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Bipolar disorder (once called manic depression) causes people to experience extreme changes in mood, thinking, energy and behaviour.
Everyone experiences mood swings, or times when we feel joyful or low. But people living with bipolar disorder experience more extreme types of mood changes, that can significantly impact on day-to-day life.
Many people living with bipolar disorder also experience other mental health issues, including anxiety disorders, substance use disorders, personality disorders, and attention-deficit hyperactivity disorder1.
Bipolar and related disorders are characterised by periods of mania (extreme ‘highs’) and periods of depression (extreme ‘lows’). Symptoms usually first appear in late adolescence or early adulthood.
It is quite a diverse condition. Some people may only experience one episode of mania, but others experience more rapid cycles. Many people experience periods of normal mood in between episodes. Some people’s lives are affected significantly, but others experience only minor challenges.
There are three related presentations that share similar features2:
Mania is a period of unusually elevated or irritable mood and activity, lasting at least one week. A manic episode is severe enough to cause difficulties in important areas of life, like work or relationships. Many people experiencing a manic episode need a stay in hospital.
A manic episode involves three or more of the following2:
Many people also experience symptoms of psychosis, such as hallucinations or delusions, during mania1.
Hypomania is like a milder form of mania – it lies between a feeling of normal elation and mania. Hypomania also involves unusually elevated or irritable mood or activity, but it’s shorter (lasting at least four days). It also involves three or more of the symptoms listed above2.
Hypomania involves a clear change in functioning but is less disruptive to a person’s life and does not require treatment or a stay in hospital.
Depressive episodes involve more than ordinary sadness. People with bipolar disorder may experience five or more of these symptoms over at least a two week period2:
If you, or someone you know, are concerned about suicide and need to talk to someone right now, call Lifeline on 13 11 14 or Suicide Call Back Service on 1300 659 467. If life is in danger and you need help immediately, please call triple zero (000).
The causes of bipolar disorder are not fully understood. There seems to be a genetic link, meaning it can run in families. There are also neurological, biological, and environmental factors that contribute to the likelihood of developing bipolar disorder1.
Around 2% of Australian adults experience bipolar disorder each year5.
People with bipolar disorder find different strategies helpful, such as:
Bipolar disorder is a long-term condition, meaning people may need support over time. Ideally, treatment and support decisions should be collaborative4.
It’s a good idea to first talk to a GP. A GP can provide information and referrals for assessment, treatment and support options, and monitor physical health.
Treatment can usually occur in the community, though during episodes of mania, sometimes people may need an inpatient hospital stay. Treatment often involves working with mental health professionals such as psychiatrists, psychologists, and case managers. Treatment can have a range of goals, such as understanding more about bipolar disorder, preventing episodes of mania or identifying them early, and managing different areas of life like work, study, and relationships.
Medication is usually recommended1. Certain medications called mood stabilisers can assist the brain to restore its normal chemical balance and help manage mood changes.
Psychological therapies can help manage symptoms of bipolar disorder, including cognitive behavioural therapy (CBT), family-focused therapy, dialectical behaviour therapy, and mindfulness-based CBT1. Some people also benefit from electroconvulsive therapy (ECT). People living with bipolar disorder can also benefit from community support programs.
The family and friends of someone experiencing bipolar disorder need care and support too — it’s okay for family and friends to set boundaries, and to prioritise their own physical and mental health.
There are many other people out there who share similar experience, and many services designed to help carers of people with mental health issues. Check out our Guide for Families and Friends for more info.
Effective medical, community, and psychological treatment is available, and a person experiencing bipolar disorder can live a fulfilling life.
To connect with others who get it, visit our online Forums. They’re safe, anonymous, and available 24/7.
1. Carvalho AF, Firth J, Vieta E. Bipolar Disorder. N Engl J Med [Internet]. 2020 Jul 1;383(1):58–66.
2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.; DSM-5). In: 5th ed. American Psychiatric Association; 2013.
3. Australian Bureau of Statistics. National Survey of Mental Health and Wellbeing: Summary of Results [Internet]. 2008.
4. Woltmann E, Grogan-Kaylor A, Perron B, Georges H, Kilbourne AM, Bauer MS. Comparative effectiveness of collaborative chronic care models for mental health conditions across primary, specialty, and behavioral health care settings: systematic review and meta-analysis. Am J Psychiatry. 2012;169(8):790–804.
5. Australian Bureau of Statistics. National Study of Mental Health and Wellbeing: 2020-2021. 2022.
www.sane.org
Helpline 1800 187 263
Bipolar disorder (once called manic depression) is a mental health condition which causes extreme mood changes. These include:
For a useful summary of bipolar disorder (including bipolar I disorder, bipolar II disorder, and cyclothymic disorder), check out our factsheet.
