Bipolar Disorder

Bipolar disorder, previously called manic depression, is a condition that affects your moods, which can swing from one extreme to another. If you have bipolar disorder, you will have periods, or episodes of depression and mania.

The two extremes are characterised as follows:

  • depression where you feel very low, and
  • mania where you feel very high. If your symptoms are slightly less severe, it is known as hypomania.

Both extremes of bipolar disorder have other symptoms associated with them (see symptoms section). Unlike simple mood swings, each extreme episode can last for several weeks or longer. The high and low phases of the illness can be so extreme that they interfere with your daily life.

The exact cause of bipolar disorder is not fully understood, but the condition seems to run in families. It is a relatively common condition, with around 1 person in 100 being diagnosed as having bipolar disorder. It can occur at any age, but often develops between the ages of 18 and 24. Both men and women, and people from all backgrounds, can get it.

The pattern of mood swings in bipolar disorder varies widely between individuals. Some people have only a couple of bipolar episodes in their lifetime and are stable in between, while others may experience many episodes.

The depression phase often comes first. Initially, you may be diagnosed with clinical depression, and then have a manic episode some time later (sometimes years later), after which your diagnosis might change. During a phase of depression, you may have overwhelming feelings of worthlessness which often lead to thoughts of suicide.
During a manic phase, you may feel extremely happy and have lots of ambitious plans and ideas. You may also spend large amounts of money on things that you cannot afford. Not feeling like eating or sleeping, talking quickly, and becoming annoyed easily, are also quite common. You may be very creative, and feel that mania is an extremely positive experience. However, during a manic phase, you may also have symptoms of psychosis, where you see or hear things that are not there.


The main symptoms of bipolar disorder are mood swings. The mood swings range from extreme happiness (mania) to extreme sadness (depression). The episodes of mania and depression can last several weeks or more. Some people with the condition can swing from highs to lows quickly, without having a normal period in between. This is called rapid cycling. In the depressive (low) phase symptoms may include:

  • feeling sad and hopeless,
  • lack of energy,
  • finding it difficult to concentrate and remember things,
  • loss of interest in everyday activities,
  • feelings of emptiness or worthlessness,
  • feelings of guilt and despair,
  • feeling pessimistic about everything,
  • self-doubt,
  • difficulty sleeping and waking up early, and
  • suicidal thoughts.

The manic (high) phase usually comes after 2-4 periods of depression and may include:

  • feeling extremely happy, elated or euphoric,
  • talking very quickly,
  • feeling full of energy,
  • feeling full of self-importance,
  • feeling full of great new ideas and having important plans,
  • being easily distracted,
  • being easily irritated or agitated,
  • not sleeping,
  • not eating, and
  • doing lots of pleasurable things which often have disastrous consequences e.g. spending a lot of money which you cannot afford.

It you have bipolar disorder, you may be unaware that you are having a manic phase and, after it is over, you may be shocked at your behaviour. However, at the time, you may think others are being very negative or unhelpful.

Some people with bipolar disorder have more frequent and severe episodes than others. Due to the extreme nature of the condition, it may be difficult to hold down a job and relationships may become strained. There is also an increased risk of suicide.

During episodes of mania and depression, you may experience strange sensations, such as seeing, hearing or smelling things that are not there (hallucinations). You may also believe things that seem irrational to other people (delusions). This is known as psychosis or a psychotic episode.


The exact cause of bipolar disorder is unknown. However, it is thought that a complex mix of physical, environmental, and social factors are involved. Bipolar disorder seems to run in families with around 1015% of the nearest relatives of people with the disorder, also having the condition.

Although bipolar disorder is not caused by stress, stressful situations can trigger episodes of mania or depression in those with the condition. For example, physical, sexual, or emotional abuse, the breakdown of a relationship, or the loss of a loved one. These kinds of events can cause of episodes of depression throughout a persons life. Also, physical illness can sometimes bring on periods of depression.

Bipolar disorder may also be triggered by overwhelming problems in everyday life, such as problems to do with money, work, and relationships.
Research has found that there are changes to the brains chemistry during phases of mania and depression. Hormone levels and chemicals that transmit signals within the brain (neurotransmitters) are affected. Understanding how this works can be useful in finding ways of treating and managing the condition.


