Bipolar Disorder

Summary

What is bipolar disorder?

Bipolar disorder is a long-term mental health condition that can cause significant changes in mood, energy, activity levels and behaviour. Someone may experience periods of unusually high mood or energy, known as mania or hypomania, as well as periods of depression. These episodes can last for days or weeks and are usually noticeably different from the person’s usual mood and behaviour.

Bipolar disorder can affect anyone and can be diagnosed at different ages, although it often develops during the teenage years or early adulthood. Having normal ups and downs in mood does not mean someone has bipolar disorder. The changes associated with bipolar disorder are usually more intense, last longer and have a noticeable impact on everyday life, relationships, school, work or decision-making.

Highs: mania and hypomania

During a manic or hypomanic episode, someone may feel unusually happy, excited, confident, energetic or restless. They may:

  • Talk much more quickly or more than usual.
  • Have lots of thoughts at once or find it difficult to concentrate.
  • Need significantly less sleep without feeling tired.
  • Feel unusually confident, powerful or capable.
  • Take risks or make impulsive decisions, such as spending lots of money, driving dangerously or behaving in ways they wouldn’t normally consider.
  • Become more sociable, active or productive than usual.
  • Become more irritable, argumentative or easily frustrated.
  • Say or do things that are unusual, inappropriate or out of character.
  • Experience changes in their perception of reality, particularly during severe mania, such as hearing or seeing things that aren’t there or believing things that others don’t.
  • In severe cases, become so unwell that they need urgent medical support or hospital treatment.

Mania and hypomania are not simply feeling happy or having lots of energy. Mania is more severe and can significantly affect someone’s judgement, behaviour and ability to function. Hypomania is a milder form, although it can still cause difficulties and may feel very different from the person’s usual self.

Lows: depressive episodes

During a depressive episode, someone may experience:

  • Feeling very low, sad, empty, hopeless or overwhelmed.
  • Losing interest in activities they normally enjoy.
  • Having little motivation or energy.
  • Feeling extremely tired or physically slowed down.
  • Sleeping much more or much less than usual.
  • Changes in appetite or weight.
  • Finding it difficult to concentrate or make decisions.
  • Withdrawing from friends, family or activities.
  • Feeling worthless, guilty or like a burden.
  • Having thoughts about self-harm, suicide or not wanting to be alive.

Depressive episodes can make school, work, relationships and everyday tasks feel much harder. Someone may struggle to get out of bed, look after themselves or maintain their usual routines.

Types of bipolar disorder

There are several types of bipolar disorder, including:

  • Bipolar I: Involves at least one manic episode. Mania can be severe enough to significantly disrupt someone’s life or require hospital treatment. Someone may also experience depressive episodes, although these are not required for a diagnosis.
  • Bipolar II: Involves episodes of major depression and hypomania, but no full manic episodes. The depressive episodes can be significant and have a substantial impact on everyday life.
  • Cyclothymia (cyclothymic disorder): Involves ongoing periods of milder mood changes, with symptoms of hypomania and depression that do not meet the full criteria for manic or major depressive episodes. These fluctuations continue over a prolonged period.

Bipolar disorder is more than ordinary changes in mood. The shifts in mood, energy and behaviour can be intense and disruptive, but bipolar disorder can be managed with the right treatment and support.

How to help myself

If you’re experiencing significant changes in your mood, energy, sleep or behaviour, keeping track of what you’re experiencing can be really helpful. You could use a mood diary or app to record your mood, sleep, energy levels, thoughts and any changes in your behaviour. Over time, this may help you notice patterns or early warning signs that your mood is changing. You can also share this information with a healthcare professional.

Try to keep your routine as consistent as possible, particularly your sleep. Getting enough sleep, eating regularly, staying hydrated and keeping some structure in your day can support your wellbeing. During periods when you feel very energised, it can be tempting to stay up late, take on lots of activities or make big plans, but protecting your sleep and routine can be particularly important.

It can help to notice your early warning signs. You might recognise that you’re talking faster, sleeping less, becoming unusually confident or irritable, spending more money, withdrawing from people or losing interest in things you usually enjoy. Let someone you trust know what your warning signs are and agree on how they can support you if they notice changes before you do.

During periods of high mood or increased impulsivity, put some barriers between yourself and risky decisions. You could ask someone you trust to help you manage spending, avoid making major life decisions while your mood is elevated, step away from situations where you might take unnecessary risks and reduce access to things that could put you in danger. Having a plan in place before you become unwell can make this much easier.

During depressive periods, focus on small, manageable steps rather than expecting yourself to function normally. Try to maintain basic routines such as eating, washing, getting dressed and taking medication if prescribed. Staying connected with people you trust and doing small amounts of enjoyable or meaningful activities can also help prevent you from becoming completely isolated.

Take your treatment as prescribed and attend appointments, even when you’re feeling better. If you notice significant changes in your mood, sleep, energy or behaviour, let your GP or mental health team know rather than waiting for things to become severe. Don’t stop or change prescribed medication without speaking to your healthcare professional first.

