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All about Bipolar Disorder

Understanding the Term ‘Bipolar Disorder’

Bipolar disorder, formerly known as ‘manic depression’, is a serious mental illness that is characterised by extreme changes in mood and behaviour that cause individuals to go from feeling severely depressed to extremely elated, often in a very short space of time. It is thought that up to 3% of the UK’s population will experience bipolar disorder at some point in their life.

The actual clinical definition of bipolar disorder, as defined by the Diagnostic and Statistical Manual for Mental Disorders (DSM), is: depressed mood and/or loss of interest or pleasure in life activities for at least two weeks and at least five symptoms that cause clinically significant impairment in social, work, or other important areas of functioning almost every day.”

A less clinical and more accessible definition is: “a mental illness that brings severe high and low moods and changes in sleep, energy, thinking and behaviour.”

Contrary to popular belief, there are actually four types of bipolar disorder which will dictate how much someone’s life is affected by the condition:

Bipolar I

  • At least one high or manic episode which has lasted for longer than one week
  • Individual may only have manic episodes, although most people with bipolar also have periods of depression
  • Untreated, a manic episode will generally last 3 to 6 months
  • Depressive episodes last rather longer – 6 to 12 months without treatment

Bipolar II

  • Characterised by more than one episode of severe depression, but only mild manic episodes – these are called ‘hypomania’

Rapid Cycling

  • Characterised by more than four mood swings in a 12-month period. This affects around 1 in 10 people with bipolar disorder and can happen with both types I and II


  • The mood swings are not as severe as those in full bipolar disorder but can be longer. This can develop into full bipolar disorder
extreme mood swings that characterise bipolar disorder

The Possible Causes of Bipolar Disorder

As with most mental illnesses, the cause of bipolar disorder is difficult to identify as a combination of factors are likely to contribute towards its development. These factors can be categorised as:

  • Genetic
  • Chemical
  • Personality
  • Environmental

Genetic Factors

Genetic factors are those which mean that the likelihood of developing a disease depends on whether certain genes of an individual are passed down from one generation to the next. This means that an individual who has a close relative, such as a parent or sibling, who has bipolar disorder is much more likely to develop it themselves. Research has suggested that the type of bipolar disorder that someone has can be a factor in determining whether or not it is passed down with bipolar II; the most common type identified with a possible genetic cause.

Chemical Factors

Chemical factors are those where an individual has a chemical imbalance in their brain, meaning that they have too much of some hormones and not enough of others. Many hormones, such as serotonin, dopamine and norepinephrine (noradrenaline), are responsible for mood regulation and when they are not balanced this may be the cause of the extreme mood swings that characterise bipolar disorder. For example, when levels of serotonin are too low, this can cause depressive episodes whilst too much norepinephrine can cause episodes of mania.

Further evidence for chemical imbalance as a cause of bipolar disorder comes from the fact that some medications that are used to treat it will ‘re-balance’ chemicals in the brain and, as such, reduce the symptoms of the condition quite successfully. Additionally, some women have their first experience of bipolar disorder after the birth of a child when hormones are known to fluctuate wildly – the brain’s inability to rebalance them may cause the onset of bipolar disorder or some other form of related mental illness such as postnatal depression or postnatal psychosis.

No one has yet discovered why brain chemistry seems to play such a big part in the onset of bipolar disorder, nor has cause and effect been established. What this means is that no one is sure if chemical imbalance causes bipolar disorder or whether bipolar disorder causes chemical imbalance.

Personality Factors

Personality factors in developing bipolar disorder are not exclusive to this particular condition, as it is thought that someone’s personality can determine how able they are to deal with stressful events, and therefore how likely they are to experience a mental illness because of this ability.

For example, someone who is very introverted and does not like to talk about themselves or to make a fuss or feel like they are burdening someone, is far less likely to admit to or discuss any problems that they may be experiencing in their life that may contribute towards a mental illness, such as a bereavement or a troubled relationship. This means that they may ignore the signs of a mental illness and so make it far more difficult to diagnose and treat.

Contrary to this, someone who is open and less worried about the impact of discussing their problems is more likely to seek advice and guidance if they have an issue and this can lead to them being supported and treated more quickly. This is likely to stop the mental illness before it has had time to affect their life, or they will recover from it more quickly.

