Mental Health Now factsheet: bipolar disorder (previously known as manic depression)

A mental disorder that causes unusual shifts in mood, energy, and activity levels which can swing from one extreme to another. The moods range from periods of extremely elated, and energized behaviour (episodes of mania or hypomania if less severe) to very sad, or hopeless episodes (episodes of depression). Each extreme episode of bipolar disorder can last for several weeks. 

The high and low phases are often so extreme that they interfere with everyday life. Episodes of depression may be experienced more often than episodes of mania and vice versa. 

Symptoms related to a phase of depression include:

• Feeling sad, hopeless or irritable, 
• Lacking energy
• Suicidal thoughts
• Loss of interest in everyday activities
• Feelings of emptiness, worthlessness, guilt, or despair
• Difficulty concentrating or remembering things
• Difficulty sleeping
• Lack of appetite
• Being delusional, having hallucinations and disturbed or illogical thinking

Symptoms related to a phase of mania include:

• Feeling very happy or elated
• Talking very quickly
• Feeling full of energy
• Feeling full of great new ideas and having important plans
• Being easily distracted
• Being easily irritated or agitated
• Not feeling like sleeping or eating
• Being delusional, having hallucinations and disturbed or illogical thinking
• Doing things that often have disastrous consequences like spending lots of money
• Engaging in risky behaviours

For either bipolar depression or mania, a psychological intervention should be offered, either one that has been developed specifically for bipolar disorder, cognitive behavioural therapy, interpersonal therapy, behavioural couples therapy or family based therapy. 

Antipsychotic or mood stabilising drugs can be offered. With appropriate treatment, recovery is likely. 

Support should also be offered for carers of people with bipolar disorder. 

Having a conversation with someone who is struggling with their extremes of mood can be very supportive. Further help can be sought from the person’s GP or Employee Assistance Programme in the first instance. 
Due to the extreme nature of bipolar disorder, support for the person will be necessary to help them stay in a job. 

Relationships may become strained. If you try to help, someone in a manic phase may believe you are being negative or unhelpful, but come back to offer help again another time. 

Stress can trigger mania symptoms so a work environment should be very structured. Hours of working could include avoiding shift work and associated sleep pattern disturbances, or working early or late hours when it is quieter, flexible working from home. 

If predictable, look out for early warning signs to get additional treatment or make lifestyle adjustments. Signs includes difficulty getting to sleep, speaking rapidly, racing thoughts, irritability, and intense boredom. 

• www.bipolaruk.org