What Is Bipolar Disorder?
Bipolar disorder is a mental health condition characterised by significant shifts in mood, energy, and activity levels. These shifts go far beyond the ordinary ups and downs that most people experience. People with bipolar disorder cycle between episodes of:
- Mania or hypomania — elevated, expansive, or irritable mood; increased energy; reduced need for sleep; rapid thoughts; and sometimes poor judgement
- Depression — low mood, loss of interest, fatigue, and other depressive symptoms
Between episodes, many people feel relatively stable. Bipolar disorder is a long-term condition, but with the right treatment and support, most people lead full and productive lives.
Types of Bipolar Disorder
Bipolar I Disorder
Defined by manic episodes lasting at least 7 days, or manic symptoms so severe they require hospitalisation. Depressive episodes typically last at least 2 weeks. Mixed episodes (simultaneous manic and depressive features) can also occur.
Bipolar II Disorder
Defined by a pattern of depressive episodes and hypomanic episodes (less severe than full mania, without psychosis or the level of impairment that requires hospitalisation). Bipolar II is not a milder form — the depressive episodes can be just as severe.
Cyclothymic Disorder (Cyclothymia)
A milder form involving periods of hypomanic and depressive symptoms that do not fully meet criteria for mania or major depression. Symptoms last at least 2 years.
Symptoms
During a manic episode
- Feeling extremely happy, euphoric, or "high"
- Feeling irritable, aggressive, or sensitive
- Increased energy, activity, and restlessness
- Needing much less sleep than usual without feeling tired
- Racing thoughts or talking very quickly
- Jumping from idea to idea, feeling easily distracted
- Impulsive or risky behaviour (spending sprees, reckless driving, uncharacteristic sexual activity)
- Inflated self-esteem or grandiosity
- In severe episodes: hallucinations or delusions (psychosis)
During a depressive episode
- Persistent sadness, emptiness, or hopelessness
- Loss of interest in things once enjoyed
- Significant changes in appetite or weight
- Sleep disturbances (insomnia or sleeping too much)
- Fatigue and loss of energy
- Feelings of worthlessness or excessive guilt
- Difficulty concentrating or making decisions
- Thoughts of death or suicide
What Causes Bipolar Disorder?
The exact cause is not fully understood, but research points to several factors:
- Genetics: Bipolar disorder runs in families. Having a parent or sibling with the condition increases your risk, though it does not mean you will develop it.
- Brain structure and chemistry: Differences in the way certain brain chemicals (neurotransmitters) and brain circuits function appear to play a role.
- Environment: Stressful life events, trauma, or disrupted sleep patterns may trigger episodes in those who are genetically vulnerable.
Treatment
Bipolar disorder is a long-term condition that usually requires ongoing management. With effective treatment, most people experience fewer and less severe episodes.
Mood-stabilising medication
Medications such as lithium, valproate, and lamotrigine are the cornerstone of bipolar treatment. They help prevent or reduce the severity of both manic and depressive episodes. Antipsychotics are used for manic episodes. Finding the right medication often takes time and close collaboration with a psychiatrist.
Psychotherapy
Therapy does not replace medication for bipolar disorder but is an important complementary treatment. Helpful approaches include:
- Psychoeducation — learning about the condition, recognising warning signs, and developing a wellness plan
- Cognitive Behavioural Therapy (CBT) — addressing unhelpful thought patterns during depressive or hypomanic states
- Interpersonal and Social Rhythm Therapy (IPSRT) — stabilising daily routines (sleep, meals, activity) to help regulate mood
- Family therapy — supporting family members and improving communication
Self-management and lifestyle
- Consistent sleep schedule — disrupted sleep is one of the most common triggers for episodes
- Regular routines — stable daily rhythms support mood stability
- Avoiding alcohol and drugs — substances can trigger episodes and interact with medications
- Recognising warning signs — many people learn their personal early warning signs of an approaching episode and can take action early
- Stress management — stress reduction techniques, exercise, and support networks
Getting a Diagnosis
Bipolar disorder is often misdiagnosed — particularly as depression, since people often seek help during a depressive episode and may not report or recognise hypomanic periods. A thorough assessment by a psychiatrist considers the full history of mood episodes.
If you suspect you may have bipolar disorder, speak to your doctor and be open about the full range of mood experiences — including periods of elevated mood, increased energy, or uncharacteristic behaviour.
Support and Recovery
Living well with bipolar disorder is possible. Many people manage it successfully with a combination of medication, therapy, strong social support, and self-awareness. Peer support groups — including those specifically for bipolar disorder — can also be invaluable.
If you are in crisis or experiencing a severe episode, call 988 (Suicide and Crisis Lifeline), call 911, or go to your nearest emergency room.