Traumatic childhood events

Environmental Factors

Environmental factors concern anything that is happening in an individual’s current and previous circumstances, so this will include any previous childhood experiences as well. Some individuals find that the onset of their bipolar disorder coincided with a time where they were experiencing some very stressful life events. Such events may include:

  • Abuse
  • Divorce
  • Relationship problems
  • Bereavement
  • Unemployment
  • Serious illness

Any of these factors alone can contribute to the onset of mental health issues but some people may find that they face more than one at the same time. For example, someone may go through a period of ill health, which means that they have to give up their job. This can lead to financial difficulties and issues within a relationship as well. When all these factors combine together, the individual may feel unable to cope and, as a result, the onset of a mental illness (such as bipolar disorder) begins.

Abuse in childhood is often a trigger for bipolar disorder because the memories of it may have been repressed into the individual’s subconscious where they have since laid dormant until being triggered by an incident that occurred in their adult life. For example, someone who was routinely beaten by a parent may have repressed the memories of the abuse as they were too painful to deal with. However, as an adult they may find themselves in a relationship that also has an element of abuse and the entire scenario is made worse because all the repressed memories from childhood are suddenly brought back into the conscious mind.

Traumatic childhood events such as losing a parent or being involved in a serious accident can also trigger a mental illness because such an upheaval in the life of a child can make it difficult for them to regulate their emotions in the future. Some children may not actually deal with the after-effects of their traumatic incident until they are an adult. They may only become aware of it in the future when their behaviour changes and they cannot identify why this is.

The Feelings an Individual May Have When Experiencing Bipolar Disorder

The feelings or symptoms that an individual who has bipolar disorder will experience will be unique to them. Some may have one type of symptom more than another or some individuals may never have one particular symptom that someone else may have consistently.

Whilst symptoms will vary, there are some that are characteristic of bipolar disorder which help health professionals to diagnose it accurately. When an accurate diagnosis is made, this can help to ensure that appropriate support and treatment is put into place to enable the individual to manage or recover.

There are two main types of symptoms that individuals will feel when experiencing bipolar disorder: depression and mania. The symptoms of these two, as the name bipolar suggests, are very different. Symptoms of one or the other will usually be followed by a period of normality before a new episode occurs.

Depressive and manic symptoms cause changes in feelings and behaviour. We will first look at depressive symptoms, which are outlined in the following table:

Depressive Symptoms

How the Individual Might Feel How the Individual Might Behave
  • Unhappy and tearful
  • Useless and worthless
  • Inadequate
  • Irritable and tense
  • Fatigued
  • Low in self-esteem and confidence
  • Unable to make decisions
  • Unable to concentrate
  • Unable to think positively or see hope for the future
  • Like a burden to others
  • Pessimistic and self-doubting
  • Eating more or less than usual
  • Not doing things that would normally bring enjoyment
  • Not sleeping (insomnia) or sleeping too much (hypersomnia)
  • Withdrawing from social interactions
  • Abusing drugs or alcohol
  • Self-harming


Untreated, depressive episodes tend to last more than manic ones, typically averaging around 6-12 months. Depressive symptoms do not only occur in people with bipolar disorder but also in someone who has unipolar depression, which is where the individual does not have manic episodes. As such, their life is likely to be impacted in many ways, not just at home but possibly at work and in any other activity that they would normally carry out.

Firstly, an individual may find that they are eating more or less than usual to try and cope with their feelings. Food can be used as a comfort to get them through the phase, or they may feel unable to summon the energy to eat or prepare meals and, consequently, their energy levels may become lower still.

Not sleeping or sleeping too much are also common behavioural changes that may affect the individual’s daily routine. Someone who has depressive symptoms can often find it difficult to get out of bed because they cannot face the day ahead, and so sleeping is a way of avoiding it. Conversely, someone who is depressed may also be experiencing an episode of severe anxiety and this will keep them awake because they are constantly worrying about everything in their life.

During this period, it is common that individuals who are prone to addictive behaviours may start to abuse drugs or alcohol, which is another self-coping mechanism to try and get through this period in their life. Whilst the individual may feel better in the short term, using drugs or alcohol to cope in the long term will likely have negative consequences because both are stimulants that can make feelings of stress and anxiety even worse.

Self-harm is also a possibility during a depressive episode where the individual feels as though they need to retain control over their life. Some individuals feel that they cannot do this any other way than by hurting themselves. Others go through such a devastating depressive period that they hurt themselves just to try and feel some kind of emotion, even if it is pain.

Finally, a withdrawal from social occasions and not doing activities that were once pleasurable are also symptomatic of depression. Individuals sometimes do not want to socialise as they cannot face being with other people, perhaps because they do not have the energy to do so or because they are too embarrassed or ashamed to tell people about their condition. Not wanting to do activities is common because often it just feels like too much effort; alternatively, the individual may be in such a depressed state that they don’t feel anything is worth doing because nothing will lift their mood. This can severely affect their ability to form and maintain relationships and may also mean that they cannot attend work whilst experiencing a depressive episode.

