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Bipolar disorder is a mental health condition that causes significant changes in mood, energy, activity and behaviour. A person may experience periods of unusually high or irritable mood, known as mania or hypomania, as well as episodes of depression.

These mood changes are more severe and persistent than the ordinary emotional ups and downs everyone experiences. They can affect sleep, judgement, relationships, employment, finances and a person’s ability to manage everyday life.

Bipolar disorder was previously known as manic depression. It is a long-term condition, but treatment can help stabilise moods, reduce the frequency and severity of episodes and support a fulfilling life.

What Is Bipolar Disorder?

Bipolar disorder involves episodes of significant mood disturbance.

During a high episode, someone may experience mania or hypomania. During a low episode, they may experience depression. Some people also have mixed episodes, in which symptoms of high and low mood occur together.

Mood episodes may last for days, weeks or longer. Between episodes, some people have long periods of relatively stable mood, while others continue to experience difficulties.

Bipolar disorder affects everyone differently. The pattern, intensity and frequency of episodes can vary considerably from one person to another.

What Is Mania?

Mania is a period of extremely elevated, energetic or irritable mood that significantly affects everyday functioning.

Someone experiencing mania may feel unusually confident, powerful or capable. They may have very little sleep without initially feeling tired and may speak rapidly or move quickly between ideas.

Possible signs of mania include:

• Feeling extremely happy, excited or irritable
• Having much more energy than usual
• Sleeping very little
• Speaking rapidly or continuously
• Experiencing racing thoughts
• Becoming easily distracted
• Feeling unusually confident or important
• Taking significant financial or personal risks
• Spending large amounts of money
• Driving dangerously
• Making impulsive sexual or relationship decisions
• Starting several projects without completing them
• Becoming argumentative or aggressive
• Experiencing hallucinations or strongly held beliefs that others do not share

A person experiencing mania may not recognise that they are unwell. They may feel better than they have ever felt and resist attempts to obtain support.

However, decisions made during mania can have serious consequences involving finances, employment, relationships, personal safety or the law.

Severe mania may require urgent specialist assessment or hospital treatment.

What Is Hypomania?

Hypomania involves symptoms similar to mania, but they are generally less severe.

A person may feel energetic, confident, sociable and highly productive. They may sleep less, speak more quickly and take on additional activities.

Hypomania may initially feel positive, particularly if it follows a period of depression. However, it can still affect judgement, relationships and decision-making.

The main difference is that hypomania does not usually cause the same level of severe impairment as mania. It does not normally include psychotic symptoms.

Hypomania can still be an important warning sign, especially when the person begins behaving very differently from their usual personality.

Symptoms of Bipolar Depression

A depressive episode can involve persistent low mood and a significant loss of interest or enjoyment.

Symptoms may include:

• Feeling sad, empty or hopeless
• Losing interest in usual activities
• Having very little energy
• Sleeping too much or too little
• Changes in appetite or weight
• Difficulty concentrating
• Feeling worthless or excessively guilty
• Moving or speaking more slowly
• Withdrawing from friends and relatives
• Struggling with work, self-care or household tasks
• Feeling unable to imagine a positive future
• Experiencing thoughts of death, suicide or self-harm

Bipolar depression can be severe and may last for weeks or months. It can be difficult to distinguish from other forms of depression without a detailed history of previous mood changes.

This is one reason why it is important to tell a healthcare professional about any past periods of unusually high energy, reduced sleep, impulsive behaviour or extreme confidence.

Different Types of Bipolar Disorder

Bipolar I Disorder

Bipolar I involves at least one manic episode. Depressive episodes are also common, but they are not required for the diagnosis.

Mania may be severe enough to require hospital treatment or may include psychosis.

Bipolar II Disorder

Bipolar II involves episodes of depression and hypomania rather than full mania.

The term does not mean that bipolar II is a mild condition. The depressive episodes can be prolonged and significantly affect everyday life.

Rapid-Cycling Bipolar Disorder

Rapid cycling describes a pattern in which someone experiences several mood episodes within a year.

NICE guidance covers bipolar I, bipolar II, mixed affective and rapid-cycling forms of the condition.

What Are Mixed Episodes?

During a mixed episode, symptoms of depression and mania or hypomania appear at the same time or change rapidly.

Someone may feel extremely energetic but also hopeless, agitated or suicidal. They may have racing thoughts while feeling emotionally distressed.

Mixed symptoms can be particularly difficult and may require urgent professional support because increased energy can occur alongside suicidal thinking.

What Causes Bipolar Disorder?

The exact cause of bipolar disorder is not fully understood. It is likely to involve several biological, genetic and environmental factors.

Possible contributors include:

• A family history of bipolar disorder
• Differences in brain chemistry and mood regulation
• Severe or prolonged stress
• Traumatic experiences
• Major life changes
• Disrupted sleep
• Alcohol or recreational drug use
• Certain physical health conditions or medications

Having a relative with bipolar disorder does not mean someone will definitely develop it.

Stressful events may trigger an episode in someone who is already vulnerable, but they are not usually considered the sole cause.

What Can Trigger a Mood Episode?

Triggers vary between individuals.

Common triggers may include:

• Several nights of poor sleep
• Working long hours without rest
• Relationship breakdown
• Bereavement
• Financial pressure
• Childbirth
• Major celebrations or life changes
• Stopping medication suddenly
• Alcohol or drug use
• Seasonal changes
• Physical illness

Sleep disruption can be an especially important early warning sign. Someone may begin needing less sleep before other symptoms of mania or hypomania become obvious.

