Bipolar Disorder

The assessment of bipolar disorder is complicated and there can be significant delays in individuals receiving a diagnosis due to the complexity involved. Research suggests that it can take on average 6 years for a person to receive a diagnosis after the person first experiences symptoms.

Bipolar experiences are typically initially understood within the context of depression. This is usually due to the fact that depression is the initial mood episode that brings individuals to seek support from mental health services. On the contrary, episodes of hypomania are often experienced as relatively positive by individuals with bipolar symptoms (especially when they occur in the context of recurrent depression) and they are often not raised as a problem during initial encounters with services. In addition, difficulties related to hypomania are often difficult for mental health services to separate from ‘normal’ behaviour or attributed to other potential causes, such as alcohol or substance misuse.

Manic episodes usually begin abruptly and last for between two weeks and four to five months. You might experience some of the following symptoms (though it is unlikely you will experience all of them).

Signs and symptoms of mania:

• Increased energy, activity, and restlessness
• Excessively high, overly good, euphoric mood
• Extreme irritability
• Racing thoughts and talking very fast, jumping from one idea to another
• Distractibility, cannot concentrate well
• Little sleep needed
• Unrealistic beliefs in one’s abilities and powers
• Poor judgement
• Risky behaviour
• Spending sprees
• A lasting period of behaviour that is different from usual
• Increased sex drive
• Abuse of drugs
• Provocative, intrusive, or aggressive behaviour
• Denial that anything is wrong

People with bipolar disorder can experience a milder form of mania known as hypomania (“under mania” or “less than mania”). As the term suggests, the symptoms of hypomania are often less severe and they can resolve after a shorter period of time. However, these episodes can also contribute to the distress experienced by people with bipolar disorder and their families and friends, depending on the circumstances and how they are managed.

Episodes of moderate or severe depression are often more readily recognised by people with bipolar disorder and their families. When people are depressed they can often find it very difficult to manage day-to-day commitments, such as work, relationships, or family events. Depression can make people feel as if they are not worthy of any assistance. This in turn can make it difficult for people to ask for help, which can contribute to further feelings of hopelessness and a sense that things will never get better. When people are feeling very low, they can experience recurrent thoughts that life is not worth living and have thoughts of harming or killing themselves.

If you have had recent thoughts of harming yourself or taking your own life, please see our ‘Urgent Help’ page.

Signs and symptoms of depression

• Lasting sad, anxious, or empty mood
• Feelings of hopelessness or pessimism
• Feelings of guilt, worthlessness, or helplessness
• Loss of interest or pleasure in activities once enjoyed
• Decreased energy, a feeling of fatigue, or being slowed down
• Difficulty concentrating, remembering, or making decisions
• Restlessness or irritability
• Sleeping too much or can’t sleep
• Change in appetite and/or unintended weight loss or gain
• Chronic pain or other persistent bodily symptoms not caused by physical illness or injury
• Thoughts of death or suicide, or suicide attempts

In a ‘Mixed State’, individuals can experience both depression and agitated or elated mood at the same time, with an increase in risk-taking and impulsive ideas as outlined above, occurring at the same time as ideas related to low self-worth and hopelessness about the future. Individuals experiencing a ‘Mixed state’ are in particular, at increased risk of suicide.

Episodes of depression tend to last longer. Like mania or hypomania, episodes of depression often follow stressful life events or other emotional upsets but the presence of such stress is not essential for the diagnosis. It is important to note that depression is very treatable. Please see the link to our depression page for further information. There are particular considerations that are required in the treatment of bipolar depression that you can discuss with your GP or Psychiatrist.

There are ways that you can help you to manage your Bipolar Disorder. Follow the links below to download information about staying well, noting when things are deteriorating and how to cope when not feeling at your best due to your Bipolar Disorder.

It is important to understand that many people are able to self-manage their lifestyle to stay well and to minimise factors that can prevent a Bipolar episode from starting.

Getting help as soon as possible is often key to a speedy recovery, therefore it is vital to be able to identify your early warning signs of a Bipolar Disorder episode.

It is useful to have things to do when you become unwell, and have some general coping strategies in place to lessen the impact of the Bipolar episode.

Should you feel in low mood or depressed there are some depression specific coping strategies, there are also mania specific coping strategies for when your mood is elevated.

Some people are prescribed medication as part of maintaining their well being, or for the treatment of the symptoms experienced as a result of either the low or elevated mood associated with Bipolar Disorder.

Community Mental Health Teams (CMHT) work together with families, carers, and other agencies involved and offer and oversee a range of interventions to help people with Bipolar disorder. In addition to interventions from doctors and psychologists, CMHTs offer input from community psychiatric nurses and occupational therapists. Input offered includes help and support regarding medication, physical health monitoring related to this, advice and direction about mood monitoring and self management, emotional support and coping strategies work, and relapse prevention.

