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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 disorder (1).
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 features (2):
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 following (2):
Many people also experience symptoms of psychosis, such as hallucinations or delusions, during mania (1).
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 above (2).
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 period (2):
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 disorder (1).
Around 2% of Australian adults experience bipolar disorder each year (3).
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 collaborative (4).
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 recommended (1). 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 CBT (1). 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.
Helpline 1800 18 7263
Bipolar disorder (once called manic depression) is a medical condition which affects the brain, causing extreme mood changes – someone with this disorder may be very ‘high’ and over-excited or very ‘low’ and depressed, often with periods of normal moods in between.
The good news is that Bipolar disorder can usually be successfully treated – most people recover well from episodes of illness and can lead fulﬁlling lives.
No one fully understands the causes but most experts agree that it’s a combination of things including heredity and changes to chemical interactions within the brain. Episodes of mania or depression may be triggered by events which a person vulnerable to Bipolar disorder experiences and finds stressful.
More people than you may think. It’s quite a common condition that affects as many as one in 50 Austalians per year. It happens to people from all ethnic backgrounds. Although it can appear at any age, it’s more likely to develop for the ﬁrst time in the teens or twenties, and tends to affect more women than men.
How long the extreme moods of Bipolar disorder last, and how intense they are, varies a lot from one person to another.
Some people experience mainly ‘highs’, some experience more ‘lows’, while others experience both extremes. 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’. For some people there is a ‘rapid cycling’ between the two states.
There are extreme moods common to Bipolar disorder that include mania, hypomania, depression psychosis.
Sometimes called ‘a manic episode’, mania means the high end of the mood scale.
Symptoms like these can cause real problems at work and in relationships. Sometimes people in this manic stage may need treatment in hospital.
This is like a milder, less extreme form of mania – on a mood scale it lies somewhere between a feeling of normal elation and mania.
To someone experiencing this mood, hypomania may seem really good – they may feel as if they’re functioning well and being very productive. However, it often leads to actions the person later regrets and, without treatment, can lead to severe mania or a switch to depression.
The difference between hypomania and mania is that it tends to be shorter (often lasting less than a week), less disruptive to a person’s social or working life, and not require a stay in hospital.
This is the low end of the bipolar mood scale, but it’s more than normal sadness. People with depression cannot simply ‘snap out of it’. They lose motivation and interest in normal activities or things they used to enjoy.
When someone is in a very extreme mood state – either very manic or very depressed, they may have symptoms of psychosis (sometimes called a ‘psychotic episode’).
Psychosis – a word that’s often misused – simply refers to a condition affecting the mind, which makes a person lose touch with reality. They may have delusions (believing things that aren’t true), which tend to ﬁt the mood that the person is in. If someone is manic, for instance, they may have delusions about being wealthy or powerful, but if they’re very depressed, they may believe they’ve done something wrong, such as committing a crime.
Occasionally some people with Bipolar disorder also have hallucinations – seeing, hearing, tasting or smelling something that isn’t there.
Psychosis is more likely to develop if the person isn’t taking medication regularly.
Medication is just the start . . .
Although Bipolar disorder can’t yet be cured, treatment can do a lot to reduce and even eliminate symptoms.
Combining medication with a healthy lifestyle and support from community services and health professionals can help to keep you well.
Being prescribed one or more drugs with different actions at different times can help you balance your moods.
It’s important to take medication as directed, otherwise your symptoms won’t be controlled as effectively. 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.
These types of medication are prescribed for Bipolar disorder:
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 unwanted side-effects.
Lithium carbonate is a mood stabiliser that many people find helpful, but can sometimes accumulate in the body and cause unwanted (and potentially harmful) effects.
To prevent this, a blood test is repeated regularly during treatment to monitor the lithium concentration and to confirm that the dose is at the right level. People taking lithium long term should also have thyroid, kidney and central nervous system monitoring to ensure there are no problems.
The signs of lithium toxicity are nausea, vomiting and diarrhoea, usually preceded by increasing tiredness, difficulties in concentrating, unsteadiness and increased thirst. If it appears that someone has a toxic reaction, the treating doctor should be contacted immediately. In most cases of toxicity, the lithium will be eliminated from the body within about two days after stopping the treatment.
Other possible side-effects of lithium (when taken at recommended levels) are a ﬁne tremor, muscular weakness and cognitive difficulties such as memory problems.
Antipsychotic medication, prescribed for some people with Bipolar disorder, can also have side-effects. As with other medications, these vary from person to person. They may include drowsiness, weight gain, dry mouth, problems with sexual function, absence of periods, and a fall in blood pressure when standing which can cause dizziness.
Always tell your doctor about any of these unwanted effects, so that you can discuss ways to avoid or manage and minimise them.
Here are some tips on how to get the most from your medication:
Talking to your doctor or another mental health professional can be very worthwhile – besides providing support, it can help you learn ways to cope with problems.
There are different types of ‘talking therapy’, including Cognitive behaviour therapy (CBT) and Interpersonal therapy (IPT).
For further information on the different types of therapies available, see Psychological treatments in the Medication and other Treatments guide.
ECT is an established, safe treatment that can be helpful for severe depression, mania and psychosis in cases where medication doesn’t help.
It works by using electrical stimulation to release brain chemicals that help restore normal functioning to the brain.
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.
The treatment, done in hospital under general anaesthetic, involves passing an electrical current through the brain.
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. Studies show that ECT does not cause any ongoing damage to the brain.