Keeping a mood and sleep record may help identify personal patterns.

How Is Bipolar Disorder Diagnosed?

There is no single blood test or brain scan that confirms bipolar disorder.

Assessment is usually completed by a psychiatrist or another qualified mental health professional. They may ask about:

• Current and previous mood episodes
• Changes in sleep and energy
• Impulsive or risky behaviour
• Depression and suicidal thoughts
• Family mental health history
• Alcohol and drug use
• Medication and physical health
• The effect of symptoms on everyday life

With permission, information from a partner or relative may be helpful because the person may not recognise changes that occurred during a high episode.

Diagnosis can sometimes take time because people often seek help during depression without recognising previous hypomanic symptoms. Other conditions can also cause similar experiences and need to be considered carefully.

Treatment for Bipolar Disorder

Bipolar disorder usually requires long-term treatment from specialist mental health services.

A treatment plan may include medication, psychological therapy, education, lifestyle changes and support for recognising early warning signs. The NHS states that treatment can help manage the condition even though there is currently no cure.

Medication

Medication may be used to treat active episodes and prevent future mood changes.

Depending on the person’s symptoms and medical history, treatment may include:

• Mood-stabilising medication
• Antipsychotic medication
• Medication for bipolar depression
• Short-term medication for severe agitation or sleep disturbance

Lithium is one commonly used mood stabiliser, although it is not suitable for everyone. People taking lithium require regular blood tests because the effective dose and the harmful dose can be relatively close.

Medication choices should be made with a psychiatrist or another qualified prescriber. The benefits, potential side effects, physical health, pregnancy considerations and previous response to treatment should all be discussed.

Do not suddenly stop bipolar medication without medical guidance. Abrupt withdrawal may increase the risk of relapse.

Psychological Therapy

Talking therapies can help someone understand their condition, cope with depression, manage stress and improve relationships.

Cognitive behavioural therapy may help identify unhelpful thoughts and behaviours. Family-focused work can improve communication and help relatives recognise warning signs.

Therapy is usually offered alongside medication rather than as a replacement for appropriate medical treatment. NICE guidance recommends care based on the person’s current mood episode, needs, preferences and relapse risk.

Creating a Relapse Plan

A relapse plan can record:

• Personal triggers
• Early signs of mania or depression
• Medication information
• People to contact
• Actions that have helped previously
• Financial safeguards
• Preferred crisis support
• Circumstances in which urgent help is needed

The plan should ideally be created while the person’s mood is stable and shared with trusted people where appropriate.

Living Well With Bipolar Disorder

Protect Your Sleep

A consistent sleep routine can support mood stability.

Try to maintain regular sleeping and waking times, including at weekends. Speak to a professional if you notice a sudden reduction in your need for sleep.

Monitor Mood Changes

A mood diary can help identify patterns involving sleep, stress, medication, energy and behaviour.

Digital apps can be useful, but a simple paper diary is enough.

Take Medication as Prescribed

Use reminders, pill organisers or support from someone you trust when needed.

Discuss side effects rather than stopping treatment independently. A clinician may be able to adjust the dose or consider another option.

Limit Alcohol and Avoid Recreational Drugs

Alcohol and drugs can disrupt sleep, worsen mood symptoms and interact with prescribed medication.

They may also increase impulsive behaviour during high episodes.

Build a Support Network

Trusted friends and relatives may notice warning signs before you do.

Discuss how they can raise concerns respectfully and what action you would like them to take.

Peer-support groups can also reduce isolation by connecting people with similar experiences.

Protect Finances During High Moods

Someone who overspends during mania or hypomania may benefit from practical safeguards.

These might include lowering spending limits, temporarily giving a trusted person oversight of important accounts or delaying major purchases.

Any arrangement should respect the person’s dignity and be agreed wherever possible.

Supporting Someone With Bipolar Disorder

Learn about the condition and ask the person what support they find helpful.

During depression, practical assistance with meals, appointments and everyday tasks may be useful.

During mania, avoid lengthy arguments about unusual beliefs. Remain calm, reduce stimulation and encourage professional assessment.

Take urgent action when the person is placing themselves or others in serious danger, is experiencing severe psychosis or is unable to care for basic needs.

Supporters also need rest, boundaries and access to their own emotional support.

When to Seek Urgent Help

Urgent help is needed when someone:

• Has suicidal thoughts or a suicide plan
• Has seriously harmed themselves
• Is unable to remain safe
• Is experiencing severe mania or psychosis
• Is behaving in a way that places others in danger
• Is no longer eating, drinking or caring for basic needs

In England, call NHS 111 and select the mental health option when urgent support is required but there is no immediate danger.

Call 999 or attend the nearest accident and emergency department when someone is in immediate danger.

Recovery and Long-Term Management

Bipolar disorder is a serious condition, but many people manage it successfully with consistent treatment and support.

Recovery does not always mean never experiencing another mood episode. It can mean recognising warning signs earlier, reducing the severity of episodes and limiting their effect on everyday life.

A personalised combination of medication, therapy, sleep management, healthy routines and practical support can help people maintain stability.

Bipolar disorder does not define someone’s identity, abilities or future. With appropriate care, people living with the condition can build meaningful relationships, pursue employment and education, and enjoy fulfilling lives.