What is bipolar disorder?
Formerly known as manic depression and sometimes called bipolar affective disorder, bipolar disorder is a long-term condition that causes episodes of mood problems, including extreme mood swings and changes in energy levels.
Is bipolar a personality disorder?
Bipolar disorder is often confused with one of the most common types of personality disorders, namely borderline personality disorder. That’s because they share some similar symptoms including mood swings and impulsiveness. However they are different disorders.
What are the signs of bipolar disorder?
If you have bipolar disorder you’ll usually go through times when you feel ‘normal’ or stable, then other times when you may sink into a deep ‘low’ or feel incredibly ‘high’:
Low mood in bipolar disorder is called a depressive mood, where you will usually feel depressed and lethargic
Feeling high is known as a manic mood, or mania, and causes feelings of extreme elation accompanied by high energy levels (overactivity)
Some people may also experience psychotic symptoms during a bipolar disorder episode.
Unlike the simple emotional ups and downs we all tend to experience every now and then, episodes of bipolar disorder can last for weeks or months at a time, sometimes even longer. These extreme mood swings can have a major impact on your life and are often very distressing and difficult to deal with.
Some people find they have more episodes of depression than episodes of mania, or vice versa, while others can go from one mood to the other without having a stable period in between. Others even experience both depression and mania at the same time, or they may swing between the two within a few hours – this is usually referred to as mixed state or a mixed bipolar episode.
Types of bipolar disorder
There are four main types of bipolar disorder:
Unspecified Bipolar disorder
Bipolar disorder type 1
This is diagnosed in people who’ve had at least one manic episode that’s lasted for a week or longer. Some people with bipolar I only have manic episodes, though most have depressive episodes too. According to the Royal College of Psychiatry, without treatment a manic episode can last three to six months, while untreated depressive episodes last six to 12 months (i).
Bipolar disorder type 2
Those with bipolar II may have depressive episodes but their manic episodes are milder than in people with bipolar I – these milder manic episodes are called hypomania.
This is the name for the condition where you have mood swings that are less severe – but often longer lasting – than the mood swings in bipolar I and II, though your symptoms may in time develop into full bipolar disorder. Rapid cycling is another term you may have heard of – it’s when someone has four or more depressive and/or manic episodes in a single year. This affects around one in 10 people with bipolar I and II (i).
Unspecified bipolar disorder
Also called other specified bipolar disorder or bipolar disorder not otherwise specified (NOS), unspecified bipolar disorder may be diagnosed if you experience some of the symptoms of bipolar disorder – such as manic and/or depressive episodes – but you don’t meet all of the diagnostic criteria for any of the other three types.
How many people are affected by bipolar disorder?
Bipolar disorder is fairly common,affecting women and men from all backgrounds equally. According to the Royal College of Psychiatry, around one in every 50 adults will experience it at some point in their life.
At what age does bipolar start?
Bipolar disorder often develops in people between the ages of 15 and 25 (very few develop it after the age of 50) (i) – surveys have shown that around 3.4 percent of 16-24-year-olds are affected by bipolar disorder, compared to just 0.4 percent of people aged 65 - 74 (ii).
What causes bipolar disorder?
Exactly what causes bipolar disorder, however, isn’t clear. In fact, there’s probably no single factor that causes it, rather a number of different things that work together to increase your chances of developing it.
What triggers bipolar?
According to the NHS, there’s no single gene that’s responsible for bipolar disorder, rather a number of genetic and environmental factors are thought to act as triggers. Situations that cause stress can trigger bipolar symptoms – for instance bereavement, childhood trauma, physical or emotional abuse or the breakdown of a relationship. Stress caused by everyday factors can play a part too, such as problems with finances, work or relationship difficulties. Sometimes physical illness or sleep disturbances can trigger bipolar symptoms too.
Chemical imbalances in the brain are also widely thought to be involved in bipolar disorder (these chemicals are called neurotransmitters and include noradrenalin, dopamine and serotonin). Having too much noradrenaline, for instance, has been linked with episodes of mania (v). On the other hand, low noradrenaline levels may trigger depressive episodes – though the commonly accepted idea that low serotonin levels in the brain cause depression has more recently been challenged, with some scientists now claiming there’s little evidence to support it (vi).
Exactly how neurotransmitter imbalances work in bipolar disorder hasn’t been fully discovered, however. According to the charity Mind, nobody knows exactly how these brain chemicals work and whether imbalance problems are a cause or a result of bipolar disorder (vii).