How long the symptoms of bipolar disorder last, how often they occur, and how intense they are, varies a lot from one person to another.
On average, people living with bipolar disorder experience more episodes of depression than they do mania or hypomania. This means it is important to understand and access support for depression, not just mania. For some people there is a ‘rapid cycling’ between the two states.
Some people may even experience both high and low moods together – they may be extremely energised, for instance, but feel very depressed and hopeless too. This is called a ‘mixed mood state’.
Some people also experience symptoms of psychosis as part of their bipolar disorder. Psychosis – a word that’s often misused – involves delusions (believing things that aren’t true) or hallucinations (seeing, hearing, tasting or smelling something that isn’t there). They may have delusions (believing things that aren’t true) or hallucinations (seeing, hearing, tasting or smelling something that isn’t there).
Here are some real stories from people with lived experience of bipolar disorder:
There is no ‘cure’ for bipolar disorder, meaning it is a long-term condition. While many people need to manage their symptoms over time, with the right support they can have minimal impact on quality of life.
The good news is that many people with bipolar disorder can recover well from episodes, and can lead long and fulfilling lives. With time, you might understand your symptoms better, figure out which treatment and support options work for you, and learn how to stay well and improve your wellbeing. Many people with bipolar disorder can stay in the workforce, connect with their local community, and have a range of fulfilling relationships.
If you, or someone you care about, is concerned about bipolar disorder, the first step is to speak with a health professional.
A general practitioner (GP) can provide initial assessment and advice. They may then provide a referral to a mental health professional, such as a psychiatrist or a psychologist, who can provide a full assessment and diagnosis, as well as suggest treatment and support options.
It can be helpful to prepare for an assessment by bringing in some notes or dot points.
An assessment for bipolar disorder may involve a combination of the following:
Families and friends are sometimes invited to provide their observations and discuss any concerns.
Unfortunately, assessments for bipolar disorder can be complex.
Sometimes it can be difficult to figure out if a person is experiencing the symptoms of bipolar disorder, or another complex mental health condition. Often people experience co-occurring conditions, which means it can be difficult to understand which conditions are causing symptoms. This is why assessments sometimes take a long time. Some people might be diagnosed with other mental health conditions first.
Bipolar disorder is usually managed through a combination of medication and other treatment and support options – psychological support, support from community services, and looking after your physical health can help to keep you well. This might involve the support of a GP, mental health professionals, and others.
It can take a while to figure out the right combination of treatment and support options for you. It can also take some time to find the right health professionals to support you. This is normal. Remember that it’s okay to ask questions, to explore your options, and to speak up if something doesn’t sit right with you.
Medication
Medication is considered a ‘first line’ treatment for bipolar disorder. This means that most people with bipolar disorder will be prescribed one or more medications which are designed to keep their mood stable. These medications are usually prescribed and monitored by a psychiatrist.
Here are some tips on how to get the most from your medication:
Medications for bipolar disorder
Different types of medication may be prescribed for bipolar disorder, such as:
Side effects
Medications often have side effects, such as muscular weakness, drowsiness, weight gain, and memory problems. It is very important to monitor any potential side effects. For example, if you take lithium in the long term, you will need regular blood tests to monitor the concentration in your bloodstream.
If you have any side-effects from your medication, tell your doctor – they may be able to reduce or change the dosage, or suggest other ways to manage the problem.
It’s important to remember that the same medication can affect people quite differently. In other words, not everyone who takes a particular medication will experience the same side-effects.
Psychological support and talking therapies
Mental health professionals can provide you with psychological therapies. These can be very worthwhile – besides providing support, it can help you learn ways to cope with problems.
There are different types of ‘talking therapies’, including cognitive behaviour therapy (CBT), family-focused therapy, dialectical behaviour therapy, and mindfulness-based CBT interpersonal therapy (IPT), and group therapies. They usually involve:
For further information on the different types of therapies available, see our Psychotherapy fact sheet.
Electroconvulsive therapy (ECT)
ECT is an established, safe treatment that can be helpful for severe depression, mania, and psychosis, sometimes used in cases where other treatments aren’t helping. It works by using electrical stimulation to release brain chemicals that help restore normal functioning to the brain. ECT is given in a hospital under general anaesthetic.
The treatment is usually only given with the consent of the person involved. An exception is when a psychiatrist believes a person is unable to give informed consent and gives the consent for them (but this should only happen after discussing the issue with the person’s primary carer). In some parts of Australia, ECT can’t be given unless two doctors agree that it’s the best approach.
There are not thought to be any long-term adverse effects, apart from memory problems, which are mostly mild and improve with time. These sometimes persist for weeks or (less commonly) months. A headache after treatment is usually gone after a few hours.