If your GP suspects that you have bipolar disorder, you will normally be referred to a specialist. This will often be a psychiatrist. If your GP thinks that, due to your illness, there is a risk that you could harm yourself, or others, s/he will arrange an appointment straight away.
The specialist will carry out an assessment which will involve asking you a number of questions to determine whether or not you have bipolar disorder, and what treatments will be most suitable for you.

You will be asked about the symptoms that you have had, and when you first experienced them. The specialist will also ask you about how you usually feel leading up to, and during, an episode of mania or depression, and whether you have had thoughts about harming either yourself or others.

S/he will also want to know about your background and family history to see if any of your relatives have had the condition. If someone else in your family has bipolar disorder, the specialist may wish to talk to them, but will ask  for your agreement before doing so.

It is extremely important for you to discuss your condition with the specialist, so that you are fully involved in the decisions about your care. However, in some cases, if your symptoms are very severe, you may be unable to make an informed decision or communicate your needs. In case this situation arises, you can produce a set of written instructions, stating what treatments and help you want or do not want. Your GP or specialist will be able to help and advise you about this.

Depending on your symptoms, you may also have tests to see whether you have a physical problem such as thyroid disease. If you have bipolar disorder, you should visit your GP on a regular basis to have a physical health check. You may have other health problems, and the medication that is used to treat the condition can have side effects. For example, putting on weight is common.


If left untreated, episodes of depression or mania can last for 6-12 months. On average, someone with bipolar disorder will have five or six episodes over a 20-year period. However, with effective treatment, episodes usually improve within about three months.

The majority of people with bipolar disorder can be treated using a combination of approaches. These include:

  • medicines to prevent episodes of mania, hypomania and depression these are known as mood stabilisers and are taken every day, long-term,
  • medicines to treat the main symptoms of depression and mania when they occur,
  • learning to recognise things that trigger an episode of depression or mania, and
  • learning to recognise the signs of an approaching episode.

Treatment for bipolar disorder

There are a number of drug treatments available that can help to stabilise mood swings. These include:

  • Lithium carbonate is the most frequently used medication in the UK to treat bipolar disorder. It is a long-term method of treatment for episodes of mania, hypomania and depression, and is normally prescribed for a minimum of six months. If you are taking lithium, you need to ensure that you stick to the prescribed dose, and do not stop taking it suddenly. In order to be effective, it is vital that the dosage is correct. If the dose is incorrect, it can cause side effects, such as diarrhoea and vomiting. If you have side effects, you should inform your GP immediately. You will also need regular blood tests (at least every six months) to ensure that your levels of lithium are not too high or too low. Also, you should not usually take non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, unless they are prescribed by your GP.
  • Anticonvulsantmedicines include valproate, carbamazepine, and lamotrigine. These are sometimes used to treat episodes of mania. Like lithium, they are long-term mood stabilisers. Anticonvulsant medicines are often used to treat epilepsy, but have also been found to be effective in treating bipolar disorder. A single medicine may be used alone, but they are sometimes used in combination with lithium in cases where the condition does not respond to lithium on its own.
  • Women who are of child bearing age, are not usually given valproate   because there may be risks to an unborn child. However, if there is no alternative, your GP should ensure that you are using a very reliable form of contraception. If you are prescribed valproate, you will also need to visit your GP to have a blood count when you begin the medication and then six months later.
  • If you are prescribed lamotrigine, you will usually be started on a low dose which will be increased gradually. If you are taking this medication, and develop a rash, you should seek medical help immediately. If you are taking the contraceptive pill, you should talk to your GP about changing to a different form of contraceptive. You will also need to have a yearly health check, but will not require any other tests.
  • Carbamazepine is usually only prescribed on the advice of an expert in bipolar disorder. The dose will be low to begin with, before being gradually increased. If you are taking other medication (including the contraceptive pill), you will need to be carefully monitored. You should have blood tests to check your liver and kidneys, when you start taking the medication, and then again after six months. You will also need to have a blood count (at the start and after six months), and may have your weight and height monitored.
  • Antipsychotic medicines are sedatives, and are sometimes used to treat an episode of mania or hypomania. They include olanzapine, quetiapine, and risperidone. Olanzapine may also be used long-term as a mood stabiliser and quetiapine for long-term bipolar depression. Antipsychotic medicines can be particularly helpful if your symptoms are severe, or your behaviour is disturbed. As they can cause side effects, such as weight gain, the initial dose will usually be low. You will need to have regular health checks (at least every three months, possibly more often), particularly if you have diabetes. If your symptoms do not improve, you may be offered lithium and valproate as well.