In-patient hospital treatment for mental illness is usually only necessary during periods when someone is very ill.
The chances are that their 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.
If a psychiatrist or other health processional 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 law covering this varies from one State or Territory to another, but the intention is to make sure people have treatment for the sake of 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.
Getting together with other people who have the same diagnosis as you can really help. As well as overcoming isolation, it’s a good way to share useful information and strategies to help you cope.
To ﬁnd a support group in your area: call the SANE Helpline on 1800 18 SANE (7263) or on SANE Helpline Online.
There may be other useful support services in your area too. These include recreational programs, personal helpers and services that provide support to ﬁnd accommodation or jobs, for instance. Ask your case manager for details.
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 a mental illness (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).
Taking positive action against an illness helps minimise the risk of another episode and reduce the effect of symptoms. It also helps people feel good about themselves because it shows they can start to take control of their lives again.
There are a number of ways in which you can take positive action, for example, relieving stress by going for a walk or meditating.
Everyone needs to ﬁnd ways to manage stress – but it’s especially important if you have Bipolar disorder because stress can trigger episodes of illness.
Having Bipolar disorder can sometimes disrupt sleep patterns. Lack of sleep can increase stress and cause problems with mood.
Speed (amphetamines), cannabis, and cocaine can all trigger manic episodes, while heavy use of cannabis can trigger psychosis (heavy use is deﬁned as smoking most days or every day).
Ecstasy’s main ingredient (MDMA) can trigger mania. Another problem with this drug is that its after-effects include depression and sleeplessness – the last things you need when you have a diagnosis of Bipolar disorder.
Benzodiazepines (minor tranquillisers) are also known to trigger episodes of depression or mood swings.
While it’s not clear what effect other party drugs like ketamine (sometimes called ‘Special K’) and GHB, may have on Bipolar disorder, the general advice for anyone with a mental health problem is to leave them alone.
While moderate alcohol intake is unlikely to be harmful (‘moderate’ means two drinks or less for women daily and no more than four drinks daily for men, with several alcohol-free days a week), people with Bipolar who drink heavily may not control their illness well.
The combination of alcohol with antidepressants and antipsychotic drugs may also make you very drowsy – talk to your doctor about how much alcohol is safe for you and what the effects may be.
If you smoke, then giving up cigarettes is a dramatic way to improve your general health and reduce the risk of serious illness (as well as improve your bank balance). While depression can be a temporary side-effect of quitting for some people, don’t let this put you off.
Talk to your doctor or psychiatrist about the best way to quit successfully and safely, avoiding the risk of associated depression.
For more information on drugs in general, please see the Guide to Drugs.
For more information on how to quit smoking, please see the Guide to a Smoking and Mental Illness.
For people affected by Bipolar disorder, it’s even more important to do things that are good for you.
Some people affected by mental illness can be at greater risk of physical health problems such as diabetes and heart disease, because of the effects of symptoms and side-effects of medication as well as lifestyle factors.
For this reason it is important to see a GP regularly and have periodic checks of weight, waist measurement and blood tests for cholesterol, blood sugar, and liver function among others.
The doctor can also advise on a healthy lifestyle, including an improved diet, getting regular exercise, quitting smoking, and sleeping well, for example.
For more information on how to live more healthily, please see the Healthy Living.
After you’ve experienced a few extreme mood swings, you’ll ﬁnd it easier to see them coming.
Signs of mania or hypomania may include having increased energy, feeling like taking on more projects, being more impatient and irritable, and feeling more ‘inspired’ than usual.
Signs of depression may be feelings of anxiety, sleeping more, or ﬁnding it hard to get out of bed in the morning. But it’s also important to know the difference between episodes and the usual ups and downs that we all experience.
It’s normal to feel down for a day or so sometimes, but if the feeling doesn’t go away, talk to your doctor. The same goes for feeling elated – it’s normal when you’ve had some good news or there’s another real reason for it, but not if you stay high as a persistent mood.
It’s not uncommon for people to have thoughts about harming themselves or taking their own life when they’re depressed – just remember that these are only thoughts, that they will pass and there’s no need to act on them.
These thoughts are also a real warning that your treatment needs improving, so talk to your doctor about them as soon as possible. Adjusting medication can help deal with the causes of suicidal thoughts, and psychological treatments can help with strategies to cope with the thoughts if they do arise again.
For more information on how to mange and prevent suicidal feelings, please see our guide to staying alive.
Depression sometimes means you don’t feel like talking to other people. It’s important to ﬁght this feeling because not mixing with others can make the depression worse. Try to make the effort to stay in touch with family, friends and neighbours – you’ll feel better for it.
Living with, or having a close relationship with, someone who has Bipolar disorder can be demanding if they have extreme moods. If they are feeling depressed, it’s important to remember that problems such as having trouble getting out of bed and lack of motivation aren’t laziness, but symptoms of an illness which can be seriously disabling.
During times of mania or hypomania, the person may feel there’s nothing wrong and become angry if you suggest there’s a problem. When the episode has passed, ask them to suggest what’s the most helpful thing you can do when they are becoming unwell.
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 good food, getting regular exercise and making time to relax all help you stay in good shape physically and mentally – 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.
The doctor and any other members of the treatment team should also be able to provide you with support and any relevant information. They sometimes need reminding about this responsibility,
For further information for families or carers of a person with Bipolar disorder, 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 in a crisis for advice on how to help.