Manic Symptoms

How the Individual Might Feel How the Individual Might Behave
  • Very happy, elated and overjoyed
  • Uncontrollably excited
  • Easily distracted and unable to concentrate
  • Full of energy
  • More important than they usually would
  • More confident and with higher self-esteem
  • Less inhibited
  • Adventurous


  • More active
  • Talking quickly and perhaps not making sense
  • Being overly friendly
  • Behaving out of character
  • Spending money recklessly
  • Making grand or unrealistic plans
  • Losing social inhibitions
  • Making risky decisions that compromise safety
  • Risky sexual behaviour
  • Being rude or aggressive
  • Not sleeping

If untreated, a manic episode is likely to last between 3 and 6 months. When someone is experiencing a manic phase, their behaviour can appear very different to what it might normally be and especially when compared to the experience of a depressive phase.

Individuals are likely to be full of energy and will find it difficult to stay still. They may also talk rapidly, sometimes not making sense to anyone else. They may seem overly friendly towards others and are more inclined to indulge in risk-taking behaviours, which include risky sexual practices as well.

These types of behaviour during this phase occur because the individual’s mood is so elevated that they feel invincible, which can lead them to making grand plans, often with no regard for their physical or financial ability to carry them out. Many individuals during this phase will spend money recklessly whether they can afford to or not and they may come across to others as rude and aggressive during this time as well.

In common with a depressive episode, the individual may be unable to sleep and may not eat. This is because they cannot concentrate for long enough to do so or because they are doing other things and do not consider sleeping and eating to be that important.

Other Types of Symptoms

As well as experiencing episodes where the individual feels either depressed or manic, some individuals experience phases of ‘mixed episodes’, which is where they will exhibit both depression and mania simultaneously. For example, they may be overactive and very talkative but with a depressed mood. Many individuals report that these periods of symptoms are the most difficult to cope with as they do not know what to expect and they cannot figure out what kind of help they need. It is during this type of episode that an individual is more likely to act on thoughts of self-harm.

They may also experience ‘rapid cycling’, which is where the individual will repeatedly go from mania to depression with no ‘normal’ phase in between. Phases are thought to last approximately three months and so an individual will have four episodes of them per year. This is thought to happen to around 10% of individuals who have bipolar disorder.

Sometimes, in extreme cases of bipolar disorder the individual may experience a ‘psychotic episode’, which is more common when the individual is experiencing mania but can occur when they are depressed as well. Someone who has an episode of psychosis will likely have hallucinations and delusions that are very real to them. These symptoms can cause them to see things that are not there or to hear voices that no one else can. Delusions can make people extremely paranoid, which can lead to reckless or dangerous behaviour, as well as leading some individuals into believing that they are a famous person, a god or even an animal.

depressive symptoms of bipolar disorder

An Individual’s Bipolar Disorder and How It May Affect Others

It can be very difficult for other people to watch and understand the behaviour of someone who has bipolar disorder. They may be at a loss to describe why the individual goes through phases of such wild mood swings but then can appear to be ‘normal’ when there is a break in the symptoms. It is, therefore, important that those people who know someone who has bipolar disorder are educated about its symptoms so that they can better understand what is happening to the individual and why it is happening.

The condition puts demands on other people who may end up caring for the individual if they are affected so much by its symptoms that it affects their ability to carry out day-to-day activities. Many carers find their responsibilities difficult to cope with and, as such, begin to feel resentful towards the person who needs care because of the impact that their condition has had on their own life. Carers need to ensure that they take care of themselves and do not neglect their own lives; they should continue carrying out activities that bring them enjoyment. Also, they should monitor themselves for any signs of deterioration in their own mental or physical health, which can easily happen when they are so consumed by caring for someone else.

Partners and children of the individual can be especially affected, because through either a manic or a depressive episode the individual’s behaviour is likely to have an impact on their life. For example, during a depressive episode, the individual may be socially unresponsive and they may not want to even interact with their children on some days. In stark contrast to this, during a manic phase, families may feel that they cannot keep up with the energy levels of the individual and may be concerned about the risky behaviour that they may indulge in. They may also fear financial instability if the individual is prone to spending large amounts of money on things that they cannot really afford. All children need stability in their lives and it can be very distressing for them to try and understand what is happening to their mum or dad whose behaviour changes so wildly.

