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Many people with bipolar disorder have long periods of time when they are happy and well. Sometimes, people can forget that their medication is helping to prevent future episodes. Other people who have recovered from a serious episode want to stop taking their medication because of unwanted side effects, or because their medication reminds them of times when they were very unwell. Talk with the person you care for about your concerns. You can ask questions such as:
Are there any side effects which they dislike? Can the person talk to their psychiatrist or doctor about these side effects? Are there other medications which may have fewer side effects?
How long ago was the person’s last serious episode of mania or depression? It can take up to twelve months for the brain to stabilise after a serious episode of bipolar.
Are there any triggers which may happen in the near future? It might be a good idea for the person to keep taking their medication during a period of stress. People who have had a serious episode of bipolar are vulnerable to having another episode if they are feeling stressed.
Can you both agree that the person will keep taking medication for the time being until the person discusses the situation with their psychiatrist or doctor?
Can you talk with the person and their doctor to ask what to do if there are symptoms of a relapse?
Are there any risks if the person stops taking their medication without talking to their doctor? Some medications can be dangerous to stop taking unless the person is supervised by a psychiatrist or other doctor.
Can you agree with the person and their doctor on a plan to reduce their medication? It can take up to three months for some medications to be reduced safely.
People with bipolar disorder are often very sensitive to stress, and stress is a major cause of bipolar episodes. Most people who have had episodes of mania and depression say that they were very stressed just before they became unwell. If a person has episodes caused by stresses that most people face from time to time, such as problems at work, relationship issues, or financial difficulties, it is very likely that they do have bipolar disorder.
If a person has experienced a single episode after a major trauma in their life, such as a miscarriage, surgery, cancer treatment, or a car accident, it is possible that they may not have bipolar. However, they should still stay in contact with their psychiatrist or doctor so that they can be monitored for any signs of a relapse.
Talk with the person you care for about your concerns. You can ask questions such as:
Do they remember doing things or feeling things in the past that seemed normal at the time but might actually have been signs of mania or depression?
Can you both talk about your loved one’s concerns with their psychiatrist, doctor, psychologist, or counsellor?
Can you both agree that the person will keep taking their medication for the time being and get a second opinion from another psychiatrist or doctor?
Although we think that bipolar disorder is in the genes, it is hard to predict who will develop the condition in a family. Some members of your family will probably have depression or bipolar, and many others will never be affected by a mood disorder at all.
The most important thing to be careful about is stress, because people who are very sensitive to stress are more likely to develop bipolar. Some things you can watch for which might indicate that your child is at risk of developing bipolar include:
Depression or anxiety
Trouble with alcohol or drugs
Difficulty sleeping, such as staying up all night when stressed
Problems at school, university, or college
Family conflict
Don’t panic if you see any of these signs! They do not mean that your child will definitely develop bipolar. However, it is a good idea to organise some help for your child as soon as you see these sorts of problems. For example, you can ask your family doctor to write a Mental Health Care Plan so that your child can see a psychologist or counsellor. You may also wish to start practicing the open communication skills described on page 29 of the Coming Home with Bipolar booklet. This can help your child to feel more comfortable if they need to tell you that something is wrong.
A serious episode of mania can be life threatening. When a person is in hospital, they are usually given antipsychotic medication to reduce the symptoms of manic illness and psychosis. These medications have lots of side effects, but these are mostly just annoying and almost never harmful. When the person you care for is out of danger, their psychiatrist or other doctor usually gives them a mood stabiliser to replace their antipsychotic.
It is common to have a period of depression after a manic episode. This can cause the person to sleep a lot and have difficulty doing ordinary things like housework and grooming. It is very important that your loved one sees their psychiatrist or other doctor regularly after coming home from hospital. It may also be a good idea for them to see a psychologist or counsellor, especially once they start to recover from their episode.
Talk with the person you care for about your concerns. You can ask questions such as:
Is the person keeping track of their feelings using a mood chart or smartphone app?
What simple things can you do to help your loved one feel a bit better? For example, you could go for a walk with the person every afternoon.
Is the person experiencing suicidal thinking or suicidal thoughts? (You can read more about these thoughts on page 19 of the Coming Home with Bipolar booklet.)
Can you talk with the person and their psychiatrist or doctor to find out whether their symptoms are being caused by their antipsychotic medication?
What would the person like to happen if they become very depressed? (You can read about Advance Care Directives on page 31 of the Coming Home with Bipolar booklet.)
Frequently Asked Questions
- Myths debunked
Fact: People with bipolar disorder can experience long periods of even, balanced mood called euthymia. Conversely, they may sometimes experience what’s referred to as a “mixed episode,” which has features of both mania and depression at the same time.
Fact: Treatment often allows you to think more clearly, which will likely improve your work. Pulitzer Prize-nominated author Marya Hornbacher discovered this firsthand. “I was very persuaded I would never write again when I was diagnosed with bipolar disorder. But before, I wrote one book; and now I’m on my seventh.” She has found that her work is even better with treatment.
Fact: In some instances, a manic person may feel good at first, but without treatment things can become detrimental and even terrifying. They may go on a big shopping spree, spending beyond their means. Some people become overly anxious or highly irritable, getting upset over small things and snapping at loved ones. A manic person may lose control of their thoughts and actions and even lose touch with Fact.
Fact: Bipolar disorder is a lifelong illness and there currently is no cure. However, it can be well-managed with medication and talk therapy, by avoiding stress, and maintaining regular patterns of sleeping, eating, and exercise.
