Bipolar disorder is persistent changes in mood, characterised by periods of either very elevated moods (hypomania or mania) or very low moods (depression). A person can fluctuate between high moods and low moods (mood swings).  Mood swings are episodic and in between these episodes the person appears completely well.

Hypomania

Hypomania is a state of elevated mood during which activity and thought speeds up. The person has less need to sleep, their mood is high, and they experience an overwhelming sense of wellbeing. They will, however, often show irritation and intolerance towards other people. Ideas may flow quickly and thought processes are relatively intact. The person feels well and in control, but may not understand the consequences of their behaviour and may react angrily if confronted. Judgment is affected and the person may become unable to make complex decisions.

Hypomania can look very much like an exaggeration of the person’s normal mood, making it difficult to convince them to seek help, or for health professionals to recognise this as part of an illness.

Mania

In a manic state, thinking can become disjointed or distorted and the person may not make sense to other people. For example, the person may be talking so fast that others cannot understand them. Hallucinations and delusions can occur, which will appear very real to the person experiencing them. During a manic episode, the person may be at risk of accidental injury, as they may not be capable of looking after themselves or making decisions in their own best interest. For example, a person may spend too much money without being able to recognise the consequences and find themselves in serious debt.

• Increased energy, activity or restlessness
• Inflated self-esteem or grandiosity
• Racing thoughts, increased ideas and rapid speech
• Excessive euphoria and feelings of wellbeing
• Extreme irritability and distractibility
• Decreased sleep requirement (e.g. getting to sleep later and waking earlier)
• Increased goal orientated activity
• Uncharacteristically poor judgment and inability to weigh up consequences
• Increased sexual drive, poor judgment in selecting sexual partners and vulnerability to sexual exploitation
• Denial that anything is wrong – inability to reflect on behaviour and its effect on others
• Overspending – feeling that one is rich and can be overly generous
• Risky behaviour (e.g. driving fast -increased sense of physical invulnerability)

Depression is a condition marked by extreme low mood(s) and lack of interest or pleasure. Thoughts are slower and there may be feelings of sadness or emptiness. Thinking is difficult and it is hard to make decisions. The person may be incapable of, or uninterested in, performing everyday tasks. Sleeping is disturbed or it may be difficult to get to sleep at all. The person may experience periods of wakefulness in the early hours of the morning, followed by oversleeping into the late morning. The person may have an increased appetite or a complete lack of appetite. They may also suffer decreased or loss of libido. Self-confidence is low and there is a generally a pessimistic outlook regarding one’s self or others.

Bipolar disorder usually develops in adolescence or early adulthood. Stress is usually a trigger for early episodes of bipolar disorder, but after a number of occurrences, the episodes of mania or depression can develop without any obvious trigger.

Bipolar 1 Disorder

Sufferers have a greater likelihood of regularly experiencing mania as well as extended periods of hypo-mania. The person may suffer more severe symptoms such as psychotic episodes (hallucinations and delusions), making them more likely to be hospitalised.

Bipolar 2 Disorder

Sufferers may be diagnosed with Bipolar 2 when the individual experiences variation of moods, including hypomanic symptoms, lasting from a few hours to a few days. The person does not experience psychotic episodes.

Mixed states

Sufferers will experience mania and depression at the same time. The person may be laughing while crying and feel sad yet they’re driven to high levels of activity.

Rapid cycling bipolar disorder

Rapid cycling is a period of frequent, distinct episodes of mania or depression occurring four or more times per year. Women are more likely than men to suffer rapid cycling.

Bipolar disorder occurs as a result of a combination of biological, psychological and social factors.
It is currently thought that a person can inherit a genetic vulnerability for the disorder. While this alone will not necessarily cause the disorder, it can significantly increase the likelihood of a mood disorder when in the presence of other risk factors such as stressful life factors or pregnancy.

It’s important to know that not all mood swings are caused by bipolar disorder. Other possible causes include physical illnesses such as diabetes or a viral or bacterial infection on the brain. Use of recreational drugs, alcohol and medications can also account for a person experiencing mood swings.

If someone you know has a sudden, significant change of mood that is out of character for them and cannot be explained by their circumstances, it is recommended they have a full physical check up to find out why these mood swings are happening.

Bipolar disorder is an illness that can take some time to diagnose and treat effectively.

Medication may be helpful in addressing the symptoms of hypo-mania, mania or depression. A combination of medications including mood stabilisers (such as lithium carbonate, carbamazepine or sodium valproate), anti-psychotic medication (used to manage manic symptoms) and antidepressants may be prescribed.

Psychological therapies may be helpful in assisting the person manage their thoughts, feelings or stress.

Support, education and counselling are important tools to help the person find ways of understanding and coping with the disorder. They can also learn to recognise triggers for their episodes.

Peer-led groups may be useful by providing support & advocacy and can assist the person to understand their experiences and find alternative ways of managing them.

Hospitalisation may  be necessary if a person becomes very unwell.

Find out more about bipolar disorder by accessing the resources and information listed below.

Although it can be difficult to accept a diagnosis of bipolar disorder and the need for ongoing treatment, those who persevere generally find it much easier to manage the severity and frequency of their illness.

See your local doctor (GP) or have an assessment conducted by a mental health professional, e.g. psychologist.

If treatment is required, discuss the options with a health professional to decide which program is right.

If you are concerned that you or someone you know is showing signs of bipolar disorder it is important to seek help from a skilled mental health professional. Don’t let misconceptions about mental illness stop you seeking help.