This section explains the symptoms of bipolar disorder, treatments, and ways to manage the condition. This section is for people with bipolar disorder or cyclothymia and their carers, relatives and friends. Show
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Overview
Need more advice?If you need more advice or information you can contact our Advice and Information Service. About & symptomsWhat is bipolar disorder?Bipolar disorder can be a life-long mental health problem that mainly affects your mood. It affects how you feel, and your mood can change massively. You can experience episodes of:
You may feel well between these times. When your mood changes, you might see changes in your energy levels or how you act. Symptoms of bipolar disorder can be severe. They can affect areas of your life, such as work, school and relationships. You usually develop bipolar disorder before you are 20. It can develop in later life, but it rarely develops after the age of 40. You could have symptoms of bipolar disorder for some time before a doctor diagnoses you. A doctor might say you have something else such as depression before you get a bipolar disorder diagnosis. This is because diagnosing mental illnesses can be sometimes difficult for doctors. They usually can’t do things like blood tests and scans to help them. Bipolar disorder used to be called manic depression. What are the symptoms of bipolar disorder?Bipolar disorder symptoms can make it difficult to deal with day-to-day life. It can have a bad effect on your relationships and work. The different types of symptoms are described below. ManiaSymptoms of mania can include:
HypomaniaHypomania is like mania but you will have milder symptoms. DepressionSymptoms of depression can include:
PsychosisSometimes you can have psychotic symptoms during a severe episode of mania or depression. Symptoms of psychosis can be:
Psychotic symptoms in bipolar disorder can reflect your mood. For example, if you have a manic episode you may believe that you have special powers or are being monitored by the government. If you have depressive episode, you may feel very guilty about something you think you have done. You may feel that you are worse than anybody else or feel that you don't exist. You can find more information about:
Types & causesWhat are the different types of bipolar disorder?There are different types of bipolar disorder. What is bipolar disorder I disorder?A diagnosis of bipolar I disorder means you will have had at least 1 episode of mania that lasts longer than 1 week. You may also have periods of depression. Manic episodes will generally last 3-6 months if left untreated. Depressive episodes will generally last 6-12 months without treatment. What is bipolar II disorder?A diagnosis of bipolar II disorder means it is common to have symptoms of depression. You will have had at least 1 period of major depression. And at least 1 period of hypomania instead of mania. What is bipolar I or II disorder with mixed features?You will experience symptoms of mania or hypomania and depression at the same time. You may hear this being called ‘mixed bipolar state’. You may feel very sad and hopeless at the same time as feeling restlessness and being overactive. What is bipolar I or II disorder with rapid cycling?Rapid cycling means you have had 4 or more depressive, manic or hypomanic episodes in a 12-month period. What is bipolar I or II with seasonal pattern?Seasonal pattern means that either your depression, mania or hypomania is regularly affected in the same way by the seasons. For example, you may find that each winter you have a depressive episode, but your mania doesn’t regularly follow a pattern. There can be some similarities between bipolar I or II with seasonal pattern and another conditional called seasonal affective disorder. What is cyclothymia?A diagnosis of cyclothymic disorder means you will have experienced regular episodes of hypomania and depression for at least 2 years. You won’t be diagnosed with bipolar because your symptoms will be milder. But they can last longer. Cyclothymia can develop into bipolar disorder. What causes bipolar disorder?Experts don’t know for sure why some people experience bipolar disorder. Your genetics can play a part and your experiences too. If any of your family members have experienced bipolar disorder, you’ve more chance of developing it too. But scientists say no single gene can be linked to bipolar disorder. Someone in your immediate family might live with bipolar disorder, like a parent, brother, or sister. If they do, there’s a 13 in 100 chance you will develop it too. The risk is higher if both of your parents or your twin live with the condition. For some people symptoms of bipolar disorder can be triggered by stressful things in their lives. These things can include:
You can find more information about ‘Does mental illness run in families’ by clicking here. Getting helpHow do I get help if I think I have bipolar disorder?The usual first step to getting help is to speak to your GP. It can help to keep a record of your moods. This can help you and your GP to understand your mood swings. Bipolar UK have a mood diary and a mood scale on their website. You can find their details in the Useful contacts section at the bottom of this page. Your GP can’t diagnose bipolar disorder. Only a psychiatrist can make a formal diagnosis. Your GP may arrange an appointment with a psychiatrist if you have:
