Bipolar affective disorder

Learn about bipolar affective disorder, signs to look for, diagnosis and treatment options.
Open / Close All Content
Share:
Found in: Mental Health Conditions
Date: September 2022

About bipolar affective disorder

People with bipolar affective disorder (formerly known as manic depression) find their moods can cycle from overly positive and active (high, also called mania) to very depressed and inactive (low, also called depression). 

Bipolar affective disorder is more than a temporary feeling of being depressed when you are stressed out or of feeling great when something goes really well. With bipolar, these feelings can be extreme and continual.

You can have periods of feeling “normal” – neither unusually high nor low – between episodes, and you might experience a mixture of manic and depressive symptoms within the same episode.

Experiencing bipolar affective disorder can be distressing, and symptoms can make daily life difficult and affect relationships, but it can be managed well with the right mix of strategies.

You may make a full recovery, or you may have symptoms on and off throughout your life. Either way, with treatment and support, you can live a full and positive life.

What causes bipolar affective disorder?

The exact cause of bipolar is unknown. Research suggests that there is a strong genetic link, in particular with close relatives: parents, children and siblings. If someone in your family/whānau has bipolar, there is an increased chance of you developing it. However, no single gene has been found to cause the disorder. 

We also know stressful life events and other factors can trigger bipolar affective disorder in some people. Stressors like unemployment, relationship problems, exams, financial difficulties, racism and other types of discrimination 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 trigger symptoms of bipolar affective disorder.

Symptoms

Signs to look out for (symptoms)

If you have bipolar affective disorder, you will have episodes of depression or mania that last for weeks or months, most days, for most of the day. During this time, the symptoms can fluctuate in severity.

You may also experience mixed moods, alternating between symptoms of mania and depression within the same episode.

Symptoms of depression

Depression can cause you to lose interest in your usual activities, become irritable, or find it hard to concentrate or make everyday decisions. This can also make thinking clearly quite difficult; you may lose confidence, feel excessively guilty and have thoughts of hopelessness, death and suicide.

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. You might find you eat much less, or much more, than usual. Or you might feel restless or that you are moving more slowly than usual.

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
  • sleep disturbances
  • changes in how much you eat
  • changes in the way you move
  • feeling suicidal or trying to hurt yourself – these feelings must always be taken seriously; get help urgently. 

Symptoms of mania

If you experience mania, you might not be distressed by it – you may feel fantastic, especially at the start of an episode. Mania symptoms vary between people, and your own symptoms may also vary over time. Some people experience hypomania, which is a milder version of mania with similar but less intense symptoms.

During a manic episode, your elevated mood can be appealing to others, and you might be the life of the party. You might tell friends you’re feeling great or never been better. However, your behaviour might 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 find you need less sleep or won’t sleep for days, yet are full of energy, and have an increased appetite for food, sex or other pleasurable things. Or you might feel like you can do a lot of things at once without getting tired.

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

You may have an increased sense of self-importance. This 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.

Some people experience psychosis (loss of touch with reality) during manic episodes. You may have hallucinations, seeing or hearing things that aren’t there. Or you may develop beliefs that don’t match reality, for example, that you have a special relationship with a god, the Queen or a famous person, or that you have special powers.

When you are experiencing mania, you may not be aware that it is connected to bipolar. The experience can feel very positive or spiritual, and this might make you less likely to seek support.

Manic episodes may include:

  •  elevated or “high” mood
  •  restlessness
  •  extreme irritability
  •  talking very fast
  •  poor judgement
  •  racing thoughts and ideas
  •  inability to sleep
  •  feeling very important
  • risky behaviour (e.g. excessive use of drugs/alcohol, spending money, aggressive or overly sexualised behaviour)
  • doing things very fast and often (e.g. excessive cleaning)
  • symptoms of psychosis (losing touch with reality).

When does bipolar disorder start?

