Having once been so scared that I would lose my entire sense of self, what I discovered is that a stable life – a balanced life – actually feels like me.

Ellen Forney

Understanding bipolar disorder

Everyone experiences highs and lows in their mood, however people with bipolar disorder experience much more dramatic shifts in their mood and energy levels. Symptoms of bipolar disorder cause distress to people with the condition and those around them. It makes day-to-day living difficult and can even put people into risky situations.

The episodes of high mood and energy levels that are experienced can be extreme and are usually called “mania” when severe and “hypomania” when less severe. Periods of low moods, known as bipolar depression, are also extreme and can cause people to feel very down, hopeless, and helpless. Bipolar disorder was previously known as “manic depression”.

Although bipolar disorder is a life-long condition, the symptoms can be well managed with the right treatment.


Types of bipolar disorder

There are two types of bipolar disorder:

  • Bipolar one disorder (bipolar I disorder), where people will experience mania, and most will have depression.
  • Bipolar two disorder (bipolar II disorder), where people experience hypomania and depression.

These categories help guide which treatment may be most suitable.

What causes bipolar disorder?

There is no one cause for bipolar disorder, but some things may make it more likely that someone will develop bipolar disorder, such as:

  • A family history of bipolar disorder.
  • Stress, trauma or illness in childhood or adolescence.
  • Drug use.

Although a lot is still unknown about the causes of bipolar disorder, when someone already has this condition, their symptoms can be brought on by stress or lack of sleep.

Who gets bipolar disorder?

About 1% of the population will experience bipolar disorder (I or II) at some point. The condition occurs in males and females and all cultures. People with bipolar I tend to first experience symptoms in their late teens, and usually, the first episode is that of depression. People with bipolar II tend to experience their first symptoms later on, usually in their late twenties.


What’s it like to have bipolar disorder?

People with bipolar disorder experience extreme highs (mania or hypomania, depending on severity), and most will experience extreme lows (bipolar depression). The combination of symptoms can vary from person to person with this condition. For example, some people may experience the following:

  • Mostly mania or hypomania.
  • Mostly depression.
  • Mania or hypomania after depression.
  • Mania or hypomania and depression features at the same time (called a ‘mixed state’).

Between the highs and lows, people with bipolar disorder feel and act normally.

Symptoms of mania or hypomania can make people feel extremely good, high, or irritable. It can also cause people to experience high energy levels, feel less need for sleep, talk more than usual, have racing thoughts, be easily distracted, become much more active, behave more impulsively or risky, and impair one’s judgement.

Symptoms of depression can make people feel down and impair their ability to enjoy things that bring pleasure. It can cause people to feel helpless, worthless, and guilty and to think about death or suicide.

It is important to get help early, as the sooner you get help, the better your chance of getting the correct diagnosis and starting effective treatment vital to your recovery.


Diagnosis of bipolar disorder

The diagnosis of bipolar disorder is usually made by a psychiatrist – however, it can sometimes be diagnosed by GPs and clinical psychologists. It is usually a diagnosis made through an assessment of a person’s behaviour and symptoms and may require seeing the person over some time before being able to make the diagnosis.

A diagnosis of bipolar disorder can only be made if someone has already had an episode of mania or hypomania. Given that depression is usually the first symptom of bipolar disorder before an episode of mania or hypomania occurs, people can often be given the diagnosis of depression before being diagnosed with bipolar disorder.

A medical examination and tests should also be performed to ensure that the symptoms are not caused by another medical condition.

Treatment and management of bipolar disorder

Conventional treatments for bipolar disorder

Mania requires urgent care from a doctor – even if you feel very good. It requires medication, and you may need to go to hospital. Severe mania is considered a medical emergency.

Medications used in the treatment of mania include sedatives, antipsychotic medication and mood-stabilising medication. These medications can also be used in hypomania. Severe mania may, at times, require Electroconvulsive Therapy (ECT), which is considered a safe and effective treatment.

Bipolar depression is best treated by a combination of medication and psychological intervention. Medications used in treating bipolar depression include antipsychotic medication, mood-stabilising medication and combining antidepressant and mood-stabilising medication. It is important to note that sometimes antidepressants can set off mania, so antidepressants are usually only used in bipolar disorder if a mood-stabilising medication is also being taken. In severe bipolar depression, ECT is sometimes used.

Complementary treatments for bipolar disorder

An integrative treatment approach for bipolar disorder may, in addition to conventional treatment such as medication and psychological treatment, include the use of nutritional supplementation and nutraceuticals and the optimisation of lifestyle factors such as diet, exercise, sleep and work routine.

Recovery from bipolar disorder

Bipolar disorder is a life-long condition, but the symptoms can be controlled with the right treatment, allowing most people to live normal, fulfilling lives. People can stay well for longer if they learn to better manage their stress, sleep, and general health – and become aware of their warning signs. It can also be helpful for the family and friends of someone with bipolar disorder to understand the condition, know what to do if the person develops symptoms and how they themselves can also be supported.