Bipolar affective disorder

Experiencing bipolar disorder can be a challenge, but it can be managed well with the right mix of strategies.
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Found in: Mental Health Conditions
Date: November 2019

Understanding bipolar

People with bipolar disorder find their moods can cycle from overly positive and active (up, also called mania) to very depressed and inactive (down, also called depression).

Bipolar disorder is more than a temporary feeling of being depressed when you are stressed out, or of feeling great when something goes really well. 
The difference with bipolar is these feelings can be extreme and continual, and you can either feel really happy, energetic and “high” or really miserable and depressed, or “low”.  People with bipolar disorder usually experience more lows than highs.

You may have symptoms on and off throughout your life or you may make a full recovery. With treatment and support you will life a happy, full, worthwhile life.

What causes bipolar disorder?

The exact cause of bipolar isn't known, although there is a family tie (genetic inheritance) to bipolar.
If someone in your family/whānau has bipolar, there is an increased chance of developing it. Researchers are still working out exact causes.

In the meantime, we know stressful life events and other factors can trigger bipolar affective disorder in some people. Stresses like unemployment, relationship problems, exams and financial difficulties can be risk factors for some people.
Early trauma (e.g. grief, physical or emotional abuse and neglect), physical illness, lack of sleep and misuse of alcohol, drugs and medications may also  symptoms of bipolar disorder.


Signs of bipolar

The symptoms of bipolar affective disorder fall into three main categories: 
  • symptoms of depression
  • symptoms of mania
  • other symptoms.

Symptoms of depression

Signs of depression may vary. Not everyone with depression will complain of sadness or a persistent low mood. You may have other signs of depression such as sleep problems − difficulty getting to sleep or waking and being unable to get back to sleep as well as feeling constantly tired. Or you might find you eat much less, or much more, than usual.

Depression can cause you to lose interest in usual activities, become irritable, find it hard to concentrate or make everyday decisions. This can also make thinking clearly quite difficult; you may lose confidence, feel excessively guilty for minor wrongs and have thoughts of hopelessness, death and suicide.
Symptoms can include:
  • low or depressed mood
  • a sense of hopelessness
  • lack of energy
  • feelings of guilt or worthlessness
  • inability to concentrate
  • loss of interest in/enjoyment of usual activities
  • feeling suicidal or trying to hurt yourself; these feelings must always be taken seriously: get help urgently
  • sleep disturbances
  • eating problems.

Symptoms of mania

If you experience mania, you might not be distressed by it. You feel fantastic. It’s others around you who see you aren't yourself. Mania symptoms vary, between people and, over time, in one person.

Your elevated mood can be infectious and you might be the life of the party. You'll tell friends you're feeling great or never been better. However, your behaviour will be recognised as excessive by friends or family. You may also be irritable and experience rapidly changing emotions from laughter to tears to anger and back. 

You may also find you need less sleep or won't sleep for days, yet be full of energy and have an increased appetite for food, sex or other pleasurable things. Or you might have a sudden need to spring clean the house, mow the lawn and paint a wall − all in one morning. With severe mania there may also be signs of psychosis (loss of touch with reality). 

Experiencing mania can also change how you process thoughts, or your ability to concentrate. For example, you may feel like your thoughts are racing and friends may notice you constantly changing the topic of conversation or that you are easily distracted.

With these changes comes an increased sense of self-importance that may start out as increased self-confidence that is not realistically in line with your skills, experience or abilities. For example, you might borrow money and start a business in a field where you have no experience.
If the mania is severe, you may lose touch with reality, believing perhaps, that you have a special relationship with a god, the Queen or a famous person or that you have special powers.

A characteristic and early feature of bipolar is the loss of insight − losing awareness that your behaviour and experiences are due to a mental health problem.

Manic episodes may include:
  •  elevated or ‘high’ mood
  •  restlessness
  •  extreme irritability
  •  talking very fast
  •  poor judgement
  •  racing thoughts and ideas
  •  unable to sleep
  •  feeling very important
  •  risky behaviour (e.g. excessive use of drugs/alcohol and spending money, aggressive or overly sexualised behaviour)
  • doing things very fast and often (e.g. excessive cleaning).

