Strategies for Managing and Living with Bipolar Disorder

Bipolar disorder (BD) is a complex, mental health condition that is characterised by significant changes in mood. Bipolar disorder symptoms can make a person experience extreme, euphoric highs and severe, depressing lows. It is estimated that 1 in 100 people will be diagnosed with BD at some point in their lives.

The mood swings associated with BD are very different from the normal mood swings associated with adolescence or hormonal changes: these mood swings are indicators of a mental health episode that may last for days or weeks. The intensity of some symptoms of bipolar disorder, in addition to its unpredictability, means the condition can have a significant impact on daily life, work, education and relationships.

A comprehensive approach to managing bipolar is vital to help people manage and live with the condition. This may include engaging regularly with healthcare professionals, having difficult conversations with friends, family or employers, attending therapy and sticking to your treatment plan. 

Understanding Bipolar Disorder

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 or disturbed thoughts
• Irritability
• Behaving in an irrational or delusional way
• Lack of appetite
• Difficulty sleeping or sleeping too much
• Feeling suicidal

Symptoms exhibited during a manic phase may include:

• Feeling extremely happy, joyous or euphoric
• Hyperactivity or high energy
• Making rash decisions with no thought of the consequences (such as spending large sums of money and getting into debt)
• Risky or out of character behaviour
• Delusional or illogical thoughts and behaviour
• Paranoia
• Hallucinations (visual, auditory etc)
• Rapid speech
• Feeling wide awake and not wanting to sleep
• Delusions of grandeur or importance
• Feeling full of new ideas or starting lots of new projects

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

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

Bipolar I

Some people are categorised as having bipolar I 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 for depression and/or mania)
• Self-help techniques
• Lifestyle changes
• Strong support networks
• Learning to recognise triggers

Bipolar disorder does not go away on its own and is best treated using a combination of:

• Medication
• Self-care
• Therapy

Outcomes are always better for people with mental health conditions if they have a supportive network of people around them including friends, family and colleagues. This is especially true of BD because people on the outside are best placed to spot the warning signs of an episode and often the person themselves may fail to recognise (and also deny) that anything is wrong. 

If someone in your life has bipolar disorder you can help to support them by making sure that they are attending their therapy appointments, are avoiding risky behaviour and are looking after their health and wellbeing. It is also crucial that they are taking their medication as prescribed. 

People with BD who stop taking their medicine will often experience an onset of symptoms soon afterwards, therefore it is a condition where medication adherence is of fundamental importance. 

Medication Management

A number of medicines are available to stabilise the mood swings associated with bipolar. The most common treatment is lithium. 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. 

Other treatment options include:

• Anti-convulsant medicine (including valproate, carbamazepine and lamotrigin
• Antipsychotics (haloperidol, olanzapine, quetiapine and risperidone)

It is important to find a treatment that is right for your circumstances; for example, valproate carries a risk of physical and intellectual deficits in babies so you would need to find an alternative if you are a woman who wants to start a family. 

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:

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

You should not stop taking your BD medication unless directed to by your doctor or psychiatrist. People will sometimes stop taking their medicine for bipolar because they dislike the side effects or because they feel that they no longer need it. They may also miss doses or stop taking their medicine as directed: this is known as medication nonadherence. This action puts you at risk of experiencing depression or mania.  

Medication nonadherence in BD is associated with:

• A mood stabiliser
• Antidepressants in conjunction with a mood stabiliser

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

You should not stop taking your BD medication unless directed to by your doctor or psychiatrist. People will sometimes stop taking their medicine for bipolar because they dislike the side effects or because they feel that they no longer need it. They may also miss doses or stop taking their medicine as directed: this is known as medication nonadherence. This action puts you at risk of experiencing depression or mania.  

Medication nonadherence in BD is associated with:

• Increased risks of relapse/recurrence
• Increased risk of detainment or hospitalisation
• Increased risk of harm or suicide
• Higher treatment costs
• Decreased chances of recovery and management

If your BD medication isn’t working or is making you feel unwell, you should book an appointment with your doctor to talk about changing the dosage or trying a new treatment such as therapy.

