Bipolar disorder can look quite different in different people. For some people, episodes can last for three to six months and occur every few years while others may experience shorter but more frequent episodes over the course of one year.^2,3

In Australia, approximately 1.3% of the population has a form of bipolar disorder.⁴ Symptoms usually start in early adulthood and for most people the disorder is a lifelong diagnosis; however, with appropriate treatment and support, bipolar disorder symptoms can be well managed and individuals are able to maintain a good quality of life.^5-7

Bipolar disorder is characterised by episodes of mania or hypomania and episodes of depression.

Mania and hypomania

Mania and hypomania are unusual and persistent periods of elevated mood (‘highs’) and increased activity or energy which may also involve:

• exaggerated self-esteem or feelings of grandiosity
• reduced need for sleep
• rapid thought and speech, which is often difficult to follow
• high distractibility
• increased activity
• risky, implusive or inappropriate behaviour
• agitation, restlessness, and feeling on edge.¹

The core features of mania and hypomania are almost identical. However, manic episodes are more severe and last longer (episodes last at least seven days), cause severe problems in the person’s relationships or work life, can lead to highly risky behaviours, and may involve psychotic experiences such as delusions and hallucinations.¹ Due to the risks associated with a manic episode, hospitalisation is often necessary.

Hypomania is described as a milder form of mania as it is shorter in duration (at least four days), there are no psychotic features, and the severity of symptoms does not require hospitalisation.¹

Depression

Depressive episodes are characterised by one or both of the following:

• feelings of sadness, emptiness or low mood that lasts for most of the day, nearly every day
• loss of interest or pleasure in almost all activities, even those usually enjoyed.¹

These symptoms are experienced most of the time for at least two weeks, along with several other symptoms over the same period that include:

• changes to appetite and sleep
• worry and negative thinking (e.g., hopelessness, guilt)
• agitation and restlessness
• fatigue or loss of energy
• thoughts about suicide
• trouble concentrating or making decisions.¹

There are a number of bipolar and related disorders.

Bipolar I disorder

Bipolar I disorder is characterised by one or more manic episodes (which last at least one week). Episodes of either depression or hypomania may also occur prior to or following a manic episode. Due to the severe nature of these symptoms, people with bipolar I disorder may require hospitalisation during an episode.^1,2

Bipolar II disorder

Bipolar II disorder is characterised by both hypomanic and depressive episodes but unlike bipolar I disorder, no manic episodes are experienced. Hypomania represents a change to the person’s usual functioning (noticeable by others) but is not, by definition, associated with impairment. Although bipolar II disorder is less severe than bipolar I disorder in terms of symptoms, it can be more chronic as depressive symptoms are often more frequent and longer-lasting.^1,8

Cyclothymic disorder

Cyclothymic disorder is characterised by persistent and unpredictable changes in mood but without the extreme highs and lows of bipolar I and II disorder, with episodes of shorter duration.¹

While the cause of bipolar disorder is not understood, a number of risk factors probably interact in the development of the disorder.

Genes

There is a strong genetic link in bipolar disorder, however, there is no single gene or set of genes responsible. It is thought that there are a number of genes involved in the inheritance of bipolar disorder, and that other personal, environmental and social factors also play a role.⁹

Environmental and social factors

There is growing research into the possible influence of environmental factors, adverse life events (e.g., childhood abuse) and other types of stress, which are now thought to play a significant role.^10,11

Health-related factors

Bipolar disorder symptoms can also be related to certain medical conditions (e.g., a traumatic brain injury) or be triggered by substance use or some medications.¹

Staying on track with medications and treatments for bipolar disorder

A team approach works best

There are things we can do to help our progress, and to stay on track. Taking a team approach with your GP, psychologist, psychiatrist and family is the best way you can manage bipolar disorder.

The team can create a wellbeing plan that helps you stick to prescribed treatments. It helps you and your family know your warning signs, and can minimise impacts of the illness on your everyday life.

Other things can assist in helping you manage the disorder and maintain quality of life, including:

• acceptance of the diagnosis of bipolar disorder
• psychoeducation including education of our families or carers
• motivation to stick to a management plan (including medication)
• awareness and self-monitoring of mood
• relapse prevention and management and knowing our relapse triggers
• integrating diagnosis into a sense of self.

Wellbeing plans

Having a ‘wellbeing plan’ is an important psychological tool for maintaining wellness between highs and lows and for preventing the exacerbation of low-level symptoms into full-blown episodes. You and your doctor can develop a personalised wellbeing plan to help keep you on track. Wellbeing plans for bipolar disorder:

• are designed to help people stay well
• identify any triggers and stresses that may cause problems
• develop strategies for coping with stressful situations
• list early warning signs of both highs and lows
• suggest positive lifestyle changes like reducing caffeine and getting regular sleep.

Wellbeing plans can also help your family know about early warning signs, and ensure you get the help you need in difficult times.

Understanding your ‘relapse signature’ can help you recognise signs and symptoms that may tell you of a future possible episode of hypomania, mania or depression.

