Bipolar disorder

What is bipolar disorder?

Bipolar disorder, previously known as manic-depression, is a mood disorder characterised by exaggerated mood swings. Bipolar means two poles, or extremes, and if you have bipolar disorder you are likely to have extreme ups and downs. You might experience varying extremes of mania, or up periods, and depression, or down periods - no one is the same. 

Mood episodes

Everyone has ups and downs (including those related hormonal changes in adolescence and to the menstrual cycle in females). However, bipolar disorder is a medical condition where you have extreme mood swings (or 'mood episodes') widely out of proportion, or totally unrelated, to what's happening in your life.  These swings affect your thoughts, feelings, physical health, emotional health, behaviour, and day-to-day functioning. These symptoms can be extremely disruptive to your life. It can also be very disruptive and distressing to your relationships with friends and family.

Every time you experience symptoms at one extreme for at least 1 week, it is called an episode. There are 4 main mood episodes - mania, hypomania, depression, and mixed mood.

Manic episode (mania)

A manic episode is a when you have an unusually and constantly elevated or bad-tempered mood, lasting at least 1 week.

During times of mania, you might experience:

• Elevated or euphoric mood - this can include being full of energy and happy. It's often described as being on a high or "on top of the world".
• Changes in activity levels - There might be changes in your sleeping and eating patterns. 
• Faster thinking and speaking patterns - Thoughts can be quicker than usual, which might lead you to speak faster and jump from subject to subject.  
• Lack of inhibitions - finding it more difficult to see what the consequences of your actions might be.
• Irritability - you might be more likely to be angry or annoyed with others, particularly if they seem to reject your plans or ideas.
• Unrealistic (or gradiose) plans and beliefs - you might have unrealistic beliefs about your talents, e.g. you might believe that you're a king, queen, film star, or a religious figure.    
• Risk taking behaviour - you might take unnecessary and unsafe risks.
• Hypersexuality - increased sexual thoughts, feelings, or behaviours; using explicit sexual language.
• Measuring behaviour - you might find it hard to decide what behaviour is appropriate to a particular situation.

Hypomanic episode (hypomania)

Hypomania is a milder form of mania that lasts at least 4 days. You don't experience full manic episodes, but milder (hypomanic) episodes. It includes symptoms such as increased thought speed and processes, elevated mood, and irritability.

Major depressive episode (depression)

A depressive episode is when you have either a depressed mood or the loss of interest or pleasure in nearly all activities, lasting for at least 2 weeks.

When you are experiencing a depressed mood you might:

• lose interest in day-to-day life 
• feel unusually tired and exhausted
• have no appetite or an increased appetite, changes in body weight 
• feel worthless or guilty 
• have difficulty concentrating.

Check out the fact sheets on Depression listed on the left side of the page for more information about the characteristics of depression.

Mixed episode

A mixed episode is when you experience both manic and major depressive symptoms nearly every day for at least one week. Your mood can vary with the time of the day.

Types of bipolar disorder

Diagnoses of different bipolar disorder are based on your experience of mood changes, what relatives and friends tell mental health workers about what they have witnessed/experienced, observation, and an assessment by a psychiatrist. Understanding the different types or classifications of bipolar disorder can help identifying the best way of managing it.

Bipolar I

Bipolar I is when you experience one or more manic episodes or mixed episodes and often one or more major depressive episodes. Each depressive episode can last for several weeks or months, alternating with intense symptoms of mania that can last just as long.

Between these extremes, you might have periods where life continues normally. Your symptoms can also be affected by changes in season (eg winter months) or life situations that come up (eg exam stress).

Bipolar II

Bipolar II is when you experience one or more major depressive episodes, along with at least one hypomanic episode. Hypomanic episodes have symptoms similar to manic episodes, but are not as severe.

Between episodes, there might be periods of normal functioning. Symptoms might also be related to seasonal changes and life situations. 

