Patient information from BMJ

Bipolar disorder: what is it?

Last published:Jul 08, 2020

Most of us have ups and downs in our moods. But if you have bipolar disorder, your mood swings are much more extreme and disrupt your daily life. With the right treatments, most people can control their extreme high and low moods.

What happens in bipolar disorder?

Bipolar disorder is a long-term mental health problem. If you have this disorder, your mood swings much further than other people's. Sometimes, you may feel very high and have lots of energy. That is called mania. Other times, you may feel very low. That is called depression.

Both bipolar mania and depression can make it hard to live a normal life. You may find it difficult to hold down a job, for example, or to attend college or university regularly.

And mania and depression can put a big strain on your relationships. But in between the mania and the depression, you may have times when you're in a normal, stable mood. That stable mood can last for weeks, months, or even years.

Bipolar disorder is also called manic depression and bipolar affective disorder.

There are two main types of bipolar disorder. They are called bipolar I and bipolar II.

• Bipolar I means you get bouts of mania and bouts of depression.

• Bipolar II also means you get bouts of mania and bouts of depression. But the mania is milder. It is sometimes called hypomania. Bipolar II is slightly more common than bipolar I.

Ask your doctor: what type of bipolar disorder do I have?

Why has it happened to me?

Doctors don’t know exactly what causes bipolar disorder. It may be to do with your levels of certain 'chemical messengers' that carry signals between different parts of your brain.

Bipolar disorder seems to be linked to your genes, although not everyone who has relatives with bipolar disorder gets it themselves. Also, some people get bipolar disorder without having a family history of the illness.

For some people, certain experiences seem to bring on the first symptoms of bipolar disorder. Or, if you already have bipolar disorder, some experiences may trigger another bout (a relapse). These include:

• stressful situations

• using drugs recreationally, and

• having a baby (if you're a woman).

Ask your doctor: what’s the most likely reason for my bipolar disorder?

What are the symptoms?

The main symptoms of bipolar disorder are periods of mania and depression.

Mania can feel good when it starts. You may:

• feel very creative

• have lots of energy

• feel very happy, and

• get excited about new hobbies and interests.

But this high mood gets out of control. You may turn aggressive and do harmful things.

Mania can make you restless and irritable, with racing thoughts. You may:

• speak very fast

• not sleep

• make impulsive decisions, and

• act in a way that is unusual for you. For example, you may go on a spending spree, or have sex with lots of people, when this is not how you normally behave. 

Some people have mania that is less severe than this. If you have mild mania (hypomania), you may speak quickly, be restless, and jump from one activity to another. But you'll be less out of control than if you had more severe mania.

A bout of mania can start suddenly. If you get full-blown mania and you don't have treatment, it will probably last for at least a week and it could last for several months. Hypomania, by definition, lasts for between four and seven days. 

The symptoms of depression in bipolar disorder are like the ones of depression in people who don't get mania. You may:

• feel sad, hopeless, or guilty

• lose interest or pleasure in things you normally enjoy, and

• have no energy.

Some people even think about killing themselves.

A bout of depression usually lasts for at least two weeks, but it can go on for several months.

Ask your doctor: what symptoms can I expect from bipolar disorder?

What will happen to me?

Most people with bipolar disorder take medicines long term to keep their mood stable. The type of medicine and the dose you take may change, depending on how well you are and what symptoms you are getting.

Most of the time you can keep your symptoms under control by taking medicine. But most people find their symptoms eventually come back (a relapse). It may happen because they stop taking their medicines. Or it may be because the medicines don't work well enough. 

Between bouts of mania and depression, you may not have any symptoms, or you may have low-level symptoms, such as a low mood. With support from your doctor and healthcare team, you may be able to lead a normal life.

Ask your doctor: how can I best keep my symptoms under control?

For more information, ask your doctor for our leaflets on what treatments work for bipolar disorder and how you can prevent a relapse.