Bipolar disorder (previously called ‘manic depression’) is a mental health disorder that causes our moods to fluctuate for days, weeks and sometimes months. Someone experiencing bipolar disorder typically goes through phases where they might appear ‘fine’ and highly keen, energetic and impulsive followed by a phase where they appear ‘depressed’ and extremely sad, unmotivated and hopeless. This fluctuation may cause the person to display uncontrollable behaviours and thoughts, and typically impacts their day-to-day life.
Anyone who recognises these signs should seek help from a mental health professional who has experience supporting and treating people living with the disorder.
Signs and symptoms
There are some very specific signs and symptoms for different episodes of people with bipolar disorder. Some symptoms overlap across episodes but generally, symptoms are often very different depending on the type of episode. Not all symptoms and signs will be present for all people.
Mania and hypomania episodes
Although mania and hypomania symptoms are similar, the symptoms in mania are more severe and last at least one week. In hypomania, symptoms are mild to moderate and tend to last for shorter periods of time (at least 4 days).
- feeling extremely high in mood as if nothing could affect their extreme happiness
- feeling extremely high in mood as if nothing could affect their extreme happiness
- not sleeping or reduced need for sleep
- increased creativity and activity
- making grand plans or schemes
- agitation, irritability and/or aggression
- heightened belief in their self-importance
- difficulty concentrating
- rapid thoughts and speech, interrupting and talking over people
- impulsiveness, such as excessive spending, risky behaviour, increased use of alcohol and/or drugs
- increased sex drive
- expressing paranoid thoughts
- forgetting to eat or losing track of times
- working excessive overtime or taking on more work than usual
- experiencing delusions and/or hallucinations
- change in sleep patterns (sleeping less or too much)
- fatigue for unknown reasons
- increased irritability or aggression
- loss of concentration
- lack of motivation, loss of interest in hobbies or social activities
- social withdrawal
- change in eating habits (loss of appetite or overeating)
- reduced sex drive
- increased anxiety
- feeling worthless
- bursting into tears
- thoughts of suicide
The sooner the person seeks help from a mental health professional, the sooner they can manage their symptoms.
Causes of bipolar disorder
There are a few causes that have been identified.
- Brain structure and function: A few studies using scanning techniques have identified changes in certain parts of the brain of people with bipolar disorder.
- Genetics: There’s also an increased chance that someone with a family history of bipolar disorder may develop the disorder. However, this is often a very slim chance.
- Stress: It’s strongly suspected that stress is a potential trigger for someone to experience an episode. How someone responds and adapts to stress, both externally and internally, may affect how the disorder develops.
How is bipolar disorder diagnosed?
Bipolar disorder is most commonly diagnosed in the late teens to early 20s, with most people having a diagnosis by the time they turn 25. Some people won’t experience their first episode until later in life, and others may not realise for many years that they’re experiencing episodes. It rarely occurs in children (or at least rarely diagnosed).
A qualified mental health professional can diagnose bipolar disorder. They may be a psychiatrist, psychologist or GP. The professional diagnosing the disorder can also determine which type of bipolar someone is experiencing.
There are two types of bipolar disorder that can be diagnosed, each presenting differently:
- Bipolar I disorder: Pronounced ‘bipolar one’ and where at least one manic episode is being experienced. People diagnosed with Bipolar I often experience both mania and depression. However, depressive episodes are not a requirement to meet the criteria for a diagnosis.
- Bipolar II disorder: This is where the person has experienced at least one hypomanic episode and at least one major depressive episode (therefore ‘bipolar two’). People diagnosed with Bipolar II experience less extreme fluctuations in moods and will not have experienced mania.
In addition, any diagnosis of bipolar disorder has requirements around the length of episodes. Generally, people must have experienced an episode for a week or more before bipolar disorder may be considered.
How is bipolar disorder treated?
The most common treatments for bipolar disorder are traditional talking therapies and medication. For some people, other treatments such as Electroconvulsive Therapy may need to be considered.
Common medications for bipolar disorder include mood stabilisers, anti-depressants, anti-psychotic medications, or a combination of these.
These medications can help people to experience less extreme fluctuations in moods. They’re most commonly used to help reduce or prevent mania (the ups).
These medications can be used to help treat depression (the lows) in bipolar disorder. In the past, there were concerns over the use of antidepressants as they could cause people to go the opposite way and into mania. These days, the use of antidepressants is considered safe to assist people who experience depressive episodes as a result of bipolar disorder.
Some people may experience different types of bipolar disorder, such as rapid cycling, or mixed episodes. Others may experience delusions or hallucinations. In these situations, anti-psychotics may be used on their own or with a mood stabiliser or anti-depressant.
The treatment for bipolar disorder can be quite complex so it is very important medication for bipolar disorder is always monitored by a GP, Psychiatrist, or other qualified health professional.
Talking therapy involves talking with a psychologist, counsellor, or other properly qualified professional. Cognitive Behavioural Therapy, and Acceptance and Commitment Therapy are two talking therapies commonly used. Talking therapy has been shown to have a positive impact for people with bipolar disorder, much more than just taking medication. People who access talking therapy tend to have fewer repeats of episodes and better quality of life.
Some people experiencing episodes of mania or severe depression often don’t respond well to medication or other therapies. When this occurs, the treating professionals may discuss the option of trying Electroconvulsive Therapy (or ECT) as a treatment.
Many people with bipolar disorder don’t need to go to hospital. Sometimes, though, hospital may be the best option to keep someone safe when they’re experiencing an episode. Perhaps during their episode they’re experiencing suicidal thoughts, or are unable to control their actions, are experiencing psychosis, or are being aggressive. For this person, hospital is the best next step.
While hospital can seem scary and overwhelming, spending a bit of time in hospital can have very positive outcomes for people with bipolar disorder. People who are very unwell in an episode and attend hospital are often able to get through their episodes sooner and with fewer disruptions to their lives.
Being in hospital means professionals can check that any medications are still working or whether the person’s medications need different medications or treatment that may be more effective.
When the patient with bipolar disorder is ready to be discharged, they often feel more confident that their medication is back on track and are usually referred to other supports in the community to help keep on top of any episodes in the future.
Help & Support
In Australia, it’s estimated that 1.3% of our population is living with bipolar disorder, with around 1 in 50 adults experiencing the disorder each year. Up to 1% Australians may experience Bipolar I disorder over their lifetime (there’s no gender difference), whereas up to 5% may experience Bipolar II disorder is (with Bipolar II rates being higher in women).
One of the biggest concerns is many people with bipolar disorder may be at the greatest risk of suicide. As treatments can be extremely effective, with the right treatment they may be able to manage their symptoms and live the life they want.
If someone suspects that they or their loved one may be experiencing bipolar disorder, it’s important to speak to a GP, psychiatrist or other trusted health professional.
There are also many support groups, websites and virtual networks, that can assist to understand the disorder or help connect with others who have lived experience.