If the information and strategies outlined here are not sufficient for you, it may be that a referral for psychological therapy could be helpful. You can discuss referral for assessment with your GP, Psychiatrist, or key worker within the CMHT.

Psychological therapies (talking therapies) can help people with Bipolar disorder by helping to treat episodes of depression, reduce vulnerability to relapse, and can help people to learn to identify and manage their symptoms of depression and mania early, before they become severe. Our mood states can be driven by our temperaments, the experiences we have in life, and our understandable responses to these experiences. For some people, bipolar disorder is influenced by high ambitions or extreme perfectionistic standards.  For others, they find it difficult to live with the fear and worry about mania or depression returning after they have recovered. For some others, anxiety or previous experience of trauma may impact our mood. An assessment with a clinical psychologist and an individualised understanding of your mood episodes may identify difficulties that could be addressed in psychological therapy.

Helpful rules to follow during a crisis:

• Third party agreement: This refers to an agreement not to make any significant decisions without consulting a third party. The third party is best being your partner or doctor.
• Coping steps: This is a step wise plan of action if you feel you are not coping. It might involve speaking to your partner, making an appointment to see your doctor, beginning your self-monitoring and self-regulation.
• No decisions rule: This is a self-applied rule not to make any decisions without prior consultation.
• Two day delay: This involves agreeing not to do anything for at least two days. If something is a good idea now, it will still be a good idea in 2 days time.

There may well be additional things you have done in the past that are helpful. Try to remember to write them down as reminders:

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Bipolar Scotland is a leading service user group for people who experience bipolar disorder. They actively support self-management approaches within their membership and deliver Self-Management Training Courses. They are active across Scotland and it is very likely there is a regular meeting of this group in your local area. Contact details are available on their website for further information. Self management approaches often involve learning to understand individual mood variation, responses to stress and identify ways of dealing with ups and downs of mood that are helpful or unhelpful. In terms of learning about bipolar disorder, Bipolar Scotland’s ‘Bipolar Disorder – The Essential Guide’ is a useful place to start.

Advance Statements 

Occasionally, people who experience symptoms of bipolar disorder require to access acute mental health care services. Advance statements can be used to specify what forms of treatment you would want to have or avoid during such episodes of care. These are particularly important for individuals who are admitted to hospital in situations where they are deemed to have temporarily lost capacity under the terms of Mental Health (Care and Treatment) (Scotland) Act 2000, further information is available in the Your Rights section.

Bipolar Disorder is often a long-term, relapsing/remitting condition. Seeing someone you care for become unwell during a relapse of bipolar can be very distressing.  People who have bipolar disorder usually have a good understanding of their condition. However, during manic episodes, and severe depression, this insight is often lost.

Seeing someone you care for go through a manic episode can be highly distressing for family, friends and carers. They will act out of character and behave in a way that causes distress to those around them.  It may be possible to talk about this when the episode has been treated and the person is well again.

People with bipolar disorder and their families benefit from maintaining an as stress-free family environment as possible. This is equally important when the person with bipolar disorder is doing well in life as a recurrence of depression or mania can be linked to positive, mixed, or negative life events / scenarios impacting on a whole family. Families who develop a sensitive awareness of bipolar disorder and the person’s individual triggers, early warning signs, and preferred responses from family members can have a significant role in supporting the person with bipolar disorder whilst ensuring family members do not become over-whelmed. Practicing communication skills and how to swiftly solve problems / achieve important goals in the family can be very helpful.

Additional Carer information and advice is available from the Meriden Family Programme, MIND, and Bipolar Scotland

It can be exhausting looking after an unwell relative or friend. Try to take some time away from caring, if possible.

You may also find support and understanding from:

• Your own GP
• A local Carers Group
• On-Line Carers Groups

Further information for carers is available on the NHS Greater Glasgow and Clyde carers site  

NHSGG&C BSL A-Z: Mental Health – Bipolar Disorder

Bipolar disorder is a mental health problem that affects your mood. It is characterised by prolonged changes to the person’s mood. These usually last several weeks or months and are far beyond what most of us experience. The person might experience:

• Periods of feeling very low and down
• Periods of feeling excessively happy and energetic for no apparent reason
• Sometimes the person may have unusual experiences, strange thoughts or might behave out of character during these periods.

These episodes would usually affect the persons day to day life and make it difficult for them to function as they normally would.

Please note that this video is from a range of BSL videos published by NHS Greater Glasgow & Clyde.