Bipolar disorder

Bipolar moods and symptoms

We all have changes in our mood, but in bipolar disorder these changes can feel very distressing and have a big impact on your life.

You may feel that your high and low moods are extreme, and that swings in your mood are overwhelming. And you may feel and behave very differently, depending on your mood. This can be difficult and confusing.

These swings in mood are sometimes called mood episodes or mood states. Not everyone experiences mood episodes in the same way or for the same amount of time.

This page covers:

• Manic and hypomanic episodes
• Depressive episodes
• Mixed episodes
• Psychotic symptoms
• Stable or neutral periods
• How often do bipolar episodes occur?

Manic and hypomanic episodes

Manic and hypomanic episodes – or mania and hypomania – both mean feeling high. Manic and hypomanic episodes have similarities in how they may make you feel or act. But there are some key differences:

• Severity of symptoms – severe mania is very serious and often requires hospital treatment. Hypomania can noticeably change your mood or behaviour, but it’s less severe than mania
• Impact on your life – manic episodes can impact your ability to do your daily activities – often disrupting or completely stopping them. Hypomanic episodes can disrupt your life, but you may still feel able to work or socialise
• Length of episode – for a mood episode to be classed as mania, it needs to last for a week or more. For hypomania, it needs to last for 4 days or more. But both manic and hypomanic episodes can last much longer than this
• Types of symptoms – you may be more likely to experience severe symptoms with mania, such as more extreme risk-taking behaviours. Manic episodes can sometimes include psychotic symptoms, like hallucinations or delusions. Hypomanic episodes never include these

Both mania and hypomania can be really tough to experience and manage. Whether you experience mania or hypomania, or if you’re not sure what you’re experiencing, it’s always OK to seek support.

Feelings 

During a manic or hypomanic episode, you might feel:

• Happy, joyful or a sense of wellbeing
• Very excited or uncontrollably excited
• Like you can’t get your words out fast enough
• Irritable or agitated
• Increased sexual energy
• Easily distracted – like your thoughts are racing or you can’t concentrate
• Confident or adventurous
• Like you’re untouchable or can’t be harmed (more likely in mania)
• Like you can perform physical and mental tasks better than normal
• Like you need less sleep than usual
• Very focused or determined to complete certain tasks or projects

Behaviours

During a manic or hypomanic episode, you might:

• Be more active than usual
• Talk a lot, speak very quickly, or not make sense to other people
• Be very friendly to others
• Say or do things that are inappropriate and out of character
• Sleep very little or not at all
• Act rudely or aggressively
• Misuse drugs or alcohol
• Spend money excessively or in a way that is unusual for you
• Lose social inhibitions
• Take risks with your safety 

What will I feel like afterwards?

After a manic or hypomanic episode you might:

• Feel very unhappy or ashamed about how you behaved
• Have made commitments or taken on responsibilities that now feel unmanageable
• Have only a few clear memories of what happened during your episode, or none at all
• Feel very tired and need a lot of sleep and rest

Depressive episodes

Depressive episodes are periods of feeling low. They last at least two weeks but can last much longer, sometimes for months. Like manic or hypomanic episodes, they can severely disrupt your everyday life. Severe depression may require medication or a stay in hospital.

Some people find that depressive episodes can feel harder to deal with than manic or hypomanic episodes. The contrast between your high and low moods may make your depression seem even deeper.

Feelings

During a depressive episode, you might feel:

• Down, upset or tearful
• Tired or sluggish
• Uninterested in things you usually enjoy
• Low self-esteem and a lack of confidence
• Guilty, worthless or hopeless
• Agitated and tense
• Like you can’t concentrate on anything
• Suicidal

Behaviours

During a depressive episode, you might:

• Not do things you normally enjoy
• Have trouble sleeping, or sleep too much
• Eat too little or too much
• Misuse drugs or alcohol
• Act withdrawn or avoid social situations
• Spend a lot of time thinking about upsetting or difficult things (also called rumination)
• Avoid contacting or responding to people
• Be less physically active than usual
• Try to self-harm or attempt suicide

If you feel unable to keep yourself safe, it’s a mental health emergency. Get emergency advice.

Mixed episodes

A mixed episode, sometimes called a mixed state, is when you feel both high and low. You may experience symptoms of depression, plus mania or hypomania at the same time. For example, you may feel very energised and impulsive, while feeling upset or tearful. Or you may feel very agitated or irritable.

