Bipolar disorder

Bipolar disorder (once called manic depression) is a mental health condition which causes extreme mood changes. These include: 

• Mania: a period of unusually elevated or irritable mood and activity, lasting at least one week 

• Hypomania: like a milder form of mania – it lies between a feeling of normal elation and mania. Hypomania also involves unusually elevated or irritable mood or activity, but it’s shorter (lasting at least four days) 
• Depressive symptoms: such as low mood, loss of interest in normal activities, fatigue, and negative thinking 

For a useful summary of bipolar disorder (including bipolar I disorder, bipolar II disorder, and cyclothymic disorder), check out our factsheet. 

Bipolar disorder is a diverse condition 

How long the symptoms of bipolar disorder last, how often they occur, and how intense they are, varies a lot from one person to another. 
 
On average, people living with bipolar disorder experience more episodes of depression than they do mania or hypomania. This means it is important to understand and access support for depression, not just mania. For some people there is a ‘rapid cycling’ between the two states. 

Some people may even experience both high and low moods together – they may be extremely energised, for instance, but feel very depressed and hopeless too. This is called a ‘mixed mood state’.  

Some people also experience symptoms of psychosis as part of their bipolar disorder. Psychosis – a word that’s often misused – involves delusions (believing things that aren’t true) or hallucinations (seeing, hearing, tasting or smelling something that isn’t there). They may have delusions (believing things that aren’t true) or hallucinations (seeing, hearing, tasting or smelling something that isn’t there). 

Here are some real stories from people with lived experience of bipolar disorder: 

• Dov’s story 
• Charlotte’s story 

• Matt’s story  

Symptoms of bipolar disorder are manageable  

There is no ‘cure’ for bipolar disorder, meaning it is a long-term condition. While many people need to manage their symptoms over time, with the right support they can have minimal impact on quality of life. 

The good news is that many people with bipolar disorder can recover well from episodes, and can lead long and fulfilling lives. With time, you might understand your symptoms better, figure out which treatment and support options work for you, and learn how to stay well and improve your wellbeing. Many people with bipolar disorder can stay in the workforce, connect with their local community, and have a range of fulfilling relationships. 

If you, or someone you care about, is concerned about bipolar disorder, the first step is to speak with a health professional. 

A general practitioner (GP) can provide initial assessment and advice. They may then provide a referral to a mental health professional, such as a psychiatrist or a psychologist, who can provide a full assessment and diagnosis, as well as suggest treatment and support options.  

It can be helpful to prepare for an assessment by bringing in some notes or dot points.  

What to expect from an assessment 

An assessment for bipolar disorder may involve a combination of the following: 

• Talking in detail about your history and experiences, including any family history of mental health conditions, any experiences of challenging or traumatic events, your medical history, and any history of substance use 
• Exploring your symptoms, including their severity, age of onset, and how long they last. This sometimes involves a structured psychological interview or written questionnaires. 
• Blood tests and other medical tests to see if there are any physical health concerns contributing towards your symptoms 
• Monitoring symptoms to understand how they might change over time 

Families and friends are sometimes invited to provide their observations and discuss any concerns. 

Assessments can take time 

Unfortunately, assessments for bipolar disorder can be complex.  

Sometimes it can be difficult to figure out if a person is experiencing the symptoms of bipolar disorder, or another complex mental health condition. Often people experience co-occurring conditions, which means it can be difficult to understand which conditions are causing symptoms. This is why assessments sometimes take a long time. Some people might be diagnosed with other mental health conditions first. 

Bipolar disorder is usually managed through a combination of medication and other treatment and support options – psychological support, support from community services, and looking after your physical health can help to keep you well. This might involve the support of a GP, mental health professionals, and others.  

It can take a while to figure out the right combination of treatment and support options for you. It can also take some time to find the right health professionals to support you. This is normal. Remember that it’s okay to ask questions, to explore your options, and to speak up if something doesn’t sit right with you.  

Medication 

Medication is considered a ‘first line’ treatment for bipolar disorder. This means that most people with bipolar disorder will be prescribed one or more medications which are designed to keep their mood stable. These medications are usually prescribed and monitored by a psychiatrist.  

Here are some tips on how to get the most from your medication: 

• It’s important to take medication as directed, otherwise your symptoms won’t be controlled as effectively. Always tell your doctor if your medication is causing problems, or if you want to make changes. 
• Don’t be afraid to ask questions about your medication – understanding what it does, and why you need it, is important. Ask how the treatment will help you, any side effects, and pros and cons.  
• Be honest with your doctor about any current medications or substance use, as these can interfere with your medication. 
• Make it simpler – dosage dispensers available from pharmacies or calendars can help you keep on track and make it easy to remember to take medication. 

