Bipolar Disorder

About & Types

Bipolar disorder can be a life-long mental health problem that mainly affects your mood. It affects how you feel and your mood can change massively. You can experience episodes of:

• Hypomania and mania
• Depression

You may feel well between these times. When your mood changes, you might see changes in your energy levels or how you act. 

Symptoms of bipolar disorder can be severe. They can affect areas of your life, such aswork, school and relationships.              

You usually develop bipolar disorder before you are 20. It can develop in later life but it rarely develops after the age of 40.

You can have symptoms of bipolar disorder for some time before a doctor diagnoses you. A doctor might say you have something else such as depression or a personality disorder before you get a bipolar disorder diagnosis.

What are the different types of bipolar disorder?

Bipolar I disorder

A diagnosis of bipolar I disorder means you will have had at least 1 episode of mania that lasts longer than 1 week. 90% of people will also have periods of depression. Manic episodes will generally last 3-6 months if left untreated. Depressive episodes will generally last 6-12 months without treatment.

Bipolar II disorder

A diagnosis of bipolar II disorder means it is common to have symptoms of depression. You will have had at least 1 period of major depression. And at least 1 period of hypomania instead of mania.

Bipolar with mixed features

You will experience symptoms of mania or hypomania and depression at the same time.12 You may hear this being called ‘mixed bipolar state’. You may feel very sad and hopeless at the same time as restlessness and being overactive.

Bipolar I or II disorder with rapid cycling

Rapid cycling means you have had 4 or more depressive, manic, hypomanic episodes in a 12 month period.

Bipolar I or II with seasonal pattern

Seasonal pattern means that either your depression, mania or hypomania is regularly affected in the same way by seasons. For example, you may find that each winter you have a depressive episode but your mania does not regularly follow a pattern. 

Cyclothymia

A diagnosis of cyclothymic disorder means you will have experienced regular episodes of hypomania and depression for at least 2 years.

Cyclothymia can develop into bipolar disorder.

Symptoms & Causes

What are the symptoms of bipolar disorder?

Bipolar symptoms can make it difficult to deal with day-to-day life. It can have a bad effect on your relationships and work. The different types of symptoms are described below.

Mania

Symptoms of mania can include:

• feeling happy or excited, even if things are not going well for you,
• being full of new and exciting ideas,
• moving quickly from one idea to another,
• hearing voices that other people can’t hear,
• being more irritable than normal,
• feeling much better about yourself than usual,
• talking very quickly, jumping from one idea to another, racing thoughts,
• being easily distracted and struggle to focus on one topic,
• not being able to sleep, or feel that you don’t want to sleep,
• thinking you can do much more than you actually can,
• make unusual, or big decisions without thinking them through, and
• do things you normally wouldn’t which can cause problem, such as:
  
  • spending a lot of money,
  • having casual sex with different people,
  • using drugs or alcohol,
  • gambling or
  • making unwise business decisions.

Hypomania

Hypomania is like mania but you will have milder symptoms. Treatment for hypomania is similar to the treatment for mania.

Depression

Symptoms of depression can include:

• low mood,
• having less energy and feeling tired,
• feeling hopeless or negative,
• feeling guilty, worthless or helpless,
• being less interested in things you normally like doing or enjoying them less,
• difficulty concentrating, remembering or making decisions,
• feeling restless or irritable,
• sleeping too much or not being able to sleep,
• feeling more or less hungry than usual,
• losing or gaining weight, when you do not mean to, and
• thoughts of death or suicide, or suicide attempts.

Read more about depression.

Psychosis

Sometimes you can have psychotic symptoms during a severe episode of mania or depression. Symptoms of psychosis can be:

• Hallucinations - This means that you may hear, see, or feel things that are not there, and
• Delusions - This means you may believe things that are not true. Other people will usually find your beliefs unusual.

Psychotic symptoms in bipolar disorder can reflect your mood. For example, if you have a manic episode you may believe that you have special powers, or are being monitored by the government. If you have depressive episode, you may feel very guilty about something you think you have done. You may feel that you are worse than anybody else or feel that you don't exist.

What causes bipolar disorder?

Research suggests that a combination of different things can make it more likely that you will develop bipolar disorder.

Genetic factors

You are 5 times more likely to develop bipolar disorder if someone in your immediate family, like a parent, brother or sister, has bipolar disorder. This risk is higher if both of your parents have the condition or if your twin has the condition.