Cyclothymic disorder

Cyclothymic disorder is a chronic (lasting a long time) fluctuating mood pattern which involves periods of hypomanic symptoms and periods of depressive symptoms. It is a milder form of bipolar disorder - the duration of the symptoms are shorter, less severe, and not as regular.

Bipolar disorder not otherwise specified

When symptoms don't fit any other type, it is called bipolar disorder not otherwise specified. The experiences of this bipolar disorder vary from person to person.

Sometimes you might experience the symptoms of a manic episode and a major depressive episode, but not fit into the above types of bipolar disorder. 

Just like the other types of bipolar disorder, bipolar disorder not otherwise specified is a treatable disorder.

Causes of bipolar disorder

Males and females have an equal chance of developing bipolar disorder, although males are often diagnosed at an earlier age. Bipolar disorder might be associated with a combination of factors including genetics, biochemistry, stress and even the seasons.  Approximately 1-5% of the population experiences bipolar disorder.

Getting help for bipolar disorder

Bipolar is a treatable disorder and usually requires long-term management and treatment. Many people with bipolar disorder are creative and intelligent and with proper management of their condition, lead full and productive lives.

There are treatment options available for managing both mania and depression. It is a good idea to speak to your doctor about which options might be best for you.  

Medication

Your local doctor should be able to tell you about what medications are available for those who experience bipolar disorder. Most people are referred to a psychiatrist (see Psychiatrist fact sheet) for diagnosis and medical treatment.

Mood stabilisers, anti-psychotics, and antidepressants can all be used in the control of Bipolar Disorder. Check out the Black Dog Institute website for more info.

Seeing a counsellor or psychologist 

If you are experiencing Bipolar Disorder you might also find it helpful to talk with someone like a psychologist, counsellor, social worker or other mental health worker. By doing this, you can gain a better understanding of what you are experiencing. It can also be helpful just to talk about how you feel and these mental health workers should help you to work out why you feel this way. 

In most situations the psychiatrist manages any medication and monitors the situation while the mental health worker assists you to manage your life better. You may like to check out the Who can help you section for more information about counsellors and psychologists.

Alternative therapies

Natural therapies, such as acupuncture or naturopathy, can sometimes be helpful in managing bipolar disorder, but this should be done in conjunction with your doctor. Your doctor should have more information about what these are and how they may help. Regular meals and a balanced diet are also important in the management of bipolar disorder.

Family/friend support network

Family and friends can help with the day-to-day management of bipolar disorder by providing feedback on mood states, giving support, friendship, understanding, and a non-judgemental listening ear.

Check out the Support from friends + family section to find out how these people can help.

Support groups

Support groups for bipolar disorder offer valuable first-hand information from others who live with the disorder. You will find support in the community both locally and on the internet (see links on left). Check out the Support groups fact sheet to find out more information.

Lifestyle

Regulating patterns of eating and sleeping can help in the management of bipolar disorder, and can help to prevent manic, hypomanic, depressive, or mixed episodes.

Stress management + relaxation

Decreasing stress levels, planning ahead and learning relaxation techniques are also important with bipolar disorder management. Check out the links on the left for more info.

Kids Helpline/Lifeline

These services can help when things get tough and you want to talk to someone anonymously about your own problems or helping out a friend. See the fact sheets on Kids Helpline and Lifeline to find out more info.

Psychiatric hospital/ward

To keep safe and get the best support, it might be necessary to be admitted to hospital during more extreme episodes of mania or depression. Check out the Psychiatric Hospital fact sheet for more info.

Helping someone with bipolar disorder

If you have a friend or a family member who has bipolar disorder you might want to check out the Supporting someone with a mental illness fact sheet. 

More information

Other things on Reach Out to check out are Reach Out Central (ROC), a new interactive space, and the community forum, where you can talk about stuff and find support on dealing with a range of topics.

Acknowledgement

Thanks to the Black Dog Institute for their assistance and advice.