Bipolar disorder explained

What bipolar disorder is

Bipolar disorder is a condition that causes extreme changes in mood and energy that go well beyond normal ups and downs. A person may have periods of feeling extremely high, called mania or a milder form called hypomania, and periods of feeling very low, which is depression. In between, mood can return to a settled, ordinary level for weeks, months or even years. The episodes are not something a person can simply snap out of; they reflect changes in how the brain regulates mood. Bipolar disorder often begins in the late teens or early twenties, and it tends to run in families, though many factors including stress, sleep loss and life events can influence when episodes happen.

The highs: mania and hypomania

During a high, a person may feel unusually elated, full of energy and self-confidence, and need very little sleep without feeling tired. Thoughts and speech can race, and they may take on lots of plans at once. While this can feel good at first, mania can lead to risky decisions, such as overspending, reckless driving or unsafe behaviour, and can damage relationships, work and finances. In severe mania, some people lose touch with reality and develop unusual beliefs or hear things others do not, which is very frightening for them and those around them. Hypomania is a milder version that does not tip into these severe features, but it is still a change from a person's usual self and is an important warning sign.

The lows: bipolar depression

The depressive side of bipolar disorder can look like other forms of depression, but it is part of the same condition. During a low, a person may feel deeply sad, empty or hopeless, lose interest in things they normally enjoy, and struggle with sleep, appetite and concentration. Energy and motivation drop, and everyday tasks can feel overwhelming. Feelings of worthlessness and, at times, thoughts of not wanting to be alive can occur, which is why the lows are often the most dangerous part of the condition. Recognising that these feelings are part of an illness, and reaching out for help early, is important. Depression in bipolar disorder is treated with care, because some treatments used for ordinary depression need adjusting.

Diagnosis and treatment on the NHS

Bipolar disorder is diagnosed by a mental health professional, usually a psychiatrist, who takes a careful history of the mood episodes over time, since the pattern of highs and lows is key. It can take time to diagnose, because people often seek help during a low and the highs may not be recognised. Treatment usually combines medicines that help stabilise mood over the long term with talking therapies, education about the condition, and support to keep a steady routine and good sleep. A written plan often includes spotting early warning signs of an episode and knowing what to do. Family and friends can play a valuable role, and many people find that combining medical treatment with self-management leads to long periods of stability.

Living well and staying safe

Many people with bipolar disorder lead full, productive lives. Helpful steps include keeping a regular sleep pattern, reducing alcohol and drugs, managing stress, and learning to notice personal early warning signs so that help can be sought before an episode takes hold. Staying in touch with the care team and not stopping medicines suddenly are important, as sudden changes can trigger relapse. Support groups and charities offer understanding from others who have been through it. Above all, it helps to know that a crisis can be met with help. If you or someone you know is in crisis or having thoughts of suicide, you can contact NHS 111 and select the mental health option, call the Samaritans free on 116 123, or call 999 if life is at immediate risk.