• Let trusted family and close friends know about your medication – people close to you can provide good support when you’re taking medication long term. It’s good for them to understand how the medication helps and what any side-effects might be. 

Medications for bipolar disorder 

Different types of medication may be prescribed for bipolar disorder, such as: 

• Mood stabilisers – may be given to treat and reduce the risk of further manic episodes and depression. Lithium is usually recommended as a first-line, long-term medication for bipolar disorder, though there are other options available if it is not tolerated or ineffective. 
• Antidepressant medication – may be prescribed to manage symptoms of depression. 

• Antipsychotic medication – may be prescribed to stabilise mood, and to manage symptoms of psychosis if these are present. 

Side effects 

Medications often have side effects, such as muscular weakness, drowsiness, weight gain, and memory problems. It is very important to monitor any potential side effects. For example, if you take lithium in the long term, you will need regular blood tests to monitor the concentration in your bloodstream.  

If you have any side-effects from your medication, tell your doctor – they may be able to reduce or change the dosage, or suggest other ways to manage the problem. 

It’s important to remember that the same medication can affect people quite differently. In other words, not everyone who takes a particular medication will experience the same side-effects.  

Psychological support and talking therapies 

Mental health professionals can provide you with psychological therapies. These can be very worthwhile – besides providing support, it can help you learn ways to cope with problems. 
 
There are different types of ‘talking therapies’, including cognitive behaviour therapy (CBT), family-focused therapy, dialectical behaviour therapy, and mindfulness-based CBT interpersonal therapy (IPT), and group therapies. They usually involve: 

• Learning more about bipolar disorder 
• Understanding how different thought processes and behaviours can impact on your mood 
• Monitoring your mood, thoughts, and behaviours 

• Identifying strategies to prevent relapses 
• Improving relationships  
• Working on individual goals 

For further information on the different types of therapies available, see our Psychotherapy fact sheet. 

Electroconvulsive therapy (ECT) 

ECT is an established, safe treatment that can be helpful for severe depression, mania, and psychosis, sometimes used in cases where other treatments aren’t helping. It works by using electrical stimulation to release brain chemicals that help restore normal functioning to the brain. ECT is given in a hospital under general anaesthetic. 
 
The treatment is usually only given with the consent of the person involved. An exception is when a psychiatrist believes a person is unable to give informed consent and gives the consent for them (but this should only happen after discussing the issue with the person’s primary carer). In some parts of Australia, ECT can’t be given unless two doctors agree that it’s the best approach. 
 
There are not thought to be any long-term adverse effects, apart from memory problems, which are mostly mild and improve with time. These sometimes persist for weeks or (less commonly) months. A headache after treatment is usually gone after a few hours.  

Peer support 

Connecting with other people who also have bipolar disorder can really help. As well as overcoming isolation, it’s a good way to share useful information and strategies to help you cope. 
 
Peer support can be formal or informal. SANE has a number of peer support services; for more information, call the SANE Helpline on 1800 18 SANE (7263) or check out this page. 
 
Alternative therapies 

Some people find alternative therapies such as acupuncture or herbal medicine helpful. If you decide to try an alternative therapy as well as your prescribed treatment, make sure that there will be no harmful side-effects. Some alternative therapies are not recommended for people with mental health conditions (herbal remedies can interact with other drugs, for example) so it is important to discuss using them beforehand with your doctor.  
 
Be wary of anyone who suggests they can cure your condition (when something sounds too good to be true, it usually is too good to be true). 

Support in the community 

Support programs are available to help people access support in the community, based on their individual needs. You may wish to ask your GP or another health professional for options for employment and educational support, financial support, accommodation support, and social activities. 

‘Acute episodes’ are very intense, and can involve mania, depression, or a combination of symptoms. They might not be frequent, but can be challenging to manage. During an acute episode, you might experience symptoms like recklessness, impulsivity, and suicidal thoughts. It’s important not to make any important decisions or life changes until after you have recovered from an acute episode. 

Monitoring early warning signs 

Acute episodes can be triggered by a range of things. It’s important to look after yourself to try to prevent these episodes from occurring, including doing what you can to manage your stress levels and get a good night’s sleep – see section 4, Looking After Yourself, for more information. 

After you have experienced a few episodes, you will probably start to notice when they are coming on. The early warning signs of mania and depression are sometimes called ‘relapse signatures’. Everyone is individual – you will have your own unique early warning signs.  

Learning about your early warning signs, monitoring them, and having a plan, can help you prevent an episode.  