Is bipolar disorder genetic?
One of the factors that has a strong connection with bipolar disorder is genetics. According to the charity Bipolar UK, studies involving twins suggests this is the case: if one twin has bipolar disorder, the other twin has a 70 percent chance of developing it too (iii). The condition does seem to run in families, says Rethink Mental Illness (iv):
If one of your parents has bipolar disorder, your risk is one in 10
If both your parents are affected, your risk is four in 10
If you have a sibling with bipolar disorder, your risk is 13 in 100
If a second-degree relative has bipolar disorder – and aunt, uncle or grandparent, for example – your risk is five in 100.
How is bipolar diagnosed?
Bipolar disorder is diagnosed by a mental health specialist, usually a psychiatrist (your GP will refer you if they think you may have the condition). At your appointment you’ll have an assessment, where you’ll be asked about your symptoms and your medical and family history. Some people may also need other tests to check whether or not they have a medical problem such as an overactive or underactive thyroid. Once you’re diagnosed, you can start your treatment straight away.
People with bipolar disorder have mood swings that are far more severe than the highs and lows most of us experience every now and then. Bipolar UK has devised a Mood Scale of zero (low) to 10 (high) to help explain how extreme bipolar moods can be (viii). For instance, people who don’t have bipolar disorder have moods that usually rank near the middle of the scale – typically four when they feel the most down to six when they feel happy and optimistic.
Those with bipolar disorder, on the other hand, experience a much wider range of moods, from zero – when everything is bleak and there’s no way out, even having recurring suicidal thoughts – to 10 (extreme manic high with psychosis and hallucinations). They can also experience a mixed state where they may, for instance, feel very low but at the same time restless or overactive.
Depressive episode symptoms
According to the Bipolar UK Mood Scale, mild to moderate depression ranks as a three or four, while severe depression ranks as zero or one. The signs and symptoms you may experience during a depressive bipolar episode are the same as those for depression:
Feeling sad, hopeless, worthless, empty or guilty
Loss of confidence
Irritability or agitation
Appetite problems (eating too much or too little)
Loss of interest in everyday and social activities
Misuse of alcohol or other substances
Lack of concentration
According to the NHS, some people are initially diagnosed with clinical depression but may go on to have a manic episode – often years later – when they may be then diagnosed with bipolar disorder (v).
Manic episode symptoms
The Mood Scale places mania right at the top at numbers nine and 10. Some of the things you may experience during a manic episode include:
Feelings of happiness and euphoria
Lack of social inhibitions
High energy levels
Irritability or agitation
Having over-ambitious plans and ideas
Lack of concentration (you may feel your mind is racing)
Spending large sums of money on items you wouldn’t normally buy or that you can’t afford, or gambling
Eating very little
Misuse of alcohol or other substances
Sleeping very little or not at all
Having a quick temper
Talking quickly (as if you can’t get your words out fast enough)
Saying things that are out of character
Potentially harmful risk taking
High levels of sexual arousal
One of the problems of mania is those affected don’t usually realise anything is wrong – often it’s the people around them who recognise the problem. Indeed, you may feel really positive during a manic episode. However, some people with bipolar disorder can also experience symptoms of psychosis during a manic episode (and sometimes during a depressive episode too). These symptoms include delusions – such as extreme paranoia or becoming convinced of things that aren’t true – and hallucinations (seeing or hearing things that aren’t there). People with bipolar disorder who experience psychosis may often be sectioned (kept in hospital) under the Mental Health Act, to make sure they’re kept safe.
Is bipolar similar to schizophrenia?
Some of the symptoms of bipolar disorder and another mental health condition called schizophrenia can overlap. Because of this the two conditions are often confused for one another – however they are both different mental health disorders. For instance, schizophrenia causes hallucinations or delusions – both of which can also be experienced by someone with bipolar psychosis. But while bipolar disorder causes changes in mood and energy levels, schizophrenia symptoms are more severe and can make you lose touch with reality. Meanwhile there is also a condition called schizoaffective disorder, which combines schizophrenia symptoms including hallucinations and delusions as well as bipolar disorder symptoms such as manic and/or depressive episodes.
This ranks seven and eight on the Mood Scale and describes a high mood, but not as extreme as that of mania. Another way to describe hypomania is that it’s similar to mania but it doesn’t last as long and feels more manageable, which means you can still function relatively well. People who are experiencing hypomania also don’t usually develop any symptoms of psychosis. That said, however, it can still have a disruptive effect on your day-to-day life, and you may still be at risk of making unwise decisions. The people around you will also usually recognise that you’re behaving differently compared with your normal self.
