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Knowledge Base » Mental Health » Bipolar Disorder Unveiled: Understanding the Highs and Lows

Bipolar Disorder Unveiled: Understanding the Highs and Lows

Recent research suggests that as many as 5% of us are on the bipolar spectrum with 1.3 million people having bipolar in the UK, according to Bipolar UK.

Bipolar is one of the UK’s most common long-term health conditions, taking, on average, 9.5 years to receive a correct diagnosis. Living with bipolar also increases a person’s risk of suicide by up to 20 times.

Defining bipolar disorder

Bipolar disorder, previously called manic depression, is where a person has extreme mood swings. These include emotional highs, known as mania or hypomania, and lows, otherwise known as depression. It is a severe mental illness, and people can have long or short periods of stability before experiencing a low or a high. People with bipolar experience an extreme range of moods from deep depression with recurring suicidal thoughts to an extreme manic high with psychosis and hallucinations. They can also experience a mixed state, where symptoms of depression and mania occur at the same time.

There are different types of bipolar disorder. Bipolar I disorder involves manic episodes that last at least seven days or are severe enough to require hospitalisation. Depressive episodes may also occur. Bipolar II disorder is characterised by a pattern of depressive episodes and hypomanic episodes, which are less severe than full-blown mania. Cyclothymic disorder involves chronic fluctuations in mood with periods of hypomania and mild depression that lasts for at least two years.

Bipolar disorder has a genetic component, which means that there is an increased likelihood of developing the condition if you have a close relative, such as a parent or sibling, with bipolar disorder. Genetics alone do not determine whether someone will develop bipolar disorder; there are also other factors, such as environmental influences and life experiences, which also play a role in the development of the disorder. Biological factors, for example imbalances in certain neurotransmitters, such as dopamine, serotonin and norepinephrine, are thought to contribute to bipolar disorder. These imbalances can affect mood regulation. Environmental factors such as experiencing traumatic events, or drug and alcohol use, can increase the risk and severity of bipolar disorder in susceptible individuals.

Bipolar disorder is a complex mental health condition and the exact cause of bipolar disorder is not yet fully understood; however, both genetic and environmental factors are believed to have an influence in the development of the condition.

The highs: mania in bipolar disorder

With bipolar disorder, when your mood shifts to mania, or hypomania which is less extreme than mania, you may feel euphoric, full of energy or unusually irritable or restless.

Symptoms of bipolar during a manic phase may include:

  • Feeling incredibly high or euphoric.
  • High levels of creativity, energy and activity.
  • Feeling highly energetic or impulsive.
  • Getting little or no sleep.
  • Grandiosity, having an inflated sense of self-esteem or self-importance. A feeling of possessing special powers, talents or abilities.
  • People may engage in numerous activities simultaneously and have a heightened sense of productivity. However, these activities may lack practicality or purpose.
  • Difficulty engaging in one activity, becoming easily distracted.
  • Experiencing racing thoughts, racing speech, or talking over people.
  • Having a poor appetite and weight loss.

The lows: depression in bipolar disorder

Symptoms of bipolar during the depressive stage may include:

  • Feelings of sadness, tearfulness or hopelessness.
  • Angry outbursts, feeling easily irritable or frustrated.
  • Loss of interest or pleasure in most or all normal activities.
  • Sleep disturbances, which may include insomnia or sleeping too much.
  • Feeling tired or lacking energy.
  • Reduced appetite and weight loss.
  • Increased cravings for food and weight gain.
  • Anxiety, agitation or feeling restless.
  • Slower reactions, thoughts, speech or body movements.
  • Feelings of being worthless or guilt, fixating on past failures or self-blame.
  • Having trouble thinking, concentrating, making decisions.
  • Problems with memory.
  • Unexplained physical problems, which can include things like aches and pains.
  • Frequent or recurrent thoughts of death, suicidal thoughts or suicide attempts. Please see our knowledge base for information on how to support someone who is feeling suicidal.
Young man unable to sleep

The bipolar spectrum

The bipolar spectrum refers to a conceptual framework which is used in psychiatry in order to understand the range of mood disorders that fall under the broader category of bipolar disorder. Traditionally, bipolar disorder was classified into two main types: bipolar I and bipolar II. However, the bipolar spectrum acknowledges that mood disorders exist on a continuum, with varying degrees of severity and symptoms beyond these two categories. The bipolar spectrum highlights the importance of considering the full range of symptoms and their impact on people’s lives when making diagnostic and treatment decisions and the importance of personalised treatment approaches that address the specific needs and experiences of people on the bipolar spectrum.

