Bipolar disorder: symptoms, types, causes and treatment

The NHS says the main symptom is extreme changes to your mood. You sometimes have high moods or low moods, usually lasting a few days or weeks at a time. If you have bipolar disorder, you will usually have times when your mood is stable and you do not have any symptoms, which can last for weeks, months or years.

Bipolar UK describes bipolar mood swings as more extreme than most people's everyday experience of feeling a bit down or happy. It also describes mixed features, sometimes called a mixed state, where symptoms of depression and mania happen at the same time.

The NHS says high moods in bipolar disorder can be severe (called mania) or mild (called hypomania). Bipolar UK describes it as a severe mental illness that causes extreme mood swings and changes in energy levels. It says the typical pattern of a bipolar episode is a period of high mood followed by a period of low mood, and each episode can last from several days to several weeks or months.

Bipolar UK says it affects people of all ages and backgrounds with no differences in how common it is by gender or ethnicity, and estimates that more than one million people in the UK have bipolar, with more than half (56%) of those living with it not having a diagnosis.

The NHS says if a GP thinks you may have bipolar disorder or another mental health condition, they will refer you to a mental health specialist (a psychiatrist). The specialist will ask about your moods, behaviour, health and family history. It says bipolar disorder can take time to diagnose because it affects everyone differently and the symptoms are similar to other mental health conditions.

The NHS says to see a GP if you have extreme changes in your moods that last a long time or affect your everyday life, and encourages you to suggest that someone you are worried about speaks to their GP.

The NHS says bipolar disorder cannot be cured, but there are treatments that can help manage it, and a mental health specialist will work with you to create a treatment plan. Treatments include medicines to help stabilise your moods and talking therapy such as cognitive behavioural therapy (CBT). Some medicines you need to take all the time, others you only take when your symptoms get worse, and medicines can cause side effects that vary depending on the medicine.

The NHS says you will usually have appointments at a GP surgery, clinic or hospital. If doctors are worried you are at risk of self-harm, suicide or harming someone else, you may need to stay in hospital or have support from a crisis team at home. It stresses: do not stop taking your medicine unless you are told to by a doctor, even if you feel better.

NICE says that people with bipolar disorder should have a physical health check at least annually, including weight, blood pressure, blood glucose and lipids, liver, kidney and thyroid function, and that lithium should not be started in primary care for people who have not taken it before, except under shared-care arrangements.

The NHS says it is not known exactly what causes bipolar disorder. You are more likely to have it if you have a parent, brother or sister who has bipolar disorder. Bipolar UK says studies on twins suggest it is mostly a genetic condition, with no single gene responsible.

The NHS lists things that can increase your chances of having it, including the following.

• Childhood trauma or abuse.

• A stressful event such as relationship problems, abuse, the death of someone close to you or money problems.

• Recreational drugs such as cannabis or cocaine.

• A parasite called toxoplasma gondii (which causes toxoplasmosis).

The NHS says it is important to know what can trigger your high and low moods, such as feeling stressed, not getting enough sleep or being too busy. It suggests the following to help keep moods stable.

• Try to have a regular routine and get plenty of sleep.

• Eat a healthy diet and exercise regularly.

• Try to avoid and manage stress.

• Do not take recreational drugs, do not smoke and do not drink too much alcohol.

• Avoid shift work or very long working hours if you can.

• Avoid flying at night or across time zones if you can.

• Do not drink lots of caffeinated drinks such as coffee, tea or cola.

Bipolar UK says bipolar symptoms are usually first noticeable in teenagers and young adults, and research has found that almost 50% of people get symptoms before the age of 21.

NICE says that if bipolar disorder is suspected in primary care in children or young people under 14 years old, they should be referred to child and adolescent mental health services (CAMHS). If you are worried about a child or young person, the NHS says to see a GP.

The NHS says some medicines for bipolar disorder are not safe to take if you are pregnant, so talk to your doctor if you are pregnant or planning a pregnancy. It also says not to stop medicines on your own. NICE points to its guideline on antenatal and postnatal mental health for managing bipolar disorder during pregnancy and the postnatal period.

The NHS says support is available if you or someone you know is having a mental health crisis or emergency, and points to where to get urgent help for mental health. It lists suicidal thoughts or thoughts about harming yourself as a symptom of low mood in bipolar disorder.

If you or someone else is in immediate danger, call 999. If doctors are worried about risk, the NHS says you may need to stay in hospital or have support from a crisis team at home.

On the NHS, bipolar disorder is diagnosed by a psychiatrist after a GP referral, with ongoing care from a mental health team and your GP. NICE sets out annual physical health reviews and shared-care arrangements for medicines such as lithium.

Some people choose to see a private psychiatrist for assessment or review. Medicines for bipolar disorder need monitoring, so make sure your GP and any NHS team know about everything you are prescribed.