Other symptoms

  • Symptoms of psychosis – similar to mania, but more extreme
    As noted under mania, sometimes your thinking may get confused. You may feel like not only do you have a special tie with a famous figure, but that you can control events in the world or have a destiny to save the world. Sometimes these beliefs or voices may take on a more paranoid form. You might believe you are being persecuted, perhaps because of your special powers or status.
  • Mixed mood symptoms
    This is when there is a mixture of symptoms of mania and depression. Mood alternates between high and irritable, and depressed. You may be unable to sleep; be overactive but feel tired; be agitated, and swing between feeling hopeless and feeling overconfident.

When does bipolar disorder start?

Bipolar generally begins between the ages of 15 and 40 years and occurs equally across all cultures.  Diagnosis in children is controversial, but we do know that adults in later life can develop bipolar. 

Up to 2% of the adult population are diagnosed with polar at some time in their lives and around 5% of people may experience milder, but noticeable mood fluctuations. 

Most people return to their usual level of wellbeing after periods of mood changes. Some will have some ongoing symptoms.

If you are in crisis

If you are in crisis, you may feel your world has fallen apart, that everything is black, that nothing makes sense or that you are in danger.

If you are extremely distressed and need immediate help, you or your family can call the mental health crisis team (which every DHB has) or call 111 for an ambulance. 

Either way you will be assessed by a mental health clinician. 

Options for care and treatment following a crisis situation are:
  • support in your own home (i.e. medication management)
  • respite care in a house staffed by mental health or peer workers
  • admission to an inpatient psychiatric ward for assessment and management of your symptoms and distress.

Where can I get help?

If you are not in a crisis situation, usually the first person you might see is a GP. 

It is important to note that to get the right treatment you need to be honest about your moods and what is going on for you. Sometimes this is hard to do particularly if you are worried about what other people think of you. 

There is no test to diagnose bipolar affective disorder. 

A diagnosis is made when you have some or all of the symptoms mentioned above. 

For this reason it is very important for a health professional to get a full understanding of the difficulties you have had, from both you and your family/whānau or others who know you well, if there are any symptoms of mood disorder. 

Before bipolar affective disorder can be diagnosed there must have been symptoms of mania for at least one week. 

If you have previously had depression, bipolar affective disorder is only diagnosed if you have an episode of mania at some point.

Treatment options

Treatment of bipolar disorder can take many different forms: medication, talking therapies, self-management (helping yourself), having a plan, whanau support and involvement, complementary therapies, education sessions, peer support, workshops and sometimes respite care in the community is useful. Usually a combination of these is best.


In treating bipolar, medicines are most often used for making your mood more stable and for helping with depression (anti-depressants). They can also be used to help you sleep.

If you are prescribed medication, you are entitled to know:
  • the names of the medication
  • what symptoms they are supposed to treat
  • how long it will be before they take effect
  • how long you will have to take them for and,
  • the side effects of the medication.

Finding the right medication can be a matter of trial and error.  There is no way to predict exactly how medicines will affect you.  Let your GP know if your medication isn’t working and work together to find the best option.

Sometimes people do not take their medication as prescribed – they may either take a lower dose than prescribed or stop one or all medications entirely.  People may self-medicate and may change their medications without their doctor’s knowledge. 

There are a number of possible reasons for this:
  • The side-effects are too severe – common ones are feeling ‘fuzzy headed’, feeling a loss of creativity and feeling ‘flat’
  • Advice from friends or relatives who may be into ‘natural therapies’ such as ‘You don’t need to take medication – it’s bad for you’
  • Having poor information or a poor understanding about what the medication is supposed to do
  • Feeling better on medication so thinking that they are “all better now and don’t need to take medication”
  • Thinking: ‘I’m not/never have been sick; I don’t need to be on medication. It’s the medication that’s making me feel ill!’
If you’re considering stopping taking your medication or changing your dose, it’s important to talk to a medical professional first. Suddenly stopping some medication can make you feel worse.

It is important to note that to date no complementary or alternative therapies on their own are effective for bipolar (though there is good evidence for benefit from a number of complementary therapies as outlined below as an addition to medication).

If you decide to use alternative therapies as well as medication and other strategies, tell your doctor. 

Many people do find that an important factor in keeping stable moods is taking prescribed medication regularly.

Talking therapies and counselling

Talking therapies (e.g. psychotherapy, or mindfulness therapy or Cognitive Behavioural Therapy – CBT) can be an important part of treatment for bipolar. 

A good therapist who you feel you can trust can help you cope with feelings and symptoms, and change behaviour patterns that may contribute to feeling unwell. 

