What is bipolar disorder?

Bipolar disorder is a chronic (long-term) condition. It involves intense mood changes that disrupt everyday life — from extreme highs to extreme lows. It affects 1 in 50 Australians each year. Bipolar disorder often develops for the first time during teenage years or early adulthood. It tends to affect more females than males. It is sometimes known as manic depression.

People with bipolar disorder will experience periods of extreme moods at different times:

• Manic (or hypomanic) episodes— feeling very euphoric or high. Hypomania means 'less than mania'. Symptoms of hypomania are like those of a manic episode, but they are less severe and don't last as long. During hypomanic episodes, changes in mood are less severe. This means that they are less likely to affect your functioning at work or with friends.
• Depressive episodes— feeling low, hopeless and very sad.

If you have bipolar disorder, what you experience during each episode (and for how long) can vary. An episode can last for weeks or even months. Your moods may not make sense in the context of what else is going on in your life.

What are the symptoms of bipolar disorder?

A person with bipolar disorder goes through mood changes that range between manic and depressive episodes.

During a manic phase, symptoms may include:

• feeling high, very happy or irritable
• inflated self-esteem or grandiose ideas
• increased energy, activity and creativity, along with a reduced need to sleep
• racing thoughts and speech (talking loudly or over people, jumping from topic to topic)
• being very easily distracted by any stimuli (such as noises or other people)
• impulsive or risky behaviours with spending, business or sexual activity
• unrealistic plans, delusions or hallucinations

During a depressive phase, symptoms may include:

• low mood
• lack of motivation
• a loss of interest in usual leisure activities or hobbies
• changes in sleep patterns
• difficulty concentrating
• withdrawing from social contact and activities
• feelings of worthlessness or guilt, which may include suicidal thoughts

CHECK YOUR SYMPTOMS — Use the Symptom Checker and find out if you need to seek medical help.

What are the different types of bipolar disorder?

Mental health professionals differentiate between 2 main types of bipolar disorder:

• Bipolar I — with extreme, long-lasting highs (mania) as well as depressive episodes. It may also include psychosis (difficulty knowing what is real or not).
• Bipolar II — with highs that are less extreme (hypomania) that only last or a few hours or days, as well as depressive episodes. It will also include periods of normal mood.

Another type of bipolar disorder is cyclothymic disorder. This causes mood changes that are less severe but still impact daily function.

Try the Black Dog Institute's self-test to see if you have symptoms that may indicate bipolar disorder.

What causes bipolar disorder?

The exact cause of bipolar disorder isn't fully understood. A combination of factors can make someone more likely to develop the condition. These include physical, environmental and social factors (including mental stress).

Genetics

In 4 out of 5 people with bipolar disorder, genetics plays a strong role. If one parent has bipolar disorder, there is a 1 in 10 chance their child will also develop the condition. If both parents have bipolar disorder, the likelihood rises to 4 in 10. Medical research is working towards understanding how genes affect your chance of experiencing bipolar disorder.

Chemical imbalances

Bipolar disorder can occur when your body struggles to produce and breakdown certain brain chemicals (neurotransmitters), such as adrenaline, dopamine, acetylcholine, serotonin and GABA (gamma-aminobutyric acid), as well as certain hormones. Brain-imaging studies suggest that structural changes can be seen in the brains of people with bipolar disorder.

Triggers

In some people vulnerable to bipolar disorder, a stressful circumstance or experience can trigger an episode of mania or depression. This may include:

• childhood physical, sexual or emotional abuse
• family conflict
• or other major life-altering events.

Misuse of certain substances such as recreational drugs are also linked to bipolar disorder.

Antidepressants are considered safe for use with bipolar depression. Their use must be closely supervised by a psychiatrist. This is because some people with bipolar disorder may be more likely to experience episodes of mania while they are taking antidepressants.

There is a higher chance of bipolar symptoms being triggered in spring. Some experts think that increased hours of bright sunshine may affect the pineal gland, a part of your brain that helps to regulate sleep.

