Bipolar Disorder

Everyone has “moods”, high and low, and this is a good thing. A person’s mood can change from day to day or multiple times in a day, and be affected by any number of things – events, interactions with other people, good or bad news, how much you’ve eaten or exercised, the weather, how much sleep you got, etc.

If you imagine mood to be like a sliding scale, with zero being the lowest mood possible (profound grief or numbness), and 10 being the highest mood (mania or euphoria), people typically move up and down the middle portion of this scale.

If someone has a mood disorder, like bipolar disorder, it means that there is an issue with how they are experiencing moods. To understand bipolar disorder, a good first step is to understand what depression is, and what manic episodes are.

Mood Episodes in Bipolar Disorder

Depression

Intense and prolonged feelings of sadness, apathy and/or low energy.

Mania

A manic episode or “mania” is an intense “high” or elevated mood. It is described by some as being full of energy, feeling euphoria or frenzied and even invincible. It can also be displayed as anger. When someone feels like this for a prolonged period of time, it might be a manic episode.

Hypomania

This could be described as a “less severe” form of mania. When experiencing hypomania, a person may have a lot of energy and an elevated mood, but their life usually is not seriously disrupted. Hypomania can progress to a full-blown manic episode or a severe depression.

When someone cycles between periods of mania, hypomania and/or depression for no obvious reason, they might be diagnosed with a type of bipolar disorder.

Misconceptions About Bipolar Disorder

Bipolar disorder is not:

• “Just a phase” or something someone can “snap out of”.
• A sign or result of low intelligence or weakness.
• A result of poor parenting or life choices.
• Always caused by an event or definitive “reason”.

There are actually two types of bipolar disorder. Someone with bipolar type I will cycle between manic and depressive episodes. Someone with bipolar type II will cycle between depression and episodes of “hypomania”.

Bipolar Type I Disorder

This type is diagnosed when someone experiences a “manic episode.” Some people with Bipolar I also go through times where they feel really sad (depressive episodes) or have milder highs (hypomania). The highs and lows can be so intense that they might find it hard to stay focused or manage everyday activities like school or work. But between these mood swings, they can have times when they feel just normal.

Bipolar Type II Disorder

People with bipolar II, on the other hand, often experience these mood changes as well, but the highs are a bit less extreme. While their lows can feel really tough, the periods when they’re feeling “up” may still feel more manageable. They often go through times when they feel like their old selves again, without the mood swings, which can make it easier for them to go about their day-to-day life. However, the lows can still make everything feel harder, and people might not always realize they need help until the depression gets really tough.

Like all mental health issues, bipolar disorder is complicated and can be caused or triggered by any combination of factors.

There seems to be evidence that family history or genetics play a role in the development of bipolar disorder, and/or brain chemistry.

Like many other mood disorders, people who have bipolar disorder might be more likely to have issues with sleep, emotional stress and substance use.

Environmental factors, like abuse or trauma can add to a person’s risk of developing bipolar disorder.

Stress can trigger an episode of depression, hypomania or mania when someone has bipolar disorder.

Below is a list of signs and symptoms for bipolar disorder. The following list should not be used to diagnose yourself or someone else. It is only intended to provide general information about bipolar disorder. If you think you might be experiencing bipolar disorder, you should see your doctor.

These signs can be explained by a number of factors or other illnesses, and anyone at some point or another may feel or behave in these ways whether they have a mental health issue or not. You may see behaviours and feelings described here that everyone has at times.

Important: There are a wide range of symptoms that a person can experience when they have bipolar disorder, and each person may experience them differently. Two different people could have a form of bipolar disorder but experience it completely differently. No two people are the same.

Because bipolar disorder is about cycling between depressive and hypomanic or manic episodes, it might be helpful to look at the symptoms of all:

Depressive Phase/Episode Symptoms

Physical Changes:

• Reduced energy, becoming easily tired.
• Feeling less active or not active at all.
• Changes in weight and appetite – eating too little or too much
• Irritability or restlessness.
• Sleep disturbances – trouble sleeping, or sleeping too much.
• Stomach or digestion problems.
• Loss of interest in sex.
• Physical symptoms with no physical cause e.g., headaches, muscle aches and pains.