Tools and checklists can help you recognise these early warning signs. It’s a great idea to use a diary or an app like eMoods (available for free on IoS and Android) to monitor your mood, sleep, and stress levels. Some common signs for an episode of mania are: 

• Increased activity and energy 

• Increased motivation 
• Needing less sleep 
• Elevated mood 

Some common early warning signs for a depressive episode are: 

• Feeling low, sad, or numb 

• Loss of energy 
• Loss of interest in people or activities 
• Difficulty concentration 
• Thoughts or suicide or death 

Planning next steps in advance 

It’s important to know what to do when you, or your family or friends, identify your early warning signs. An action plan can include: 

• Who to tell, such as close family or friends 
• How family and friends can help you 
• Your preferences for treatment and support options, including referral pathways 
• Emergency contact numbers.  

Share this with your family, your GP, and any mental health professionals involved in your support. 

You may also wish to look into advance care planning, which involves planning for your future health care in times where you may be unable to communicate your preferences or make treatment decisions. This is a team effort, involving identifying a trusted family member or friend who can make decisions on your behalf, and discussions with healthcare professionals. It also involves completing an Advance Care Directive. Information varies by state – for example, here is information for Victoria and NSW. 

Treatment for acute episodes 

It’s not always possible to manage symptoms of an acute episode at home. Often, this requires an inpatient stay at a hospital, to stabilise symptoms and keep you safe.  

The chances are that your stay will be as short as possible and in the psychiatric unit of a general hospital, rather than a hospital dealing only with psychiatric illness. In some cases, you may need a longer stay, such as if you are experiencing rapid cycling, or your treatment team are concerned that you might harm yourself. 

Treatment might involve trialling new medications, or changing dosage of existing medications. You might also access other treatment and support options such as individual or group therapy, or electroconvulsive therapy (ECT). 

Treatment and consent 

If a psychiatrist or other health professional recommends someone needs treatment and the person doesn’t agree, they may sometimes be treated without their consent. In some parts of the country, this is known as ‘sectioning’ or ‘scheduling’. 
 
The exact circumstances for involuntary treatment vary between different States and Territories, but in general people receive treatment in this way to ensure their own health or safety, or that of others.    
 
There may be legal limits on how long someone can be treated without their consent, and they may ask to be discharged by a doctor or a body such as a Mental Health Review Board. These facts should be explained to anyone having treatment without their consent. 

To learn more about your rights, contact or visit the website of your state’s Office of the Public Advocate.  

Managing suicidal thoughts and behaviour 

It’s not uncommon for people to have thoughts about harming themselves or taking their own life when they’re experiencing an acute episode – try to remember that these are only thoughts, that they will pass, and there’s no need to act on them. 
 
These thoughts can also be a real warning that your treatment needs improving, so talk to your doctor about them as soon as possible. Adjusting medication can help manage suicidal thoughts. Plus, psychological therapies can help address causes of the thoughts, and identify  strategies to cope if they arise again. 
 
For more information on how to manage and prevent suicidal feelings, please see our guide to support when you're concerned about suicide. 

If you, or someone you know, is having suicidal thoughts and is in immediate danger, please call triple zero (000) and ask for an ambulance. Don’t leave the person alone until help arrives.   

For help and support, call Lifeline on 13 11 14 or Suicide Call Back Service on 1300 659 467.   

This section describes the important things you can do to look after yourself – both by yourself, and with the support of your family, friends, and advice from trusted health professionals. By doing what you can to look after yourself, you are likely to feel more in control, and have a better chance at preventing or reducing the severity of episodes of depression or mania.  

Check out our Healthy Living guide for more information on maintaining your wellbeing and physical health. 

Managing stress 

Everyone needs to find ways to manage stress – but it’s especially important if you have bipolar disorder, because stress can sometimes trigger symptoms. 
 
Some suggestions: 

• Going for a walk, yoga, meditation, aromatherapy, or having a long bath can all help to relieve stress – find what works for you. 

• Relaxing with things you enjoy should be a regular part of your life – whether it’s a movie, a book, listening to music, watching TV, meeting people, or being with a pet. 
• Think about ways of reducing stress in your life. Don’t try to pack too much into your day, for instance, and try to deal with one thing at a time. 
• If you can’t avoid stressful events, give yourself time to relax and recover afterwards. If stress is becoming a problem, ask your doctor or a mental health professional to suggest ways of dealing with it. 

Prioritising sleep 

There is a strong link between symptoms of bipolar disorder and sleep. Difficulties with sleep can make you more vulnerable to both depressive and manic episodes, and can also be an early warning sign of mania. Lack of sleep can also increase stress levels, and cause problems with mood. 
 
Some suggestions: 

• Try to avoid things that interfere with sleeping patterns, for example – shift work, staying out all night, or staying up late to study. 
• Try to keep a regular bedtime and wake time. 
• Get to know what helps you sleep, for example – having a warm bath before bedtime, allowing enough time to wind down before bedtime, avoiding caffeinated drinks in the afternoon and evening (cola drinks, as well as coffee or tea) or too much alcohol before bed (alcohol can make it easy to fall asleep, but can lead to poor quality sleep). 

