Bipolar disorder: what it is and what it is not

A condition of mood, energy and sleep

Bipolar disorder is a health condition in which mood, energy, sleep and the speed of thinking change for periods of days, weeks or months. It is not waking up cheerful and feeling irritable by the afternoon. These are phases with a beginning, a middle and an end, in which a person sleeps, talks, decides and relates to others differently from their usual self, and the people around them tend to notice.

There are different forms. In type I there has been at least one episode of mania, the most intense high. In type II there are episodes of depression and of hypomania, a milder high, without ever reaching full mania. In cyclothymia the highs and lows are smaller and frequent, drag on for at least two years and get in the way of life, without reaching the size of an episode. Type II is not a weak version of type I: its depressions tend to be long and heavy.

The four phases you will hear about

In mania, energy shoots up for at least a week. The person sleeps three hours and wakes up ready to go, talks non-stop, jumps from one subject to another, makes huge plans, spends money they do not have, drives fast, gets into fights or into sex without care. Sometimes ideas appear of having a special mission or of being followed. People in mania usually do not think they are ill, and that is part of the condition, not stubbornness.

Hypomania has the same ingredients in a smaller dose, for a few days. You get more done, feel creative and sociable, need little sleep. That is why many people enjoy it and never mention it to their doctor. The problem is that it often opens the door to a depression soon afterwards.

Bipolar depression looks like any depression: sadness, tiredness, loss of pleasure, guilt, sleeping too much or too little, thoughts of death. And there is the mixed state, when both sides arrive together: a racing mind and rock-bottom mood, agitation, irritability and despair at the same time. A mixed state is one of the riskiest phases and calls for quick contact with whoever looks after you.

What it is not

"He is so bipolar, he changes his mind every five minutes." That kind of remark, common at home, at work and online, confuses more than it explains. Changing mood several times in one day, blowing up in an argument or being an intense person is not bipolar disorder. And using the word as an insult makes people with the diagnosis hide their treatment, which comes at a cost.

Nor is it a flaw of character, weakness or attention seeking. There is a strong genetic part, and the environment matters: sleepless nights, intense stress, drug use, some medicines. Having the diagnosis does not define who you are, does not make anyone dangerous, and does not stop you working, studying, dating or having children.

Why the diagnosis takes time

Many people are first diagnosed with depression, sometimes for years. That makes sense: people usually look for help during a low, and nobody books an appointment because they are sleeping little and feeling great. Anxiety, alcohol use and ADHD can also come along and blur the picture.

You help a great deal when you tell your clinician about the highs, even the ones that felt good: weeks of short sleep without tiredness, unusual spending, five projects started at once. Bringing someone who has known you for years to an appointment also helps, because they remember things you did not notice. If similar problems run in your family, say so.

Living well with it is possible

With ongoing treatment, many people spend long stretches stable, working, raising children and making plans. That does not happen by luck: it depends on care that continues even when you are well, on knowing your own signs and on protecting your sleep. The other readings in this track cover each of those parts.

Two situations cannot wait for the next appointment. If you or someone close to you has gone two nights or more with almost no sleep, without feeling tired, talking fast and making risky decisions, go to a health service or an emergency department today. And if thoughts of dying or hurting yourself come up, ask for help now: the support step of this track shows the crisis contacts.