Changes in Thinking:

• Thinking is slowed down, difficulty thinking, concentrating or remembering.
• Difficulty making decisions, avoiding making decisions.
• Thoughts of being a failure, critical or judgmental toward oneself.
• Obsessive thoughts, sense of impending doom or disaster, feeling like something bad is going to happen.
• Persistent thoughts of death, suicide or attempts to hurt oneself.

Changes in Feeling:

• Depressed/low mood, intense sadness or frequent crying.
• Loss of interest in activities that were once a source of pleasure.
• Loss of interest and enjoyment in work, hobbies, people.
• Decreased interest in and enjoyment from sex.
• Feelings of uselessness, hopelessness, excessive guilt, and worthlessness.
• Feeling numb, empty or an absence of feelings.
• Feeling detached from life or others.
• Reduced confidence and self-esteem.
• Impatience, anger, aggression or irritability, even over small matters.

Changes in Behaviour:

• Social isolation, withdrawal from work, school, friends, hobbies.
• Neglecting duties such as homework, housework, or paying bills.
• Decrease in physical activity and exercise.
• Decrease in self-care (not showering, grooming, eating etc.).
• Self-harming behaviours and/or risky behaviour (reckless driving, unprotected sex, etc.).
• Increased use of alcohol or drugs (prescription and/or non-prescription).

Manic Phase/Episode Symptoms

A manic phase can come on very quickly, sometimes within a single day, or can build slowly. Manic episodes can last for hours, weeks or months. Signs of a manic episode include:

• A sudden feeling of exhilaration and giddiness that increases in intensity – an excessively good mood with no real “reason”.
• Extreme optimism, which can lead to poor decisions or a lack of judgement (e.g. spending all your money on lotto tickets).
• Extreme self-confidence can reach the point of delusions (e.g. believing that you can talk to God).
• Feeling invincible, unstoppable.
• Excessive plans or participation in a very large number of activities – failing to recognize that there is not enough time in the day to complete everything.
• Reckless/poor judgement and increase of risky activities (e.g. reckless driving, spending sprees, increased intake of alcohol or other drugs or risky/unusual sexual activity, etc.).
• Racing thoughts and ideas -thoughts race uncontrollably, words spill out in a non-stop rush, ideas change abruptly from topic to topic, disorganized speech and thoughts.
• Decreased need for sleep – going for days with little or no sleep without feeling tired.
• Distractibility; focus on small, irrelevant details.
• Sudden irritability, rage, paranoia, emotional outbursts.
• For some, a manic episode can cause someone to lose touch with reality which can progress to delusions and/or hallucinations.

Hypomania Symptoms

People who have bipolar II disorder experience episodes of hypomania. This could be described as a “less severe” form of mania. When experiencing hypomania, a person may have a lot of energy and an elevated mood, but their life usually is not seriously disrupted. Hypomania can progress to a full-blown manic episode or a severe depression.

Bipolar disorder is treatable. For bipolar disorder or any other mental health concern, if signs or symptoms are interfering with your life in any way, or you’re just feeling like you are in distress or feeling low, it’s time to seek help. You don’t need to wait until things get really “bad” before you seek help.

For instance, if sleep patterns, eating, relationships, school, work, or enjoyment of life are being negatively affected, it’s a good idea to talk to someone. That someone could be a friend you trust, a teacher, your family doctor, a crisis line, or a counsellor.

Helping a Friend with Bipolar Disorder

If it is a friend you are concerned about, they may resist help or not even recognize that they need it. They might need you to make the first step.

As always, if you feel like your friend might hurt him/herself or someone else, it’s time to call emergency services.

Visit the Help Section to find out how to get help for yourself or a friend.

Like other mental health issues, bipolar disorder and how it is experienced will differ from person to person. Because each case is unique, the treatment will likely be unique for each individual.

Common Approaches to Bipolar Disorder Treatment

Treatment for bipolar disorder may include a combination of strategies. Most often, a treatment strategy will include trying medication paired with psychotherapy. Every person is different, so if medication is used, it may take a while to find the medication that works best for you. Individual or group counselling may also be helpful. Some people may need to spend time in a hospital, while others may find outpatient clinics more helpful.

Sometimes, while a person is living with bipolar disorder, part of the treatment might be about treating individual symptoms on a temporary or ongoing basis to make someone feel more comfortable while they try to get better. For instance, if someone is having trouble sleeping, a doctor might suggest treatment strategies to help that person get some sleep.

