Bipolar disorder: what it is, the signs and how it is treated

Bipolar disorder is often confused with ordinary mood swings: “I’m so bipolar, my mood changes ten times a day.” In fact it is a specific mental health condition, and it is worth understanding properly, both for people who recognise themselves in it and for their families. I am a psychologist, not a psychiatrist. This article is for information only: diagnosing bipolar disorder and prescribing medication are a psychiatrist’s work. I will explain what the condition is and how a psychologist can help alongside medical treatment.

What bipolar disorder is

Bipolar disorder affects mood, energy, activity and thinking. A person has episodes of depression and episodes of mania or its milder form, hypomania. Between episodes, mood can stay stable for weeks, months or even years. The World Health Organization estimates that about 0.4% of people worldwide live with bipolar disorder.

Signs of mania and hypomania

• an unusually high, elated or irritable mood
• a lot of energy and much less need for sleep, without feeling tired
• fast speech and racing thoughts, jumping from one idea to the next
• inflated self-esteem and grand plans
• risky decisions: big spending, sudden trips, reckless driving

In severe mania a person may lose touch with reality and hold beliefs that others do not share. Hypomania is similar but milder. It can feel like simply a very good spell, which is one reason it often goes unnoticed.

Signs of a depressive episode

Low mood, loss of interest and pleasure, tiredness, changes in sleep and appetite, poor concentration, guilt, hopelessness and sometimes thoughts of death. It counts as an episode when these symptoms last most of the day, nearly every day, for at least two weeks.

Type I and type II in plain words

• Bipolar I: there has been at least one manic episode that lasted at least a week or was severe enough to need hospital care. Depressive episodes usually happen too.
• Bipolar II: there are depressive episodes and hypomania, but never full mania. Type II is not a “milder” version: depressive spells can be long and heavy.

How it differs from ordinary mood swings and from “borderline”

Everyone has ups and downs: a good day, a bad evening. In bipolar disorder, episodes usually last days or weeks, they are a clear change from how the person normally is, and they affect work, relationships and sleep.

Bipolar disorder is also often confused with borderline personality disorder. In borderline personality disorder, moods shift sharply and often, with episodes lasting from a few hours to a few days. In bipolar disorder, an episode is a longer period with changes in energy, sleep and activity. Only a specialist can tell them apart, and sometimes a person has both.

How it is diagnosed

There is no blood test or scan for bipolar disorder. A psychiatrist asks in detail about your mood across your whole life, past episodes, sleep and family history, and often, with your consent, wants to speak to someone close to you. A doctor will also check for physical causes, such as thyroid problems.

A questionnaire cannot identify bipolar disorder: NICE advises against using questionnaires to identify it in primary care. The PHQ-9 test on this site measures symptoms of depression and does not detect bipolar disorder.

If you have ever had spells of unusually high energy, little need for sleep and racing thoughts, tell your doctor before starting an antidepressant. In bipolar disorder antidepressants are generally not prescribed on their own, because they can trigger mania. The choice of medication is always the psychiatrist’s.

Can bipolar disorder be cured?

It is a long-term condition, and in many cases treatment continues for years, often for life. It does not go away for good, but treatment helps people manage symptoms and improves quality of life. Treatment usually combines several things:

• medication prescribed and monitored by a psychiatrist, such as mood stabilisers. Do not stop it on your own, even when you feel well.
• psychological help designed for bipolar disorder: psychoeducation, CBT, interpersonal and social rhythm therapy, work with the family.
• a steady daily routine and enough sleep.

What a psychologist does alongside medical treatment

My role is not to replace the psychiatrist but to work alongside them. As NICE and the NHS describe it, psychological work for bipolar disorder includes:

• Understanding the condition: what an episode is and what treatment does (psychoeducation).
• Recognising your own early warning signs, for example sleeping two hours less than usual, starting lots of projects at once or pulling away from people.
• A plan for staying well: what you and your family do at the first signs, and when it is time to call the doctor.
• A steady routine: regular times for sleep, meals and activity. Lack of sleep, stress, being too busy, long flights across time zones, alcohol and drugs can trigger an episode.
• Support for the family: how to talk, how to help without taking control, and how to look after themselves too.

People with bipolar disorder have a higher risk of suicide. If you or someone close to you is having thoughts of suicide, do not wait: get help from a doctor the same day. If there is immediate danger, call 911.

Where to start

If you recognise yourself or someone close to you in this description, the first step is an assessment by a psychiatrist. If you are not sure where to turn, or you want support for yourself or your family alongside treatment, book a free 15-minute intro video call. I will tell you honestly what I can help with and when it is better to start with a doctor. My sessions are held in Armenian or Russian only, online from any country or in person in Yerevan.