Bipolar disorder

Bipolar disorder is a mental health problem which affects mood. Everyone experiences changes in their mood, but in bipolar disorder these variations tend to be extreme, distressing and can have a massive impact on your day to day life.
Previously Bipolar disorder has been referred to as manic depression as it is characterised by periods of mania and depression. In some situations it may also be referred to as bipolar affective disorder. Bipolar disorder is well known, but misunderstood by many, which can make the diagnosis even more challenging. As with all mental health problems, the issues experienced are unique to the individual and so it is important that the approach is tailored to you.

Mania, or manic episodes, are unique to bipolar disorder and are therefore essential to the diagnosis. These episodes usually begin suddenly and last between 2 weeks and 4-5 months. Some of the common feelings and behaviours are:


  • Happy/euphoric
  • Over excitement – so much it is difficult to talk fast enough
  • Irritability
  • Increased libido
  • Racing thoughts
  • Lack of concentration/easily distractible
  • Over confidence
  • Feeling special/untouchable


  • Being more active than usual
  • Talking quickly often not making sense
  • Being over friendly
  • Saying/doing inappropriate things which you wouldn’t normally
  • Getting very little or no sleep
  • Being rude or aggressive
  • Spending money excessively
  • Drug and alcohol use
  • Taking risks
  • Losing social inhibitions

Depressive episodes

The symptoms of a depressive episode are similar to that of depression and include; feeling down, upset or tearful, being tired, lacking enjoyment in previously liked activities, low self-confidence, guilt, hopelessness, being agitation or tense, self-harm or suicidal ideation, changes in eating habits, being withdrawn and being less active. These feelings are likely to be more intense in the context of Bipolar disorder because of the contrast between manic and depressive episodes. These episodes can be long lasting, sometimes lasting for several months.

Psychotic symptoms

Some people with a diagnosis of Bipolar disorder will experience psychotic symptoms. These are most likely to occur during manic episodes although they can also occur during depressive episodes. These symptoms can be particularly difficult to deal with as they will feel very real at the time.
Psychotic symptoms include; delusions of grandeur, paranoia, hallucinations which can be auditory (hearing voices), visual (seeing things), smell, taste or even tactile (feelings on your skin).

Mixed episodes

Unfortunately, manic and depressive episodes don’t always occur independently of each other. In some cases people may experience both at the same time and these can be the most difficult and dangerous episodes as it may be more challenging than usual to deal with the symptoms, it can be difficult to understand your own emotions and therefore, what help to seek. It can also be most difficult for your friends, family and professionals to know how to help during these episodes.

On the other hand, people will often have periods when they are stable or neutral in between episodes. In some cases people experience stability for years in between episodes.


There are three, currently recognised, forms of Bipolar Disorder:

Bipolar I

You have experienced at least one episode of mania lasting a week or more.

You may have experienced a depressive episode but this is not necessary.

Bipolar II

You have experienced both at least one episode of severe depression and symptoms of hypomania.

Hypomania is similar to mania but symptoms tend to be more manageable, last for a shorter period of time and don’t include any psychotic symptoms.


You have experienced both periods of depression and hypomania but less severe than those experienced in the other two forms of bipolar disorder.


NICE guidelines suggest that treatment for Bipolar Disorder should include a combination of medication and talking treatments. The treatment offered at the time will depend on the current episode that you are experiencing.

Cognitive Behavioural Therapy (CBT) – this is likely to be offered to help with depressive episodes, however, this will not be offered during a period of mania or hypomania. CBT is a therapy which assumes that a person’s mood is related to their patterns of thought. These thoughts then continue to affect a person’s mood, behaviour and physical state. CBT aims to stop the negative cycles of thought which cause you to feel low, therefore improving mood and leading to more positive behaviours.

Medication – a psychiatrist or GP will be able to prescribe medication depending on the symptoms you are experiencing at the time, the severity of the symptoms, past experiences, physical health and how likely you are to consistently take your medication.