According to Bipolar UK, hypomania can sometimes feel very pleasurable (iii). However, if it isn’t treated it can develop into a manic episode.
Bipolar symptoms in women
Studies suggest women are more likely to have bipolar II than bipolar I, which means they have depressive episodes but milder episodes of mania (hypomania) (ix). In fact women with bipolar disorder in general tend to experience more depressive episodes than men, with studies suggesting they’re twice as likely to be affected by depression than men with bipolar disorder (x). This can mean that women are sometimes misdiagnosed with depression instead of bipolar disorder.
Researchers have also found women with bipolar disorder may be more likely than men to have mixed bipolar episodes (xi) and experience rapid cycling (ix), and that they may also be more likely to attempt suicide than men (ix).
Meanwhile a review of 13 studies has discovered women with bipolar disorder are more likely than men to experience social issues as a result of living with their condition, including social stigma, loss of self-determination and changes in their relationships (xii).
Bipolar disorder treatments
If you don’t have any treatment, depressive episodes can last much longer than if you were being treated. And without treatment the amount of time you spend in a normal mood between manic or depressive episodes can also become shorter, with depressive episodes in particular often becoming more frequent and lasting longer.
Can bipolar be cured?
There’s no cure for bipolar disorder but there are several treatments available that can help make life a bit easier.
Medicines are frequently prescribed for treating bipolar disorder, including mood stabilisers that help prevent manic and depressive episodes, as well as medicines that treat the symptoms of depression and mania when they happen. Mood stabilisers should be taken regularly, as stopping taking them suddenly could trigger an episode of mania (xiii).
With some mood stabiliser medicines you’ll also need regular blood tests to check how well your liver, thyroid and kidneys are functioning, as well as to make sure your dosage isn’t too high or too low. Sometimes people with bipolar disorder are treated with just a mood stabiliser, though antidepressants are often used in conjunction with mood stabilisers too.
Bipolar disorder therapy
Talking therapies – including cognitive behavioural therapy (CBT), interpersonal therapy and family therapy – can also be helpful when used alongside medicines for bipolar disorder. These are usually recommended in between episodes of mania or depression.
Another type of psychological treatment is psycho-education, which is where you learn more about your condition and how to help yourself. People with bipolar disorder may also be encouraged to use a technique called mood monitoring. This can help you to recognise when your mood is starting to swing, which means you have time to get the help and support you need. Learning to recognise your triggers can also be helpful in the same way, as can recognising how you feel physically and emotionally during the run-up to having an episode.
Bipolar and pregnancy
Like other mental health problems, bipolar disorder can become worse during pregnancy. Also, many medicines that are routinely prescribed for the condition are not usually prescribed for pregnant women as they may harm the foetus – especially during the early stages of pregnancy. However, if you are already taking prescription medication for bipolar symptoms and you become pregnant, always see or talk to your doctor or specialist before stopping taking it.
Living with bipolar disorder
If you’ve been diagnosed with bipolar disorder, lifestyle advice will also be part of your treatment. Some of the things you can do yourself to help reduce the impact your condition has on your day-to-day life include the following:
Is bipolar affected by diet?
According to the NHS eating well can help reduce the symptoms of bipolar disorder, particularly the depressive symptoms (xiv). Sticking to a healthy diet will also help prevent weight gain, which is a common side effect of some of the medicines used to treat bipolar disorder.
Aim to eat at least five portions of fruit and veg every day, combined with plenty of starchy carbohydrates (ideally higher-fibre carbs such as wholemeal bread, pasta and brown rice) and some protein and low-fat dairy foods. Try to limit your intake of foods that are high in fat, salt and sugar, and have just small amounts of oils and spreads (choose unsaturated versions such as products made from vegetable, rapeseed, olive and sunflower oils).
Find out more on what makes a healthy balanced diet by reading about the Eatwell Guide.
Bipolar and exercise
Keeping as fit as possible can also help with depressive and manic episodes as exercising uses up some of that excess energy when you’re feeling high, and releases ‘feel-good’ chemicals called endorphins in your brain when you’re feeling low (vii). Staying active can help you watch your weight too. Aim to be moderately active for at least 150 minutes each week – taking a brisk walk is one way to clock up some exercise time, or you could try any kind of activity that makes you breathe faster and feel warmer.