The bipolar spectrum includes:

  • Bipolar I disorder – this is characterised by manic episodes that last at least seven days or by manic symptoms that are so severe that immediate hospital care is required. Depressive episodes may also occur.
  • Bipolar II disorder – this involves a pattern of depressive episodes and hypomanic episodes, which are less severe than manic episodes.
  • Cyclothymic disorder – this is a milder form of bipolar disorder which is characterised by chronic fluctuations in mood, with numerous periods of hypomanic symptoms and depressive symptoms that do not meet the criteria for major depressive episodes.
  • Bipolar disorder not otherwise specified (BP-NOS) – this category includes bipolar disorder symptoms that do not fit the criteria for bipolar I or bipolar II but still represent a clinically significant disturbance.
  • Subthreshold bipolar disorder – some people may experience symptoms that resemble those of bipolar disorder but do not meet the full diagnostic criteria. This can include brief or atypical mood swings.
  • Bipolar spectrum in youth – bipolar disorder can also occur in children and adolescents, presenting with similar mood disturbances but often with unique developmental consideration.

Living with bipolar disorder

Bipolar is a long-term condition; however, with the right treatment and by practising self-help techniques, the impact of living with the condition can be reduced.

Some things you can do in order to help reduce your symptoms and lead as fuller life as possible whilst living with the condition include:

  • Seeking professional help – consult a mental health professional for an accurate diagnosis and personalised treatment plan. Treatment often involves a combination of medication, therapy and lifestyle adjustments.
  • Understanding the condition – it is essential to educate yourself about the condition, including its symptoms, triggers and treatment options.
  • Keeping active and healthy eating – eating a healthy, well-balanced diet and keeping fit can help to reduce the symptoms of bipolar disorder, particularly the depressive symptoms, or the lows. It can also give you something positive to focus on and provide you with a routine. A healthy diet, combined with exercise, will also help you to maintain a healthy weight. A common side effect of medical treatments for bipolar disorder can be weight gain.
  • Ensuring you attend your annual health check – you should have a check-up at least once a year to monitor your risk of developing cardiovascular disease or diabetes and to check your blood pressure.
  • Building a support network – surround yourself with supportive friends, family members and mental health professionals who understand your condition and can offer encouragement and assistance when needed.
  • Educating loved ones – help educate your family and friends about bipolar disorder to foster understanding and reduce stigma. Open communication can also help them provide you with better support.
  • Being open about your condition – wherever this is appropriate, you should try to talk about your condition with family members and friends. You can also take part in self-help groups that can put you in touch with other people with the condition. This enables you to share ideas and helps you feel less alone in your condition.
  • Medication management – medications like mood stabilisers, antipsychotics and antidepressants are commonly used to manage bipolar disorder symptoms. It is crucial to take medications as prescribed and communicate any concerns or side effects to your healthcare provider
  • Therapy and counselling – psychotherapy can be beneficial for managing mood episodes, coping with stress and improving interpersonal relationships. Cognitive behavioural therapy (CBT), dialectical behaviour therapy (DBT), and interpersonal therapy are among the approaches that may be helpful.
  • Developing coping strategies – learn and practise coping strategies to manage mood swings and reduce stress. This may include maintaining a routine, getting regular exercise, practising mindfulness or relaxation techniques, and cultivating a strong support network.
  • Self-care – prioritise self-care activities that promote physical and emotional wellbeing, such as getting enough sleep, eating a well-balanced diet, avoiding alcohol and drugs, and engaging in activities that you enjoy.
  • Monitoring mood changes – keep track of your mood swings, triggers and symptoms. You can do this by using a mood diary or tracking app. This can help you and your healthcare provider better understand your condition and adjust treatment as needed.
  • Planning for crises – develop a crisis plan outlining steps to take during severe mood episodes or emergencies. Include contact information for your healthcare providers, trusted individuals and crisis hotlines.
Young man seeking treatment for mental health

Treatment and support

Treatment and support for bipolar disorder typically involve a combination of medication, therapy, lifestyle adjustments and support networks.

