Bipolar disorder is a mental health condition in which mood, energy and activity move between two extremes: episodes of mania or hypomania, when mood and energy are unusually high, and episodes of depression, when they are very low. Between episodes, many people are stable for weeks, months or years.
Key points
- Bipolar disorder brings episodes of mania or hypomania, episodes of depression, and stable periods between them.
- In England, 1.9% of adults screened positive for possible bipolar disorder in 2023/4.
- Bipolar I involves mania lasting longer than a week. Bipolar II involves hypomania and major depression, without full mania.
- Most people present when depressed, so bipolar disorder is frequently diagnosed as depression first.
- In the UK a psychiatrist makes the diagnosis, not a GP.
Symptoms
- Manic or hypomanic: very high or irritable mood, high energy, needing less sleep, racing thoughts, impulsive spending or risk taking.
- Severe mania can also bring hallucinations, delusions or paranoia.
- Depressive: persistent sadness, loss of interest, low energy, disturbed sleep, feelings of worthlessness, thoughts of suicide.
Causes and risk factors
- Genetic factors are significant; a close relative with bipolar disorder raises the risk.
- Childhood trauma and stressful life events; recreational drug use as a possible trigger.
- Disturbed sleep is both a trigger for episodes and a symptom of them.
Treatment
- Mania or hypomania: one of four antipsychotics - haloperidol, olanzapine, quetiapine or risperidone.
- Depression: a psychological intervention designed for bipolar disorder, or medicines such as fluoxetine with olanzapine, quetiapine alone, or lamotrigine.
- Long term: lithium is recommended as first-line, with valproate, olanzapine or quetiapine as alternatives, alongside structured psychological treatment.
When to speak to a professional
- Low mood, loss of interest or low energy has lasted weeks, especially alongside days of unusually high energy or far less need for sleep.
- Ask for an urgent appointment if mania seems to be developing, if depression is severe, or if anyone is at risk.
If you need help now: Samaritans, call 116 123, free, 24/7. Shout, text SHOUT to 85258. NHS 111, then choose the mental health option. Call 999 if anyone is in immediate danger.