They might refer you to a psychiatrist at your local NHS community mental health team (CMHT). Your GP should make an urgent referral to the CMHT if they think that you might have mania or severe depression. Or there is a chance that you are a danger to yourself or someone else. Your GP should refer you to your local NHS early intervention team if you have an episode of psychosis and it’s your first one. Bipolar disorder can be difficult to diagnose because it affects everyone differently. Also, the symptoms of bipolar disorder can be experienced by people who have other mental illness diagnoses. It can take a long time to get a diagnosis of bipolar disorder. You can find more information about:
Treatment and managementWhat is the treatment for mania, hypomania and depression?You can check what treatment and care is recommended for bipolar disorders on the National Institute for Health and Care Excellence (NICE) website. NICE produce guidelines for how health professionals should treat certain conditions. You can download these from their website at: The NHS doesn’t have to follow these recommendations. But they should have a good reason for not following them. What medications are recommended?Mood stabilisers are usually used to manage mania, hypomania and depressive symptoms. The mood stabilisers we talk about in this factsheet are:
Mania and hypomania If you are taking antidepressants your doctor may advise you to withdraw from taking them. You will usually be offered an antipsychotic first. The common antipsychotics used for the treatment of bipolar disorder are:
If the first antipsychotic you are given doesn’t work, then you should be offered a different antipsychotic medication from the list above. If a different antipsychotic doesn’t work, then you may be offered lithium to take alongside it. If the lithium doesn’t work you may be offered sodium valproate to take with an antipsychotic. Sodium valproate is an anticonvulsive medication. Sodium Valproate shouldn’t be given to girls or young women who might want to get pregnant. Your doctor should think about giving you benzodiazepine medication short term. Your doctor will suggest different dosages and combinations to you depending on what works best for you. Your personal preferences should be listened to. Depression
Fluoxetine is an antidepressant. Lamotrigine is an anticonvulsant medication. Your doctor can prescribe the above medication alongside:
If you would like to take medication, doctors will use different dosages and combinations depending on what works best for you. Your personal preferences should be listened to. You can find more information about:
What psychological treatments are recommended?If you have an episode of depression you should be offered medication and a high intensity talking therapy, such as:
What is cognitive behavioural therapy (CBT)? What is interpersonal therapy? You can find more information about ‘Talking therapies’ by clicking here. What are the long-term treatments for bipolar disorder?Bipolar disorder is a life-long and often recurring illness. You may need long term support to help manage your condition. What medication options are there?Your doctor will look at what medication worked for you during episodes of mania or depression. They should ask you whether you want to continue this treatment or if you want to change to lithium. Lithium usually works better than other types of medication for long-term treatment. Your doctor should give you information about how to take lithium safely. If lithium doesn't work well enough or causes you problems, you may be offered:
Your doctor should monitor your health. Physical health checks should be done at least once a year. These checks will include:
What psychological treatments are recommended?You should be offered a psychological therapy that is specially designed for bipolar disorder. You could have individual or group therapy. The aim of your therapy is to stop you from becoming unwell again. This is known as ‘relapse.’ Your therapy should help you to:
If you live with your family or are in close contact with them, you should also be offered ‘family intervention.’ Family intervention is where you and your family work with mental health professionals to help to manage relationships. This should be offered to people who you live with or who you are in close contact with. The support that you and your family are given will depend on what problems there are and what preferences you all have. This could be group family sessions or individual sessions. Your family should get support for 3 months to 1 year and should have at least 10 planned sessions. Is there any other support?Your mental health team should give you advice about exercise and healthy eating. If you want to return to work, you should be offered support with that including training. You should get this support if your care is managed by your GP or by your community mental health team. You might not be able to work or to find any. Your healthcare professionals should think about other activities that could help you back to employment in the future. Your healthcare team should help you to make a recovery plan. The plan should help you to identify early warning signs and triggers that may make you unwell again and ways of coping. Your plan should also have people to call if you become very distressed. You should be encouraged to make an ‘advance statement.’ This is an instruction to health professionals about what you would like to happen with your care if you ever lack mental capacity to make your own decisions. What is the Care Programme Approach?You may be assessed under the Care Programme Approach (CPA) if you have complex needs or you are vulnerable. CPA is a package of care that is used by secondary mental health services. You will have a care plan and someone to coordinate your care. All care plans should include a crisis plan. CPA aims to support your mental health recovery by helping you to understand your:
CPA should be available if you have a wide range of needs from different services or you are thought to be a high risk. Both you and your GP should be given a copy of your care plan. Your carers can be involved in your care plan and given a copy if you give your consent for this to happen. You can find more information about:
What if I’m not happy with my treatment?If you aren’t happy with your treatment you can:
There is more information about these options below. How can I speak to my doctor about my treatment options?You can speak to your doctor about your treatment. Explain why you aren’t happy with it. You could ask what other treatments you could try. Tell your doctor if there is a type of treatment that you would like to try. Doctors should listen to your preference. If you aren’t given this treatment, ask your doctor to explain why it isn’t suitable for you. What’s a second opinion?A second opinion means that you would like a different doctor to give their opinion about what treatment you should have. You can also ask for a second opinion if you disagree with your diagnosis. You don’t have a right to a second opinion. But your doctor should listen to your reason for wanting a second opinion. What is advocacy?An advocate is independent from the mental health service. They are free to use. They can be useful if you find it difficult to get your views heard. There are different types of advocates available. Community advocates can support you to get a health professional to listen to your concerns. And help you to get the treatment that you would like. NHS complaints advocates can help you if you want to complain about the NHS. You can search online to search for a local advocacy service. What is the Patient Advice and Liaison Service (PALS)?PALS is part of the NHS. They give information and support to patients and a good place to start if you’re not happy with any aspect of the NHS. You can find your local PALS’ details through this website
link: How can I complain?You can complain about your treatment or any other aspect of the NHS verbally or in writing. See our information on ‘Complaining about the NHS or social services’ for more information. You can find out more about:
What can I do to manage my symptoms?You can learn to manage your symptoms by looking after yourself. Selfcare is how you take care of your diet, sleep, exercise, daily routine, relationships and how you are feeling. What lifestyle changes can I make?Making small lifestyle changes can improve your wellbeing and can help your recovery. Routine helps many people with their mental wellbeing. It will help to give a structure to your day and may give you a sense of purpose. This could be a simple routine such as eating at the same time each day, going to bed at the same time each day and buying food once per week. Your healthcare professionals should offer you a combined healthy eating, exercise and sleep programme. You can find more information about wellbeing any physical health
at: What are support groups?You could join a support group. A support group is where people come together to share information, experiences and give each other support. You might be able to find a local group by searching online. The charity Bipolar UK have an online support group. They also have face to face support groups in some areas of the country. Their contact details are in the Useful contacts at the bottom of this page. Rethink Mental Illness have support groups in some areas. You can find out what is available in your area if you follow this link: www.rethink.org/about-us/our-support-groups. Or you can contact our General Enquiries team on 0121 522 7007 or for more information. What are recovery colleges?Recovery colleges are part of the NHS. They offer free courses about mental health to help you manage your symptoms. They can help you to take control of your life and become an expert in your own wellbeing and recovery. You can usually self-refer to a recovery college. But the college may inform your care team. Unfortunately, recovery colleges aren’t available in all areas. To see if there is a recovery college in your area you can use a search engine such as Google. What is a Wellness Recovery Action Plan (WRAP)?Learning to spot early signs of mania or depression is important in self-management. The idea of the WRAP is to help you stay well and achieve what you would like to. The WRAP looks at areas like how you are affected by your illness and what you could do to manage them. There are guides that can help with this. You can ask your healthcare professional to make one with you or ask them for a template of one. There is more information about the WRAP in the further reading section at the bottom of this page. Rethink Mental Illness has created a guide called ‘Staying well with bipolar’. This is a guide based on information from people who have or support someone with bipolar disorder. You can download it