Peer support
Connecting with other people who also have bipolar disorder can really help. As well as overcoming isolation, it’s a good way to share useful information and strategies to help you cope.
Peer support can be formal or informal. SANE has a number of peer support services; for more information, call the SANE Helpline on 1800 18 SANE (7263) or check out this page.
Alternative therapies
Some people find alternative therapies such as acupuncture or herbal medicine helpful. If you decide to try an alternative therapy as well as your prescribed treatment, make sure that there will be no harmful side-effects. Some alternative therapies are not recommended for people with mental health conditions (herbal remedies can interact with other drugs, for example) so it is important to discuss using them beforehand with your doctor.
Be wary of anyone who suggests they can cure your condition (when something sounds too good to be true, it usually is too good to be true).
Support in the community
Support programs are available to help people access support in the community, based on their individual needs. You may wish to ask your GP or another health professional for options for employment and educational support, financial support, accommodation support, and social activities.
‘Acute episodes’ are very intense, and can involve mania, depression, or a combination of symptoms. They might not be frequent, but can be challenging to manage. During an acute episode, you might experience symptoms like recklessness, impulsivity, and suicidal thoughts. It’s important not to make any important decisions or life changes until after you have recovered from an acute episode.
Acute episodes can be triggered by a range of things. It’s important to look after yourself to try to prevent these episodes from occurring, including doing what you can to manage your stress levels and get a good night’s sleep – see section 4, Looking After Yourself, for more information.
After you have experienced a few episodes, you will probably start to notice when they are coming on. The early warning signs of mania and depression are sometimes called ‘relapse signatures’. Everyone is individual – you will have your own unique early warning signs.
Learning about your early warning signs, monitoring them, and having a plan, can help you prevent an episode.
Tools and checklists can help you recognise these early warning signs. It’s a great idea to use a diary or an app like eMoods (available for free on IoS and Android) to monitor your mood, sleep, and stress levels. Some common signs for an episode of mania are:
Some common early warning signs for a depressive episode are:
It’s important to know what to do when you, or your family or friends, identify your early warning signs. An action plan can include:
Share this with your family, your GP, and any mental health professionals involved in your support.
You may also wish to look into advance care planning, which involves planning for your future health care in times where you may be unable to communicate your preferences or make treatment decisions. This is a team effort, involving identifying a trusted family member or friend who can make decisions on your behalf, and discussions with healthcare professionals. It also involves completing an Advance Care Directive. Information varies by state – for example, here is information for Victoria and NSW.
It’s not always possible to manage symptoms of an acute episode at home. Often, this requires an inpatient stay at a hospital, to stabilise symptoms and keep you safe.
The chances are that your stay will be as short as possible and in the psychiatric unit of a general hospital, rather than a hospital dealing only with psychiatric illness. In some cases, you may need a longer stay, such as if you are experiencing rapid cycling, or your treatment team are concerned that you might harm yourself.
Treatment might involve trialling new medications, or changing dosage of existing medications. You might also access other treatment and support options such as individual or group therapy, or electroconvulsive therapy (ECT).
Treatment and consent
If a psychiatrist or other health professional recommends someone needs treatment and the person doesn’t agree, they may sometimes be treated without their consent. In some parts of the country, this is known as ‘sectioning’ or ‘scheduling’.
The exact circumstances for involuntary treatment vary between different States and Territories, but in general people receive treatment in this way to ensure their own health or safety, or that of others.
There may be legal limits on how long someone can be treated without their consent, and they may ask to be discharged by a doctor or a body such as a Mental Health Review Board. These facts should be explained to anyone having treatment without their consent.
To learn more about your rights, contact or visit the website of your state’s Office of the Public Advocate.
It’s not uncommon for people to have thoughts about harming themselves or taking their own life when they’re experiencing an acute episode – try to remember that these are only thoughts, that they will pass, and there’s no need to act on them.
These thoughts can also be a real warning that your treatment needs improving, so talk to your doctor about them as soon as possible. Adjusting medication can help manage suicidal thoughts. Plus, psychological therapies can help address causes of the thoughts, and identify strategies to cope if they arise again.
For more information on how to manage and prevent suicidal feelings, please see our guide to support when you're concerned about suicide.
If you, or someone you know, is having suicidal thoughts and is in immediate danger, please call triple zero (000) and ask for an ambulance. Don’t leave the person alone until help arrives.
For help and support, call Lifeline on 13 11 14 or Suicide Call Back Service on 1300 659 467.
This section describes the important things you can do to look after yourself – both by yourself, and with the support of your family, friends, and advice from trusted health professionals. By doing what you can to look after yourself, you are likely to feel more in control, and have a better chance at preventing or reducing the severity of episodes of depression or mania.
