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Bipolar disorder can be a life-long mental health problem that mainly affects your mood. It affects how you feel and your mood can change massively. You can experience episodes of:
You may feel well between these times. When your mood changes, you might see changes in your energy levels or how you act.
Symptoms of bipolar disorder can be severe. They can affect areas of your life, such aswork, school and relationships.
You usually develop bipolar disorder before you are 20. It can develop in later life but it rarely develops after the age of 40.
You can have symptoms of bipolar disorder for some time before a doctor diagnoses you. A doctor might say you have something else such as depression or a personality disorder before you get a bipolar disorder diagnosis.
A diagnosis of bipolar I disorder means you will have had at least 1 episode of mania that lasts longer than 1 week. 90% of people will also have periods of depression. Manic episodes will generally last 3-6 months if left untreated. Depressive episodes will generally last 6-12 months without treatment.
A diagnosis of bipolar II disorder means it is common to have symptoms of depression. You will have had at least 1 period of major depression. And at least 1 period of hypomania instead of mania.
You will experience symptoms of mania or hypomania and depression at the same time.12 You may hear this being called ‘mixed bipolar state’. You may feel very sad and hopeless at the same time as restlessness and being overactive.
Rapid cycling means you have had 4 or more depressive, manic, hypomanic episodes in a 12 month period.
Seasonal pattern means that either your depression, mania or hypomania is regularly affected in the same way by seasons. For example, you may find that each winter you have a depressive episode but your mania does not regularly follow a pattern.
A diagnosis of cyclothymic disorder means you will have experienced regular episodes of hypomania and depression for at least 2 years.
Cyclothymia can develop into bipolar disorder.
Bipolar symptoms can make it difficult to deal with day-to-day life. It can have a bad effect on your relationships and work. The different types of symptoms are described below.
Symptoms of mania can include:
Hypomania is like mania but you will have milder symptoms. Treatment for hypomania is similar to the treatment for mania.
Symptoms of depression can include:
Sometimes you can have psychotic symptoms during a severe episode of mania or depression. Symptoms of psychosis can be:
Psychotic symptoms in bipolar disorder can reflect your mood. For example, if you have a manic episode you may believe that you have special powers, or are being monitored by the government. If you have depressive episode, you may feel very guilty about something you think you have done. You may feel that you are worse than anybody else or feel that you don't exist.
Research suggests that a combination of different things can make it more likely that you will develop bipolar disorder.
You are 5 times more likely to develop bipolar disorder if someone in your immediate family, like a parent, brother or sister, has bipolar disorder. This risk is higher if both of your parents have the condition or if your twin has the condition.
Researchers have not found the exact genes that cause bipolar disorder. But different genes have been linked to the development of bipolar disorder.
Different chemicals in your brain affect your mood and behaviour. Too much or too little of these chemicals could make you develop mania or depression.
Stressful life events can trigger symptoms of bipolar disorder. Such as childhood abuse and the loss of a loved one. They can increase your chances of developing depressive episodes.
The first step to get help is to speak to your GP.
It can help to keep a record of your moods. This can help you and your GP to understand your mood swings. Bipolar UK have a mood diary and a mood scale on their website. You can find their details in the ‘useful contacts’ section at the end of this factsheet.
The first step if you're worried that you have bipolar disorder is to see your GP. Gos don't normally diagnose bipolar disorder. If they share your concerns, then they may refer you to a psychiatrist. Only a psychiatrist should make a formal diagnosis. A psychiatrist is part of the Community Mental Health Team (CMHT). Your GP may arrange an appointment with (CMHT) if you have:
Your GP should refer you to an Early Intervention Team if you have your first episode of psychosis.
Bipolar disorder can be difficult to diagnose because it affects everyone differently. Also, bipolar symptoms can be the same as other mental health problems. It can take a long time to get a bipolar diagnosis, In the meantime, there are things you can try to help yourself.
You can check what treatment and care is recommended for bipolar disorders on the National Institute for Health and Care Excellence (NICE) website.
Mood stabilisers are usually used to manage mania, hypomania and depressive symptoms.
Examples of medications used as mood stabilisers for bipolar disorder include:
Mania and hypomania
You should be offered a mood stabiliser to help manage your mania or hypomania. Your doctor may refer to your medication as ‘antimanic’ medication.
If you are taking an antidepressant your doctor may think about stopping this medication.
You will usually be offered an antipsychotic first. The common antipsychotics used for the treatment of bipolar disorder are:
If the first antipsychotic you are given doesn’t work then you should be offered a different antipsychotic medication from the list above.
If a different antipsychotic doesn’t work then you may be offered lithium to take alongside it. If the lithium doesn’t work you may be offered sodium valproate to take with an antipsychotic. Sodium valproate is an anticonvulsive medication.
Sodium Valproate shouldn’t be given to girls or young women who might want to get pregnant.
Your doctor should think about giving you benzodiazepine medication short term.
Your doctor will use different dosages and combinations depending on what works best for you. Your personal preferences should be listened to.
Your doctor should offer you medication to treat depressive symptoms. You may be offered the following medication:
Fluoxetine is an antidepressant. Lamotrigine is an anticonvulsant medication.
