Bipolar disorder

Bipolar bisorder, previously known as manic-depression, is a mood disorder characterised by exaggerated mood swings. Bipolar means two poles, or extremes. 

If you’ve been diagnosed with bipolar disorder you’re likely to have extreme ups and downs. You might experience varying extremes of mania (up periods), and depression (down periods). No one is the same.

As with any diagnosis it’s important not to define yourself or anyone else by that label. Bear in mind that it will not apply to you for the rest of your life.

There are different ways to understand mental health problems and a doctor’s interpretation is just one way of making sense of what’s going on for someone in their life.

We all need to think about our mental health in a holistic way, to fully understand ourselves and the people around us.

Mood episodes

Everyone has ups and downs, and they’re caused by lots of things. However, bipolar disorder is a medical diagnosis where you have extreme mood swings (or ‘mood episodes’) widely out of proportion, or totally unrelated, to what’s happening in your life.

These swings affect your thoughts, feelings, physical health, emotional health, behaviour and day-to-day functioning. These mood swings can extremely disrupt your life. They can also be very disruptive and distressing to your relationships with friends and family.

Every time you experience symptoms at one extreme for at least one week, it’s called an episode. There are four main types of mood episodes a person with bipolar disorder can have: mania, hypomania, depression and mixed mood.

Manic episode (mania)

A manic episode is when you have an unusually and constantly elevated or bad-tempered mood, lasting at least one week.

During times of mania, you might experience:

  • Elevated or euphoric mood – this can include being full of energy and being happy. It’s often described as being on a high or “on top of the world”
  • Changes in activity levels – there might be changes in your sleeping and eating patterns
  • Faster thinking and speaking patterns – thoughts can be quicker than usual, which might lead you to speak faster and jump from subject to subject
  • Lack of inhibitions – finding it more difficult to see what the consequences of your actions might be
  • Irritability – you might be more likely to be angry or annoyed with others, particularly if they seem to reject your plans or ideas
  • Unrealistic (or grandiose) plans and beliefs – you might have unrealistic beliefs about your talents eg you might believe that you’re a king, queen, film star, or God
  • Risk taking behaviour – you might take unnecessary and unsafe risks
  • Hypersexuality – increased sexual thoughts, feelings, or behaviours; using explicit sexual language
  • Measuring behaviour – you might find it hard to decide what behaviour is appropriate to a particular situation.

Hypomanic episode (hypomania)

Hypomania is a milder form of mania that lasts at least four days. You don’t experience full manic episodes, but milder (hypomanic) episodes. It includes symptoms such as increased thought speed and processes, elevated mood, and irritability.

Major depressive episode (depression)

A depressive episode is when you have either a depressed mood or the loss of interest or pleasure in nearly all activities, lasting for at least two weeks.

When you are experiencing a depressed mood you might:

  • lose interest in day-to-day life
  • feel unusually tired and exhausted
  • have no appetite or an increased appetite, and changes in body weight
  • feel worthless or guilty
  • have difficulty concentrating.

Check out depression for more information.

Mixed episode

A mixed episode is when you experience both manic and major depressive symptoms nearly every day for at least one week. Your mood can vary with the time of the day.

Types of bipolar disorder

Diagnoses of different bipolar disorder are based on your experience of mood changes, what relatives and friends tell mental health workers about what they have witnessed/experienced, observation, and an assessment by a psychiatrist.

Understanding the different types or classifications of bipolar disorder can help to identify the best way of managing it.

Bipolar I

Bipolar I is when you experience one or more manic episodes or mixed episodes and often one or more major depressive episodes. Each depressive episode can last for several weeks or months, alternating with intense symptoms of mania that can last just as long.

Between these extremes, you might have periods where life continues normally. Your symptoms can also be affected by changes in season (eg winter months) or life situations that come up (eg exam stress).

Bipolar II

Bipolar II is when you experience one or more major depressive episodes, along with at least one hypomanic episode. Hypomanic episodes have symptoms similar to manic episodes, but are not as severe. Between episodes, there might be periods of normal functioning. Symptoms might also be related to seasonal changes and life situations.

Cyclothymic disorder

Cyclothymic disorder is a chronic (lasting a long time) fluctuating mood pattern which involves periods of hypomanic symptoms and periods of depressive symptoms. A milder form of bipolar disorder with shorter duration of symptoms as well as less severe, and not as regular.

Bipolar disorder not otherwise specified

When symptoms don’t fit any other type, it’s called bipolar disorder not otherwise specified. The experiences of this vary from person to person. Sometimes you might experience symptoms of a manic episode and a major depressive episode, but not fit into the above types of bipolar disorder. Just like the other types of bipolar disorder, it can be managed.

Causes

As with any mental health problem, bipolar disorder might be associated with a combination of factors including genetics and environment.

Where to get help

Bipolar disorder is manageable, and usually requires long-term support. Many people with bipolar disorder are creative and intelligent, and with proper management of their condition, lead full and productive lives. There are treatment options available for managing both mania and depression.

It’s a good idea to speak to your doctor about which options might be best for you. See face-to-face help for lots of practical information on how to get the best support.

Medical help

Your GP should be able to tell you about what medications are available for those who experience bipolar disorder. Most people are referred to a psychiatrist for diagnosis and medical treatment. Mood stabilisers, anti-psychotics, and antidepressants can all be used in the management of bipolar disorder. Read medication, management and treatment options, and talking to your doctor.