You may also experience highs and lows very quickly after the other, within the same day or hour.

A mixed episode can be particularly difficult to cope with, as:

• It can be harder to work out what you’re feeling
• It can be harder to identify what help you need
• You might find managing your emotions harder and more exhausting
• Your friends, family or doctor might struggle to know how to best support you
• You may be more likely to act on suicidal thoughts and feelings

If you feel unable to keep yourself safe, it’s a mental health emergency. Get emergency advice.

Psychotic symptoms

Not everyone with a diagnosis of bipolar disorder experiences psychosis, but some people do. It’s more common during manic episodes, but can also happen during depressive episodes.

These kinds of experiences can feel very real to you at the time, which may make it hard to understand other people’s concerns about you.

Psychotic symptoms can include:

• Delusions, such as paranoia
• Hallucinations, such as hearing voices

For more information, see our ages on psychosis.

Stable or neutral periods

It’s common to have stable or neutral periods in between episodes. This doesn’t mean that you have no emotions during this time. It means that you’re not currently experiencing mania, hypomania or depression, or that you’re managing your symptoms effectively.

You might find you feel stable for years in between episodes. Or your periods of stability might be much shorter.

Stable periods can feel like a relief. But they can also feel challenging in their own way. You may feel:

• Happy, calm or relieved
• Worried about becoming unwell again
• Embarrassed or guilty about things you did or said when you were unwell
• Like you have lots to sort out or catch up on
• Like you have to ‘get back to normal life’ straight away
• That you miss elements of your life or personality from when you were unwell
• Unsure about whether to continue with medication or other treatment

How often do bipolar episodes occur?

Bipolar episodes happen at different times for different people. The frequency can depend on a lot of things, such as:

• Your exact bipolar disorder diagnosis
• How well you’re able to manage your symptoms
• How you’d personally define an episode
• Whether certain situations or experiences can trigger episodes. For example, you might find that sleeping very little or going through a stressful life event could trigger a manic episode

The length of mood episodes can also vary. They can last for a few weeks or much longer. What’s normal for you can also change over time.

These experiences can be extremely difficult to cope with while going through them. While you’re feeling stable, it can be helpful to think about the future.

What types of bipolar disorder are there?

Bipolar disorder is often broken down into types and subtypes. Your doctor may diagnose you with a particular type of bipolar disorder. This will depend on how you experience different bipolar moods and symptoms, and how severely they affect you.

Not all medical professionals agree on how to classify or diagnose bipolar disorder. More research in this area is needed.​

You may hear several different words or phrases used to describe types of bipolar. This can be confusing and frustrating. Especially if you feel that your experiences are not being fully understood. Or if you are being told different things by different people.

This page covers:

• Bipolar 1
• Bipolar 2
• Cyclothymia
• Rapid cycling bipolar
• Bipolar with mixed features
• Bipolar with seasonal pattern
• Unspecified bipolar

Bipolar 1

You may get a diagnosis of bipolar 1 if you have experienced:

• At least one episode of mania which has lasted longer than a week
• Some depressive episodes too, although not everyone does

Bipolar 2

You may get a diagnosis of bipolar 2 if you have experienced both of the following:

• At least one depressive episode
• Symptoms of hypomania that have lasted at least four days

Cyclothymia

You may get a diagnosis of cyclothymia if:

• You’ve experienced both hypomanic and depressive mood episodes over the course of two years or more
• Your symptoms aren’t severe enough to meet the diagnostic criteria of bipolar 1 or bipolar 2

Cyclothymia can sometimes develop into bipolar 1 or bipolar 2. Cyclothymia can be a difficult diagnosis to receive. You may feel as though someone is saying your symptoms are ‘not serious enough’, but this isn’t the case. Cyclothymia can seriously impact your life. And mental health is a spectrum that covers lots of different experiences.

Rapid cycling bipolar

You may be told you have bipolar 1 or 2 ‘with rapid cycling’ if you’ve experienced 4 or more depressive, manic or hypomanic or mixed episodes within a year.

This might mean:

• You experience episodes of mania or hypomania, followed by episodes of depression
• You feel stable for a few weeks between episodes. For example, you may cycle between manic episodes and stable periods
• You experience episodes that last months, weeks or days

If you have bipolar disorder, you may experience rapid cycling at certain times in your life and not others.

Currently, rapid cycling is not officially considered a separate type of bipolar disorder. More research is needed about rapid cycling and how best to treat it.