Psychotherapy and Counselling

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

• 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 is often helpful if those close to you also 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.

Lifestyle and Self-Care

BD is a complex condition that is unlikely to be effectively managed without medical or psychiatric interventions, however you can support your recovery and wellbeing by taking good care of yourself both mentally and physically.

If you have problems with your mental health, you may find the following lifestyle and self-care tips helpful:

Exercise regularly

Staying active and getting exercise can help boost our mental health and may even improve symptoms of mild to moderate depression by increasing endorphins (the ‘feel good’ hormone).

Exercising can also provide a routine for people and gives us something positive to focus on. It is something that can be structured, such as a weekly class, freestyle, such as a run or jog in the park or even done at home. If you are not a fan of high impact exercise or cardio, you could try yoga or tai chi which can help with concentration, discipline, stress reduction and flexibility.

Weight gain is often a side effect of bipolar medication and exercising regularly can help to maintain a healthy weight.

Eat a healthy and balanced diet

A healthy and varied diet is essential for our overall wellbeing. It is essential that we all get the correct vitamins and minerals as well as protein and many people are lacking in these essentials.

To keep your diet on track, try to:

• Avoid sugary, fatty and ultra-processed foods
• Eat five portions of fruit and vegetables per day
• Cook from fresh where possible
• Eat at regular times to keep your blood sugar levels steady

Some medicine for bipolar disorder may put you at an increased risk of developing diabetes. A healthy diet in addition to regular exercise can decrease the risk of developing diabetes. You will also be offered yearly checks to monitor you for the condition which you should go to.

Attend an annual health check

Free appointments are available once per year to check your weight, blood pressure and perform routine blood and urine tests. These health checks are offered to people with mental health conditions such as schizophrenia, bipolar or psychosis. Appointments usually last 30 to 45 minutes.

Attending these appointments is optional, however it is highly recommended as it gives you an opportunity to check your physical health checked as well as discuss any concerns with a nurse or doctor.

During your annual health check, a doctor nurse will assess your overall health, discuss any medication you are on and ask you how you are coping in general. They can offer advice on quitting smoking, reducing alcohol consumption and weight management.

Sleep

Getting enough good quality sleep contributes to good mental health and overall wellbeing. Symptoms of bipolar disorder can interfere with our sleep and some medication can also affect it. However, try to maintain a consistent sleep schedule and have good sleep hygiene:

• Go to bed and wake up at regular times
• Make sure you have a quiet comfortable space for sleeping
• Maintain a comfortable temperature in your room
• Don’t eat heavy a meal just before bed
• Avoid alcohol and drugs as they can interfere with your normal circadian rhythm

Practice relaxation techniques

To manage stressful situations that may set off a BD episode, it may help to try relaxation techniques such as deep breathing, meditation or mindfulness.

Always try to prioritise positive coping mechanisms rather than resorting to negative ones, such as alcohol; negative coping strategies may seem like a quick fix but they will usually make you feel worse in the long-term.

Try not to let the pressure build up; stress exacerbates poor mental health. Take a break as needed from activities that are overwhelming or overstimulating, including work or school related activities.

Support Networks

Support networks can provide practical and emotional support during difficult times. They can also raise the alarm if symptoms are escalating, especially when the person experiencing them is in denial.

If you have bipolar, you may be involved with different services that will help you to monitor the condition. These may vary depending on your age, personal circumstances and where you live and may include some of the following:

• Friends and family
• Romantic partner
• Employer and colleagues
• Teachers
• Doctor or nurse at your GP surgery
• Community mental health team (CMHT) (For over 18s)
• Child and Adolescent Mental Health Service (CAMHS) (For under 18s)
• Early intervention teams
• Crisis services
• Acute day hospital
• Assertive outreach teams

You may experience additional problems as a result of your mood episodes such as debt or problems at work. We know that stress is a key trigger for bipolar symptoms and there are services available to help you deal with secondary problems that you might need to use. These include:

• Benefits advice – you may be entitled to government benefits if you are out of work or working part-time due to mental health
• Debt management – advisors can help you to organise, consolidate, manage and sometimes even write off debts that accrue during manic episodes
• ACAS – expert advisors can speak to you about employment issues and explain how you are covered under The Equality Act 2010 if you receive discrimination at work due to your mental health condition

Recognizing Triggers and Warning Signs

It is important to pay close attention to your moods if you have bipolar disorder. You may find that keeping a mood diary or using an app to track your moods and note any changes helps.

