The Impact of Bipolar Disorder on Relationships and Work Life

Introduction

Bipolar disorder (BD) is a complex mental health condition that can significantly affect your moods. It is estimated that 1 in 100 people will be diagnosed with BD at some point in their lives.

The symptoms of BD can make a person experience extreme highs and severe lows. Unlike typical mood swings, these mental health episodes can last for days or weeks which can have a significant impact on daily life and relationships.

Bipolar disorder will not go away on its own and is best treated using a combination of medication, self-care and therapy. Outcomes are better for people with mental health conditions if they have a supportive network of people around them including friends, family and colleagues.

Bipolar disorder (formally known as manic depression) is characterised by cycles of mania and depression.

In a depressive phase, symptoms of bipolar disorder may include:

• Feeling sad, lonely or hopeless
• Lacking in energy or motivation
• Thinking negative thoughts
• Being irritable
• Behaving in an irrational or delusional way
• Lacking in appetite
• Unable to sleep or sleeping too much
• Feeling suicidal

Symptoms exhibited during a manic phase may include:

• Feeling extremely happy or euphoric
• Hyperactivity
• Making rash decisions with no thought of the consequences (such as spending large sums of money)
• Risky or out of character behaviour
• Delusional or illogical thoughts and behaviour
• Hallucinations
• Talking quickly
• Feeling wide awake and not wanting to sleep
• Delusions of grandeur or importance

Sometimes, manic symptoms are described as hypomania. Symptoms of hypomania are usually not as severe as mania and do not last as long.

If you experience any of the above symptoms you should make an appointment to see your GP. If they suspect you have bipolar, they will arrange for you to see a psychiatrist for a specialist assessment.

Research is ongoing into bipolar and not all medical professionals agree on exactly how to categorise the condition. Broadly speaking, you may receive a diagnosis for bipolar I or bipolar II.

Bipolar I

Some people are categorised as having bipolar one if:

• They have had a minimum of one episode of mania that lasted more than a week
• Some depressive episodes

Bipolar II

Some people are categorised as having bipolar II if:

• They have had a minimum of one depressive episode
• Hypomania for at least four days

Sometimes, people with bipolar disorder experience phases of depression and mania that swing rapidly from one to the other. This is sometimes called rapid cycling. To be diagnosed with rapid cycling you will usually have exhibited four or more depressive, manic or mixed episodes within one year.

Others experience bipolar in a mixed state where they display a mixture of manic and depressive symptoms during a single episode, such as feeling low and depressed alongside hyperactivity. In a mixed state, people’s moods sometimes change significantly throughout the course of one day or even one hour.

BD is a long-term condition, although the effects of it can usually be managed using a combination of:

• Treatments (such as medication to treat symptoms of depression and/or mania)
• Self-help techniques
• Lifestyle changes
• Strong support networks
• Learning to recognise triggers

A number of medicines are available to stabilise the mood swings associated with bipolar. These include:

• Lithium (the most common treatment)
• Anti-convulsant medicine (including valproate, carbamazepine and lamotrigine)
• Antipsychotics (haloperidol, olanzapine, quetiapine and risperidone)

Not all available treatments are suitable for all individuals, for example valproate carries a risk of physical and intellectual deficits in babies and is therefore not suitable for women who want to start a family. If you are taking lithium, you will be required to have blood tests every three months to check that the lithium levels in your body are not too high.

The depression associated with BD cannot always be managed with antidepressants in the way depression is typically treated. This is because taking antidepressants alone has been linked with relapse in BD patients. Usually, it is more effective to treat depressive BD episodes with either:

• a mood stabiliser, or
• antidepressants in conjunction with a mood stabiliser.

Most people with BD can be successfully treated without having to stay in hospital and can remain at home, preferably under the care of family or loved ones. Very occasionally, BD can cause sufferers to become a danger to themselves or others and may lead to detainment in a secure unit.

The impact on personal relationships

Bipolar disorder can have an impact on the people around the sufferer, mainly because of the unpredictable nature of the condition.

People with bipolar disorder may struggle to maintain long-term relationships with friends and romantic partners. It can also make family dynamics more complex and challenging, causing resentment and jealousy between siblings in particular, who may feel that their brother or sister with BD gets extra attention or constantly causes problems.

When a person with bipolar is having a manic episode, they may not be aware of it. This can lead to resistance when friends or loved ones try to help as the person in the grip of mania does not realise how irrational they are being. Occasionally, during episodes of mania and depression people may experience hallucinations or psychosis. This can be overwhelming for people on the outside to understand and deal with.

BD can make people act out, behave out of character and engage in risk-taking behaviour such as spending large sums of money on expensive items that they cannot afford and do not need. This can result in financial problems which can put additional pressure on relationships.

Strategies for navigating relationship challenges

Navigating relationships in the modern world can be hard for everyone; when you have a mental health condition it adds an additional layer of complexity and pressure.