For more information on rapid cycling, see the Bipolar UK website.

If your mood changes quickly within the same day, or the same hour, this is usually classed as a mixed episode, rather than rapid cycling. But some people use the term rapid cycling to describe this experience.

Bipolar with mixed features

You may be told that you have bipolar 1 or 2 ‘with mixed features’ if you experience mixed episodes. This is when you experience depression and mania or hypomania at the same time, or very quickly after each other. This is sometimes called mixed bipolar state or mixed affective bipolar.

Bipolar with seasonal pattern

You may be told that you have bipolar 1 or 2 ‘with seasonal pattern’. This means that the time of year or seasons regularly affect your mood episodes.

Unspecified bipolar

You may hear this if your symptoms don’t quite fit into the diagnostic categories for other types of bipolar disorder.

But this doesn’t mean that:

• Your symptoms are any less difficult
• You don’t need treatment or support

Using any of these terms can help both you and health professionals discuss your diagnosis and treatment more specifically. If they ever use words or phrases you don’t understand, you can ask them to explain.

How is bipolar disorder diagnosed?

This page covers:

• What will my doctor ask me?
• How long will diagnosis take?
• Challenges with getting a diagnosis

What will my doctor ask me?

To make a diagnosis of bipolar disorder, your doctor will ask you about:

• How many symptoms you experience
• Which types of mood episodes you experience
• How long your mood episodes last for
• How many mood episodes you’ve had
• How often your mood episodes occur
• How your symptoms impact your life
• Your family history

They may also:

• Ask you to keep a diary of your moods to help you both identify patterns and triggers
• Check up on your physical health. For example, some conditions like thyroid problems can cause mania-like symptoms

Only a mental health professional like a psychiatrist can give you a bipolar disorder diagnosis – not your GP.

However, if you’re experiencing bipolar moods and symptoms, discussing it with your GP can be a good first step. They can refer you to a psychiatrist, who will be able to assess you.

How long will diagnosis take?

As bipolar disorder involves changes in your moods over time, your doctor may want to observe you for a while before making a diagnosis.

Your doctor will want to be careful that they give you the correct diagnosis. Bipolar disorder has some symptoms in common with other mental health problems, such as:

• Depression
• Borderline personality disorder (BPD)
• Post-traumatic stress disorder (PTSD)
• Schizoaffective disorder
• Post-traumatic stress disorder (PTSD)

Because of this, it might take a long time to get a correct diagnosis – sometimes it can take years.

If you drive, you need to tell the Driver and Vehicle Licensing Agency (DVLA) that you have been diagnosed with bipolar disorder.

For more information on your right to drive, including when and how to contact the DVLA, see Mind’s legal pages on fitness to drive.

Challenges with getting a diagnosis

The symptoms of bipolar disorder can overlap with other mental health problems. Different people may experience or express their symptoms in different ways. And professionals do not always get it right.

Because of this, you might:

• Not get a diagnosis of bipolar disorder when you feel you should have one
• Get a diagnosis of a different mental health problem, which you don’t agree with
• Get a diagnosis of bipolar disorder that you think is incorrect

Even if you think your diagnosis is correct, you may still feel that it doesn’t completely fit your experiences.

If you are unhappy or concerned about your diagnosis, it’s important to discuss this with your doctor. You can make sure your voice is heard, seek a second opinion and take steps if you’re not happy with your doctor.

What causes bipolar disorder?

No one knows exactly what causes bipolar disorder. Research suggests that a combination of factors could increase your chance of developing it. This includes physical, environmental and social conditions.

This page covers:

• Childhood trauma
• Stressful life events
• Brain chemistry
• Family links
• Medication, drugs and alcohol

Childhood trauma

Some experts believe that experiencing a lot of emotional distress as a child can cause bipolar disorder to develop. This could be because childhood trauma and distress can have a big effect on your ability to manage your emotions.

This can include experiences like:

• Neglect
• Sexual, physical or emotional abuse
• Traumatic events
• Losing someone very close to you, such as a parent or carer

Stressful life events

You may be able to link the start of your symptoms to stressful experiences or situations in your life. Some people also find that stress can trigger a mood episode. Or it may make symptoms feel more intense or difficult to manage.