Role of Family Support and Therapy

Family members of someone who has bipolar disorder may participate in therapy or support groups, or benefit from learning about it and ways to support their loved one at home.

Finding Support While Waiting for Help

If you have to wait to get an appointment, there are many places that offer bipolar disorder support while you wait. Find out where to call in your area.

Along with bipolar disorder treatment from your doctor or therapist, there are things you can do to help and support your own recovery.

Every story is different, and sometimes people need to try different types of mental health supports before they find the right plan for them. Be patient, and don’t give up.

A person living with bipolar disorder, like any other person, will benefit from maintaining wellness and having good supports in their life.

Mood disorders are sometimes misunderstood by people who don’t have direct experience with it. Because everyone feels “lows” and “highs” from time to time, people who don’t have a mood disorder might get them mixed up with feelings that are a normal part of life. Some common myths about bipolar disorder and other mood disorders are:

Myth: Depression means feeling sad.

Fact: Depression isn’t the same as sadness, and people who have depression don’t always feel “sad”. Sometimes depression shows itself through anger, worry, aggression, or apathy (not feeling or caring about anything). These feelings may come and go. Sometimes people who have depression may even seem “fine” to family and friends.

Myth: Bipolar disorder is all in your head. People just need to pull themselves together.

Fact: Telling someone with any mental illness to “pull themselves together” is like telling someone with poor eyesight to just try harder to see. It just doesn’t work that way. There are factors at play when someone has a bipolar disorder that make it very difficult or impossible to maintain or “control” their mood without help.

Myth: If a person is depressed or manic, there has to be a reason.

Fact: Bipolar disorder is complicated. For some, it can seemingly come out of nowhere with no discernible “reason”. There doesn’t have to be an event or incident to cause an episode of depression or mania. Sometimes it just happens.

Myth: The manic phase of bipolar disorder is like feeling really happy, and is a nice break from feeling depressed.

Fact: Mania is not the same as feeling “really happy”. It can be frightening, disruptive and destructive. Many people who experience it describe sleeplessness, risky behaviour and doing or saying things that they later regret. The manic phase can prevent someone from going to work or school, create situations that put a strain on relationships or even end in hospitalization. Someone with bipolar II disorder doesn’t have full-blown manic episodes. Instead, they have episodes of hypomania, which is like a less severe form of mania. Depending on who you ask, a person with type 2 might say that an episode of hypomania is a temporary relief from depression. Given the choice, however, people living with any form of bipolar disorder would likely prefer to be able to stabilize their mood rather than live with the severe “ups and downs” associated with bipolar disorder.

Myth: Bipolar II disorder is like the “softer” or “lesser” of the bipolar types.

Fact: The way bipolar disorder is categorized is according to the level of manic symptoms. Someone with bipolar I experiences mania, while those with bipolar II experience hypomania. Because of this, some people might think that bipolar II is not quite as troubling as bipolar I disorder. However, bipolar II disorder can still be really problematic for someone, as it can cause longer episodes of depression and other complications. Regardless of the type of bipolar disorder someone is living with, they will likely need help and support to feel and do their best.

Myth: Mood disorders are forever.

Fact: Mood disorders like bipolar disorder can be managed effectively. Treatment can lead to a full recovery. Some cases may need ongoing management, but not all. Statistically, mood disorder symptoms lessen as people age.

Myth: There is no need to go to a medical doctor for treatment. Bipolar disorder can be cured by will power, a holiday, or a great night of partying.

Fact: Will power cannot cure a mental illness. A depressed person experiencing lack of pleasure in their surroundings will likely not enjoy holidays either. Substance use can worsen or complicate bipolar disorder. Mood disorders are illnesses that should be treated by a doctor and social support from family, friends and community.

Myth: When a person with a bipolar disorder talks about suicide, they don’t really mean it.

Fact: Not all people with mood disorders attempt suicide, but suicide is a risk when someone is struggling with their mood. Most people who are thinking of suicide say something about it before attempting. If someone you know, whether you know them to be depressed or not, is talking about suicide, take them seriously.

Myth: People who “have it all” – a supportive family, wealth, power, etc. are not likely to develop bipolar disorder.