If you have BD, it is important to:

• Be open with those around you
• Reach out for help when needed
• Seek expert advice such as marriage counselling or debt advice

In addition to taking medication, some people with BD find that psychological treatments are helpful to them, such as:

• Psychoeducation
• Psychoeducation Cognitive Behavioural Therapy (CBT)
• Family therapy

Psychoeducation can help people to learn more about bipolar, whereas CBT helps with learning coping mechanisms and reframing negative thoughts. It can help to get those close to you to partake in talking therapies to further understand and support you.

Family therapy is aimed at problem solving and improving communication between family members or partners. It encourages a collaborative approach to improving mental health outcomes where everyone supports one another and works together.

The impact on work life

Stress can be a significant trigger for BD symptoms and it is important to try to reduce stress, including work-related stress where possible.

People with BD are entitled by law, under the Equality Act 2010, to have reasonable adjustments made to their work.

Reasonable adjustments might look like:

• Working shorter days
• Working more flexibly
• Having regular check-ins with their boss or team leader
• Adjusting their workload

Due to the extreme changes in mood that bipolar disorder can cause, people who suffer from BD may find themselves shifting quickly from being extremely productive and focused to becoming distant and indifferent towards their work. This might lead to a worker being incorrectly labelled as lazy or unmotivated.

If a person suffers a manic episode whilst at work, their colleagues may find it unnerving or shocking, especially if they lack knowledge about bipolar disorder. Without the proper understanding and support, this can affect work relationships and the working environment.

Openness and clear communication are key to reducing the stigma around mental illness in the workplace. When BD is properly managed, the risk of mania or hypomania is significantly decreased; this is why it is vital to keep up with your treatment plan.

Strategies for managing work life with BD

With the correct treatments, bipolar disorder is a manageable condition that many people around the globe live with. Although it may require some extra understanding and adjustments, it is possible for someone who is diagnosed with BD to hold down a job and even have a successful career:

Some tips for managing your work life if you have BD include:

• Know your triggers (for example, if lack of sleep seriously affects you, shift work or very long hours may not suit you)
• Do not be afraid to request help or adjustments from your employer: they legally have to consider your request
• Never feel ashamed about having a mental health condition
• Try to be proactive rather than defensive if colleagues have questions about BD – education is key to increasing understanding and empathy
• Look for jobs where you can work on a remote or hybrid basis if this would suit you better
• Make the most of your downtime and rest whenever you need to, to avoid overstretching and overexerting yourself
• Use trial and error, to find what works for you
• Never feel pressurised to stay in a job or situation that has an adverse effect on your mental health

Self-care is also an important part of managing symptoms. This includes:

• Taking breaks before you feel overwhelmed rather than getting stressed
• Practising deep breathing or mindfulness techniques to decrease stress levels
• Making sure to exercise and getting fresh air
• Eating a healthy balanced diet and staying hydrated
• Avoiding drugs and alcohol. Alcohol is a depressant and both drugs and alcohol can affect your mood and increase emotional instability
• Trying to get enough sleep and sticking to a routine

People with bipolar disorder may thrive in creative or project oriented careers where you can work intensely on one particular task for short periods of time. For others, short notice changes of schedule or unpredictability may disrupt a person’s mood if they have BD. If this is the case for you, it may be best to try to stick to a schedule as far as possible. This might mean looking for work that is:

• Regular
• Structured
• Works around your life (causes minimal disruption to your mealtimes, sleep patterns etc.)

If you are unable to work due to BD or need to take a break from work you may be entitled to certain benefits from the government to help tide you over during periods of economic inactivity.

The importance of seeking professional help

BD is a long-term condition and will usually get worse without professional intervention. As discussed, one of the symptoms of bipolar disorder is extreme depression. If you are feeling depressed you are at an increased risk of self-harm and suicide. Some research shows that the risk of suicide for people with BD is up to 20 times higher than that of the general population. It is important to get professional help for BD to get your symptoms under control and to ensure you can continue living a full and happy life.

Bipolar disorder is not something that you should be facing alone. It is important to work closely with healthcare providers, therapists and your close support network.

Conclusion

Bipolar disorder is a long-term mental health condition that affects at least 1% of the population. Mood stabilising and anti-depressant medication are available to treat the mood swings associated with BD. Taking medication at the correct dosage and as prescribed is vital for it to work correctly.

Psychotherapy is also an option if you have bipolar disorder. It can complement your medication and also give you the opportunity to involve your family or partner in therapy sessions. This can improve communication and understanding.

Having bipolar does present challenges in the workplace. You can take steps to mitigate the impact BD has on your career and ask your boss for reasonable adjustments if needed. Remember to take care of yourself, take breaks to avoid overwhelm and find what works for you as an individual.

By maintaining a healthy lifestyle (including diet, exercise and adequate sleep) and managing stress you will keep yourself in peak condition to face the challenges that mental health struggles can cause. With the right treatments and a good support system, people with BD should be able to have successful relationships and careers, be great parents and lead fulfilling lives.