Parents of the individual who has bipolar disorder may find that they feel guilty about their child’s diagnosis of bipolar disorder because they feel in some way responsible, questioning if they have passed on a faulty gene or if it was how they raised their child.

Friends of the individual who has bipolar disorder may find it difficult to relate to the individual because the person who they know changes so much when they are manic or depressed. This can put a strain on friendships and many will be lost, which can be very difficult for the person who has bipolar disorder to live with, especially if they are reliant on those friends for support.

There is still much stigma associated with mental illness and this means that individuals with bipolar disorder may be subject to discrimination because of their condition, which can be difficult for others around them to cope with. For example, people with mental illnesses are often portrayed as violent and out of control, which, whilst certainly possible for some, does not accurately reflect the majority of people. Despite this, many individuals will find themselves shunned by others when they admit to having a mental illness. Even though there is legislation in place to protect individuals who have a mental illness against discrimination, this can still happen because some individuals will not feel as though they can report what is happening to them to the relevant people. This may happen at work, where someone has their role terminated because they have taken so much time off. Some employers will do this stating that it is because they are no longer capable of carrying out their job effectively, but the reason behind it may be the individual’s mental illness and the way in which the employer now perceives them.

Finally, it is important for the individual and others around them that they can accept the diagnosis of bipolar disorder and be supported in managing its symptoms. Whilst there is no cure for the condition, it may be managed to a point where its affects are rarely felt and incidents of mania and depression become fewer and fewer. The individual must be reassured that having bipolar disorder is not their fault and that they should be able to ask for help when they need it. Simply knowing that they have a support network may be enough for individuals to feel less anxious, which may have a positive effect in reducing environmental triggers that could cause an episode to begin.

The Demands of Daily Life That May Influence Symptoms of Bipolar Disorder

Someone’s daily life can be full of potential demands that may influence the symptoms of bipolar disorder. The severity of their influence will be determined by the individual’s ability, or their perceived ability, to cope with the demands.

Some demands will be common to everyone and many will find them more difficult to cope with than others. Examples of these demands include:

  • Relationship problems
  • Work stress
  • Unemployment
  • Poor housing
  • Health problems
  • Raising children
  • Experience of loss

Relationship problems may mean that the individual feels out of control with what is happening in a big part of their life. They may be too afraid to end a relationship, even if they feel as though it is not going well and the future will not change that status. They may live with a domineering or abusive partner who threatens to harm themselves if the relationship ends or who dictates every aspect of how they live their lives.

Work stress is a very common cause of anxiety that can be a trigger for mental illness. Being overworked or feeling underappreciated can affect someone’s self-esteem, which is another factor in the onset of some types of mental illness. When someone works in an organisation that is poorly managed and where individuals do not feel as though they are being treated equally it can be a big factor in causing someone to feel unnecessarily stressed. Many individuals who have financial problems often find that they have to work more than one job and this can have a very negative impact on their ability to have time for themselves and for their family, which may lead to relationship problems.

In contrast to being overworked, individuals who are experiencing unemployment may also find that they are subject to a lot of stress and anxiety. Unemployment can lead to a lowering of self-esteem because many individuals’ sense of worth is tied into their job role. When someone is unemployed, there is more chance that they will get behind with paying bills and this can lead to debt and financial difficulties, which the individual may feel is overwhelming.

If someone has a chronic (long-term) health problem, they can experience mental illness as a by-product of this. If the health problem causes someone’s quality of life to be impaired, this often results in them experiencing depression, and, for some people, this can be experienced alongside periods of mania, giving rise to bipolar disorder. These two things, when combined, can cause a cycle of ill health because of the fluctuation in hormones that occur because of the health problem. For example, someone who is undergoing extreme stress is more susceptible to further illness because their body produces large amounts of the hormone cortisol to try and alleviate the stress.  Raised cortisol levels are known to reduce the effectiveness of the immune system and have been linked to heart problems and raise the risk of strokes.

Whilst raising children can be a very challenging yet rewarding experience, many individuals find the demands of children to be completely overwhelming. This is especially prevalent for people whose children have an illness of their own, either mental or physical. Parents may feel hopeless in the face of illness or they may feel guilty because they think that it is, in some way, their fault. Children with some issues such as attention deficit hyperactive disorder (ADHD) can be very demanding and their behaviour can cause severe upset within a family. When an individual feels that the demands of this are too much, then mental illness may occur as a result.

Finally, whilst it might not necessarily be a daily demand, an incident of loss such as bereavement or even a divorce can have effects that impact the life of the individual far after the incident of loss has taken place. Loss can even be considered to be a traumatic incident, and because of this it has a significant impact on someone’s physical, emotional and mental stability.

many individuals find the demands of children to be completely overwhelming.