Things that can cause stress include:

• A relationship breakdown
• Money worries and poverty
• Experiencing trauma
• Losing someone close to you
• Being abused, bullied or harassed, including experiencing racism
• Feeling lonely or isolated
• Lots of change or uncertainty
• Feeling under pressure while working, studying or looking for work
• Big events, such as weddings or holidays

For more information on the links between stress and mental health, see our pages on managing stress.

Brain chemistry

Evidence shows that you can treat bipolar symptoms with certain psychiatric medications which act on the neurotransmitters. These are the ‘messenger chemicals’ in your brain.

This suggests that bipolar disorder may relate to functional problems of the neurotransmitters. While some research supports this, no one knows for sure how these neurotransmitters work. And we don’t know whether problems with these are a cause of bipolar disorder, or a result of it.

Family links

If you experience bipolar disorder, you’re more likely to have a family member who also experiences bipolar moods and symptoms. But they might not have a formal diagnosis. This suggests that bipolar disorder can be passed on genetically through families.

But this doesn’t strictly mean that there is one ‘bipolar gene’. Family links are likely to be much more complex.

For example, researchers think that social factors can also trigger experiences of bipolar disorder symptoms. And family members can be an influential part of your environment as you grow up.

Medication, drugs and alcohol

Medication, drugs and alcohol may cause you to experience some bipolar moods and symptoms. For example:

• Medication – some medications can cause hypomania or mania as a side effect. This can happen when you’re taking them, or as a withdrawal symptom when you stop taking them. This includes medications for physical conditions and psychiatric medications – including some antidepressants. Depression can also be a side effect of a lot of different medications. It’s important to discuss any concerns about medication side effects with your doctor
• Alcohol or recreational drugs – using these can cause you to experience symptoms similar to mania, hypomania or depression. It can often be difficult to distinguish the effects of alcohol and drugs from mental health symptoms

Some studies suggest that using certain recreational drugs can increase your risk of developing bipolar disorder. But the evidence is very limited.

If you’re worried about the effects of medication, alcohol or recreational drugs on your mental health, it’s important to discuss it with your doctor.

For more information, see Mind’s pages on antidepressants and our page on the mental health effects of alcohol and recreational drugs. 

Treatment for bipolar disorder

The two main types of treatment for bipolar disorder are medication and talking therapies. The exact combination of treatments offered will depend on whether you’re managing a current mood episode, or managing your mental health in the longer term.

This page covers:

• What treatment could help me manage a current episode?
• What treatment could help me in a crisis?
• What treatment could help me in the longer term?
• Talking therapies for bipolar disorder
• Electroconvulsive therapy for bipolar disorder

See below for information on medication for bipolar disorder to find out more about the different types of medication you may be prescribed.

What treatment could help me manage a current episode? 

Your treatment for a bipolar usually depends on what kind of episode you’re experiencing.

During depressive episodes:

• Your doctor is likely to offer you medication. This might be new medication or a change to your current bipolar medication
• Your doctor might offer you a structured psychological treatment that’s used to treat depression, such as cognitive behavioural therapy (CBT)

During manic or hypomanic episodes:

• Your doctor is likely to offer you medication. This might be new medication or a change to your current bipolar medication
• Your doctor is unlikely to offer a talking treatment if you’re currently experiencing a manic or hypomanic episode

See our pages depression or hypomania and mania for more information on these treatments, and tips for taking care of yourself.

What treatment could help me in a crisis?

You may need to access crisis services if:

• You start to feel very unwell
• A mood episode is lasting for a long time
• Your regular treatment isn’t helping

Crisis services may include:

• Emergency support, such as going to A&E
• Support from a crisis resolution and home treatment (CRHT) team
• Hospital admission

For more information about your options in a crisis, see Mind’s pages on crisis services.

What treatment could help me in the longer term?

Long-term treatment aims to help you maintain stable moods and manage your symptoms. As you start to feel more stable, most of your support could come from a community mental health team or your GP. But your GP should also put you in touch with a mental health specialist.

Health professionals should work with you to help you identify:

• Clear emotional and social recovery goals – you can work towards these, regularly reflect on them and revise them with your doctor
• A crisis plan – this helps you know what to do if you experience any of your early warning signs or triggers, or start feeling very distressed
• How you feel day-to-day – it helps to be aware of how best to manage your mood and notice any changes
• A medication plan – this includes dates where you can review your dose, how well the medication is working and any side effects

If you’re receiving a talking therapy, you might set some of these goals with your therapist. You should share these goals with your GP. You may also want to share them with others in your life, such as your family, friends, partner or carer.