Your doctor can prescribe the above medication alongside: .
Doctors will use different dosages and combinations depending on what works best for you. Your personal preferences should be listened to.
If you have an episode of depression you should be offered a high intensity talking therapy, such as cognitive behavioural therapy (CBT) or interpersonal therapy as well as medication. Read more about therapy.
Bipolar disorder is a life-long and often recurring illness. You may need long term support to help manage your condition.
Your doctor will look at what medication worked for you during episodes of mania or depression. They should ask you whether you want to continue this treatment or if you want to change to lithium.
Lithium usually works better than other types of medication for long-term treatment. Your doctor should give you information about how to take lithium safely. If lithium doesn't work well enough or causes you problems, you may be offered:
Your doctor should monitor your health. Physical health checks should be done at least once a year. These checks will include:
You should be offered a psychological therapy that is specially designed for bipolar disorder. You could have individual or group therapy.
The aim of your therapy is to stop you from becoming unwell again. This is known as ‘relapse.’ Your therapy should help you to:
If you live with your family or are in close contact with them you should also be offered ‘family intervention.’
Family intervention is where you and your family work with mental health professionals to help to manage relationships. This should be offered to people who you live with or who you are in close contact with.
The support that you and your family are given will depend on what problems there are and what preferences you all have. This could be group family sessions or individual sessions. Your family should get support for 3 months to 1 year and should have at least 10 planned sessions.
Your mental health team should give you advice about exercise and healthy eating.
If you want to return to work you should be offered support to help with training or returning to work. You should get this support if your care is managed by your GP or by you community mental health team.
If you can’t work, or haven’t been able to find work at the moment, your healthcare professionals should think about other activities that could help you back to employment in the future.
Your healthcare team should help you to make a recovery plan. The plan should help you to identify early warning signs and triggers that may make you unwell again. And ways of coping. Your plan should also have people to call if you become very distressed.
You should be encouraged to make an ‘advance statement.’ This is an instruction to health professionals about what you would like to happen with your care if you ever lack mental capacity to make your own decisions.
If you are not happy with your treatment you can:
There is more information about these options below.
You should first speak to your doctor about your treatment. Explain why you are not happy with it. You could ask what other treatments you could try.
Tell your doctor if there is a type of treatment that you would like to try. Doctors should listen to your preference. If you are not given this treatment ask your doctor to explain why it is not suitable for you.
A second opinion means that you would like a different doctor to give their opinion about what treatment you should have. You can also ask for a second opinion if you disagree with your diagnosis.
You don’t have a right to a second opinion. But your doctor should listen to your reason for wanting a second opinion.
An advocate is independent from the mental health service. They are free to use. They can be useful if you find it difficult to get your views heard. There are different types of advocates available. Community advocates can support you to get a health professional to listen to your concerns. And help you to get the treatment that you would like. MindWise offer advocacy services – find out more.
You can learn to manage your symptoms by looking after yourself. Self-care is how you take care of your diet, sleep, exercise, daily routine, relationships and how you are feeling.
Making small lifestyle changes can improve your wellbeing and can help your recovery.
Routine helps many people with their mental wellbeing. It will help to give a structure to your day and may give you a sense of purpose. This could be a simple routine such as eating at the same time each day, going to bed at the same time each day and buying food once per week.
Your healthcare professionals should give you advice about diet and exercise.
Sleep can be a particularly important part of self care if you’re living with bipolar disorder. Practicing good sleep hygiene can help you to control your symptoms.
You could join a support group. A support group is where people come together to share information, experiences and give each other support.
You might be able to find a local group by searching online. The charity Bipolar UK have an online support group. They also have face to face support groups in some parts of Northern Ireland. Find your nearest group here.
Recovery colleges offer free courses about mental health to help you manage your symptoms. They can help you to take control of your life and become an expert in your own wellbeing and recovery. You can usually self-refer to a recovery college. There are lots of Recovery Colleges across Northern Ireland. You can find them by searching within your local trust website.
Make a Wellness Recovery Action Plan (WRAP)
Learning to spot early signs of mania or depression is important in self-management. The idea of the WRAP is to help you stay well and achieve what you would like to. The WRAP looks at areas like how you are affected by your illness and what you could do to manage them. You can find guides on completing a WRAP here.
How can I get support?
You can speak to your GP. You should be given your own assessment through the community mental health team to work out what effect your caring role is having on your health and explore what support you need.
You can also contact our Carer Support Service.
Supporting the person you care for
You might find it easier to support someone with bipolar disorder if you understand their symptoms, treatment plan and self-management techniques. You could ask them to share this information with you.
The person that you care for may also have a care plan. This outlines the care that they will get and who is responsible for it. A care plan should always have a crisis plan. A crisis plan will have information about who to contact if they become unwell. You can use this information to support and encourage them to stay well and get help if needed.
Aware supports people who experience depression and bipolar disorder, all across Northern Ireland.
Support for people with bipolar disorder (including hypomania) and their families and friends. They also have a supportive online community
0333 323 3880
0808 808 7777
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