Bipolar disorder
Also known as: bipolar, bipolar affective disorder
Bipolar disorder is a mental health condition that causes extreme mood changes, with high moods (mania or hypomania) and low moods (depression).
When to seek care
If someone is in immediate danger or has seriously harmed themselves, call 999 or go to A&E. For urgent mental health support, call NHS 111 and choose the mental health option. Samaritans can be called free on 116 123 at any time. NHS 111 Wales advises speaking to a mental health specialist, or a GP if there is none, about extreme mood changes that last a long time or affect everyday life, or when a diagnosed person's treatment is not helping.
Overview
Bipolar disorder is a mental health condition marked by extreme mood changes. High moods are called mania or hypomania, and low moods are called depression. The NHS says these moods usually last a few days or weeks at a time, and NHS 111 Wales says people often have stable periods in between, which can last for weeks, months or years. Some people have milder symptoms than others. Bipolar disorder cannot be cured, but treatment can help manage it.
Causes
- The exact cause is not known.
- A research review describes the condition as highly heritable, and family history is the strongest known risk factor.
Risk factors
- Having a close relative with the condition
- Childhood trauma
- Stressful life events
- Using some recreational drugs
Symptoms
What a clinician may find
- Episodes of high mood, called mania or hypomania, and of low mood, called depression
- Being more irritable than usual and sleeping much less than normal during mania
- Low energy, changes in sleep and appetite, feelings of worthlessness, poor concentration and withdrawal from others during depression
- Mixed episodes, in which manic and depressive symptoms occur together
- Hallucinations or delusions in some severe episodes
Complications
- Psychosis, with hallucinations or delusions, during severe episodes
- Thoughts of suicide or self-harm during depression
Diagnosis
Diagnosis can take a long time. Bipolar UK's Bipolar Commission reported an average delay of about nine and a half years before people receive a diagnosis, and notes there are no physical tests for it. Mood symptoms caused by a medical condition, such as an overactive thyroid, are classed separately from bipolar disorder, and clinicians may check thyroid function to rule out a physical cause.
Treatment
The NHS says the main treatments are medicines to stabilise mood and talking therapy such as cognitive behavioural therapy (CBT). A mental health specialist works with the person to create a treatment plan, and most people have a combination of treatments that includes medication, talking therapy and lifestyle changes. NICE names lithium as the preferred long-term treatment. The NHS says an antidepressant is not usually prescribed unless a bipolar specialist has recommended it.
Prevention
Mind says a regular routine, enough sleep, a balanced diet and regular exercise can help keep mood steadier. Keeping a mood diary can help a person spot patterns, triggers and early warning signs of a relapse.
Key facts
| Fact | Detail |
|---|---|
| Also called | Bipolar; bipolar affective disorder (a name used in NHS Scotland guidance) |
| Main features | Episodes of high mood (mania or hypomania) and low mood (depression) |
| Between episodes | People often have stable periods, which can last for weeks, months or years (NHS 111 Wales) |
| Main types | Bipolar I, bipolar II and cyclothymia |
| Outlook | Cannot be cured, but can be managed with treatment |
| Crisis support | 999 if in immediate danger; NHS 111 mental health option; Samaritans 116 123 any time |
What is bipolar disorder and what are the episodes?
Bipolar disorder is a mental health condition that mainly affects mood. People with it have extreme mood changes, with high moods called mania or hypomania and low moods called depression. Hypomania is a milder form of mania. The NHS says these moods usually last a few days or weeks at a time. NHS 111 Wales says people often have stable periods with no symptoms, which can last for weeks, months or years. During mania a person may be more irritable than usual and sleep much less than normal, according to Rethink Mental Illness. Depression can bring low energy, changes in sleep and appetite, feelings of worthlessness, poor concentration and withdrawal from other people. NHS 111 Wales also lists suicidal thoughts and thoughts of self-harm among the features of depression. Severe manic or depressive episodes can include hallucinations or delusions, which are symptoms of psychosis.
What types of bipolar disorder are there?
In bipolar I disorder, a person has at least one manic episode, and this is often accompanied by periods of deep depression. In bipolar II disorder, a person has hypomanic and major depressive episodes rather than full mania. The US National Institute of Mental Health says people with bipolar II often seek help only for depression, and their hypomania can go unnoticed.
The NHS describes cyclothymia as a mild form of bipolar disorder. The Royal College of Psychiatrists says its mood swings are less severe than those in full bipolar disorder but can last longer. The NHS says people with cyclothymia are at risk of developing full bipolar disorder, so it is important to get help before reaching this stage, and it is not known how many will go on to develop it.
The Royal College of Psychiatrists also describes mixed states, a blend of mania and depression, such as feeling very low while also restless and overactive.