Talking therapies for bipolar disorder

Your doctor might offer one of several talking therapies to help you manage bipolar disorder in the longer term. These could include:

• Cognitive behavioural therapy (CBT) – looks at how your feelings, thoughts and behaviour influence each other and how you can change these patterns
• Interpersonal therapy – focuses on your relationships with other people. Looks at how your relationships affect your thoughts, feelings and behaviour – and how they affect your relationships
• Behavioural couples therapy – focuses on recognising and trying to resolve emotional problems between partners
• Individual psychoeducation – involves a brief intervention helping you to identify triggers, spot warning signs and develop coping strategies
• Group psychoeducation – involves working in a group of people with shared experiences. Aims to build knowledge about bipolar disorder and self-management. It is led by a trained therapist
• Family-focused therapy – involves working as a family to look at behavioural traits, identify risks and build communication and problem-solving skills

Some of these treatments are more widely available than others. It can also depend on what you and your doctor agree would be most useful for you.

How can talking therapies help in the longer term?

In the longer term, talking therapies for bipolar disorder can help you to:

• Understand, make sense of, or find meaning in your bipolar disorder
• Reflect on the impact of bipolar disorder throughout your life
• Identify early warning signs and symptoms
• Develop strategies to cope with early symptoms, triggers and episodes
• Make a crisis plan
• Set goals and plans for staying well

Electroconvulsive therapy for bipolar disorder

Doctors should only consider electroconvulsive therapy (ECT) as a treatment option for bipolar disorder in extreme circumstances.

The National Institute for Health and Care Excellence (NICE) produces guidelines on best practice in healthcare. It advises that doctors could consider ECT if you meet both of the following criteria:

• You’re experiencing a long and severe period of depression, or a long period of mania
• Other treatments have not worked, or the situation is life-threatening

If you feel like you’re in this situation, you should discuss it with your doctor. They must explain ECT in a clear and accessible way before you make any decisions.

Medication for bipolar disorder

If you get a diagnosis of bipolar disorder, it’s likely that your psychiatrist or GP will offer you medication.

This page covers:

• What will my doctor need to know?
• Antipsychotics
• Lithium
• Anticonvulsants
• Antidepressants

What will my doctor need to know?

To help decide which medication to offer, your doctor might need to look into factors such as:

• Your current symptoms – for example, if you’re currently experiencing a manic, hypomanic, depressive or mixed episode
• Your past symptoms – such as the types of mood episodes you have experienced, and how long they have lasted
• How you’ve responded – to treatments in the past
• The risk of another episode – this could include what has triggered episodes in the past
• Your physical health – in particular if you have kidney problems, weight problems or diabetes
• How likely you are to stick to a medication routine
• Your sex and age – in particular whether you are able to become pregnant
• In older people, a test of mental processes – for example, the test used to diagnose dementia

Before you take any medication

Before you decide to take any medication, make sure you have all the facts you need to feel confident about your decision.

For guidance on what you might want to know before taking any medication, see Mind’s pages on:

• What you should know before taking any psychiatric medication
• Receiving the right medication for you
• Your right to refuse medication

Antipsychotics for bipolar disorder

If you’re currently experiencing a manic or hypomanic episode, your doctor is likely to prescribe you an antipsychotic.

Your doctor is also likely to prescribe antipsychotics if you experience psychotic symptoms in an episode of mania or severe depression.

The National Institute for Health and Care Excellence (NICE) – the organisation that produces guidelines on best practice in healthcare – recommends the following antipsychotics:

• haloperidol – also known as Dozic, Haldol, Haldol Decanoate, Serenace
• olanzapine – also known as Zalasta, Zyprexa, ZypAdhera
• quetiapine – also known as Atrolak, Biquelle, Ebesque, Seroquel, Tenprolide, Zaluron
• risperidone – also known as Risperdal, Risperdal Consta

If your first antipsychotic doesn’t work, your doctor might offer another from the list above. If the second doesn’t work, your doctor might offer lithium to take together with an antipsychotic.

If you take an antipsychotic, you’ll need to have regular health checks with your doctor.

For more information, see Mind’s pages on antipsychotics.

