What is Bipolar Disorder?
Bipolar disorder is also sometimes called
manic depression, bipolar affective disorder or bipolar mood
Bipolar disorder is an illness in which there
are extreme changes or swings in mood.
Everyone has times in their life when they
feel very happy (such as when you are about to go on holiday) or
very sad (such as when your pet dies). But it only becomes a
disorder when the mood changes are unusual or extreme. This can
range from being unusually happy (known as mania or hypomania), to
being unusually sad (depression) for no apparent cause.
What causes it?
Although the causes are not fully understood,
bipolar disorder tends to run in families. In people who have
bipolar disorder, episodes may happen at times of stress or
How common is it?
Bipolar disorder is extremely rare in young
children, but there are quite a few studies that suggest that it
may start in teenage years and in early adult life. It affects
about one in 100 adults.
What are the symptoms
In bipolar affective disorder a person can have (1)
manic/hypomanic episodes, (2) depressive episodes or (3) mixed
There are different types of this disorder
depending on how severe the symptoms are or how long they last.
The mood changes can sometimes happen very
rapidly within hours or days (sometimes called rapid cycling). For
some people, the mood symptoms are less severe (sometimes called
In between the highs and lows, there are
usually ‘normal’ periods that can last for weeks or months.
However, for some people, especially when they have had disorder
from some time, these periods of ‘normalcy’ can be shorter or
difficult to see.
Below is a list of the sort of symptoms that
can occur in each type of episode. You need to have at least one
manic or hypomanic episode to be diagnosed with bipolar
You need to have several symptoms at the same
time for at least several days. If there is just one symptom, then
it is unlikely to be bipolar disorder.
Symptoms that can occur during a ‘high’ or manic
- feeling incredibly happy or 'high' in mood, or very
- feeling irritable
- talking too much -increased talkativeness
- racing thoughts
- increased activity and restlessness
- difficulty in concentrating, constant changes in plans
- over confidence and inflated ideas about yourself or your
- decreased need for sleep
- not looking after yourself
- increased sociability or over-familiarity
- increased sexual energy
- overspending of money or other types of reckless or extreme
Hypomania is a milder form of mania (less
severe and for shorter periods). During these periods people can
feel very productive and creative and so see these experiences as
positive and valuable.
However, hypomania, if left untreated, can
become more severe, and may be followed by an episode of
depression. At the extreme end, some people also develop something
Symptoms that can occur during a
- feeling very sad most of the time
- decreased energy and activity
- not being able to enjoy things you normally like doing
- lack of appetite
- disturbed sleep
- thoughts of self-harm or suicide.
On the milder end, you may just feel sad and
gloomy all the time. Here too, at the extreme end, some people can
develop psychosis (see our factsheet on psychosis).
Symptoms that can occur during a mixed
- A mixture of manic symptoms and depressive symptoms at the same
What effects can Bipolar Disorder
have?The exaggerated thoughts, feelings and behaviours can
impact on many aspects of life, for example:
- loss of confidence
- loss of sense of control a person feels over their life
- poor concentration with studies
- problems with relationships with family and friends
- behaviour that places a young person's health or life at
The first step is recognising that there might
be a problem. Other people are likely to have noticed that you seem
different from your usual self, particularly those who live with
you. Speak to people who might know you well, such as family and
- behaviour that could place your health or life at risk, like
drinking alcohol or using drugs.
How is it treated?
In the short term, depending on whether you
are high or low and how severe it is, you may need different
treatments. When you have severe symptoms, you may need medications
and also sometimes admission to hospital to help your symptoms and
also keep you safe.
In the long term, the goal of treatment is to
help you have a healthy, balanced and productive life. This would
include understanding the condition, controlling the symptoms and
preventing the illness from coming back. Below we briefly describe
each aspect of the treatment:
Help with understanding yourself and the illness
It is very important that you and your family
are helped to understand bipolar disorder, how best to cope and
what to do to reduce the chances of it coming back. You and your
family may notice ‘triggers’ to your episodes and/or early warning
signs that an episode is starting. Being aware of these can help
reduce the chance of episodes occurring and getting help in the
earliest stages of an episode can stop it from getting worse.