Avoid alcohol, smoking, and recreational drugs 

Health guidelines recommend that healthy adults should drink no more than 10 standard drinks of alcohol per week, and no more than 4 on any one day. While moderate alcohol intake is unlikely to be harmful, you might find that alcohol can intensify symptoms and worsen the symptoms of bipolar disorder. Sometimes alcohol can interact in dangerous ways with prescription medications. For some people, not drinking at all is the best and safest option. Talk to your GP or psychiatrist about how much alcohol is safe for you. 

If you smoke cigarettes, then giving up cigarettes is a dramatic way to improve your general health. While depression can be a temporary side-effect of quitting for some people, don’t let this put you off. Talk to your GP or a mental health professional about the best way to quit successfully and safely. 

Some types of recreational drugs can trigger episodes of depression, mania and psychosis. Others can cause difficulties with sleep – which can also trigger episodes. For these reasons, it is important to avoid them.  
 
Getting regular check-ups 

People living with bipolar disorder are at increased risk of physical health issues. For this reason it is important to see a GP regularly. Your GP can help monitor your weight, diet, heart, liver and thyroid function, haemoglobin and glucose levels, and more.  
 
Your doctor can also advise on a healthy lifestyle, including nutrition, exercise, and sleep. For more information, please see the Healthy Living guide. 

Stay connected 

Depression sometimes means you don’t feel like talking to other people. It’s important to try to push through this feeling – because not spending time with others can make symptoms of depression worse. Try to make the effort to stay in touch with family, friends and neighbours – you’ll feel better for it in the long term.  

Connecting with others who also live with bipolar disorder can also help you feel connected and understood. Check out SANE’s Forums and Peer Support options. 

Having a close relationship with someone who has bipolar disorder can be challenging at times. It can be difficult to know how to help effectively. 

For example, if they are feeling depressed, it can be difficult to motivate them to go to events or socialise, and they might struggle to maintain a friendship or relationship. During times of mania or hypomania, the person may feel there’s nothing wrong and become angry if you suggest there’s a problem. This can cause conflict.  

Here are some suggestions for supporting them effectively: 

• Try to remember that their symptoms are not their fault – problems such as having trouble getting out of bed and lack of motivation aren’t laziness. They are symptoms of a mental health condition.  
• Encourage them to monitor for early warning signs and form an action plan. If possible, try to have a copy of the action plan, including what to do if they are becoming unwell and unable to look after themselves or keep safe.  
• If possible, try to be actively involved in their treatment. It’s okay to ask to be involved, and to discuss what your role might look like. Their GP and any other members of the treatment team should also be able to provide you with support and any relevant information.  

Remember, carers need to look after their own health too. When someone you care about has an extreme emotional state, it’s natural for you to be affected by this. 
 
While caring for the person, try to maintain your own life, interests and feelings. Eating well, getting regular exercise, and making time to relax all help your physical and mental wellbeing – and that makes it easier to cope. This will help you be a better carer, as well as help your own mental health. 
 
Many people find it helpful to be in touch with a carer support group. The SANE Forums provide a safe, moderated online space where people affected by mental illness, as well as family and others carers, can share information and advice and provide mutual support. 
 
For further information, please see our guide for families, friends, and carers. 

In a crisis 

If you or someone you know experiences a mental health crisis, it can be difficult for others to know what to do. See How to help when someone is suicidal and How to help in a crisis for advice. 

If you, or someone you know, is having suicidal thoughts and is in immediate danger, please call triple zero (000) and ask for an ambulance. Don’t leave the person alone until help arrives.   

For help and support, call Lifeline on 13 11 14 or Suicide Call Back Service on 1300 659 467.   

Australian Government Department of Health and Aged Card (2022) How much alcohol is safe to drink? https://www.health.gov.au/topics/alcohol/about-alcohol/how-much-alcohol-is-safe-to-drink  

Beyond Blue (n.d.) Electroconvulsive therapy (ECT). https://www.beyondblue.org.au/mental-health/depression/treatments-for-depression/medical-treatments-for-depression/electroconvulsive-therapy-ect  

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Elias A, Thomas N, Sackeim HA. Electroconvulsive therapy in mania: a review of 80 years of clinical experience. American Journal of Psychiatry. 2021 Mar 1;178(3):229-39. 

Farren CK, Hill KP, Weiss RD. Bipolar disorder and alcohol use disorder: a review. Current Psychiatry Reports. 2012 Dec;14:659-66. 

National Collaborating Centre for Mental Health (2014). Bipolar Disorder: The assessment and management of bipolar disorder in adults, children and young people in primary and secondary care.  https://www.nice.org.uk/guidance/cg185/evidence/full-guideline-pdf-4840895629