Lithium for bipolar disorder

Your doctor might prescribe lithium as a long-term treatment for bipolar disorder. It can help to:

• Prevent mood episodes
• Reduce the risk of experiencing severe mania or recurring depression
• Reduce the risk of experiencing suicidal feelings or self-harm

It’s typically a long-term treatment, usually prescribed for at least six months. For lithium to be effective, the dosage must be correct. You’ll need regular blood and health checks while taking lithium, to make sure the levels are right for you.

For more information, see Mind’s page on lithium.

Anticonvulsants for bipolar disorder

Three anticonvulsant drugs, used as mood stabilisers, are licensed to treat bipolar disorder:

• carbamazepine – also known as Tegretol. This is sometimes prescribed to treat episodes of mania. It can be prescribed if lithium is ineffective or unsuitable for you. For more information, see Mind’s page on carbamazepine
• valproate – also known as Depakote, Epilim. This can be used to treat episodes of mania and is typically a long-term treatment. It can be prescribed if lithium is ineffective or unsuitable for you. Your doctor is unlikely to prescribe you valproate if you’re able to become pregnant. This is because it can lead to significant risks in pregnancy. The Medicines and Healthcare products Regulatory Agency (MHRA) is updating its recommendations on the use of valproate. But if you’re currently taking valproate, it’s important to continue taking it unless your doctor tells you otherwise. For more information, see Mind’s page on valproate
• lamotrigine – also known as Lamictal. This is licensed to treat severe depression in bipolar disorder, but NICE does not recommend it for treating mania. If you’re pregnant and taking lamotrigine, NICE recommends regular check-ups. For more information, see Mind’s page on lamotrigine

For more information, see Mind’s pages on mood stabilisers.

Antidepressants for bipolar disorder

Your doctor might offer you a type of antidepressant medication, such as selective serotonin reuptake inhibitors (SSRIs). Antidepressants might be offered in combination with one of the medications described above.

Remember: always check with your doctor or pharmacist before taking any medications together, or closely following one another. The medications could interact badly with each other.

For example, combining lithium with SSRIs can increase the risk of side effects like serotonin syndrome.

For more information, see Mind’s pages on antidepressants.

Self-management for bipolar disorder

Bipolar disorder can make you feel like you have little control. However, there are lots of things you can do to manage your symptoms and improve your wellbeing.

This page covers how you can:

• Get to know your moods
• Take practical steps
• Look after your physical health
• Build a support network

Get to know your moods

Learning how to understand your moods could help you find ways to manage them. These tips may help:

Monitor your mood

You might find it helps to keep track of your moods over a period of time. You could try noting down mood patterns in a diary or on your phone. Bipolar UK has a mood scale and mood diary, which are free to use.

Understand your triggers 

You might find it helps to understand what can trigger changes in your mood. Triggers are different for different people. Some examples include:

• Feeling overwhelmed or busy
• Stressful periods
• Significant life events, like weddings, having a child or losing a loved one
• Periods of change or uncertainty
• Lack of sleep
• Other physical or mental health issues
• Changes or problems with your treatment for bipolar disorder

It can help to recognise these patterns. Then you can take action to avoid the trigger or minimise its impact.

Learn your warning signs

You may start to notice a pattern to how you feel before an episode. This could be changes in your:

• Sleeping pattern
• Eating patterns or appetite
• Behaviour

Being aware that you’re about to have a change in mood can help you make sure that:

• You have support systems in place
• You can focus on looking after yourself
• You’re able to share warning signs with family and friends who can help you

Take practical steps

These are some practical tips to help you manage the effects of bipolar disorder on your daily life.

Stick to a routine

Having a routine can help you feel calmer if your mood is high, motivated if your mood is low, and generally more stable. Your routine could include:

• Day-to-day activities, such as the time you eat meals and go to sleep.
• Making time for relaxation, mindfulness, hobbies and social plans.
• Taking any medication at the same time each day. This can also help you manage side effects and make sure there’s a consistent level in your system.

Manage stress

Stress can trigger mood episodes. There are lots of things you can try which might help you to:

• Avoid stress
• Manage stress
• Look after yourself when you feel stressed

For more information, see our pages on managing stress.

Try to manage your finances

It can be very scary and stressful when your finances feel out of control. If you’re struggling, try talking to someone you trust about practical steps you can take. There are also organisations that may be able to help.

You can:

• Contact the National Debtline for free financial advice, without judgement.
• Read money and debt guidance from Bipolar UK and Citizens Advice.

For more information, see Mind’s pages on money and mental health, financial decisions and capacity and claiming benefits.