If, for any reason, your GP or specialist advises you to stop taking medication for bipolar disorder, the dose should be gradually reduced over a minimum of four weeks, and up to three months, if you are taking an antipsychotic or lithium. If, for any reason, you have to stop taking lithium, you should see your GP about taking an antipsychotic or valproate instead.

If you have rapid cycling (quickly changing from highs to lows without a normal period in between), you may be prescribed a combination of lithium and valproate. If this does not help, you may be offered lithium on its own, or lithium, valproate, and lamotrigine. However, you will not usually be prescribed an antidepressant unless an expert in bipolar disorder has specifically recommended it.

Treating depression
If you are already taking medication for bipolar disorder, and you develop depression, your GP should check that you are taking the right dose and change it if necessary. Episodes of depression in bipolar disorder can be treated in a similar way to clinical depression. This includes the use of antidepressant medications.
Antidepressants are effective in about 70% of cases. However, it can take time (2-4 weeks) for them to take affect, so if you are prescribed a course of antidepressants, you need to be patient and persevere with them. There are several different types of antidepressants, and some have possible side effects. Some common antidepressants include:

  • Tricyclic drugs for example, dothiepin, imipramine, and amitryptyline,
  • Selective Serotonin Reuptake Inhibitors and Noradrenaline Reuptake Inhibitors (SSRIs and SNRIs) for example, fluoxetine, venlafaxine, and reboxetine, and
  • Monoamine Oxidase Inhibitors (MAOIs) for example, phenelzene and isocarboxazid.

Learning to recognise triggers

If you have bipolar disorder, it is possible to learn to recognise the warning signs of an approaching episode of mania or depression. This will not prevent the episode occurring, but will enable you to get help in time. This might mean making some changes to your treatment, perhaps adding an antidepressant or an antipsychotic medicine to the mood stabilising medication that you are already taking. Your GP or specialist will be able to advise you about this.

Compulsory treatment

You should be able to receive the majority of your treatment without having to stay in hospital. However, if your symptoms are very severe, or you are being treated under the Mental Health Act because there is a danger that you will harm either yourself, or others, you can be admitted to hospital. As an alternative, it may be possible for you to receive treatment in a day hospital and return home at night.

Other methods of treatment

You may also be offered psychological treatment that will help you to deal with your depression, your symptoms, and provide advice about how you can improve your relationships. For example, advice may include, taking regular exercise, and planning activities that you enjoy, and that give you a sense of achievement. You may also receive advice about your diet and how to ensure that you sleep well.

Future treatments

The development of new, better mood stabilising medicines is ongoing. There are also a number of other treatments currently being researched, such as transcranial magnetic stimulation and vagal nerve stimulation.


If you have bipolar disorder, you cannot prevent episodes of mania or depression occurring, but there are things that you can do to help manage the condition effectively. Some useful tips include:

  • avoid stressful situations which may trigger an episode of mania or depression,
  • avoid drinking too much alcohol or taking recreational drugs, as this may trigger an episode of mania,
  • if prescribed a mood stabiliser medicine, ensure that you take it regularly, as stopping suddenly can trigger an episode of mania or depression,
  • if you get any side effects, from medication that you have been prescribed, tell your doctor as soon as possible. S/he will be able to change the dose or the type of medication, and
  • learn about your illness so that you can recognise the signs of an approaching episode, and can take the necessary steps to manage it successfully.

If you have bipolar disorder, the help and support of your family and friends can be invaluable. If they know that you have the condition, and understand what it is about, they will be able to recognise when your behaviour is out of character, and encourage you to get help. They will also be able to talk to you about your illness, and provide you with comfort and support when you are having an episode of mania or depression.

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