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. Thomas (admin) says:

    Hi B,

    It's great that you've got the energy and drive to start seeking help - and you're right to try and find a good GP as somewhere to start. GPs, like everyone, are often extremely under-resourced and over-worked, which is probably why there's a waiting list for the one you approached. I know this doesn't help you right now though.

    You probably did already - but you could tell them you think you might need help rather immediately and ask if there's any way they can book you in sooner? It still might not be possible, but there's no harm in trying. You could put your name down for an appointment - for as soon as they're able to book you in, and in the mean time have a look around for another GP?

    While all GPs are going to be different - and yes the one you approached sounds good - all GPs have the capacity to advise or refer people struggling with mental health issues. Maybe just seeing someone soon will help, and if you find they're not great you still have the option of keeping your appointment with the original GP.

    Depending on where you live many GP clinics (especially in inner cities, or more urban areas) will see you straight away. Of course they all won't, but while you've got the drive it might be worth calling around to book in with someone.

    Even the work you've started doing (i.e. taking action in calling a GP, talking with us) is a step in the right direction. It takes energy and is great that you've begun.

    Depending on what sort of help/advice you're looking for, you could talk to someone who isn't a GP (at least while/if you're still waiting for an appointment). I'm thinking of something like counselling services with trained professionals to help. Turn2me have online and inexpensive services and MyMind have face-to-face services around the country that are also not too expensive.

    I hope some of this helps. Do try to keep up the momentum and try not to let this set-back of having to wait for that particular GP be too disheartening. You deserve to feel better and you can.

    Best of luck with it,
    Thomas.

  2. B says:

    Hi just looking for a bit of advice as the penny has finally dropped with me that I need to get some help.
    I recently tried to make an appointment with a gp that came highly recommended to me by a good friend so I could get the ball rolling. Only to be told that she wont take new patients til at the earliest next month Jan 15. If om being honest is came as a serious sucker punch and I felt like really deflated after the call.
    Anyway just wondering have I any other options or is this normal length of time to wait?
    Im finally going to seek help as im having a period of great form and energy and really don't want to slip back down over Christmas.

    Id appreciate any advice.

  3. Thomas (admin) says:

    Hi Jackie
    Sorry to hear you're having a tough time accessing support for you and your son - that can't be easy. I passed your question on to our clinical advisor and she said that in terms of the symptoms you feel your son has, it's very common to get mixed messages because much of the information available online is American. There's been a history of Bipolar Disorder being diagnosed much more often in young people in the US. They use different criteria mainly based on irritability, but the problem is that the condition does not persist into adulthood therefore it seems not to be the same as Bipolar as we would understand it i.e. a lifelong condition.

    She says that a significant number of children and young people do present with emotional instability which can look like bipolar, especially if their mood is ever unstable and if they tend to over-react to situations. However, in Europe we would feel that Bipolar is a very rare condition in a child. She has seen it a few times, but not very often in about 20 years of practice. When it does occur it is very severe and would usually involve admission to a child and adolescent in-patient psychiatric unit. The only way to access one of them would be through a CAMHS.

    For your son's well-being though there should still be support that you can access. Your son doesn't need to be given a label in order to receive the support he deserves. If he's not ticking a box or being diagnosed with anything in particular, this shouldn't mean he can't get help. She said that Psychotherapy or play or art therapy (depending his age) would often be the first line approach and you could look for this directly and privately.

    You should be able to talk with your GP about the possibility of getting a referral to a therapist should you wish. But, there can be huge waiting lists in the public health system.

    In terms of support for yourself, have a look at our sister site - Reachout.com/parents. As you say, you're quite worried, which must take its toll on you and in order to offer the best support for your son, it could be worth making sure you're being supported yourself, no-matter how informally.

    I hope some of this helps.

    Thomas.

  4. Jackie says:

    I believe my son is undiagnosed for a bipolar disorder..I have been passed from pillar to post nobody seems to know what is going on with him...but as I read more and more I believe this is what his dificulties are due to..he has certain traits of things but is not being said to be ADHD or asbergers or autistic but has some traits..im at my whites end now.I do my best I want help and support for him my heart is broken .where can I to to have my son assessed..in Ireland ..

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