Researchers have not found the exact genes that cause bipolar disorder. But different genes have been linked to the development of bipolar disorder.

Brain chemical imbalance

Different chemicals in your brain affect your mood and behaviour. Too much or too little of these chemicals could make you develop mania or depression.

Environmental factors

Stressful life events can trigger symptoms of bipolar disorder. Such as childhood abuse and the loss of a loved one. They can increase your chances of developing depressive episodes.

Diagnosing Bipolar

The first step to get help is to speak to your GP.

It can help to keep a record of your moods. This can help you and your GP to understand your mood swings. Bipolar UK have a mood diary and a mood scale on their website. You can find their details in the ‘useful contacts’ section at the end of this factsheet.

The first step if you're worried that you have bipolar disorder is to see your GP.  Gos don't normally diagnose bipolar disorder.  If they share your concerns, then they may refer you to a psychiatrist. Only a psychiatrist should make a formal diagnosis. A psychiatrist is part of the Community Mental Health Team (CMHT). Your GP may arrange an appointment with (CMHT) if you have:

• Depression, and
• Ever felt very excited or not in control of your mood or behaviour for at least 4 days in a row

Your GP should refer you to an Early Intervention Team if you have your first episode of psychosis.

Bipolar disorder can be difficult to diagnose because it affects everyone differently. Also, bipolar symptoms can be the same as other mental health problems. It can take a long time to get a bipolar diagnosis,  In the meantime, there are things you can try to help yourself.

Treatment

You can check what treatment and care is recommended for bipolar disorders on the National Institute for Health and Care Excellence (NICE) website.

Medications

Mood stabilisers are usually used to manage mania, hypomania and depressive symptoms.

Examples of medications used as mood stabilisers for bipolar disorder include:

• Lithium carbonate
• Certain antipsychotic medication
• Certain anticonvulsive medication
• Certain benzodiazepine medication

Mania and hypomania

You should be offered a mood stabiliser to help manage your mania or hypomania. Your doctor may refer to your medication as ‘antimanic’ medication.

If you are taking an antidepressant your doctor may think about stopping this medication.

You will usually be offered an antipsychotic first. The common antipsychotics used for the treatment of bipolar disorder are:

• Haloperidol
• Olanzapine
• Quetiapine
• Risperidone

If the first antipsychotic you are given doesn’t work then you should be offered a different antipsychotic medication from the list above.

If a different antipsychotic doesn’t work then you may be offered lithium to take alongside it. If the lithium doesn’t work you may be offered sodium valproate to take with an antipsychotic. Sodium valproate is an anticonvulsive medication.

Sodium Valproate shouldn’t be given to girls or young women who might want to get pregnant.

Your doctor should think about giving you benzodiazepine medication short term.

Your doctor will use different dosages and combinations depending on what works best for you. Your personal preferences should be listened to.

Depression

Your doctor should offer you medication to treat depressive symptoms. You may be offered the following medication:

• Fluoxetine with Olanzapine
• Quetiapine
• Olanzapine or
• Lamotrigine

Fluoxetine is an antidepressant. Lamotrigine is an anticonvulsant medication.

Your doctor can prescribe the above medication alongside: .

• Lithium, and
• Sodium valproate.

Doctors will use different dosages and combinations depending on what works best for you. Your personal preferences should be listened to.

Psychological treatments

If you have an episode of depression you should be offered a high intensity talking therapy, such as cognitive behavioural therapy (CBT) or interpersonal therapy as well as medication. Read more about therapy.

What are the long-term treatments for bipolar disorder?

Bipolar disorder is a life-long and often recurring illness. You may need long term support to help manage your condition.

Medication

Your doctor will look at what medication worked for you during episodes of mania or depression. They should ask you whether you want to continue this treatment or if you want to change to lithium.

Lithium usually works better than other types of medication for long-term treatment.  Your doctor should give you information about how to take lithium safely. If lithium doesn't work well enough or causes you problems, you may be offered:

• Valproate,
• Olanzapine, or

Your doctor should monitor your health. Physical health checks should be done at least once a year. These checks will include:

• measuring your weight,
• blood and urine tests,
• checking your liver and heart, and
• checking your pulse and blood pressure.

Psychological treatments

You should be offered a psychological therapy that is specially designed for bipolar disorder. You could have individual or group therapy.

