Bipolar I disorder: mania, depression, diagnosis and treatment

Bipolar disorder is a mental health condition with extreme mood changes. The NHS describes high moods (mania or hypomania) and low moods (depression), each usually lasting a few days or weeks. NICE explains that a person can have only one or two episodes a year or fewer and be well the rest of the time, while some people have many episodes each year or do not get well between episodes.

Bipolar I is the type in which mania occurs. Bipolar UK says a diagnosis means at least one episode of mania lasting longer than a week, sometimes with psychosis. During mania, NICE says a person may feel very happy and energetic, become so overexcited that they cannot control what they are doing, feel much more confident than usual and take risks they would not normally take. The person often does not realise they are ill during an episode of mania.

The NHS lists the symptoms of high mood and low mood. High moods can be severe (mania) or mild (hypomania).

• Mania: feeling very happy, excited or irritable, a lot of energy, not needing much sleep, racing thoughts, talking fast, feeling overly confident, being impulsive or extravagant, such as spending lots of money, saying or doing things that are inappropriate.

• Psychotic symptoms in severe mania: hearing things that are not real (hallucinations), believing things that are not true (delusions) or feeling paranoid.

• Depression: feeling sad or hopeless, losing interest, low energy, sleeping too much or too little, eating too much or too little, difficulty concentrating, and thoughts of suicide or self-harm.

The NHS says support is available if you or someone you know is having a mental health crisis, and points to urgent help for mental health including NHS 111. If someone is in immediate danger, or has made a suicide attempt or may harm others, call 999 or go to A&E. Bipolar UK notes that someone in a manic episode is seriously unwell and often needs hospital treatment. The NHS says that 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.

The NHS says if a GP thinks you may have bipolar disorder they will refer you to a mental health specialist (psychiatrist), who will ask about your moods, behaviour, health and family history. Diagnosis can take time because symptoms vary between people and are similar to other mental health conditions. Bipolar UK adds that psychiatrists sometimes diagnose a type of bipolar depending on the pattern of moods, and that not all doctors agree on how to categorise types.

A history from family or friends can be very valuable, because during mania a person may not recognise that they are unwell.

The NHS says a mental health specialist will work with you to create a treatment plan. Treatments may include medicines to stabilise moods and talking therapy such as cognitive behavioural therapy. Some medicines are taken all the time and others only when symptoms get worse, and all can cause side effects that vary from person to person. The NHS stresses not to stop taking bipolar medicine unless told to by a doctor, even if you feel better, and warns that some medicines are not safe in pregnancy, so you should talk to your doctor if you are pregnant or planning a pregnancy.

Appointments are usually at a GP surgery, clinic or hospital. If you are at risk of harming yourself or others, hospital admission or a home crisis team may be needed. Bipolar UK says that with the right treatment and support mood swings can be managed and many people can live and function well.

The NHS says it is important to know what can trigger your high and low moods, such as stress, not enough sleep or being too busy. It suggests a regular routine, plenty of sleep, a healthy diet, regular exercise and managing stress, and avoiding recreational drugs, smoking, too much alcohol, shift work or very long hours, flying at night or across time zones, and lots of caffeine.

Early warning signs, such as needing less sleep, are worth sharing with the person who knows you best and with your care team, so that a plan can be put in place before an episode escalates.

The NHS says you will be supported by a mental health specialist or GP and that charities including Bipolar UK, Mind and Rethink Mental Illness offer information and support, including groups and online forums. Bipolar UK says bipolar affects people of all ages and backgrounds, that symptoms are usually first noticeable in teenagers and young adults and that getting a diagnosis can open the door to effective treatment, support and self-management.

On the NHS, care is organised through a GP, community mental health team and psychiatrist, with crisis and inpatient services when needed. Private psychiatry can offer quicker assessment, and some people use it for a second opinion, but because mood stabilisers require monitoring and crisis planning, it is helpful for private and NHS clinicians to share information.