Bipolar and insomnia
Disturbed sleep can be a trigger as well as a symptom of bipolar episodes for many people (vii), so try not to burn the candle at both ends. Getting plenty of sleep may also help keep your mood stable or shorten an episode, says Mind (vii).
If you find getting a good night’s sleep a challenge, try some of the tips in our guide to sleep and insomnia.
Bipolar and alcohol
People living with bipolar disorder sometimes use alcohol or illegal street drugs as a way of getting some relief, but both alcohol and recreational drugs can trigger an episode of mania too. If you have bipolar disorder, it’s important to avoid alcohol and illegal drugs, as staying alcohol and drug-free can help you feel more stable.
If you’re concerned about your drinking or drug taking, talk to your GP or your specialist. You can also find tips for cutting down on alcohol in our guide to alcohol misuse.
Bipolar and stress
Many people with bipolar disorder find stress is often a trigger for an episode of mania or depression. If that happens to you, try to avoid stressful situations whenever you can. However, it’s just not possible to avoid stress altogether. Find out some of the things you can do to keep your stress levels more manageable by reading our guide to stress symptoms and signs.
One of the ways you can tackle stress is to practise mindfulness – find out how this works by reading our guide to using mindfulness to manage stress.
Stick to a routine
Having a regular daily routine can help you feel more stable as well as calmer if you’re having an episode of mania or more motivated if you’re having a depressive episode. Some of the things you could schedule in your daily plan include regular times for meals and a nightly sleep routine, where you put aside a certain amount of time to relax before going to bed at the same time every night. Include fun things in your routine too, such as hobbies and socialising. It can also be very helpful to take any medication you’ve been prescribed at the same time every day.
Join a bipolar support group
Joining a group or online community where other people know how you’re feeling and what you’re going through can be incredibly supportive and also a valuable source of information and help. Bipolar UK, for instance, has an online forum for anyone who’s affected by bipolar – find out more by visiting bipolaruk.org.
Make other people aware
It may not feel comfortable at first but being open with the people around you about your condition can be really beneficial. Making your friends and family more aware about bipolar disorder and how to tell when you’re starting to develop an episode may be useful, because you may not be aware of it yourself (especially if you’re having an episode of mania). The people around you can also help you to look after yourself as well as understand how your condition is affecting you.
Supplements for bipolar disorder
Vitamin supplements are not a substitute for prescribed bipolar medication, but they could help boost your health in general and help you to manage triggers such as stress. If you’re taking medication for your condition, always check with your doctor or specialist before taking any of the following supplements (or any type of supplement):
High-strength fish oils
The omega-3 fatty acids found in oily fish such as salmon, sardines, mackerel, herring and fresh tuna may help support your general physical health as well as your mental health. For instance, scientists have discovered omega-3s help reduce levels of the stress hormone cortisol, which may help your body cope with stress more effectively (xv). An analysis of studies looking at the use of omega-3s in treating bipolar disorder also suggests there’s strong evidence they may be helpful in improving depressive episodes, but not episodes of mania (xvi).
These days even vegetarians and vegans can enjoy the benefits of omega-3 fatty acids found in fish, as supplements containing omega-3s sourced from marine algae are now more widely available.
Vitamin B complex
As well as being essential for your overall health, B vitamins may be useful for combating stress. A review of clinical trials, for instance, has found B vitamins have benefits for both healthy people and those who have a high risk for problems with stress (xvii). There is, however, only weak evidence to suggest taking specific B supplements such as B12 and B6 might help directly with mood disorders such as bipolar (xviii).
A traditional Ayurvedic herb, ashwagandha is often used to help with stress, with researchers from India suggesting it may reduce levels of the stress hormone cortisol (xix). A study published in the Journal of Clinical Psychiatry has also found ashwagandha might help boost certain aspects of cognitive health in people with bipolar disorder, including auditory-verbal working memory, reaction time and social cognition (xx).
There’s currently no evidence to suggest this non-protein amino acid derived from tea can treat the symptoms of bipolar disorder. However, many people take theanine supplements to relieve stress and anxiety, with studies suggesting they may help make you feel calmer without also making you feel drowsy (xxi).
Bipolar disorder can be upsetting and difficult to live with, especially when you’re having a manic or depressive episode. Learning more about your condition and what triggers it for you can make you feel more in control of your life. This guide shows how your lifestyle can help you manage your symptoms and boost your wellbeing too.
Want to know more?
Find out more about a variety of mental health conditions in our pharmacy health library’s mental health section.
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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.
Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.