely they will seek support for feelings of depression and be first diagnosed as clinically depressed. If they then, perhaps much later, have a manic episode, they may be re-diagnosed as having bipolar.

Some symptoms of bipolar disorder are similar to those of other illnesses. Also, people with bipolar often have other issues such as eating disorders, anxiety disorders, or substance addiction. This can complicate the diagnosis of bipolar.

People with bipolar disorder are also more likely to have migraines, obesity, thyroid problems and heart disease, all of which may be diagnosed prior to a bipolar diagnosis.

If you suspect you might have bipolar disorder, the first step is to visit your GP and explain your symptoms to them in as much detail as you can. It can be useful to keep a ‘mood journal’ to record your feelings in the time leading up to making an appointment, so you can give a clear view of your experience. Your GP will likely ask you about:

  • The symptoms you get

  • The length of your manic and depressive episodes

  • How frequently they occur

  • The impact the episodes and symptoms have on your daily life

  • Your family history

If your GP is concerned by your symptoms, they may refer you to a specialist mental health professional, such as a psychiatrist. Your GP will not make a diagnosis of bipolar disorder; this is something a psychiatrist will assess you on.

Causes of bipolar disorder

The exact causes of bipolar disorder are not known. There are, however, risk factors that increase likelihood of developing the illness.

Environmental factors

Extreme stress, abrupt life-changing events, and trauma are all considered possible causes for bipolar.

Family history

Bipolar often runs in families. Having a parent or sibling with bipolar disorder increases the chance of developing the disorder, though most people with a relative with bipolar will not have the illness. Some research suggests certain genes could play a part in the development of bipolar. Experts believe that variations in many genes, combined with lifestyle and environmental factors, are involved in triggering the illness.

Brain structure

Some studies have shown that the brains of people with bipolar disorder may differ from those who do not suffer from mental health issues, and from those who suffer with other mental health conditions. There’s some evidence that chemical imbalances in the brain can lead to some bipolar symptoms.

Treatment of bipolar disorder

Bipolar disorder is commonly treated with a combination of medication and talking therapy. This is a life-long condition and there is no known cure; all treatment is to help someone with bipolar live a full and satisfying life. With proper support, symptoms can become much less severe and more manageable.

“Have someone you trust tell you if they think you’re heading in one direction or the other”

HealthUnlocked bipolar survey response, 2018

If your symptoms are interfering with your day-to-day activities, you may be given medicines to stabilize your mood. These include antipsychotic drugs to help in your manic phase, and antidepressants for depressive episodes. If you are prescribed medication, your doctor should ensure you understand the risks and benefits. You should ask about anything that is not made clear to you. If you want to cut down or stop medication, you should always talk to your GP first. It can be dangerous to stop some medicines abruptly.

It’s possible your GP won’t prescribe medication for you, and some people with bipolar choose not to take medicine. But medication can be very helpful in stabilizing your mood and can be beneficial alongside talking therapies, such as psychotherapy, counselling, or cognitive behavioural therapy (CBT), which is often recommended for those with bipolar disorder.

There’s usually no need to go into hospital with bipolar. But if depression or mania are severe or there’s a risk you might harm yourself or others, you might need a stay in hospital.

Living with bipolar disorder

A bipolar diagnosis may come as a shock and you might need to take some time to come to terms with it. For others, it will be a relief to know what is wrong and that it can be treated. Whatever your reaction, it’s helpful to explain the diagnosis to your family and friends and to consider how to best move forward.

Adapting your lifestyle to best be able to manage your symptoms is important for your wellbeing. Learning to recognize any triggers or signs of depressive or manic episodes can help you look after yourself and get the care you need, when you need it. Triggers or signs that you may be having a manic or depressive episode could include changes in appetite, sleeping patterns, or behaviours.

Regular exercise, a nutritious diet, and a healthy sleep pattern are helpful in supporting bipolar disorder.

“Exercise, regular sleep patterns and healthy eating all probably help as does maximising social contact”

HealthUnlocked bipolar survey response, 2018

It may also be helpful, when you are feeling well, to prepare for a time when you may not be feeling so good. This might include writing notes about how you can best be supported when you are in a crisis and sharing these with a trusted friend or family member.

You can live a full life with bipolar disorder but, as with many mental health conditions, it needs monitoring and careful management.

Those living with bipolar disorder may experience some stigma, largely rooted in a lack of understanding about the condition and mental health issues in general. People may have misconceptions or negative perceptions of bipolar disorder.

Support and apps

“Listen to your doctors, but most of all get in a group with others that have the same disorders”

HealthUnlocked bipolar survey response, 2018

Support can come in many forms, and it’s important to make use of it when you need it. There’s no shame in talking to others about your situation and asking for help.

There are many online communities, such as the Shaw Mind Foundation community at HealthUnlocked, where you can read what others are talking about, ask questions, or just chat. Most large bipolar and general mental health charities also run online communities.

If you would like to meet others going through similar experiences to your own, you can also find local support groups.

Talking therapies such as psychotherapy or counselling can also be great sources of support. They give you the chance to talk about the impact bipolar disorder has on your life. This can help you to identify your triggers and develop strategies to cope. You can find a UK therapist at welldoing.org.

Smartphone Apps

There is a range of smartphone apps that can help you manage aspects of your illness.

iMoodJournal is an affordable app that is both a journal and mood tracker. You can record details of sleep, medication and mood on a day-to-day basis and keep track of how you are feeling. This kind of app can be helpful in identifying your triggers. eMoods and Mood Log are two free alternatives.

Healthline gives details and user ratings for popular bipolar apps. You can also find apps by searching for ‘bipolar’ in your device’s app store.