Supporting Someone With Bipolar Disorder

Q: Bipolar means your mood changes a lot during the day.

This is a myth. Episodes last days, weeks or months. Mania lasts at least a week. Hypomania lasts at least four days. Depression lasts at least two weeks. A mood that flips within hours is something else.

Q: The high part is the main problem.

This is a myth. Most time unwell is spent low. People with bipolar I were followed for many years. They had depressive symptoms in about a third of all weeks. They had high symptoms in under a tenth.

Q: Once you are well, you can stop the medication.

This is a myth. Feeling well is often the medicine working. Stopping lithium suddenly brings a high risk of relapse within months. Any change should be slow, and planned with a doctor.

Q: People with bipolar disorder are dangerous.

This is a myth. They are far more likely to be harmed than to harm. Most people with bipolar disorder are never violent. The biggest risks are to themselves. Those risks are suicide, debt, and damage to their health and their relationships.

Q: It often takes years to get the right diagnosis.

This one is true. True. About six years, on average. The first episode is often depression, and a high may not come for years. So many people are treated for depression alone before anyone recognises bipolar disorder.

Q: Sleep can trigger an episode.

This one is true. True. Lost sleep is a well-known trigger of mania. A few short nights can tip someone into a high. Sleep also tends to shorten just before mania starts. This is why protecting sleep is part of treatment.

Bipolar disorder is a mood condition defined by episodes of mania or hypomania, usually alongside episodes of depression, in which energy, sleep need, judgement and speed of thought all move together.

Also called: Manic depression, Bipolar affective disorder, Bipolar I disorder, Bipolar II disorder.

ICD-10 F31 · ICD-11 6A60

The word gets used for moods.

People call a moody friend bipolar. They say it about the weather too. So the real illness gets pictured as someone happy at lunch and angry by dinner. Real episodes last days, weeks or months. And most of that time is spent low, not high.

START HERE

The same message, two replies

Tap any reply to see what it does.

havent slept in 3 days and honestly never felt better. got SO many plans. call me!!

Lands well

Love the energy. Three days is a lot without sleep though. How are you doing?

This is warm, and it names the sleep. Lost sleep is one of the clearest early signs of mania. It is also easier to talk about than mood is.

honestly fine. better than fine

Is this one of the signs on your plan? Happy to help you call someone.

Many people with bipolar disorder have agreed an early-warning plan. Pointing at their own plan respects that the plan belongs to them.

ugh. maybe. ok

I will come over after work. No big decisions before then?

This offers company. It also asks gently for a pause on big spending and big choices, which is exactly what mania makes hardest.

Lands badly

lol you are so manic

This turns a real episode into a joke. It also makes it much harder to raise the subject seriously later on.

just go to bed then?

In mania the need for sleep really does drop. Staying awake is not a choice they are making. Saying this makes the person feel brushed aside.

you dont get it

are you off your meds again?

This is the most common reply, and the most hurtful. Episodes happen on medication too, and the question sounds like an accusation.

Read. Stops replying for a week.

AND WHAT TO DO

If you are close to someone with bipolar disorder

Learn their early signs while they are well. Agree together what you will do if you see those signs.
Watch their sleep. A sudden drop in sleep is often the first sign of a high. Sleep can also change before a low starts.
During a high, do not argue against their big ideas. Suggest waiting instead, before any big decision or big spending.
During a low, keep in touch even when they do not reply. Take any talk of suicide seriously, every single time.
Remember that the person is not the episode. What someone says in mania is not always what they think.

MYTH CHECK

Six things people say. Two of them are true.

Answer before you read the answer. It sticks better.

Bipolar means your mood changes a lot during the day.

Verdict: myth.

Episodes last days, weeks or months.

Mania lasts at least a week. Hypomania lasts at least four days. Depression lasts at least two weeks. A mood that flips within hours is something else.

The high part is the main problem.

Verdict: myth.

Most time unwell is spent low.

People with bipolar I were followed for many years. They had depressive symptoms in about a third of all weeks. They had high symptoms in under a tenth.

Once you are well, you can stop the medication.

Verdict: myth.

Feeling well is often the medicine working.

Stopping lithium suddenly brings a high risk of relapse within months. Any change should be slow, and planned with a doctor.

People with bipolar disorder are dangerous.

Verdict: myth.

They are far more likely to be harmed than to harm.

Most people with bipolar disorder are never violent. The biggest risks are to themselves. Those risks are suicide, debt, and damage to their health and their relationships.

It often takes years to get the right diagnosis.

Verdict: true.

True. About six years, on average.

The first episode is often depression, and a high may not come for years. So many people are treated for depression alone before anyone recognises bipolar disorder.

Sleep can trigger an episode.

Verdict: true.

True. Lost sleep is a well-known trigger of mania.

A few short nights can tip someone into a high. Sleep also tends to shorten just before mania starts. This is why protecting sleep is part of treatment.

WHAT THE MISUNDERSTANDING COSTS

6 years — on average between the first symptoms and the right diagnosis.

on average between the first symptoms and the right diagnosis.

The first episode is usually a low. So the first diagnosis is usually depression. When the highs come, they can feel good, or they can feel like finally getting things done. So nobody reports them.

Those years cost something. An antidepressant given on its own can tip some people into mania. And the medicines that prevent episodes cannot be started until the diagnosis is right.

THE SAME ACT, TWICE

What it looks like, and what it is

Tap a card to turn it around.

Spent all their savings in a week.

In mania, every plan looked certain to work. The part of the brain that says "wait" had gone quiet.

Cancelled everything for a month.

Depression took away the energy to answer a message, let alone show up. The shame about cancelling then made it worse.

Seems completely fine now.

Between episodes they usually are fine. They also know it can come back, and they live with knowing that.

Obsessive about going to bed at the same time.

Sleep is their warning system and their protection. A few late nights can cost them months.

Said awful things during a high.

Irritable mania can make someone cruel and quick with it. Afterwards they often barely recognise themselves.

Will not drink at the party.

Alcohol disturbs sleep and reacts with their medication. This is a rule that keeps them well.

BACKGROUND

Where the stigma comes from

The word is used as slang

People call moody friends and bad weather bipolar. That makes the illness sound like a personality quirk. It also makes real episodes harder to take seriously.

Films show only the high

Mania looks dramatic on screen. The long quiet depressions take up most of the illness, and they almost never get shown.

Episodes can damage trust

Things done in mania hurt real people. Spending sprees and affairs are examples. The illness gets blamed on the person, and the person usually blames themselves too.

The medicines have a reputation

People sometimes think lithium is old or harsh. It is actually one of the best-studied medicines in psychiatry.