Bipolar Disorder and How the Demands of Daily Life May Influence Symptoms

When someone is undergoing a period of stress in their life, their hormone levels are liable to fluctuate more than they would in normal circumstances. For someone who is susceptible to mental illness, this can mean that the likelihood of their condition being triggered is severely increased.

Depressive Episodes

Hormone levels that are raised or lowered over a consistent period of time have a big impact on an individual’s coping abilities because the constant stress of their daily life means that levels are never able to return to normal. Therefore, if someone’s ‘feel good’ hormones are consistently low, this can lead to a depressive episode as their normal hormone levels are not being raised back to where they should be.

A depressive episode is characterised by low mood, where the individual is likely to be subject to withdrawal and isolation. A sign that someone is entering a depressive episode is that they are hypersensitive to criticism, something that may be difficult to avoid if they are in a difficult relationship or having problems at work.  When a depressive episode is happening, the individual may also have problems communicating. This may make it difficult for them to attend appointments if they know that they need to speak with their GP or a member of a community mental health team. Additionally, they may have problems opening up to others about how they are feeling in general, which worsens their feelings of isolation.

Any type of daily demand that causes stress is likely to negatively impact the individual because it is known that, in up to 50% of individuals, bipolar disorder often occurs alongside another mental illness such as an anxiety disorder, a phobia or a panic disorder. Trying to cope with another illness, as well as bipolar disorder, can magnify the effects of daily demands and intensify the symptoms caused by bipolar.

Dealing with the effects of a depressive episode may make the temptation of turning to drugs or alcohol difficult to resist. Studies have indicated that up to 60% of individuals who experience bipolar disorder also have some form of substance abuse problem as well, and this can mean that when they feel as though they can no longer cope that drinking or taking drugs is their only alternative. Not only is this dangerous for their overall physical and mental health but it can also mean that sometimes their mood is misdiagnosed. For example, someone who is taking a lot of cocaine will exhibit the symptoms of someone who is going through a manic episode but they are just acting in response to the drug. In contrast, someone who experiences a ‘crash’ after a drug or alcohol binge may be mistaken as being in a depressive phase when they are not.

Someone who is in a depressive phase may also be more susceptible to negative thinking patterns, which means that they cannot see any positives in any given situation and have most likely given up hope for their future as well. They may not be able to seek help from their support network or summon the energy to visit their GP because they do not believe there is any point as everything in their life has become hopeless.

Manic Episodes

Just as hormones can cause depressive episodes, they are also thought to be linked to manic ones as well. Many people who know someone who has bipolar disorder will maintain that manic episodes are more dangerous for the individual because this is when they are most likely to exhibit risky behaviours. This might mean that they:

  • Spend money extravagantly
  • Have unprotected sex
  • Drive recklessly
  • Behave inappropriately in social situations

Once their manic episode has passed, their behaviour during this phase will often cause the individual to feel guilt and shame about what they did during that time. They may also have been insulting to people, spoken to them tactlessly and have left many others upset by the way that they have interacted with them, especially if that type of behaviour is out of character.

A manic episode is when someone is also likely to behave aggressively, and signs that this may be about to happen need to be closely monitored. Carers or family members of someone who is susceptible to aggression when they are in a manic episode may need to seek advice about how to deal with the individual when they are behaving in this way.

Alcohol and drugs are a problem in a manic episode but in a different way to when the individual is experiencing depression. Instead of using them as a support mechanism, the individual may drink and take drugs as part of risk-taking behaviours. Therefore, they are likely to indulge in doing this more and taking in more substances because many individuals when manic will feel that they are invincible and that nothing can harm them despite clear evidence to the contrary.

Interestingly, many individuals may not recognise when their mood has changed to manic and will only release that their behaviour was different when the episode has passed. This is why it is vital that the individual and those around them are aware of the signs and symptoms of each phase so that support and treatment can be offered as quickly as possible.

