Bipolar disorder: mood episodes, symptoms, care and support explained

Everyone has ups and downs, but in bipolar disorder the mood changes are much more extreme and can disrupt work, relationships and safety. This article explains the condition using information from the NHS, the US National Institute of Mental Health and the World Health Organization (WHO).

1. Introduction

The NHS describes bipolar disorder as a mental health condition in which a person has extreme mood changes, with episodes that are either high or low and usually last days or weeks ^[1]. The National Institute of Mental Health says it causes clear shifts in mood, energy, activity levels and concentration ^[2]. WHO estimates that about 36 million people worldwide were living with bipolar disorder in 2023, around 0.4% of the global population, and that it mainly affects working-age adults ^[3].

Between episodes, mood may be stable for weeks, months or even years ^[1]. WHO notes that many people are misdiagnosed and that treatment coverage is low ^[3].

2. Types and mood episodes

• Mania is a period of unusually high mood and energy. Hypomania is similar but milder and usually does not severely affect daily life ^{[1, 3]}.
• Depressive episodes involve low mood, loss of interest and other symptoms. WHO says symptoms must last most of the day, nearly every day, for at least two weeks to count as an episode ^[3].
• Bipolar type I involves at least one manic episode, usually together with depressive episodes. Bipolar type II involves hypomanic and depressive episodes but no manic episodes ^[3].

3. Signs and symptoms

During a high mood episode, the NHS lists ^[1]:

• feeling very happy, excited or irritable
• high energy, restlessness and little need for sleep
• racing thoughts, trouble concentrating and fast or excessive talking
• overconfidence, risk-taking and impulsive spending
• in severe cases, hallucinations (seeing or hearing things that are not there), delusions (fixed false beliefs) or paranoia

During a low mood episode, symptoms include sadness, hopelessness, feeling worthless, loss of interest, low energy, changes in sleep and appetite, poor concentration and sometimes thoughts of suicide or self-harm ^{[1, 3]}.

4. Causes and risk factors

The exact cause is not known. The NHS says the risk is higher if a parent or sibling has the condition, and lists other factors such as childhood trauma or abuse, major stressful events and recreational drugs such as cannabis or cocaine ^[1]. WHO says biological (including genetic), psychological and social factors may all contribute, and that events such as bereavement or relationship breakdown can trigger or worsen symptoms ^[3].

5. Diagnosis

The NHS says a GP may refer you to a psychiatrist, who asks about your moods, behaviour, physical health and family history. Diagnosis can take time because symptoms overlap with those of other mental health conditions ^[1]. Only a qualified professional can make the diagnosis.

6. Treatment and management

WHO says effective care usually combines medicines with psychological and social support ^[3]. The doctor decides what is suitable for each person.

• Medicines. Mood-stabilising medicines are used, and some people take them continuously. WHO notes that some need blood tests and monitoring, that side effects need watching and that some are unsafe in pregnancy and breastfeeding ^{[1, 3]}. The NHS says never to stop medicines without medical advice, even when you feel well ^[1]. Tell your doctor if you are pregnant or planning a pregnancy.
• Talking therapy. Cognitive behavioural therapy (CBT), interpersonal therapy and psychoeducation, which means learning about the condition, can reduce depressive symptoms and the chance of relapse ^{[1, 3]}.
• Crisis care. The NHS says that if there is a risk of self-harm, suicide or harm to others, a hospital stay or home support from a crisis team may be needed ^[1].
• Family and community support. Support groups, peer support and family education can help ^[3].

7. Prevention and self-care

The NHS and WHO suggest ways to stay well ^{[1, 3]}:

• Keep a regular routine and good sleep.
• Eat a healthy diet and take regular exercise.
• Learn your personal triggers, such as stress, poor sleep or being overly busy.
• Avoid recreational drugs, heavy drinking, smoking and large amounts of caffeine.
• Where possible, avoid shift work and crossing time zones.
• Try peer support groups, remembering that online comments are not medical advice.

WHO adds that good employment with reasonable adjustments can support recovery and self-esteem ^[3].

8. Living well and rights

WHO states that people with bipolar disorder should be treated with respect and dignity and take part in decisions about their care. Stigma and discrimination can limit access to care, education, work and housing ^[3]. WHO also says people with bipolar disorder die on average about 13 years earlier than the general population. It adds that they are more likely to smoke, use alcohol and have physical conditions such as heart or lung disease ^[3].

9. When to see a doctor

The NHS advises seeing a doctor if mood changes are extreme, long lasting or affect daily life, or if treatment is not helping ^[1]. If you are worried about someone else, encourage them to get help. If you are in distress or having thoughts of suicide or self-harm, reach out for help right now. In India, call Tele-MANAS on 14416. In the United States, call or text 988. You do not have to cope alone. In the United States, the National Institute of Mental Health also says to call 911 in life-threatening situations ^[2].

In an emergency, call your local emergency number (112 in India, 911 in the United States).

10. Conclusion

Bipolar disorder involves episodes of high and low mood that can seriously affect life, yet recovery is possible with appropriate care. Medicines, talking therapy, healthy routines and family support work together, and a psychiatrist guides treatment. If mood changes are extreme or you feel unsafe, seek help without delay.