There are several different services available if you are being treated for bipolar disorder. Some of these are accessed through a referral from your GP, others can be accessed through your local authority. Some of the different services include:

  • Community mental health teams (CMHT) – these provide the main part of local specialist mental health services. They offer assessment, treatment and social care support.
  • Early intervention teams – these services provide early identification and treatment if you have the first signs of psychosis. Your GP is usually able to refer you directly to an early intervention team.
  • Crisis services – crisis services can treat you for a sudden episode and they allow you to be treated at home, instead of in a hospital. They are specialist mental health teams that can deal with crises that happen outside normal office hours, for example in the evening or weekends.
  • Acute day hospitals – these are an alternative to inpatient care in a hospital setting. You can visit every day or be seen as often as you need.
  • Assertive outreach teams – these teams provide intensive treatment and rehabilitation within the community. Staff can visit you at home and liaise with other services, such as your GP or social services, to get you the ongoing support that you need. They can also provide practical help, such as helping to find suitable housing and work.

Some other treatment options include:

  • Medication – mood stabilisers are the primary medications used to manage bipolar disorder. Antipsychotics may also be prescribed to help manage manic or mixed episodes. Antidepressants may be used in some cases. They may be used cautiously alongside mood stabilisers in order to manage depressive episodes, although their use is controversial due to the risk of inducing manic episodes. Medication adherence is crucial for managing symptoms effectively. However, finding the right combination of medications often requires careful monitoring and adjustments by a mental health professional.
  • Therapy – there are several different types of therapy suited to different people. Psychoeducation involves learning about bipolar disorder – its symptoms, triggers, and management strategies – and can empower people with bipolar to better manage their condition. Cognitive behavioural therapy (CBT) is a type of therapy that helps people identify and change negative thought patterns and behaviours that contribute to mood swings. Interpersonal and social rhythm therapy (IPSRT), is a type of therapy that focuses on stabilising daily routines and managing interpersonal relationships in order to help prevent mood episodes. Family therapy can be useful, as when family members are involved in therapy, this can improve communication, reduce conflict and provide support for both the individual with bipolar disorder and their loved ones.
  • Lifestyle adjustments – this can include things like maintaining a regular sleep schedule, as disrupted sleep patterns can trigger mood episodes, and avoiding drugs and alcohol, as substance abuse can exacerbate symptoms of bipolar disorder and interfere with treatment. Healthy lifestyle habits, for example eating a balanced diet, engaging in regular physical activity and managing stress, can help stabilise mood.
  • Support networks – accessing support groups and connecting with others who have bipolar disorder can provide valuable peer support and reduce feelings of isolation. Having a strong support system of understanding and compassionate friends and family can make a significant difference in managing bipolar disorder. Healthcare providers are essential in terms of having regular follow-up appointments with a psychiatrist and other healthcare providers to ensure ongoing monitoring of symptoms and the effectiveness of treatment.
Friend showing support and compassion

Conclusion

Navigating the highs and lows of bipolar disorder is a difficult journey that needs understanding, support and a society free from the stigma of having mental health difficulties.

Through accessing the right treatment and therapy, and with a strong support network, people living with bipolar disorder can find stability and lead fulfilling lives. It is imperative for society to destigmatise mental illness and foster an environment of acceptance and empathy. By acknowledging the highs and lows of bipolar disorder and providing compassionate care, we can strive towards a more inclusive and supportive community for people affected by this condition.

For further reading around getting support with mental health problems, please see our knowledge base.

The Depression and Bipolar Support Alliance provide support for anyone affected by bipolar disorder.

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About the author

Claire Vain

Claire Vain

Claire graduated with a degree in Social Work in 2010. She is currently enjoying her career moving in a different direction, working as a professional writer and editor. Outside of work Claire loves to travel, spend time with her family and two dogs and she practices yoga at every opportunity!



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