Plan ahead for a crisis

When you’re in the middle of a crisis, it can be difficult to tell people what kind of support you’d find most helpful. While you’re well, it can be useful to make a plan for how you want to be treated when you’re unwell.

For more information, see Mind’s pages on crisis services.

Look after your physical health

Taking care of our physical health can often help to support our mental wellbeing. Here are some tips to manage your health:

Try to get enough sleep

For lots of us with bipolar disorder, disturbed sleep can be both a trigger and a symptom of episodes. Getting enough sleep can help you keep your mood stable or shorten an episode.

For more information, see our pages on coping with sleep problems.

Eat a healthy diet

Eating a balanced and nutritious diet can help you feel well, think clearly and calm your mood. You can read more in this blog on Bipolar UK.

Exercise regularly

Gentle exercise, like yoga or swimming, can help you relax and manage stress. Regular exercise can help by:

• Using up energy when you’re feeling high
• Releasing endorphins – the ‘feel-good’ chemicals in the brain – when you’re feeling low

For more information, see Mind’s pages on physical activity.

Build a support network

Building a support network could help to manage your mood. This might include friends, family or other people in your life who you trust and can talk to. The kind of support they can offer includes:

• Being able to recognise signs that you may be experiencing a mood episode
• Helping you look after yourself by keeping a routine or a healthy diet
• Listening and offering their understanding
• Helping you reflect on and remember what happened during a manic episode
• Helping you plan for a crisis

Peer support for bipolar disorder

Connecting with people who have similar or shared experiences of bipolar disorder can be really helpful. You could try talking to other people to share your feelings, experiences and ideas for looking after yourself. For example:

• Mind – contact Mind’s Infoline  or visit a local Mind to see what support is in your area
• Online forums – try an online peer support community, such as Mind’s Side by Side and Bipolar UK’s eCommunity
• Local groups – find a local support group through an organisation such as Bipolar UK
• Recovery colleges – check if your local area has a recovery college. Recovery colleges offer courses about mental health and recovery in a supportive environment. You can find local providers from Mind Recovery Net

If you’re seeking peer support on the internet, it’s also important to know how to stay safe online.

For more information and tips, see Mind’s page on peer support.

Supporting someone with bipolar disorder

This page is for friends, partners and family who want to support someone with bipolar disorder.

Seeing someone you care about going through the symptoms of bipolar disorder can feel distressing. But you can offer support in lots of ways, while also looking after your own wellbeing.

This page covers how you can:

• Be open about bipolar disorder
• Learn their warning signs and triggers
• Make a plan for difficult times
• Discuss behaviour you find challenging
• Avoid making assumptions
• Look after yourself

Be open about bipolar disorder

Being open to talking and listening to someone’s experiences can help them feel supported and accepted. You could try to:

• Let them know you want to understand what they’re going through, rather than trying to fix things for them
• Ask open questions to learn more about how they’re feeling. For example, ‘what’s it like having bipolar?’ Or ‘what do you need me to understand about it?’
• Avoid minimising their experiences. For example, saying things like ‘everyone goes through tough times’ could make someone feel that you haven’t understood how hard things are for them
• Listen rather than give advice

You can learn more about these experiences by reading blogs by family and friends on the Bipolar UK website.

Learn their warning signs and triggers

Most people have some warning signs that they’re about to experience a mood episode. Many people will also have triggers, such as stress, which can bring on an episode. Try to:

• Talk to them about their warning signs, exploring what they may be
• Let them know if you’ve noticed behaviours that often happen before an episode. For example, you could say ‘I’ve noticed that you’ve been sleeping less, and I’m worried you might be becoming unwell’
• Understand what their triggers are and how you can help avoid or manage them

Make a plan for difficult times

When they are feeling well, try talking to them about the support you can offer during a mood episode. This can help you both feel more stable and in control of what’s happening.

You could discuss ideas such as:

• Noting things down that have or haven’t worked in the past. This could be by writing notes in a diary or on your phone, or by recording voice notes
• Agreeing code words or signs that they are struggling. For example, you could plan words or symbols between you to mean different feelings. They could use these as a quick way to ask for help if they’re struggling to describe how they’re feeling
• Offering a second opinion about projects or commitments, to help them consider whether they’re taking too much on
• Helping them manage money while they’re unwell, if they’d like you to
• Helping them keep a routine, including regular meals and sleeping patterns
• Developing a crisis plan. For ideas on what to include see Mind’s information on planning for a possible crisis

It can also help to discuss how someone wants you to treat them when they are coming out of a period of ill health. Try to follow their lead about how much they want to talk about what happened while they were unwell.