What causes bipolar disorder, and what can trigger episodes?
The exact cause of bipolar disorder is not known. A review of the research describes it as highly heritable, and having a parent with the condition is considered the most important risk factor. MedlinePlus says environmental conditions likely interact with genetic factors to determine overall risk.
Childhood trauma is a recurring theme in the research. One review links childhood maltreatment to more severe and frequent mood episodes and an earlier start. Stressful life events and substance use are also associated with the condition, although it is hard to tell whether substance use leads to an episode or happens during one.
Mind lists examples of things that can trigger an episode, including stressful periods, lack of sleep, significant life events such as weddings, having a child or losing a loved one, periods of change or uncertainty, and feeling overwhelmed or busy. In a Bipolar UK survey, poor sleep was named as the biggest trigger for a first episode or a relapse.
How is bipolar disorder diagnosed and treated?
Diagnosis can take a long time. Bipolar UK's Bipolar Commission reported an average delay of about nine and a half years before people receive a diagnosis, and notes there are no physical tests for it. Mood symptoms caused by a medical condition, such as an overactive thyroid, are classed separately from bipolar disorder, and clinicians may check thyroid function to rule out a physical cause.
The NHS says bipolar disorder cannot be cured, but treatments can help manage it. The main treatments are medicines to stabilise mood and talking therapy such as cognitive behavioural therapy (CBT). NICE names lithium as the preferred long-term treatment. A mental health specialist works with the person to create a treatment plan, and most people have a combination of treatments that includes medication, talking therapy and lifestyle changes. The NHS says an antidepressant is not usually prescribed unless a bipolar specialist has recommended it, because antidepressants alone can lead to relapse.
Living with bipolar disorder
Mind says a regular routine can help mood feel calmer when it is high and more motivated when it is low. Getting enough sleep can help keep mood stable or shorten an episode. Gentle exercise such as yoga or swimming can help with relaxation and managing stress, and a balanced, nutritious diet can help a person feel well and think clearly.
Mind suggests noting down mood patterns in a diary or on a phone. Bipolar UK offers a free mood scale, mood diary and mood tracker app, which can help people spot their patterns, triggers and any early warning signs of a relapse. Bipolar UK also runs courses that cover mood monitoring and early warning signs plans.
Mind describes a crisis plan, best made while a person is well, that sets out what to do if early warning signs or triggers appear or the person feels very distressed.
When should someone get help?
If someone is in immediate danger or has seriously harmed themselves, for example with an overdose, or may be about to, the NHS advises calling 999 or going to A&E. For feelings that make a person feel unsafe, distressed or worried about their mental health, the NHS lists NHS 111, which has a mental health option. Samaritans can be called free on 116 123 at any time of day.
NHS 111 Wales gives two situations in which to seek help: extreme mood changes that last a long time or affect everyday life, and a diagnosis where treatments are not working. It advises speaking to a mental health specialist if the person has one, and otherwise a GP. NHS Inform in Scotland says people can also phone 111 for advice if they are worried about someone else.
Frequently asked questions
Can bipolar disorder be cured?
The NHS says bipolar disorder cannot be cured, but there are treatments that can help manage it. The main treatments are medicines to stabilise mood and talking therapy such as CBT. A mental health specialist works with the person to create a treatment plan.
What is the difference between mania and hypomania?
Hypomania is a milder form of mania. In bipolar I disorder a person has at least one manic episode, while bipolar II involves hypomanic and major depressive episodes rather than full mania. The US National Institute of Mental Health says the hypomanic episodes in bipolar II are less severe than the manic episodes in bipolar I.
Does bipolar disorder run in families?
A research review describes bipolar disorder as highly heritable, and having a parent with the condition is considered the most important risk factor. The same review says most people with a close relative who has bipolar disorder will not develop it themselves. The exact cause is not known.
How long does a diagnosis take?
It can take a long time. Bipolar UK's Bipolar Commission reported an average delay of about nine and a half years before people receive a bipolar diagnosis, and notes there are no physical tests for it. Clinicians may check thyroid function to rule out a physical cause of mood symptoms.
What helps in a crisis?
The NHS advises calling 999 or going to A&E if someone has seriously harmed themselves or may be about to. For feeling unsafe or distressed, NHS 111 has a mental health option. Samaritans can be called free on 116 123 at any time. Mind describes a crisis plan, made in advance, that sets out what to do if early warning signs or triggers appear.
Connected pages in detail
What each linked page on Anatomy Nexus covers, in a line, for Bipolar disorder.
Conditions
- Overactive thyroid (hyperthyroidism) Excess thyroid hormone, most often from Graves' disease, in which antibodies stimulate the thyroid to overproduce.