Quick answer

What is bipolar disorder?

Bipolar disorder causes extreme mood swings — manic or hypomanic highs (elevated mood, reduced sleep, risky behaviour) alternating with depressive lows. Types include bipolar I (full mania) and bipolar II (hypomania plus depression). Treatment combines mood stabilisers like lithium, antipsychotics, and psychological therapy. See a GP if mood swings severely disrupt life — urgent help if psychotic, suicidal, or not sleeping for days with reckless behaviour.

Bipolar disorder — beyond ordinary mood swings

Bipolar disorder (formerly manic depression) is a serious mental health condition causing extreme mood episodes — highs (mania/hypomania) and lows (depression) — separated by periods of relative stability.

Affects roughly 1 to 2% of population — onset typically late teens to early 30s — often delayed diagnosis because first episode may be depression.

Types

Bipolar I

  • ≥1 manic episode — lasting ≥7 days (or any duration if hospitalised)
  • mania may include psychosis
  • depressive episodes common

Bipolar II

  • hypomania — ≥4 days — elevated mood/energy without full mania severity or psychosis
  • ≥1 major depressive episode
  • not “milder bipolar” — depression often disabling

Cyclothymia

  • chronic fluctuating moods — hypomanic and depressive symptoms < full criteria — ≥2 years

Mania and hypomania — signs

MANIA (more severe):

  • euphoria or irritability
  • decreased sleep need — “feel fine on 2 hours”
  • grandiosity — unrealistic plans, spending
  • racing thoughts, pressure of speech
  • risky behaviour — sex, drugs, finances, driving
  • psychosis possible — delusions of grandeur

HYPOMANIA:

  • similar but shorter, no psychosis, less impairment
  • may feel productive — others notice change

Lack of insight common during mania — family often spot first.

Depressive episodes

Like major depression — low mood, anhedonia, fatigue, guilt, suicidal thoughts — often more prolonged and treatment-resistant without mood stabiliser.

Diagnosis

Psychiatric assessment — GP refers to community mental health team or psychiatrist.

Mood diaries help — date, sleep, energy.

Exclude:

  • substance-induced — cocaine, steroids, antidepressant-induced mania
  • thyroid disease
  • ADHD overlap — different chronic pattern

Treatment

Mood stabilisers

Lithium:

  • gold standard for mania prevention
  • narrow therapeutic index — blood levels, thyroid, renal monitoring

Valproate:

  • effective — teratogenic — not in women of childbearing potential without contraception programme

Lamotrigine:

  • better for depression prevention — slow titration — rash risk

Antipsychotics

Quetiapine, olanzapine, aripiprazole — acute mania and maintenance

Antidepressants

Use cautiously — with mood stabiliser — can trigger mania/hypomania if alone

Psychological

Psychoeducation, CBT, interpersonal social rhythm therapy — regular sleep/wake prevents relapse

Crisis and safety

Mania emergency:

  • dangerous behaviour
  • psychosis
  • exhaustion from no sleep

Depression emergency:

  • suicidal ideation — 999 / crisis team

Advance statements — care preferences when well

Living with bipolar

  • sleep hygiene — #1 relapse trigger is sleep loss
  • avoid drugs/alcohol
  • MedicAlert, trusted contacts
  • Bipolar UK — peer support

Not a life sentence to chaos — most achieve long stability with tailored medication and lifestyle rhythm.

Manic spending or days without sleep is medical emergency, not personality flaw — seek help early.

Common questions

What is the difference between bipolar I and bipolar II?
Bipolar I — at least one full manic episode (hospital-level severity possible) — depressive episodes common but not required for diagnosis. Bipolar II — hypomania (less severe mania — no psychosis, shorter) plus major depressive episodes — hypomania can still impair relationships and work.
What does a manic episode feel like?
Persistently elevated or irritable mood, increased energy, reduced need for sleep (feel rested on 3 hours), racing thoughts, talking fast, grandiose plans, impulsive spending, sexual risk-taking, or starting unrealistic projects. Judgment impaired — often lack insight until episode ends.
Is bipolar disorder the same as mood swings?
No — normal mood swings are brief and tied to events. Bipolar episodes last days to weeks or months — mania/hypomania meets specific criteria with functional impairment. Borderline personality disorder involves rapid mood shifts over hours — different diagnosis.
How is bipolar disorder treated?
Mood stabilisers — lithium, valproate, lamotrigine (maintenance especially); antipsychotics — quetiapine, olanzapine for mania or maintenance; psychological therapy — CBT, psychoeducation, family-focused therapy. Antidepressants only with mood stabiliser cover — can trigger mania alone.
Can people with bipolar work normally?
Many do with stable treatment — some need occupational adjustments during recovery. Discrimination is unlawful — disclose only if choosing to. Relapse prevention — sleep regularity, stress management, medication adherence — critical.

Sources