About bipolar disorder
People with bipolar 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 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 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 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 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 disorder.
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 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 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.
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.
Thanks to Dasha Fedchuk, 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.