Common triggers include:

• Stress and upheaval
• Use of drugs and alcohol
• Physical illness
• Sleep disturbances
• Trauma
• Negative life events
• Hormonal changes

Suddenly stopping taking your medication without being advised to do so by a doctor is likely to trigger behaviour associated with BD. It is important that you speak to your doctor before stopping medication or changing dosage.

You may find that even if you keep track of your moods and avoid triggers, sometimes, an episode may occur without any apparent cause. Early intervention is key in managing mood episodes before they reach crisis levels.

Crisis Planning

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

Once you have been diagnosed with BD you may find that you interact with healthcare workers from different teams in order to get regular support (see our ‘Support Networks’ heading for further details on this). In addition to your routine care plan, it is a good idea to have a plan in place in case a severe mental health episode or crisis arises.

If you suffer a mental health crisis, this usually means that you or someone else is in imminent danger.

If you have BD, you may benefit from having a crisis plan in place, particularly in case of suicidal thoughts or an extreme mood episode. Your crisis plan may form part of your self-management strategy for living with bipolar.

You can form your plan with help from your support network, including family or your clinical team, or you may prefer to complete it alone. Your crisis plan may help you to feel more in control and it will be an individual plan that is unique to you. It may include some of the following:

• Early warning signs and triggers
• Who you feel most comfortable speaking to in a crisis
• Identify who within your friends and family are best placed to support you and how
• Any treatments that you actively want to avoid (if you are unable to give informed consent)
• Steps to keep you physically safe
• Are any additional safety nets required for you in terms of your responsibilities in a crisis, for example do you require childcare if you have to go into hospital?

If you are able to write down your crisis plan (either physically or electronically) and let trusted people know about it then they will be better placed to help you when you are experiencing disordered thinking or unable to communicate clearly.

If you require urgent help for a mental health crisis, you will find the following resources useful:

• Dial 999 in an emergency to get help from emergency services, including ambulance or police
• Attend your nearest accident and emergency department to be seen
• Call your local Crisis Team or Mental Health Team
• Call NHS 111 for non-emergency help
• Request an urgent appointment at your local GP
• Call your therapist and tell them what is happening, they should be able to give advice and signpost you to appropriate resources

Stress can be a significant trigger for BD symptoms and it is important to try to reduce stress where possible. This can sometimes make it challenging to manage bipolar disorder in a work or education environment.

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:

Work-Life Balance

Stress can be a significant trigger for BD symptoms and it is important to try to reduce stress where possible. This can sometimes make it challenging to manage bipolar disorder in a work or education environment.

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
• Changing or adapting their role
• Having regular check ins with their boss or team leader
• Adjusting their workload

You can also try some self-help style techniques in the workplace such as:

• Setting realistic goals for yourself
• Reducing or managing stress
• Using healthy coping mechanisms
• Watching out for warning signs that you are overwhelmed or triggered

Conclusion

Bipolar disorder BD is a complex mental health condition that can be challenging to manage. It is characterised by mood swings and cycles of mania and depression. Outcomes are best for patients who take a holistic approach to their recovery and acknowledge the roles of medication adherence, engaging with therapy and practicing self-care in managing their bipolar symptoms.

It is also crucial for people with BD to have a supportive network of individuals around them and an awareness of their triggers or warning signs of an episode. Many people also find it beneficial to have a plan in place in case a mental health crisis emerges detailing how to best care for them if they are struggling to communicate their needs coherently.