Bipolar I disorder: mania, depression and long-term management

NICE Clinical Knowledge Summaries describe bipolar disorder, previously called manic depression, as a serious long-term mental illness usually characterised by episodes of depressed and elated mood and increased activity. Bipolar I is the pattern in which manic episodes occur, while hypomania, a milder high, is the feature that defines bipolar II.

The NHS says the main symptom is extreme change in mood: high moods (mania or hypomania) or low moods (depression), usually lasting a few days or weeks, with stable periods between.

The NHS lists symptoms of high mood, which can be severe (mania) or mild (hypomania).

• feeling very happy and excited, or very irritable or aggressive

• a lot of energy, restlessness, or not needing much sleep

• racing thoughts or being unable to concentrate

• speaking fast or talking a lot, sometimes without making sense to others

• a high sex drive

• feeling overly confident or adventurous

• being impulsive or extravagant, such as spending lots of money

• saying or doing things that are rude, inappropriate or out of character

• hearing things that are not real (hallucinations), believing things that are not true (delusions) or feeling paranoid

The NHS lists low mood symptoms in bipolar disorder: feeling sad or upset, losing interest in usual activities, low energy, difficulty sleeping or sleeping a lot, eating too much or too little, low confidence, feeling worthless or hopeless, difficulty concentrating, avoiding people, and suicidal thoughts or thoughts of harming yourself. NICE CKS says the most important complications of bipolar disorder are suicide and deliberate self-harm.

Other consequences listed by NICE CKS of acute episodes include financial difficulty from overspending, injuries and accidents, sexually transmitted infections and unplanned pregnancy from disinhibition, damage to reputation, income and relationships, self-neglect and exhaustion, exploitation by others, substance misuse and gambling harms.

The NHS says that if a GP thinks you may have bipolar disorder they will refer you to a psychiatrist, who asks about moods, behaviour, health and family history. It can take time to diagnose because it affects everyone differently and symptoms resemble other mental health conditions. NICE CKS says people with suspected bipolar disorder should be referred for specialist assessment, with a risk assessment deciding urgency, and hospital admission arranged urgently if someone is a danger to themselves or others.

The NHS says a specialist works with you on a treatment plan that may include medicines to stabilise moods and talking therapy such as CBT. Some medicines are taken all the time, others only when symptoms worsen, and they can cause side effects that vary by medicine. If there is a risk of self-harm, suicide or harming others, a stay in hospital or crisis team support at home may be needed. Do not stop medicine without medical advice, even if you feel better.

The NHS advice on staying well includes regular 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 where possible, and lots of caffeine. Bipolar UK, Mind and Rethink Mental Illness offer information and support.

NICE CKS includes a scenario for women of childbearing age, because some medicines used for bipolar disorder carry risks in pregnancy; plan pregnancy with your specialist rather than stopping medicine alone.

The exact cause is not known. The NHS says you are more likely to have it if a parent, brother or sister has it, and lists childhood trauma or abuse, stressful events such as relationship problems or bereavement, recreational drugs such as cannabis or cocaine, and the parasite Toxoplasma gondii as things that can increase the chance.

If you or someone else is in crisis, call 999 or go to A&E, or use NHS 111 for urgent mental health advice.