Examples of the Symptoms That May Occur in a Manic and Depressive Episode

Some symptoms of both manic and depressive episodes are similar but many are very different; symptoms of both are depicted in the table below:

Depressive Episode Symptoms Manic Episode Symptoms
  • Severely depleted energy levels
  • Exhaustion
  • Having poor self-esteem and confidence
  • Poor concentration
  • Problems managing daily tasks and activities
  • Feeling hopeless
  • Having no hope about the future
  • Frustration
  • Irritation
  • Avoiding intimacy with partner
  • Changes in appetite – eating more or less
  • Changes in sleeping patterns
  • In severe causes, hallucinating and having delusions
  • Feeling as though high on drugs
  • Excitable for no apparent reason
  • Poor concentration due to racing thoughts and ideas
  • Talking rapidly about many subjects, which may become jumbled up
  • Feeling less need for sleep
  • Making spur of the moment decisions
  • Spending lots of money, sometimes with disastrous consequences
  • Making decisions which involve risky behaviour
  • Dominating conversations

Medical Intervention for Bipolar Disorder

There are four main types of medical intervention that may be needed for someone who has bipolar disorder:

  • Medication
  • Hospitalisation
  • Therapy
  • Referral to a specialist, such as a psychiatrist


Antipsychotics tend to be prescribed in cases of schizophrenia, bipolar disorder and severe depression or anxiety; they work by boosting or reducing the effect of certain chemicals in the brain. The way in which the drug is administered will determine how quickly it works – if it is taken in regular tablet form, it can take up to several days before any difference is noticed. However, if it is administered by a direct injection into a muscle, it can work within an hour, and this may be the method that the individual experiences if they have been admitted to hospital. Examples of antipsychotic drugs include chlorpromazine, clozapine and flupentixol.

During episodes of depression, a doctor may prescribe SSRIs – selective serotonin reuptake inhibitors which stop too much serotonin being reabsorbed so more is available in the brain. Serotonin is a ‘feel good’ hormone that is often found to be depleted in individuals who experience depressive episodes. SSRIs can increase the amount of serotonin in the brain, which in turn can help lift someone’s mood.

Mood stabilisers may also be used as part of the individual’s treatment. These work by helping to lift the depressive symptoms and by ‘flattening’ those that induce mania. Unlike many other drugs that are used to treat mental illness, they can be used longer term because there is significantly less risk of them becoming addictive.

For any kind of medication that may be used long term, the individual should be given a medication plan that will show what drugs they are taking, what the dosage is, what the frequency is and also should enable them to identify how well it is working and any side effects that they are experiencing.


Hospitalisation is sometimes necessary in order to stabilise someone who is having a manic episode. Many individuals will realise that their condition is serious enough to warrant hospital treatment and, as such, will voluntarily attend in order to be supported. However, some individuals may not realise this and they will have to be detained under the Mental Health Act 1983, sometimes referred to as being ‘sectioned’. This happens when the individual is seen to be a threat to themselves or to others, and is actually quite a rare circumstance.

Whilst in hospital, the person may have an injection to calm them down so that they are able to discuss what is happening to them in a more rational manner. Some may behave aggressively but this is not as common as people may be led to believe. However, whilst someone is in hospital, they will be closely monitored to watch for signs of suicidal behaviour or behaviour that may harm others. For those individuals who do have to be hospitalised, they will normally need 1-2 weeks of inpatient treatment before they can be discharged. However, for some individuals whose behaviour continues to be a threat to them or to others, the period of treatment can be considerably longer.


Psychotherapy is a type of ‘talking therapy’, which may be useful in getting to what the root cause of the depression aspect of the bipolar disorder is. It is useful because it can identify subconscious trauma that the individual cannot bring into their conscious mind because it is too painful. Because they cannot think about it, they cannot identify the cause and therefore they cannot resolve it.

Many individuals will undergo months of psychotherapy before having a ‘breakthrough’ in identifying why they are experiencing mental illness, but once the cause is identified then this will enable the individual and the therapist to work together to resolve any ongoing issues that the initial trauma has caused. This type of therapy will be used when the individual is experiencing a depressive episode and will not be useful during a manic phase.

Cognitive Behavioural Therapy (CBT)

CBT works by enabling the individual to look at their negative thinking patterns and readjust them so that they do not automatically fear the worst and can self-question in times where they may catastrophise. For example, if the individual fears that they have no hope for the future because they have lost their job, they will be encouraged to talk about the feelings that not having a job gives them and then rationalise how likely it actually is that they will never get another job or that they will end up homeless. Breaking negative thinking patterns is vital in enabling individuals to live their life independently once they reach the end of their therapy sessions.

Referral to a Specialist

Before making the decision to admit someone to hospital, an alternative may be to make an appointment for them to see a mental health specialist. This will likely be a psychiatrist but may also be a community psychiatric nurse. Both individuals are able to assess the severity of mental illness but only the psychiatrist is able to prescribe medication, so he or she may be seen initially with follow-ups by the community team.

