Bipolar disorder

Also called Manic depression

Mood that swings between depression and mania, in episodes lasting weeks. Not a description of a changeable temperament.

What it is

The word has been ruined by casual use. People describe the weather as bipolar. That trivialises a condition that, untreated, takes years off lives.

Bipolar disorder means episodes of mood that last weeks or months and change how somebody thinks, sleeps and judges risk. Depression at one end. Mania or hypomania at the other, which is not happiness but a state of accelerated, overconfident, sleepless energy.

It affects roughly one in fifty people. The average gap between first symptoms and correct diagnosis is around nine and a half years, largely because people seek help when depressed and rarely when high.

Signs you might notice

In a high: barely sleeping and not feeling tired. Talking fast, jumping between ideas, spending heavily, starting five projects. Irritability rather than euphoria, often. Sometimes psychosis.

In a low: the full weight of depression, often worse and longer than the high.

Between them, long stretches of being entirely well, which is the part families forget when they are frightened.

The single most reliable early sign of a high, and the one to watch for, is reduced need for sleep.

How it can affect day-to-day life

The damage usually happens in the highs and gets paid for in the lows. Money spent, jobs resigned from in a burst of certainty, relationships and reputations altered in a fortnight. Then the mood drops and the person has to live in the wreckage.

Insight is the cruel part. In a high, the illness feels like recovery. People stop medication because they finally feel well, which is exactly the mechanism that starts the next episode.

Suicide risk in bipolar disorder is significantly higher than in the general population. That is the plainest reason to take it seriously.

Supporting someone well

Protect sleep as if it were medication, because functionally it is. Disrupted sleep both triggers and signals an episode.

Write a plan while the person is well. What the early warning signs are, who to call, what they want done about money and access. Then follow it when it happens, even if they argue.

Agree the money question in advance. A second signature on large spending, agreed voluntarily during a stable period, prevents a great deal of harm and is not a loss of autonomy if the person chose it.

Track mood over months, not days. A daily record is what makes an episode visible while it is still early. Fiducia Life has a feelings and wellbeing record built for that, and a Calm Room for the nights that get loud.

Do not argue with a high directly. You will not win, and you will lose the trust you need in a fortnight's time.

Where to get help

Bipolar disorder is managed by a psychiatrist, not by a GP alone. Ask for a referral to the community mental health team and be specific about episodes of elevated mood, because if you only describe the lows you will be treated for depression, and some antidepressants can trigger a high.

Bipolar UK have an eLearning service and peer support groups.

In a crisis, call 111 and select the mental health option, or go to A and E.