Check out our Healthy Living guide for more information on maintaining your wellbeing and physical health.
Everyone needs to find ways to manage stress – but it’s especially important if you have bipolar disorder, because stress can sometimes trigger symptoms.
Some suggestions:
There is a strong link between symptoms of bipolar disorder and sleep. Difficulties with sleep can make you more vulnerable to both depressive and manic episodes, and can also be an early warning sign of mania. Lack of sleep can also increase stress levels, and cause problems with mood.
Some suggestions:
Health guidelines recommend that healthy adults should drink no more than 10 standard drinks of alcohol per week, and no more than 4 on any one day. While moderate alcohol intake is unlikely to be harmful, you might find that alcohol can intensify symptoms and worsen the symptoms of bipolar disorder. Sometimes alcohol can interact in dangerous ways with prescription medications. For some people, not drinking at all is the best and safest option. Talk to your GP or psychiatrist about how much alcohol is safe for you.
If you smoke cigarettes, then giving up cigarettes is a dramatic way to improve your general health. While depression can be a temporary side-effect of quitting for some people, don’t let this put you off. Talk to your GP or a mental health professional about the best way to quit successfully and safely.
Some types of recreational drugs can trigger episodes of depression, mania and psychosis. Others can cause difficulties with sleep – which can also trigger episodes. For these reasons, it is important to avoid them.
Getting regular check-ups
People living with bipolar disorder are at increased risk of physical health issues. For this reason it is important to see a GP regularly. Your GP can help monitor your weight, diet, heart, liver and thyroid function, haemoglobin and glucose levels, and more.
Your doctor can also advise on a healthy lifestyle, including nutrition, exercise, and sleep. For more information, please see the Healthy Living guide.
Depression sometimes means you don’t feel like talking to other people. It’s important to try to push through this feeling – because not spending time with others can make symptoms of depression worse. Try to make the effort to stay in touch with family, friends and neighbours – you’ll feel better for it in the long term.
Connecting with others who also live with bipolar disorder can also help you feel connected and understood. Check out SANE’s Forums and Peer Support options.
Having a close relationship with someone who has bipolar disorder can be challenging at times. It can be difficult to know how to help effectively.
For example, if they are feeling depressed, it can be difficult to motivate them to go to events or socialise, and they might struggle to maintain a friendship or relationship. During times of mania or hypomania, the person may feel there’s nothing wrong and become angry if you suggest there’s a problem. This can cause conflict.
Here are some suggestions for supporting them effectively:
Remember, carers need to look after their own health too. When someone you care about has an extreme emotional state, it’s natural for you to be affected by this.
While caring for the person, try to maintain your own life, interests and feelings. Eating well, getting regular exercise, and making time to relax all help your physical and mental wellbeing – and that makes it easier to cope. This will help you be a better carer, as well as help your own mental health.
Many people find it helpful to be in touch with a carer support group. The SANE Forums provide a safe, moderated online space where people affected by mental illness, as well as family and others carers, can share information and advice and provide mutual support.
For further information, please see our guide for families, friends, and carers.
If you or someone you know experiences a mental health crisis, it can be difficult for others to know what to do. See How to help when someone is suicidal and How to help in a crisis for advice.
If you, or someone you know, is having suicidal thoughts and is in immediate danger, please call triple zero (000) and ask for an ambulance. Don’t leave the person alone until help arrives.
For help and support, call Lifeline on 13 11 14 or Suicide Call Back Service on 1300 659 467.
Australian Government Department of Health and Aged Card (2022) How much alcohol is safe to drink? https://www.health.gov.au/topics/alcohol/about-alcohol/how-much-alcohol-is-safe-to-drink
Beyond Blue (n.d.) Electroconvulsive therapy (ECT). https://www.beyondblue.org.au/mental-health/depression/treatments-for-depression/medical-treatments-for-depression/electroconvulsive-therapy-ect
Carvalho AF, Firth J, Vieta E. Bipolar Disorder. N Engl J Med [Internet]. 2020 Jul 1;383(1):58–66.
Elias A, Thomas N, Sackeim HA. Electroconvulsive therapy in mania: a review of 80 years of clinical experience. American Journal of Psychiatry. 2021 Mar 1;178(3):229-39.
Farren CK, Hill KP, Weiss RD. Bipolar disorder and alcohol use disorder: a review. Current Psychiatry Reports. 2012 Dec;14:659-66.
National Collaborating Centre for Mental Health (2014). Bipolar Disorder: The assessment and management of bipolar disorder in adults, children and young people in primary and secondary care. https://www.nice.org.uk/guidance/cg185/evidence/full-guideline-pdf-4840895629