It can also be useful to create a wellbeing or crisis plan with a professional and the people you trust. This can include your early warning signs, things that help you feel stable, people you can contact, what you would like others to do if you’re becoming unwell and what to do if you’re experiencing a mental health crisis.

If you’re experiencing thoughts of suicide, severe confusion, hallucinations, extreme agitation or behaviour that puts you or someone else at immediate risk, seek urgent help through 999, A&E or NHS 111.

How to help a loved one

If someone you care about has bipolar disorder, learning what their usual mood, energy and behaviour look like can help you notice when something is changing. Everyone experiences bipolar disorder differently, so talk to them when they are feeling well about what their early warning signs might look like. They may notice things such as sleeping much less, talking more quickly, becoming unusually energetic or irritable, spending more money, withdrawing from others or losing interest in things they normally enjoy.

Create a plan together for when their mood starts to change. This might include agreeing who they would like to contact, what helps them feel more settled and what you can do if they are becoming more unwell. During periods of high mood, you may be able to help them slow down, protect their sleep, avoid major decisions and put some limits around risky activities or spending. During depressive periods, gentle encouragement and practical help with everyday tasks can be useful. Try to support them without taking away their independence or making every decision for them.

If someone is experiencing mania or hypomania, they may not recognise that anything is wrong and may feel particularly confident, energetic or productive. Avoid arguing about whether they are “being irrational”. Instead, stay calm and talk about specific changes you’ve noticed, such as “I’ve noticed you’ve barely slept for the last few nights and you’re making lots of big plans.” Encourage them to contact their mental health team or GP and help them reduce situations that could increase risk.

During a depressive episode, someone may withdraw, have very little energy or feel hopeless. Keep checking in even if they don’t respond much, and offer practical support with things like food, appointments, getting outside or staying connected with other people. Take any talk of self-harm or suicide seriously and ask directly about how they are feeling. If you believe they are in immediate danger, call 999 or take them to A&E.

Try to avoid blaming, judging or shaming them for symptoms or behaviours that happen when they are unwell. At the same time, supporting someone doesn’t mean accepting behaviour that harms you or others. It is okay to set boundaries and seek support for yourself. You can involve other trusted adults or professionals rather than trying to manage a crisis alone.

Encourage them to stay connected with their treatment and mental health team. You could help them attend appointments, remember important information or keep track of changes in their mood and sleep, if they want you to. Don’t encourage them to stop or change medication without speaking to their healthcare professional first.

Myth Buster

Myth: “Bipolar disorder is just normal mood swings.”

Truth: Everyone experiences changes in their mood, but bipolar disorder involves significant and sustained changes in mood, energy and activity levels. A manic or hypomanic episode can last for days or longer and involve major changes in sleep, behaviour, thinking and decision-making. Depressive episodes can also be severe and have a significant impact on everyday life. Bipolar disorder is not simply going from being happy one minute to sad the next.

Myth: “People with bipolar disorder are violent and dangerous.”

Truth: Having bipolar disorder does not make someone violent or dangerous. Like people experiencing many other mental health difficulties, people with bipolar disorder may be more likely to experience vulnerability, stigma or become victims of crime than to harm someone else. Severe episodes of mania can sometimes involve impulsive or unpredictable behaviour, particularly when someone is very unwell, but this does not mean that people with bipolar disorder are inherently dangerous.

Myth: “Bipolar disorder can only be treated with medication.”

Truth: Medication can be an important part of treatment for bipolar disorder and can help stabilise mood and reduce the risk of future episodes. However, treatment can also involve psychological therapy, education about bipolar disorder, support with relationships and routines, and maintaining healthy sleep and lifestyle habits. The most appropriate combination of support will depend on the individual.

Myth: “Mania is just being happy and productive.”

Truth: Mania is much more than feeling happy or having lots of energy. Someone experiencing mania may feel extremely energised or confident, but they can also become irritable, restless, impulsive or distressed. They may sleep very little, make risky decisions, spend large amounts of money or behave in ways that are very different from their usual self. Severe mania can involve losing touch with reality and may require hospital treatment.

Myth: “Someone with bipolar disorder is always either manic or depressed.”

Truth: Bipolar disorder doesn’t mean that someone is constantly experiencing an extreme mood episode. People can have periods of stable mood between episodes and may feel like themselves for long periods of time. The pattern and frequency of episodes varies from person to person, which is why individualised treatment and support are important.

Therapy

Therapy for bipolar disorder can help someone understand their mood changes, recognise early warning signs and develop strategies for staying well. It is usually used alongside medication where medication has been prescribed, rather than as a replacement for it.

