bipolar, mania, depression, CBT

People with bipolar disorder experience extreme mood swings from periods of overactive, “hyper” or agitated behaviour (manic episodes) to periods of severe depression (depressive episodes). Each mood state can vary in length and frequency lasting between weeks to months, with depressive episodes tending to last longer than manic episodes. The time in between these mood swings can also vary, with some people being well for long periods of time in between episodes.

There are different types of bipolar disorder:

  • Bipolar I: is characterised by manic episodes, often with depressive episodes as well.
  • Bipolar II: is characterised by depressive episodes alternating with a milder form of manic episode referred to as ‘hypomania’.
  • Cyclothymia Disorder: where the cycles between episodes are shorter and the moods themselves are milder.
  • Rapid Cycling: this involves experiencing four or more episodes per year.
  • Mixed states: experiencing depression and elation at the same time.
  • Depression or mania with psychotic symptoms: characterised by symptoms of either severe depression or mania (see below) combined with experiencing symptoms associated with psychosis such as hearing or seeing things that others do not and having thoughts and beliefs that others do not share or that other people are trying to harm you.

There are number of possible causes of bipolar disorder. It can run in families suggesting some genetic links. Those with bipolar disorder are more likely to have experienced traumatic events younger in life. Factors that contribute to bipolar disorder include stressful life events, social factors, sleep problems, psychological factors and physical illness.  It effects men and woman equally and tends to begin when people are in their 20s to 30s but can start earlier.

What are the signs?

Manic episodes
Symptoms may include:

  • feeling euphoric – excessively ‘high'
  • restlessness
  • extreme irritability
  • talking very fast
  • racing thoughts
  • lack of concentration
  • having a lot of energy
  • a reduced need for sleep
  • an exaggerated/grandiose sense of own importance
  • poor judgement
  • excessive and inappropriate spending
  • increased sexual drive
  • risky behaviour
  • misusing drugs or alcohol
  • aggressive behaviour.

Depressive episodes
Symptoms may include:

  • a sense of hopelessness
  • feeling emotionally empty
  • feeling guilty
  • feeling worthless
  • chronic fatigue
  • difficulty sleeping or sleeping too much
  • weight loss or gain
  • changes in appetite
  • loss of interest in daily life
  • lack of concentration
  • being forgetful
  • suicidal thoughts

When is bipolar disorder a problem?

Many people learn to live with their symptoms and episodes effectively and lead successful, fulfilling lives. However, both manic and depressive episodes can be difficult, distressing and cause problems for people in their everyday lives. For example, debt from overspending, impulsive behaviour, feeling suicidal, exhaustion from lack of sleep or food and difficulties in relationships. Bipolar disorder, like all mental health difficulties will affect people in different ways. It can be really helpful to learn how it affects you and when it is impacting on your life to the extent you need extra support.

What helps bipolar disorder?

The first important factor is to be correctly diagnosed. People are often misdiagnosed with depression or personality disorder.  Additionally, physical illness such as overactive thyroid glands can mimic symptoms of mania. Using illicit substances such as cocaine, ecstasy and amphetamines can also cause symptoms similar to mania. Seeking an assessment from your GP or specialist is vital to help you get the appropriate treatment.
The National Institute for Health and Care Excellence (NICE) has guidelines for treating bipolar disorder and suggest psychological interventions during periods of relative stability. These include psychoeducation, learning to monitor your mood, identify early warning signs, relapse prevention, coping strategies, living with bipolar and daily routines. Medication can also be helpful to reduce symptoms but do not provide a cure.

When you should seek help immediately

If you are putting yourself or others at risk, for example overspending, not getting any sleep, not eating, finding yourself in risky situations or start to feel as though life is not worth living you must seek professional support via your GP, Samaritans or local crisis team.