Bipolar Disorder

bipolar disorder

Bipolar disorder is sometimes called manic depression or bipolar affective disorder. In this condition you have periods where your mood (affect) is in one extreme or another:

  • One extreme is called depression.
  • The other extreme is called mania (or hypomania if symptoms are less severe), where you feel high or elated along with other symptoms.

The length of time you spend in each extreme can vary. You can have any number of episodes of highs and lows throughout your life. In between episodes of highs or lows there may be gaps of weeks, months or years when your mood is normal.

Some people swing from highs to lows quite quickly without a period of normal mood in between. This is called rapid cycling. (If you have the rapid cycling form of the condition you have at least four mood swings per year.)

Who gets bipolar disorder?

It can occur at any age but most commonly first develops between the ages of 18 and 30. It occurs in the same number of men as women.

What causes bipolar disorder?

The exact cause is unknown. Your genetic make-up seems to play a part, as your chance of developing this condition is higher than average if other members of your family are affected. Stressful situations may trigger an episode of mania or depression in people prone to this condition.

What are the symptoms of mania and hypomania?

Mania causes an abnormally high or irritable mood which lasts at least one week - but usually lasts much longer than this.

  • Grand ideas about yourself and your own self-importance.
  • Increased energy. You also tend to move quickly and need less sleep than usual.
  • Be more talkative than usual. You tend to talk quickly.
  • Flight of ideas. This means that you tend to change quickly from one idea to another.
  • Easily distracted.
  • Full of new ideas and plans.
  • Irritation or agitation, particularly with people who do not seem to understand your great ideas and plans.

Wanting to do lots of pleasurable things (but these can often lead to painful consequences). For example, you may:

  • Spend a lot of money
  • Be less inhibited about your sexual behavior.
  • Make rash decisions, often on the spur of the moment.
  • Take part in risky exciting adventures.
  • Drink a lot of alcohol, or take illegal drugs.

Severe mania may also cause psychotic symptoms where you lose touch with reality. If mania is not treated, the bizarre and uninhibited behavior may cause great damage to your relationships, job, career and finances.

What are the symptoms of depression?

With true depression, you have low mood and other symptoms each day for at least two weeks. Symptoms also become severe enough to interfere with day-to-day functions.

  • Low mood for most of the day, nearly every day.
  • Loss of enjoyment and interest in life, even for activities that you normally enjoy.
  • Abnormal sadness, often with weepiness.
  • Feeling guilty, worthless, or useless.
  • Poor motivation.
  • Poor concentration.
  • Sleeping problems:
  • Sometimes difficulty in getting off to sleep.
  • Sometimes waking early and unable to get back to sleep.
  • Sleeping too much sometimes occurs.
  • Lacking in energy, always feeling tired.
  • Difficulty with affection, including going off sex.
  • Poor appetite and weight loss.
  • Being irritable, agitated, or restless.
  • Physical symptoms such as headaches, palpitations, chest pains and aches and pains.
  • Recurrent thoughts of death.

How is bipolar disorder diagnosed?

It is often your friends or family who are the ones that can see that you are not your usual self. They may encourage you to see your doctor.
If you go to see your doctor because you have an episode of depression, it can be more difficult to diagnose bipolar disorder. This is because depression is common and you may not recognise that in the past you may have had some of the symptoms of mania or hypomania.

What is the usual pattern and outcome of bipolar disorder?

Bipolar affective disorder is a lifelong condition.

Without treatment

  • The average length for an episode of mania is four months. But for some people it can last much longer.
  • Some people's mood recovers completely between episodes of mania or depression. In others, their mood does not completely recover.
  • The average length for an episode of depression is six months but, again, it can be longer.

As time goes on, the time period of normal mood between episodes of mania or depression tends to get shorter. Also, episodes of depression tend to become more frequent and last for longer.

With treatment

There is no once and for all cure. Treatment usually means that episodes of mania or depression are shorter and/or may be prevented.

What is the treatment for bipolar disorder?

Treatments include:

Treating episodes of mania, hypomania and depression when they occur.


Lithium is the most commonly used medicine for bipolar disorder in the world. It comes as a tablet and has been used for many years. However, it is not clear how it works. It is used to treat episodes of mania, hypomania and depression. It is also taken by many people long-term as a mood stabiliser.

Anticonvulsant medicines

Sodium valproate, carbamazepine and lamotrigine are used to treat episodes of mania. They are also used long-term as mood stabilisers. Sodium valproate is not usually used in women who could get pregnant. This is because there is a chance that it could harm a developing baby.

Antipsychotic medicines

A common name for these is major tranquillisers. They include olanzapine, quetiapine and risperidone - but there are others. Once one of these medicines is started, the symptoms of mania or hypomania often settle within a week or so.

Treating episodes of depression

Antidepressant medicines are commonly prescribed.

They do not usually work straight away. It takes 2-4 weeks before their effect builds up fully. A normal course of antidepressants is for six months or more after the symptoms of depression have eased. If you stop them too soon the depression may quickly return.

Lithium may also be used to treat depression as well as being a long-term mood stabiliser. A combination of lithium and an antidepressant may be used to treat an episode of depression.

Quetiapine may also be used to treat depression if you are not already taking an antipsychotic medicine.

Cognitive therapy is another option which can work well to treat depression. It is a talking treatment.

Regular exercise may also help to ease symptoms of depression.

Other treatments and new developments

Electroconvulsive therapy (ECT) in which a mild electrical current is passed through the brain, is recommended for severe bipolar disorder which does not respond to treatment with medicines.

Self-help for bipolar disorder

  • Try to avoid stressful situations which may trigger an episode of mania or depression.
  • Try to establish a daily routine, and schedule daily activities so that you have things to occupy your time.
  • Try to do some regular relaxing activities (for example, resting in a quiet place).
  • Try not to drink much alcohol or take any street drugs.
  • If you are prescribed a mood stabiliser medicine, take it regularly.
  • Consider being quite open to family and friends about your condition.
  • Learn about your condition.
  • Consider joining a self-help or patient group.
  • When you are well, consider putting some safeguards on your money so that you cannot overspend if you become high.

Pregnancy and bipolar disorder

If you are planning to become pregnant, or if you have an unplanned pregnancy, you should contact your doctor or specialist mental health team as soon as possible. You may need a change to your medication.

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