Fact: The highs and lows of bipolar disorder are very different from common mood swings. People with bipolar disorder experience extreme changes in energy, activity, and sleep that are not typical for them. The psychiatry research manager at one U.S. university, who wishes to stay anonymous, writes, “Just because you wake up happy, get grumpy in the middle of the day, and then end up happy again, it doesn’t mean you have bipolar disorder — no matter how often it happens to you! Even a diagnosis of rapid-cycling bipolar disorder requires several days in a row of (hypo)manic symptoms, not just several hours. Clinicians look for groups of symptoms more than just emotions.”
Fact: While spirituality and faith can provide comfort and support, bipolar disorder is a medical condition that requires evidence-based treatment. Spiritual interventions alone are not a cure for the disorder.
Fact: Taking medication for bipolar disorder acts preventatively to help people avoid future manic or depressive episodes. Always consult with your doctor before starting or stopping any new medications.
Fact: According to the Diagnostic and Statistical Manual (DSM-5), there are seven types of bipolar disorder:
Bipolar I – features at least one manic episode
Bipolar II – features at least one hypomanic episode
Cyclothymic Disorder – features hypomanic and depressive symptoms in rapid cycles
Substance/Medication-Induced Bipolar and Related Disorder
Bipolar and Related Due to Another Medical Condition
Other Specified Bipolar and Related Disorder
Fact: Bipolar disorder involves extreme mood swings, but it is not the same as regular mood swings. It includes episodes of mania (elevated mood and energy) and depression (low mood and energy) that can be severe and disruptive.
Fact: Bipolar disorder is a medical condition, not a personality trait. The mood fluctuations are a result of chemical imbalances in the brain, and individuals with bipolar disorder cannot simply control or snap out of their episodes.
Fact: Bipolar disorder is more common than many people realize. It affects approximately 2-3% of the population worldwide. While it might not be as prevalent as some other mental health conditions, it is not rare.
Fact: Bipolar disorder can start in adolescence or even childhood. It does not exclusively impact adults and can affect individuals at any age.
Fact: Feelings of euphoria and invincibility can seem harmless, but for patients with bipolar disorder they aren't. They can be a sign of mania should be treated cautiously with medication and consultation with a health professional i.e. a psychiatrist.
Fact: Not everyone with bipolar disorder experiences mixed episodes (both mania and depression simultaneously). Some individuals may have predominantly depressive or manic episodes.
Fact: Bipolar disorder has a strong genetic component, and it is not caused by external factors like upbringing or trauma. However, life stressors can exacerbate symptoms.
Fact: While medication is often a crucial part of managing bipolar disorder, therapy, lifestyle changes, and support from loved ones are also essential in managing the condition effectively. Electroconvulsive therapy (ECT) is an alternative treatment for some when mediation is not effective.
Fact: While some individuals with bipolar disorder may be creative, not everyone with the condition possesses exceptional artistic talents. This myth can romanticize the disorder and overlook the significant challenges it can pose.
Fact: Antidepressants are never a sole treatment for bipolar disorder
Fact: Bipolar disorder is a highly treatable condition. With the right treatment plan, including medication and therapy, many people with bipolar disorder can lead fulfilling and stable lives.
Fact: The vast majority of people with bipolar disorder are not violent or dangerous. Violent behaviour is not a symptom of the disorder itself. However, during manic episodes, individuals may engage in risky behaviours, and they may need support and monitoring.
Fact: Individuals with bipolar disorder have a greater risk of suicide than the general population. As many as 19 percent of people with this condition die by suicide, and as many as 60 percent attempt suicide, according to research published in Bipolar Disorders.
Fact: Bipolar disorder is a medical condition, and having it is not a reflection of a person's character or strength. It can affect individuals from all walks of life.
Fact: The behaviours associated with bipolar disorder, especially during manic episodes, can be impulsive and challenging, but they are not excuses for bad behaviour. It's important to understand that these actions are often beyond the individual's control.
Fact: Bipolar disorder is a chronic condition that cannot be cured by willpower or positive thinking alone. It requires appropriate medical treatment, support, and self-care to manage the symptoms effectively.
Fact: Bipolar disorder and schizophrenia are distinct conditions. While both involve changes in thinking and mood, schizophrenia is primarily characterised by disruptions in thinking, perception, and reality, whereas bipolar disorder revolves around mood swings between mania and depression.
Fact: Bipolar disorder is a lifelong condition, and individuals do not simply "outgrow" it. However, with appropriate treatment and support, many people can effectively manage their symptoms and lead fulfilling lives.
Fact: Bipolar disorder can impact various aspects of an individual's life, including their energy levels, sleep patterns, and cognitive function. It can also affect their relationships, work, and overall quality of life.
Fact: Bipolar disorder is a highly individualised condition, and the experiences of those who have it can vary widely. The severity, frequency, and duration of mood episodes, as well as the response to treatment, differ from person to person.
Fact: While substance abuse can exacerbate bipolar symptoms, it is not the cause of the disorder. Bipolar disorder has biological and genetic roots, and substance abuse is often a way some individuals try to self-medicate.
Fact: Many individuals with bipolar disorder lead fulfilling lives, hold steady employment, and have healthy relationships. With proper treatment, support, and self-care, it is possible to manage the condition and pursue personal and professional goals.
Fact: With the right treatment, therapy, and support, many people with bipolar disorder can effectively manage their symptoms, achieve stability, and lead fulfilling lives. It is not a hopeless condition.
Fact: Bipolar disorder has been recognised and documented for centuries. While our understanding of the disorder has evolved over time, it is not a recent invention.
Fact: The causes of bipolar disorder are complex and include genetic, biological, and environmental factors. While childhood trauma or stress can contribute to the development of mental health issues, it is not the sole cause of bipolar disorder.
Fact: Bipolar disorder is a neurobiological condition with genetic and chemical components. It is not related to a lack of self-discipline or willpower.