A psychiatrist is also a medically trained doctor and so they are able to carry out physical examinations as well if this is what they feel is required during an initial visit. Other aspects of that visit will likely include:

  • Asking about the problem that has brought the individual there
  • Asking about the individual’s life and their thoughts about their current circumstances
  • Taking blood pressure and temperature as part of a physical exam
  • Collating information from other sources such as family, GP or social workers to get a better picture of what has gone on so far and so are able to gain a ‘holistic’ view of the current issue

Once the psychiatrist has reached a diagnosis, they can prescribe medication and will very likely organise a follow-up appointment, either with themselves or with someone in the individual’s local community mental health team.

The Ways That an Individual with Bipolar Disorder Can Help to Manage Their Illness When Entering a Manic and Depressive Episode

It is important that when an individual has bipolar disorder that they are aware of any subtle changes in their mood or behaviour which might indicate that they are entering a depressive or manic episode. There are several ways in which the individual can also help to manage their own illness when they are experiencing one of the phases, although it may take some time for them to come to terms with the fact that they have to do this, and many will need a lot of support from the outset.

Managing a Manic Episode

Since a manic episode is, arguably, more dangerous in many ways than a depressive episode, the key is to recognise mood changes very early on in order to stop any kind of risk-taking behaviours from taking place. For example, someone may notice one day that they feel strangely invigorated; this may be simply because they have been exercising or that they are just feeling in a very positive frame of mind. However, if there appears to be no specific cause for the elated mood then this would need to be monitored to ensure that if it is the start of a manic episode that it is managed appropriately.

Some individuals, especially those who have had a recent diagnosis, may struggle to understand the signs of a change in mood. Therefore, it would be useful for them to meet with others who have the same disorder. Not only will this help them because they may be able to gain valuable advice about managing the condition but it is also very reassuring for someone who has a mental illness to realise that they are not the only ones who sometimes struggle with their day-to-day life. Meeting with others can also build confidence about the future because the individual will be able to see that having bipolar disorder does not mean that their life is completely dictated by the condition but that they can learn to manage it effectively.

Asking for support from friends and family is vital during a manic episode, especially if the individual is known to indulge in risk-taking behaviours. For example, the individual might ask someone to take their credit and debit cards from them so that they are not able to spend money recklessly. They may also ask others to accompany them when they are going out so that they can be monitored until the phase has passed. Others may advise the individual to defer important decisions until they are in a better frame of mind to do so. Any decision made in a manic phase may not accurately reflect what the individual actually wants as it is completely influenced by their mood.

Finally, during this phase it is vital that individuals keep in touch with their health care support team and continue to take medication that has been prescribed. The manic phase often means that individuals believe that they no longer need help and support and that they can stop taking any drugs that they have been prescribed because they have a feeling of invincibility. However, it is even more important during this time that they reach out for support and accept it, wherever it is offered.

During a Depressive Episode

During a depressive phase, individuals can be very difficult to engage with so it is vital that they have confidence to ask for support if they feel that they are becoming depressed. Just like with a manic phase, monitoring their mood is vital and this can be done by other people as well as by the individual themselves.

Since a depressive episode is likely to render the individual feeling very low in mood, it is important that before they get to that point they find enjoyable things to do that will help bring some positivity to their lives, and may also work as a valuable distraction technique away from their mood. If they can involve others in doing enjoyable activities, then this is likely to be even better for them as they are able to talk and socialise at the same time.

Eating and sleeping regularly are important even if the individual feels unwilling or unable to do one or the other (or both). Being low in energy from lack of nutrients or lack of sleep will only make a depressive phase feel worse, so it is really important that the individual eats when they should and takes advantage of being able to sleep when they can. This may mean that they have to ask others to care for children or they may need to take some time off work, but if they have a good support network, then this should be less of a problem.

Exercising helps to release hormones that regulate mood, such as serotonin. Therefore, finding time to regularly exercise may lessen the impact of a depressive phase. Exercise is also good for overall well-being because it makes individuals feel better about themselves and so increases self-esteem.

Keeping to a routine can help individuals feel as though they are in control of their lives, and if they are feeling especially low in mood, can give them a reason to get out of bed. Lack of control is another major factor in the onset of mental illness, so enabling the individual to take control of as much of their life as they possibly can may also lessen the impact of a depressive phase.

Finally, staying in touch with friends and family will enable the individual to feel supported and offers an opportunity for them to talk about their condition and have others understand how it feels so that they can be in a better place to provide support. Staying in regular contact with friends and family also lessen the possibility that the individual will isolate themselves, which is another factor that may make the depressive phase even worse.