Talking therapy is not just “talking about your problems”; effective therapies that help people with bipolar disorder typically involve using tools to help get balance into your thinking and feeling an may also involve working toward solutions or working towards accepting your diagnosis. 

Some therapy may involve homework, such as tracking your moods, writing about your thoughts, or participating in social activities that have caused anxiety in the past. 

You might be encouraged to look at things in a different way or learn new ways to react to events or people. 
You might be worried you won’t know what to talk about with a counsellor. 

It might help you to make a list of what you’d like to discuss, things that are bothering you, feelings you’re experiencing. Bring it with you to your appointment. 

The list might include:
  • issues in your family/whānau or other relationships
  • symptoms like changes in eating or sleeping habits
  • anger, anxiety, irritability or troubling feelings
  • thoughts of hurting yourself.

Most counselling and talking therapies are brief and focused on your current thoughts, feelings and life issues. Focusing on the past can help explain things in your life, but focusing on the present can help you cope with the present and prepare for the future.

What can I do to help myself?

You’re the expert in your own mental health and wellbeing. Taking charge of your recovery and doing things that make you feel better, stronger and more in control will help your recovery from depression.

Learning to recognise the early triggers and warning signs of an upcoming episode and knowing what to do to cope will help you maintain your wellbeing and feel more in control of your mental health.

It is also really important to look after your physical wellbeing. 

Make sure you get an annual check-up with your doctor. Being in good physical health is known to help your mental health.  

It can be hard to find the energy or motivation to look after yourself. Start small – return a text message, open a window, close your eyes and listen to the birds singing. Slowly build up to bigger things and try to notice what makes you feel better.

Make a list of things that feel good and keep it on your phone, your diary or on the fridge. When you’re struggling, check your list and pick one thing you can do right now that might help.

These may include:
  • learning about bipolar and read/listen to stories of other people who have found a way through
  • learning your particular early warning signs or triggers by keeping a mood diary
  • identifying and reducing stressful activities
  • ensuring you are eating healthy food
  • using relaxation exercises, yoga, meditation or massage
  • getting enough sleep (this can be difficult for new parents, but sleeping when you can is important)
  • spending time in nature – even just sitting in the sunshine listening to the birds singing for a few moments can be really helpful
  • getting some exercise
  • peer support (e.g. support groups)
  • support from people with the same background as you (if you feel that is important to you e.g. age, ethnic group, sexual orientation)
  • getting support from family/whānau, friends, therapists
  • humour: comedies on TV, funny movies
  • cut back on non-prescribed drugs and alcohol
  • fun: Make sure you regularly do things that you enjoy and that give your life meaning
  • being kind to yourself and others
  • practices from your own culture (e.g. Māori or Pasifika therapies)
  • write a ‘relapse plan’.

Having a “Wellbeing Plan”

Many people find that having a written plan, developed together with your GP/psychiatrist can help you to feel you’re in control if difficult feelings return.

Make sure others (i.e. family/whānau, partners, and community mental health staff) are aware of your plan and what you’d like to happen if you become unwell again.
Plans can detail (in your own words) symptoms, what can trigger depression or mania and what things help you. They can also list the numbers of support people, helplines and more, and outline what you’d like to happen if you need professional support.

Keep your plan in a place that’s easy to find in a hurry – you might even like to write in on your phone or take a photo of it to keep on your phone.

Family/whānau support and involvement

The level of family/whānau support and involvement you need is up to you. 

Family/whānau members may be struggling to know how to help. If there are specific things that would help you, try asking for them. Say: “it would be really helpful if you helped me fold the laundry/washed the dishes/make me some toast/take the kids out for a bit.” 

Remember it may be difficult and distressing for family/whānau and friends to see you feeling so low, and they may need to:
  • seek support for themselves from friends, family/whānau and/or counsellors
  • educate themselves on depression
  • get help with understanding what is happening to you
  • learn to set clear boundaries about behaviour
  • learn to manage their own stress.
Family/whānau can learn to use words that may help you feel supported:
  • “You are not alone in this. I'm here for you."
  • “You may not believe it now, but the way you're feeling will change.”
  • “I may not be able to understand exactly how you feel, but I care about you and want to help.”
  • “You are important to me. Your life is important to me.”
Thanks to Janet Peters, registered psychologist for reviewing this content. Date last reviewed: October 2019