Discuss behaviour you find challenging

Supporting someone with their mental health can at times be very difficult, frustrating or frightening.

If someone is hearing or seeing things that you don’t, they might feel angry, annoyed or confused if you don’t share their beliefs. What feels real for them is real in those moments. If this happens:

• Stay calm if you can
• Help with breathing exercises or relaxation if they feel able to try these
• Focus on supporting them with how they’re feeling, rather than confirming or challenging their reality. Let them know that, although you don’t share the belief, you understand that it feels real for them

During a manic episode, they may do things that feel embarrassing, strange or upsetting to you. You could try to:

• Calmly discuss your feelings with them when they’re feeling able to
• Explain how specific things they’ve done make you feel, rather than making general statements about their actions
• Avoid being judgemental or critical. And don’t hold onto things that were said when they were unwell. Especially if they’ve apologised or told you they didn’t mean it

See our pages on psychotic experiences and supporting someone who is experiencing psychosis.

During a depressive episode, they may avoid contacting or responding to people. This can be difficult to cope with. You may feel worried about them, or rejected. You could try to:

• Avoid taking things personally if you can
• Keep checking in, even though they might not respond
• Send short messages that don’t require a lengthy response

When they feel well again, you could discuss what might help you both cope with similar difficult times in future. For example, you could agree a code word, emoji or picture that they could send you to let you know they’re safe but can’t talk right now.

Avoid making assumptions

You might find yourself always looking out for signs that they are starting a bipolar episode. This is completely understandable. But this might not be the most helpful way to support them. You can:

• Remember everyone is different. It’s possible to display a range of emotions and behaviour, while still feeling well overall
• Try not to assume that any change in mood is a sign that they’re unwell. Each person’s experience is unique. If you’re not sure, talk to them to check
• Remind yourself that setbacks are normal. They may be managing their symptoms well for some time and then have a more difficult period
• Avoid assuming what someone can and can’t do. If you think they need help, offer your support, but try not to start handling things for them without checking that this is what they want or need

Look after yourself

It’s important to spend time and energy looking after yourself. You may feel very worried about the person you’re supporting, but looking after your own wellbeing means you can keep supporting them.

For example, you could try to:

• Talk to someone you trust. This could be a friend, family member, your GP, or a helpline. Bipolar UK also has support groups for family, friends, and carers
• Involve trusted family and friends in supporting them, with their consent. Sharing out different responsibilities may make things feel more manageable. If you’re part of a group supporting someone, such as a family or group of friends, try to make sure the support is consistent
• Find ways to relax. For example, spend time on a hobby you enjoy or try relaxation exercises
• Pace yourself. Take things one step at a time and remember that you’re doing something really valuable in trying to support someone. So be proud of any small wins and try to celebrate these
• Be kind to yourself when you’re struggling. It’s okay not to handle everything as well as you’d like or to make mistakes

For more information on looking after yourself, see Mind’s pages on how to cope when supporting someone else and improving your wellbeing. You can also visit the Carers UK website.

Useful contacts for bipolar disorder

Bipolar UK

bipolaruk.org
Information and support for people affected by bipolar disorder, hypomania and mania. Offers a telephone peer support line, an online peer support community, and local support groups across the country.

Carers UK

0808 808 7777
advice@carersuk.org
carersuk.org
Advice and support for anyone who provides care. 

Hub of Hope

hubofhope.co.uk
UK-wide mental health service database. Lets you search for local, national, peer, community, charity, private and NHS mental health support. You can filter results to find specific kinds of support.

Mind

Mind’s helplines provide information and support by phone and email.

Local Minds offer face-to-face services across England and Wales. These services include talking therapies, peer support and advocacy.

Side by Side is Mind’s supportive online community for anyone experiencing a mental health problem. 

National Debtline

nationaldebtline.org
Information and advice about debt, including a helpline, online webchat and sample letters for writing to creditors.

NHS UK

nhs.uk
Information about health problems and treatments, including details of local NHS services in England.

Samaritans

116 123 (freephone)
jo@samaritans.org
Freepost SAMARITANS LETTERS
samaritans.org
Samaritans are open 24/7 for anyone who needs to talk. You can visit some Samaritans branches in person.