Speaking to friends for support

The Ways That Others Can Help the Individual with Bipolar Disorder to Manage Their Illness

Having bipolar disorder can be a very frightening experience and so it is vital that the friends and family of the individual who has the condition are patient and understanding about the mood changes that occur as a result. This is not always going to be easy because the individual can be very difficult to communicate with; both when they are depressed and when they are manic. However, they should be continually encouraged to talk about their feelings so that they feel that they can rely on the support of others when they need it. This encouragement will help prevent them from keeping everything bottled up inside.

The wishes of the individual should be respected, which means that if they want to be left alone then this is what should happen (although it would be better for everyone’s peach of mind if they were still monitored whilst they spent time on their own). If, during a manic phase, they insist on making a decision that might be considered risky but cannot be persuaded out of it, then they should be enabled to make that decision with as little negative consequence as possible. It is also important that should there be any remorse or shame from the individual once their manic phase has ended that they are supported and not judged because of what they have done.

If it is possible, family and friends should have as much knowledge about the condition as they possibly can. Therefore, educating themselves may enable them to monitor the signs and symptoms that might accompany a manic or depressive phase and they will be much better placed to provide support quickly to try and stop an episode being more severe than it needs to be. If someone is acting as a carer then they should get as much information as possible about their legal rights and entitlements and ensure that they take good care of themselves as well, because caring for someone with a mental illness can be a very challenging role.

Finding support groups will almost certainly help the individual and any carers to feel less isolated. Support groups are also a very good source of information and advice that may be useful for someone who has bipolar disorder. Support groups can help everyone to realise that they are not the only ones in this situation and that the condition can be effectively managed, which is something that may occasionally feel very difficult, especially if the individual is experiencing a particularly bad manic or depressive phase.

Those around the individual must be prepared to be flexible to accommodate their needs, which may change very quickly. For example, someone who has anxiety as part of their disorder may cancel plans at the last minute because they cannot face the thought of a social situation. Whilst the continual shift in mood of the individual can be difficult, it is important that their family and friends remain supportive because this will certainly have a positive effect on the individual’s perception of their ability to cope.

Helping with appointments might be necessary because sometimes, in both manic and depressive phases, the individual may find it difficult to take information in and to communicate their needs in an effective manner. Just being at an appointment for support can also make a big difference in whether or not the individual actually attends, as many will be very reluctant to do so.

Finally, to ensure that the individual retains as much of their independence as possible, it is vital that they are given responsibility of their own life back when they are well. This does not mean, of course, that they should feel abandoned but that they are back in control of deciding things for themselves, which is something that they may have found difficult whilst experiencing a manic or depressive episode.

The Local Resources and Treatments Available to an Individual Experiencing Bipolar Disorder

Libraries are an excellent local source of information where individuals can educate themselves about their condition. Often the understanding of why someone is behaving in the way that they are can act as a way of reducing anxiety levels, and this can lead to a decrease in the chances of an episode of mania or depression being triggered. If someone cannot face leaving their home, they can access information and some online therapy courses from their home but they must ensure that these come from a reputable source.

Health centres often have walk-in appointments where individuals can attend to discuss any problems that they are having with their mental illness. Professionals will be on hand to assist in giving advice about the issue, possibly pointing them in the direction of a GP appointment or for ways in which they can reduce the possibility of an episode of depression or mania being triggered. Many health centres are able to offer discounted memberships at local gyms where individuals can attend to improve their confidence and self-esteem or possibly partake in lessons such as yoga and Pilates, which are known to be beneficial in helping to reduce levels of stress and anxiety.

Support groups are very common for mental health problems, and organisations such as Mind offer them in many towns. It is said that the people who experience the issue are the biggest experts about it, and joining a support group can be rewarding on many levels. Individuals feel understood and accepted when they are speaking with others who have gone through, or are going through, the same thing that they are. Helping someone else is also good for an individual’s self-esteem and confidence and it can also be a very rewarding opportunity.

The Samaritans are an organisation available to people around the clock to provide advice and support for people who are in distress. Their service is completely confidential and can prove to be a lifeline for individuals who have no support network and feel as though they have nowhere else to turn.

A psychiatrist may refer someone who has bipolar disorder to their local mental health team. These teams consist of a variety of health professionals who may be able to help someone live with their bipolar disorder by taking steps to manage the condition effectively. For example, there may be psychiatric nurses, occupational therapists, counsellors and support workers who, along with the individual, will put together a plan of support so that everyone can work together in enabling the individual to retain a sense of normality and live in a meaningful manner.

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