Talking treatments (also known as ‘psychological
These may include different types of therapies
- Cognitive-behavioural therapy (CBT)
The young person, sometimes with their family,
learns to understand the links between their feelings and thoughts
and how this affects their behaviour (see our factsheet on
- Family-focused treatment (family therapy) -
The whole family can be helped to reduce stress, solve problems and
Medication plays an important role in the
treatment of bipolar disorder, especially if episodes are
The choice of medication can depend upon the
type of episode (manic or depressed). Everyone is different, and so
the type of medication that is recommended will also be
Medications can have mild or even severe
side-effects. Your psychiatrist will be able to advise about what
they are and about what can be done to help. The risk of
side-effects needs to be balanced against the risk of the damaging
effects of the illness on a person's life.
Antipsychotic medications are usually used for
high/manic episodes, while antidepressant medications are used for
the low/depressive episodes. You may also need medications called
mood stabilizers (e.g. lithium) which help to keep your mood stable
both during and between episodes.
It is important that medications are not taken
only when the problems are serious. If you have had more than one
severe episode of illness, staying on medication is important to
reduce the risk of further episodes. Medication may be needed for
months or even years. Some people may, under medical supervision,
be able to stop their medication when they have recovered and have
felt well for a while.
You may need physical examination and tests
(like blood test) before starting or while you are on medication.
It is important that if you are prescribed medication, you are
regularly seen by your doctor or psychiatrist.
What can you do?
The high or low episodes can last from a few weeks to months. It
is important to recognise that you are not alone and to keep up
hope. Some people only have one or two episodes. For others the
highs and lows can occur through their adult life. When this
happens, it is important that you learn to live with it and manage
- The first step is recognising that something is different or a
problem. Other people are likely to have noticed that you seem
different from your usual self, particularly those who live with
- Speak to people who know you well, such as family and
- Seeking medical advice early on is very important. If the
bipolar illness can be identified and treated quickly, this reduces
its harmful effects.
- If you already have a diagnosis, understand your illness and
problems. This can help you to take control and get help before it
gets more difficult. This can mean steps like planning for a crisis
and making choices about your career.
- Do things which help you to have a good health, like having a
balanced healthy diet, doing some exercise, and getting a good
- Try to identify what makes you feel ‘stressed’ and identify
ways of dealing with it.
How do I get help?
You may need to see your GP to talk about your
concerns. They can then refer you to your local child and
adolescent mental health service (CAMHS) who can offer more
If you have a school counsellor/nurse or
learning mentor, they can also be a useful person to talk to and
may also be able to refer you to the local child and adolescent
mental health services.
Christina's story, aged 16
"I was a happy, confident person studying for
11 GCSEs, and enjoying a good social life with a large circle of
friends. All seemed well in my life.
Suddenly from feeling really cheerful, happy and full of energy,
I withdrew to my room, stopped eating and stopped talking to
everybody, even my parents. I was having vivid hallucinations,
became paranoid and even thought about hurting myself.
My parents became really worried and eventually I was admitted
to a child and adolescent psychiatric unit.
I now realise that I was manic before I plunged into black
depression. One I was diagnosed as bi-polar (manic depressive), I
was able to understand and come to terms with my illness.
Medication was given to me to deal with the mood swings,
together with a talking therapy.
With support from my family and friends, I am now back at school
and I hope to go to medical school in the next couple of
Rachel's story, aged 15
"Rachel is fifteen-year-old girl who has
suffered episodes of depression in the past. Two months ago she
started to talk very quickly and seemed to have lots of energy. She
was excited about everything and was making all her friends laugh a
Over a three-day period Rachel barely slept or ate and started
to say things that did not really make sense; for example, she told
friends that was a princess in Taiwan. She also started swearing
and became extremely flirtatious, which was out of character. She
is quoted as saying, "I've never felt so great - I'm flying. I'm
eleven on a scale of one to ten."
Rachel's parents were very worried and on the fourth night of
her not sleeping, they took her to the local A&E department,
where she was seen by a psychiatrist who arranged for her to stay
in hospital. A diagnosis of bipolar disorder was confirmed and
treatment was given to bring Rachel's mood back to normal. She now
has treatment to help prevent episodes of both depressed and
abnormally high mood in the future.
She has been working with a community psychiatric nurse to
improve her abillity to recognise her own mood state and take
measures to protect herself from further episodes."
The Young Mind: an essential guide to mental health for young
adults, parents and teachers.