Fact: Though poverty or family issues may be contributing factors for mood disorders, it can affect people across all social and economic levels. Many rich and famous people have been known to have bipolar disorder. The causes vary, and can have nothing to do with how much money you have or how great your family is.

Myth: If I have bipolar disorder or any other mental illness, I’m going to have to go to the hospital.

Fact: For some, spending time in a hospital for a mental illness is part of the treatment strategy and can be very helpful. There’s nothing wrong with that! Others will never have to go to the hospital, as therapy, medication, group counselling or other strategies may be enough to help someone get better.

Myth: I have mood swings sometimes. It must mean I have bipolar disorder.

Fact: Healthy people experience a wide range of moods. Your mood is affected by all sorts of things, like what’s going on in your life, interactions you have with people during the day, whether or not you’ve eaten or exercised, how much sleep you got last night, etc. Having bipolar disorder is different, because the cycles of mood are often sudden and/or unexplainable, prolonged and extreme to the point where it gets in the way of life.

Supporting someone with any type of serious illness can be challenging. Ways to help and support a friend or loved one who is living with bipolar disorder:

Educate Yourself

Know the signs and symptoms of bipolar disorder so you can offer the type of support your friend or family member needs. Recognizing changes early on can help you better understand what your friend is going through and enable you to respond appropriately.

Encourage Professional Support

Encourage professional help for your friend when needed (see Help Section). Someone experiencing a manic episode needs to be encouraged to seek help from their doctor, who may be able to help them relax and get some sleep. It may be difficult, but try and encourage them to get this help.

Visit Your Friend

If your friend is in the hospital, go and visit them if you are able. The hospital may be scary and overwhelming for them and a friendly face can help. Make sure to ask about visitor rules first.

Assist Your Friend in Avoiding Triggers

Help your friend to avoid triggers like substances or situations that can cause them to relapse or feel unwell.

Understand the Treatment Process

Treatment is a process. Medications and therapy can take time to help alleviate symptoms of bipolar disorder. Be aware of this and try to be supportive as your friend adjusts.

Actively Listen

Be a sounding board. Listening without judgement and without trying to “fix” their problems can be incredibly helpful.

Maintain Composure While Communicating

Stay calm and don’t take things personally. Sometimes bipolar disorder can really distort how someone perceives conversations or situations. How someone reacts or communicates when they have bipolar disorder may be confusing, distressing or even hurtful at times. They may be feeling overwhelmed and acting out, and it’s probably not about you.

When someone is having a manic episode, it can be hard to communicate effectively with them. Stay calm, give brief answers and be firm. Try postponing conversations that are getting out of hand or becoming problematic and try not to get involved in an argument.

Some people who are experiencing a manic episode get caught up in making plans and engaging in lots of activities/projects. Avoid getting swept up in this and committing to helping them with these. Try gently suggesting that they stop and think and postpone plans that seem risky.

Discuss Limits and Boundaries

When your friend is relatively well and calm (e.g. not experiencing a manic episode) have a conversation with them about limits and boundaries. This might include trying to head off risky behaviour (setting limits on how money is spent, creating a list of rules around other risky behaviours) and personal boundaries (creating limits on how late they can call you, talking about behaviours that cross the line).

Offer Help & Support

Ask your friend how else you can help. It may be as easy as just providing a distraction, asking them to do simple, relaxing things with you (like hanging out, watching a movie etc.).

Consider Their Needs

Some people need time to themselves, while others might need to spend time with people. Be supportive and try to resist the temptation to tell them what you think they need to do.

Set Your Own Boundaries

Set some boundaries for yourself and take care. You can’t help someone if you’re feeling overwhelmed yourself.

See the Help Section for more info about helping a friend and self-care.

A mood tracking app, mood. by mindyourmind, co-created with youth, that allows you to track and see patterns with your mood over time.

Find more about Bipolar Disorder.

The information on this page is a simple overview of a complicated health issue. For more in-depth information in bipolar disorder, please visit these resources and references or speak to a medical professional.

Ontario – call ConnexOntario to find out where there are mental health supports in your community.

Crisis – in any situation where someone is at risk of hurting themselves or others, call 911 or a local crisis line. You can find resources near you on the free and confidential Be Safe App.

Please see the Help Section for more information and resources.

References

1. Centre for Addiction and Mental Health (CAMH)
2. Canadian Mental Health Association (CMHA)
3. Mood Disorders Association of Canada