Medication which helps to stabilise mood (e.g. Lithium) is the first line of treatment for the acute phases of bipolar disorder (mania and hypomania), as well as relapse prevention. However, we now know that providing psychological support and intervention alongside treatment with prescribed medication, improves treatment outcomes.^5-7,12 Psychological approaches which research has found to be effective are:

Cognitive-Behavioural Therapy (CBT)

CBT is a type of psychotherapy which helps people with bipolar disorder prepare for and respond appropriately and effectively to circumstances which might trigger a manic, hypomanic, or depressive episode. For example, for some people with bipolar disorder, stress or lack of sleep can act as a trigger, and so learning ways to manage stress and to improve sleep can help prevent an episode. This type of therapy also equips individuals with the skills and strategies needed to modify unhelpful thoughts, feelings and behaviours so they can better cope with their symptoms and gain more control over their lives.¹³

Family-Focused Therapy (FFT)

FFT involves the person and their caregivers (parents or spouse) in communication and problem-solving training. It grows out of the strong evidence that criticism and hostility in families are a risk for relapse in people with schizophrenia and mood disorders.¹⁴

Interpersonal and Social Rhythm Therapy (IPSRT)

IPSRT helps people with mood disorders, such as bipolar disorder, to develop skills and techniques to cope with life stressors, maintain regular daily routines (e.g., healthy sleep patterns), manage important relationships, and to take medication as prescribed.¹⁵

Psychoeducation

Psychoeducation aims to provide individuals and families with important information about bipolar disorder to improve illness awareness, help with picking up on early signs of the disorder, and empower them to cope with their symptoms. Psychoeducation is a component of all evidence-based psychological interventions, including those mentioned above.¹⁶

1. Aldwin, C. (2012). Stress and coping across the lifespan. In S. Folkman (Ed.), The Oxford Handbook of Stress, Health, and Coping: Oxford University Press.
2. McEwen, B. S. (2005). Stressed or stressed out: What is the difference? Journal Of Psychiatry & Neuroscience: JPN, 30(5), 315-318.
3. Jamieson, J. P., Mendes, W. B., & Nock, M. K. (2013). Improving acute stress responses: The power of reappraisal. Current Directions in Psychological Science, 22(1), 51-56. doi: http://dx.doi.org/10.1177/0963721412461500
4. Hermans, E. J., Henckens, M. J. A. G., Joëls, M., & Fernández, G. (2014). Dynamic adaptation of large-scale brain networks in response to acute stressors. Trends in Neurosciences, 37(6), 304-314. doi: http://dx.doi.org/http://dx.doi.org/10.1016/j.tins.2014.03.006
5. Barlow, D. H., Rapee, R. M., & Perini, S. (2014). 10 steps to mastering stress: A lifestyle approach. New York, NY: Oxford University Press.
6. Pretzer, J. L., & Beck, A. T. (2007). Cognitive approaches to stress and stress management. In P.M. Lehrer, R.L. Woolfolk & W.E. Sime (Eds.), Principles and Practice of Stress Management (Third ed., pp. 465-496). New York: Guilford Publications.
7. Crawford, C., Wallerstedt, D. B., Khorsan, R., Clausen, S. S., Jonas, W. B., & Walter, J. A. (2013). A systematic review of biopsychosocial training programs for the self-management of emotional stress: Potential applications for the military. Evid Based Complement Alternat Med, 2013, 747694. doi: http://dx.doi.org/10.1155/2013/747694
8. Fjorback, L. O., Arendt, M., Ornbol, E., Fink, P., & Walach, H. (2011). Mindfulness-based stress reduction and mindfulness-based cognitive therapy: A systematic review of randomized controlled trials. Acta Psychiatr Scand, 124(2), 102-119. doi: http://dx.doi.org/10.1111/j.1600-0447.2011.01704.x
9. Faasse, K., & Petrie, K. J. (2015). Stress, coping and health. In James D. Wright (Ed.), International Encyclopedia of the Social & Behavioral Sciences (2nd ed., Vol. 23, pp. 551-555): Elsevier.
10. Sharma, M., & Rush, S. E. (2014). Mindfulness-based stress reduction as a stress management intervention for healthy individuals: A systematic review. Journal of Evidence-Based Complementary & Alternative Medicine, 19(4), 271-286. doi: http://dx.doi.org/10.1177/2156587214543143
11. Chiesa, A., & Serretti, A. (2009). Mindfulness-based stress reduction for stress management in healthy people: A review and meta-analysis. The Journal of Alternative and Complementary Medicine, 15(5), 593-600. doi: http://dx.doi.org/10.1089/acm.2008.0495
12. Stetz, M. C., Thomas, M. L., Russo, M. B., Stetz, T. A., Wildzunas, R. M., McDonald, J. J., . . . Romano, J. A. (2007). Stress, mental health, and cognition: A brief review of relationships and countermeasures. Aviation, Space, and Environmental Medicine, 78(Supplement 1), B252-B260.
13. Meichenbaum, D. (2007). Stress Inoculation Training. In P.M. Lehrer, R.L. Woolfolk & W.E. Sime (Eds.), Principles and Practice of Stress Management, (Third ed., pp. 497-516). New York: Guilford Publications.
14. Kaplan, A., & Laygo, R. (2003). Stress managment. In W. O’Donohue, J. E. Fisher & S. C. Hayes (Eds.), Cognitive behavior therapy: Applying empirically supported techniques in your practice (pp. 411-417). New Jersey: John Wiley & Sons.
15. Claessens, B. J. C., van Eerde, W., Rutte, C. G., & Roe, R. A. (2007). A review of the time management literature. Personnel Review, 36(2), 255-276. doi: http://dx.doi.org/10.1108/00483480710726136
16. Sirgy, J. M., & Wu, J. (2013). The pleasant life, the engaged life, and the meaningful life: What about the balanced life? In Antonella Delle Fave (Ed.), The exploration of happiness: Present and future perspectives (pp. 175-191). Dordrecht: Springer Netherlands.