Bipolar disorder generally begins between the ages of 15 and 40, although it can develop later in life. It is rare for children younger than 15 to be diagnosed with bipolar disorder.

Up to 2% of the adult population are diagnosed with bipolar disorder at some time in their lives. Most people return to their usual level of wellbeing after episodes. 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 may hurt yourself.

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

You will then be assessed by a mental health clinician. Options for care and treatment following a crisis situation are usually discussed in collaboration with your clinician and whānau, and can include:

  • 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 think you may have bipolar affective disorder but are not in a crisis situation, usually the first person you might see is a GP.

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, or if you’ve felt judged or stigmatised in the past.

Your GP can refer you to a psychiatrist or clinical psychologist who can carry out an evaluation for bipolar. Medical tests may also be carried out to rule out other conditions.

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.

People are generally diagnosed with either bipolar I or bipolar II. Bipolar I involves episodes of depression and mania, with the manic symptoms lasting for at least one week. Bipolar II involves epressive episodes and at least one episode of hypomania – a milder form of mania – lasting for at least four days. 

Treatment options

Treatment of bipolar disorder can take many different forms: medication, talking therapies, self-management (helping yourself), having a plan, whānau support and involvement, complementary therapies, cultural supports (e.g. rongoā, kaumatua/kuia, marae/iwi health providers), education sessions, peer support, workshops and sometimes respite care in the community. Usually a combination of these is best.

Medication

Many people with bipolar disorder find that taking prescribed medication regularly is an important factor in keeping stable moods. 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
  • 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”, shaky hands, loss of creativity, feeling “flat”, weight gain and loss of sex drive
  • Advice from friends or relatives 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.

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. There is strong evidence to show that a combination of medication and therapy is more effective than medication alone.

A good therapist who you trust can help you cope with feelings and symptoms, and change behaviour patterns that may contribute to your 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 and 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. The therapist may help you put together a wellbeing plan.

If you are worried you won’t know what to talk about with a therapist, it might help you to make a list of what you’d like to discuss, things that are bothering you, and 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
  • disconnection from cultural identity
  • thoughts of hurting yourself.

Other strategies to support recovery

Complementary therapies 

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and that may be used to complement and support it.

They are not treatments for bipolar, but they may enhance your life and help you to maintain wellbeing.

In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri, rongoā and aromatherapy have all been shown to have some effect in alleviating mental distress.


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 bipolar disorder.

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.


Things that people with bipolar disorder have found helpful: 

  • during a depressive episode, starting small – returning a text message, opening a window, closing your eyes and listening to the birds singing – and slowly building up to bigger things
  • learning about bipolar and reading/listening 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
  • 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
  • cutting back on non-prescribed drugs and alcohol
  • fun: making sure you regularly do things that you enjoy and that give your life meaning
  • being kind to yourself and others
  • using fidget toys as a distraction
  • practices from your own culture (e.g. Māori or Pasifika therapies)
  • writing a “wellbeing plan” (see below).

You could make your own list of the things that help you and keep it on your phone, in 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.


Having a “Wellbeing Plan”

Many people find that having a written plan, developed together with a health professional or another trusted person, can help them to feel they’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 it 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. 

Bipolar affective disorder is often misunderstood, and family/whānau members may be struggling to know how to help. If there are specific things that would help you, try asking for them. For example, if you are feeling depressed, you might say, “It would be really helpful if you folded the laundry/washed the dishes/made me some toast/took the kids out for a bit.”

It may be difficult and distressing for family/whānau and friends to see you experiencing a bipolar episode, and they may need to:

  • seek support for themselves from friends, family/whānau and/or counsellors
  • educate themselves on bipolar disorder
  • get help with understanding what is happening to you
  • learn to set clear boundaries
  • 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 Dasha Fedchuck, clinical psychologist, and members of the Mental Health Foundation's lived experience group for reviewing this content. Date last reviewed: September, 2022.

Thanks also to Sutherland Self-Help Trust for making the 2022 updates possible.