  • Psychoeducation – Helps someone understand bipolar disorder, including triggers, early warning signs, treatment and how sleep, stress and routines can affect mood. It can also help families understand how to provide appropriate support.
  • Cognitive Behavioural Therapy (CBT) – Can help someone recognise and challenge unhelpful thoughts and develop strategies for managing depression, anxiety and behaviours that may contribute to mood difficulties.
  • Interpersonal and Social Rhythm Therapy (IPSRT) – Focuses on maintaining consistent daily routines, particularly sleep, waking times, meals and social activities. Regular routines can help support mood stability and reduce disruption to the body’s internal rhythm.
  • Family-Focused Therapy (FFT) – Involves the person and their family or carers. It focuses on improving communication, recognising early warning signs, managing conflict and developing plans for responding to changes in mood.
  • Dialectical Behaviour Therapy (DBT) – Can help with emotional regulation, distress tolerance, impulsivity and relationship difficulties. It may be particularly useful when someone experiences intense emotions or difficulties with self-harm.
  • Mindfulness-based approaches – Can help someone notice changes in their thoughts, emotions and physical sensations without immediately reacting to them. These approaches may support emotional regulation and managing stress.
  • Relapse prevention and crisis planning – Helps someone identify their personal warning signs for mania or depression and develop a plan for what to do when these signs appear. This might include identifying who to contact, how to protect sleep and what professional support to access.

Helplines

Mind

Mind is a mental health charity providing information, advice and support for people experiencing mental health difficulties. They cover a wide range of mental health and wellbeing issues, including anxiety, depression, stress, relationships, loneliness, coping with difficult experiences and managing everyday life. Mind provides information to help people understand what they are experiencing, know their rights, find appropriate support and feel less alone.

Phone: 0300 123 3393
Opening times: 9am–6pm, Monday to Friday (excluding bank holidays)
Email: info@mind.org.uk
Website: www.mind.org.uk 

Bipolar UK

Bipolar UK is a charity providing information, advice and peer support for people affected by bipolar disorder, including people with bipolar and their families, friends and carers. They provide one-to-one support, support groups, an online community and resources about living with bipolar disorder.

Phone: 0333 323 3880
Opening times: 9am–5pm, Monday–Friday
Email: info@bipolaruk.org
Website: www.bipolaruk.org
Online community: Available 24 hours a day

YoungMinds

YoungMinds is a national charity supporting the mental health and wellbeing of children and young people. They provide information, advice and support for parents and carers who are concerned about a young person’s mental health, and help people understand mental health difficulties, find appropriate support and access useful resources. Their Parents Helpline can provide information, advice, emotional support and signposting to other services. 

Parent helpline: 0808 802 5544 (9:30 am – 4 pm on Mondays, Thursdays and Fridays, and from 9:30 am – 6 pm on Tuesdays and Wednesdays)
Email: parents@youngminds.org.uk
Webchat: https://www.youngminds.org.uk/parent/parents-helpline/

Childline
Childline is a free service for young people to talk to a counsellor about anything. The service is available 24 hours a day, 7 days a week. Childline is available to anybody who is 18 years old or younger.

Phone: 0800 1111
Opening times: Available 24 hours a day, 7 days a week, 365 days a year
You can also find helpful resources, speak to a counsellor online or send a message on their site.
Website: www.childline.org.uk

For adults concerned about a child, the NSPCC can be contacted 

NSPCC

NSPCC is a children’s charity that works to protect children and prevent abuse and neglect. They provide support and advice for adults about child abuse, neglect, child safety, online safety and children’s mental and emotional wellbeing. 

Phone: 0808 800 5000
Opening times: 10 am–4 pm, Monday–Friday
Email: help@nspcc.org.uk
Email opening times: 11 am–4 pm, 7 days a week
Website: www.nspcc.org.uk

Shout

Shout is a free, confidential text messaging service that provides support to anyone who is struggling to cope. It can help with a wide range of issues, including stress, anxiety, low mood, loneliness, relationship difficulties, bullying, self-harm, suicidal thoughts, feeling overwhelmed and other mental health challenges.

Text: SHOUT to 85258
Opening times: Available 24 hours a day, 7 days a week, 365 days a year
Website: www.giveusashout.org

Samaritans

Samaritans is a charity providing emotional support to anyone who is struggling to cope or needs someone to talk to. They are there for people experiencing all sorts of difficulties, including stress, anxiety, loneliness, relationship or family problems, bereavement, feeling overwhelmed and concerns about mental health or suicide.

Phone: 116 123
Opening times: 24 hours a day, 7 days a week, 365 days a year
Website: www.samaritans.org

The Mix 

The Mix is a charity providing free information, advice and support for young people on all sorts of issues that can affect their lives and wellbeing. This includes mental health, relationships, money, housing, work and education, drugs and alcohol, bullying, social media, family difficulties and many other challenges. They offer information and practical advice to help young people understand what they are going through, make informed decisions and find further support when they need it. 

Phone: 0808 808 4994
Opening times: 11 am–11 pm, 7 days a week
Website: http://www.themix.org.uk
Crisis Messenger: Text THEMIX to 85258 – available 24 hours a day, 7 days a week.

CALM (Campaign Against Living Miserably)

CALM (Campaign Against Living Miserably) is a charity providing support for people who are struggling with their mental health or experiencing emotional distress. They support people with issues including low mood, anxiety, loneliness, stress, suicidal thoughts and difficult life experiences.

Phone: 0800 58 58 58
Opening times: 5pm–midnight, every day
Webchat: 5pm–midnight, every day
WhatsApp: Available through the CALM website
Website: www.thecalmzone.net