To see a counsellor or psychologist

If you’re experiencing bipolar disorder you might find it helpful to talk with someone like a psychologist, counsellor, social worker or another mental health worker. By doing this, you can gain a better understanding of what you are experiencing.

It’s also helpful just to talk about how you feel and these mental health workers should help you to work out why you feel this way. In most situations a psychiatrist manages any medication and monitors the situation, while a mental health worker assists you to manage your life better.

Look at face-to-face help for more information about counsellors, psychologists and psychiatrists.

Other therapies

Alternative therapies such as Mindfulness, can sometimes be helpful in managing bipolar disorder, but this should be done in conjunction with your doctor. Your doctor should have more information about alternative therapies and how they may help. Regular meals and a balanced diet are also important in the management of bipolar disorder.

Family/friend support network

Family and friends can help with the day-to-day management of bipolar disorder by providing feedback on mood states, giving support, friendship, understanding, and a non-judgemental listening ear. Check family and friends to find out how these people can help.

Support groups

Support groups for bipolar disorder offer valuable first-hand information from others who live with the disorder. Shine provides a list of supports in your area. Aware also run support groups across the country.

Lifestyle

Regulating patterns of eating and sleeping can help in the management of bipolar disorder, and can help to prevent manic, hypomanic, depressive, or mixed episodes.

Stress management and relaxation

Decreasing stress levels, planning ahead and learning relaxation techniques are also important in the management of bipolar disorder. Have a look at relaxation. Everyone’s different so it can take a little while to find something that works for you, but keep at it.

Psychiatric hospital/ward

To keep safe and get the best support, it might be necessary to be admitted to hospital during more extreme episodes of mania or depression. Sometimes it can be the most effective way to deal with the situation for that period of time.

Management of it

Loads of people manage really well with a bipolar disorder diagnosis and live full and successful lives with it. It’s not always easy at first, but through working with doctors and other supportive people/services, you can find a way of managing it that suits you, and get on with everything else.

Helping someone with bipolar disorder

If you have a friend or family member who has bipolar disorder, it can be hard to know how you can support them and be there to help. Learning about the condition can be really helpful. Take a look at supporting someone with a mental health problem for information, advice and helpful signposts. 

 

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  1. ReachOut.com says:

    Hi Phyllis,

    Thanks for your question - it's a good one, as it's not always a straightforward situation.

    It is our understanding that generally it is a psychiatrist who diagnoses bipolar disorder, but some GPs will also diagnose. This could happen for a number of reasons, including how comfortable the GP is in dealing with mental health problems and what they feel is best for the person.

    Generally the best way to get a referral to see a psychiatrist is through your GP. So when we're feeling concerned about a mental health problem, the GP is often the first health professional you express those concerns to.

    Your GP then has the choice of whether to refer you to a psychiatrist. Sometimes they will decide to treat you themselves and keep an eye on things, or they can refer you to a psychiatrist.

    If your GP does refer you to a psychiatrist, you can still talk to your GP to discuss medications you may have been prescribed by the psychiatrist or your care plan in general.

    If you express concerns about the care plan agreed with your psychiatrist or you think the treatment or medication is not working, your GP can adjust that care plan by changing the treatment or prescribing new or different medications. In cases like this, the GP will let your psychiatrist know what they are doing.

    It’s a really good question Phyllis and we’re going to put it to our clinical advisor as well. If she has any other thoughts or information for you, we will reply again to you.

    We hope this helps to clarify a little bit Phyllis.

    Take care,
    Fenella

  2. Phyllis says:

    I was always of the opinion that ONLY psychiatrists could diagnose and arrange to treat this severe illness.The role of the G.P.I thought was secondary to that of the psychiatrists who's care you agree to be under.

  3. Naoise says:

    Hello Colette
    Sorry to hear what you've been going through and for so long. Unfortunately, you need an doctor to give you a diagnosis for Bipolar disorder and then discuss and work with you about the best management and what suits. You may find diagnostic tools for Bipolar disorder but these are really not advisable to do yourself as you should get a diagnonsis from a doctor.

    This is not something that you should embarassed talking to your doctor about, however, if you are, that's OK, but maybe you could try a new doctor? Here is a list registered GPs in Ireland http://www.icgp.ie/. It is important for you Colette, to deal with a doctor you are comfortable with. You should then try to get your previous files transfered to your new doctor so that they have all the historic details about any previous treatments you've had for depression.

    If you're shy about bringining it up all you have to say is that you were reading about and you could mention this site to the doctor. Doctors are not always happy to hear about use of the internet to look up symptoms but we are clinically adviced for all of these articles and the doctor may already know of this website.
    So the next best step for you Collete, is finding a doctor you're happy with as the management of Bipolar disorder can take awhile to find out what suits you best, take a look at http://ie.reachout.com/inform-yourself/depression/management-and-treatment-options/ and be as informed as you can about what might come up.

    People can have very full lives with both a depression or Bipolar disorder diagnosis, it's just all about finding what works best for you. Knowing as much as you can about will help and also talking to a close family member or friend for support.
    Take care
    Naoise

  4. Colette says:

    I think I could be bipolar but I do not want to seem stupid by saying it to a doctor as I would be embarrassed. I have been depressed for several years up and down and every time the depression hits it seems to get worse with more consequences I just want to be and feel normal. I have been treated for depression but I have read the symptoms and seem to have some is there anywhere I can go for a test without my own g p been involved until I find out for sure

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