here: You can find more information about ‘Recovery’ by clicking here. RisksWhat risks and complications can bipolar disorder cause?There can be complications and risks for people who live with bipolar disorder. But these risks can be lessened with the right support and treatment. What about suicide and self-harm?You might have an illness where you experience psychosis, such as schizophrenia or bipolar disorder. Your risk of suicide is estimated to be between 5% and 6% higher than the general population. You are more likely to try to take your own life if you have a history of attempted suicide and depression. It is important that you get the right treatment for your symptoms of depression and have an up to date crisis plan. There is also research that suggests you are 30% - 40% more likely to self-harm if you live with bipolar disorder. What about financial risk?If you have mania or hypomania you may struggle to manage your finances. You may spend lots of money without thinking about the effect that it may have on your life. You could make a ‘Lasting Power of Attorney.’ This is a legal process. This means that you pick someone that you trust to manage your finances if you lack mental capacity to manage them by yourself. You can work with your carer and mental health team. You can form an action plan. This can say what they can do if you have a period of mania or hypomania and you start to make poor financial decisions. What about physical health risk?People with bipolar disorder have a higher rate of physical illnesses such as diabetes and heart disease. You should have a physical health check at least once every year to help manage these risks. What about alcohol and drugs risk?Just over 30% of people with bipolar disorder misuse drugs or alcohol. Drinking alcohol, smoking or taking other drugs while taking medication could stop your medication working properly and make your symptoms worse. If you want advice or help with alcohol or drug use contact your GP. What about driving risk?You must tell the Drivers and Vehicle Licensing Agency (DVLA) that you have bipolar disorder. You must stop driving if you have an episode of severe depression, hypomania, mania or psychosis. You can find out more about:
Family, carer's and friendsInformation for family, carers and friendsHow can I get support?You can speak to your GP. You should be given your own assessment through NHS mental health services to work out what effect your caring role is having on your health. And what support you need. Such as practical support and emergency support. These are some other options for you:
Rethink Mental Illness run carers’ support groups in some areas. You can also search for groups on the Carers Trust website:
How can I support the person I care for?You might find it easier to support someone with bipolar disorder if you understand their symptoms, treatment and self-management skills. You should be aware of what you can do if you are worried about their mental state. It can be helpful to know contact information for their mental health team or GP. You could find out from your relative if they have a crisis plan. You could help your relative to make a crisis plan if they don’t have one. As a carer you should be involved in decisions about care planning. But you don’t have a legal right to this. The medical team should encourage the person that you care for to allow information to be shared with you. You can find out more information about:
Further readingWellness Recovery Action Plan (WRAP) Plus. Formerly living without Depression and Manic Depression - Mary Ellen Copeland, PhD. The Wellness Recovery Action Plan® or WRAP® is a self-designed wellness process. You can use a WRAP to get well, stay well and make your life your own. It was developed in 1997 by a group of people who were searching for ways to overcome their own mental health issues and move on to fulfilling their life dreams and goals. Website: www.mentalhealthrecovery.com Useful contactsBipolar UK Telephone: 0333 323
3880 The Hearing Voices Network Address: c/o Sheffield Hearing Voices Network, Limbrick Day Service, Limbrick Road, Sheffield, S6 2PE Need more advice?If you need more advice or information you can contact our Advice and Information Service. Which symptoms related to communication is likely to be present in a manic patient?Pressured speech is a common symptom of bipolar disorder and other mental health conditions. It typically occurs when a person is experiencing manic episodes. During this time, a person may feel compelled to speak quickly, erratically, and without stopping.
What are the five symptoms of mania?Mania and hypomania. Abnormally upbeat, jumpy or wired.. Increased activity, energy or agitation.. Exaggerated sense of well-being and self-confidence (euphoria). Decreased need for sleep.. Unusual talkativeness.. Racing thoughts.. Distractibility.. What is the difference between mania and hypomania?Mania and hypomania differ with respect to duration, intensity, and functional impairment: Duration: In mania, an elevated or irritable mood lasts at least one week. In hypomania, symptoms last for at least 4 days. Intensity: In mania, symptoms are severe, and in hypomania, they are mild to moderate.
Which medical condition may exist when a patient displays mild symptoms of mania?Bipolar disorder can cause your mood to swing from an extreme high to an extreme low. Manic symptoms can include increased energy, excitement, impulsive behaviour, and agitation. Depressive symptoms can include lack of energy, feeling worthless, low self-esteem and suicidal thoughts.
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