The aim of your therapy is to stop you from becoming unwell again. This is known as ‘relapse.’ Your therapy should help you to:

• understand your condition,
• think about the effect that your thoughts and behaviour have on your mood,
• monitor your mood, thoughts and behaviour,
• think about risk and distress,
• make plans to stay well,
• make plans to follow if you start to become unwell,
• be aware of how you communicate, and
• manage difficulties you may have in day to day life.

If you live with your family or are in close contact with them you should also be offered ‘family intervention.’

Family intervention is where you and your family work with mental health professionals to help to manage relationships. This should be offered to people who you live with or who you are in close contact with.

The support that you and your family are given will depend on what problems there are and what preferences you all have. This could be group family sessions or individual sessions. Your family should get support for 3 months to 1 year and should have at least 10 planned sessions.

Other support

Your mental health team should give you advice about exercise and healthy eating.

If you want to return to work you should be offered support to help with training or returning to work. You should get this support if your care is managed by your GP or by you community mental health team.

If you can’t work, or haven’t been able to find work at the moment, your healthcare professionals should think about other activities that could help you back to employment in the future.

Your healthcare team should help you to make a recovery plan. The plan should help you to identify early warning signs and triggers that may make you unwell again. And ways of coping. Your plan should also have people to call if you become very distressed.

You should be encouraged to make an ‘advance statement.’ This is an instruction to health professionals about what you would like to happen with your care if you ever lack mental capacity to make your own decisions.

I’m unhappy with my treatment 

If you are not happy with your treatment you can:

• talk to your doctor about your treatment options,
• ask for a second opinion,
• get an advocate to help you speak to your doctor,
• contact the Patient and Client Council and see whether they can help, or
• make a complaint.

There is more information about these options below.

Treatment options

You should first speak to your doctor about your treatment. Explain why you are not happy with it. You could ask what other treatments you could try.

Tell your doctor if there is a type of treatment that you would like to try. Doctors should listen to your preference. If you are not given this treatment ask your doctor to explain why it is not suitable for you.

Second opinion

A second opinion means that you would like a different doctor to give their opinion about what treatment you should have. You can also ask for a second opinion if you disagree with your diagnosis.

You don’t have a right to a second opinion. But your doctor should listen to your reason for wanting a second opinion.

Advocacy

An advocate is independent from the mental health service. They are free to use. They can be useful if you find it difficult to get your views heard. There are different types of advocates available. Community advocates can support you to get a health professional to listen to your concerns. And help you to get the treatment that you would like. MindWise offer advocacy services – find out more.

Self-Care

You can learn to manage your symptoms by looking after yourself. Self-care is how you take care of your diet, sleep, exercise, daily routine, relationships and how you are feeling.

Lifestyle

Making small lifestyle changes can improve your wellbeing and can help your recovery. 

Routine helps many people with their mental wellbeing. It will help to give a structure to your day and may give you a sense of purpose. This could be a simple routine such as eating at the same time each day, going to bed at the same time each day and buying food once per week.

Your healthcare professionals should give you advice about diet and exercise.

Sleep

Sleep can be a particularly important part of self care if you’re living with bipolar disorder.  Practicing good sleep hygiene can help you to control your symptoms.

Support groups

You could join a support group. A support group is where people come together to share information, experiences and give each other support.   

You might be able to find a local group by searching online. The charity Bipolar UK have an online support group. They also have face to face support groups in some parts of Northern Ireland. Find your nearest group here.

Recovery College

Recovery colleges offer free courses about mental health to help you manage your symptoms. They can help you to take control of your life and become an expert in your own wellbeing and recovery. You can usually self-refer to a recovery college. There are lots of Recovery Colleges across Northern Ireland. You can find them by searching within your local trust website.

Make a Wellness Recovery Action Plan (WRAP)

Learning to spot early signs of mania or depression is important in self-management. The idea of the WRAP is to help you stay well and achieve what you would like to. The WRAP looks at areas like how you are affected by your illness and what you could do to manage them. You can find guides on completing a WRAP here.

Support

How can I get support?

You can speak to your GP. You should be given your own assessment through the community mental health team to work out what effect your caring role is having on your health and explore what support you need.

You can also contact our Carer Support Service.

Supporting the person you care for

You might find it easier to support someone with bipolar disorder if you understand their symptoms, treatment plan and self-management techniques. You could ask them to share this information with you.

The person that you care for may also have a care plan. This outlines the care that they will get and who is responsible for it. A care plan should always have a crisis plan. A crisis plan will have information about who to contact if they become unwell. You can use this information to support and encourage them to stay well and get help if needed.