Females who are predisposed to bipolar disorder are more likely to experience their first episode while they are pregnant or after they have their baby.

How is bipolar disorder diagnosed?

If you're concerned about extreme mood changes in yourself or someone else, it's important to seek support and help. Speak to your GP or mental health professional for an assessment.

Your doctor will ask:

• about your moods
• how long you have experienced them
• and how they affect your daily life

Diagnosing bipolar disorder usually involves a thorough examination of your physical health. This is to rule out a physical cause or other health concerns. It also involves an assessment of your mental state and the careful assessment of your symptoms and life experiences.

FIND A HEALTH SERVICE — The Service Finder can help you find doctors, pharmacies, hospitals and other health services.

How is bipolar disorder treated?

You can treat bipolar disorder effectively but it needs careful and ongoing management. Treatment usually involves long-term medicines. It may also involve psychological therapy and other lifestyle changes.

Initial treatment

Most people with bipolar disorder are first prescribed medicines to stabilise their mood. A doctor will choose and adjust medicines to suit the person's specific needs. Types of medicines might include mood stabilisers and/or antipsychotics.

Electroconvulsive therapy (ECT) is sometimes recommended by psychiatrists. This is only when medicines aren't effective in stabilising someone's mood.

Ongoing treatment

The goal of ongoing treatment is to prevent relapse, build resilience and help to improve quality of life. This may involve one or more of the following medicines:

• antidepressant medicines — may be helpful for a short period of time. It is important that they are only taken in combination with a mood stabiliser for people with bipolar disorders
• lithium, a long-term mood stabiliser
• Anticonvulsant medicines such as valproate, carbamazepine and lamotrigine
• antipsychotic medicines such as olanzapine, aripiprazole, quetiapine and risperidone

To manage bipolar disorder effectively, it's important to take your medicines exactly as directed. Tell your doctor if you're concerned about any side effects. Your doctor may be able to change your treatment or suggest ways to manage the problem.

Therapy

Psychological therapies ('talking therapies') can help to manage bipolar disorder, alongside medicines. These include:

• psychotherapy
• cognitive behavioural therapy (CBT)
• counselling

These therapies can help to reduce the risk of relapse and improve quality of life. During therapy, you may learn how to think differently about events in your life, and respond to them in a helpful way. Therapy can also help you learn how to cope with stressors that may have triggered episodes in the past.

Can bipolar disorder be prevented?

There's no guaranteed way to prevent someone from developing bipolar disorder. But many people manage it successfully with the right treatment and support. A successful strategy may include medicines, therapy and other self-help strategies.

If you have a family history of bipolar disorder, it's important to be aware of early warning signs. Your friends and family need to be aware of them too. Avoid taking substances that can trigger manic or hypomanic episodes such as:

• recreational drugs such as cocaine, ecstasy and amphetamines (also known as amphetamines)
• too much caffeine

Other ways to prevent relapses or episodes include:

• learning to manage your stress
• ensuring you get enough sleep

What are the complications of bipolar disorder?

If left untreated, bipolar disorder can lead to longer and more severe mood changes. For example, episodes of bipolar-related depression can last up to 12 months. Manic episodes can last up to 6 months without ongoing treatment.

Someone living with bipolar disorder may also have a higher risk of the following:

• substance abuse (for example, alcohol or drugs)
• anxiety
• heart and cardiovascular conditions
• diabetes
• unhealthy weight (such as overweight and obesity)
• suicidal thoughts

Some of these problems may need to be managed at the same time as bipolar disorder.

With the right treatment and support, most people with bipolar disorder can live productive and fulfilling lives.

Resources and support

For more information and support, try these resources:

• Call 13 11 14 or visit Lifeline Australia if you need support, 24 hours a day.
• Read testimonies of living with bipolar disorder on the Black Dog Institute website.
• Explore Reachout.com’s curated list of mobile apps and boost your health and wellbeing.
• Head to R U OK? and learn about simple conversations that could change a life.

Other languages

Do you prefer to read languages other than English? Health Translations Victoria has a number of fact sheets about bipolar disorder and mental health in several community languages.