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Bipolar disorder means that you are manic and depressed for different periods. In between, you can feel good and live as usual. You who have bipolar disorder need to seek care because the illness can sometimes make you feel very ill. You can get a treatment that helps you feel better.

There are different types of bipolar disorder. Bipolar disorder type 1 is the most well-known variant of the disease and was formerly known as a manic depressive disorder. 

Symptoms of bipolar disorder

The symptoms of bipolar disorder are that you have different periods of mania and depression

Being manic means being excessively excited and energetic, while depression means the opposite, that all desire and energy has run out. The difference between how you feel when you are manic and when you are depressed is very big. The word bi means two in Latin. That the mood swings between these two opposites are what has given name to bipolar disorder.

The vibrations in your mood can be experienced as very powerful, both for yourself and the surroundings. Between the periods you can often feel good and live as usual.

Most often, the symptoms of mania and depression come separately for different periods. You may also have manic and depressive symptoms at the same time. You may only get mannies, but it is unusual.

It is common to have symptoms of bipolar disorder for the first time during adolescence. It can be difficult to get a diagnosis when you are young because your symptoms can be difficult to distinguish from other mental illnesses. Nevertheless, it is important that you get a diagnosis as early as possible so that you get the right treatment. 

Mania and hypomania

You may have a manic period if you recognize the following:

  • You are excessively energetic and excited.
  • You’re overactive.
  • You have extremely high self-confidence.

When you are manic, you have a lot of energy and can feel creative or restless. You may have difficulty obstructing your ideas and impulses, and it is normal that you need less sleep than usual. 

Manin can cause you to lose judgment and do things you wouldn’t do otherwise. It can lead to you doing unthinkable things, such as spending too much money or exposing yourself or others to dangerous situations. 

Some may feel that they are feeling as good as they are manic and that only the surroundings are boring who do not understand, while others may feel that they are more easily irritated or angry. After a manic period, it can feel very hard to realize that you have said and done things that you regret.

A softer form of mania is called hypomania. Then the symptoms do not usually lead to conflicts or have other serious consequences.

Hypomania has the following symptoms: 

  • You have more energy than usual. 
  • You are more positive than usual.
  • You are more creative than usual.

The first symptom of hypomania is often that you get a reduced need for sleep.

Depression

If you have depression, you rarely feel happy, not even when you do things that you usually like. The desire and power to deal with things diminishes or disappears, and even everyday chores can feel heavy. 

If you are depressed, you usually have the following symptoms:

  • Anxiety
  • Feelings of guilt
  • Concentration difficulties
  • Feelings of emptiness, hopelessness, despair or anger

If the depression becomes very severe, you may have thoughts of hurting yourself or have serious suicidal thoughts.

You can have depression without it being a bipolar disorder.

Psychotic symptoms

Severe mania or severe depression can cause you to perceive and interpret reality differently. It is also called delusions or psychosis. Psychoses can occur in both mania and depression.

For example, the symptoms of a depressive psychosis may be that you believe you are being persecuted or subject to slander. If you instead have a manic psychosis, your heightened mood and great self-confidence can, for example, make you think you can solve the world problems. 
The psychotic symptoms usually disappear when you begin to feel better.

Different forms of bipolar disorder

There are different types of bipolar disorder. The symptoms can change through life, and thus the type of bipolar disorder you have.

Most people with bipolar disorder are complete without symptoms between the periods, but not all. There are those who are depressed almost all the time and have very short periods of hypomania or mania. 

Bipolar disorder often begins with one or more depressions. Then it can be difficult to know if it is a disease characterized by recurring depression alone, or if it is bipolar disorder. Getting depression without mania is much more common than having bipolar disorder. 

It is very unusual, but there are those who only have recurring manners or hypomania. Often, depression comes later in life, but not always. 

Bipolar disorder type 1

Type 1 bipolar disorder means you have severe mania and severe depression. Both conditions can be so severe that you need hospital care. 

When you get a strong mania, you can become so overactive that you get hard to sleep, which increases the risk of psychosis. You can also become aggressive and risk injuring yourself or others.

Severe symptoms of depression can involve thoughts of harming oneself or committing suicide. Between the periods of illness, you can often feel good and live as usual. 

Bipolar disorder type 2

In addition to depression, you who have bipolar disorder type 2 also have periods of mild manic symptoms, called hypomania. Hypomania can be experienced as increased energy, creativity or restlessness. 

Although bipolar disorder type 2 does not involve as severe a manner as bipolar disorder type 1 and is, therefore, more difficult to detect, it is important that you get a diagnosis. The reason is that you may need a different treatment than the one that has recurring depression alone.

Among other things, you may need to take medicines that stabilize your mood, while taking medicines for depression.

Heavy commuting and intermittent conditions

You can also have one or more periods of mixed states, so-called mixing episodes or intermediate states. Then you can have manic and depressive symptoms at the same time, or commute vigorously between conditions within the same day.

Being overactive and restless one moment, and in the next feeling hopelessness and despair, is usually extremely difficult. Suicidal thoughts are then common.

You may have psychotic symptoms during a mixing episode, but they may also be associated with a depressive or manic period. Psychotic symptoms mean that you have delusions and experience life changed, as in a dream. You can then believe that you control existence or understand existence on a higher plane, which no others have understood.

When and where should I seek care?

Contact a health center if you have symptoms of mania or depression and have difficulty coping with everyday life.

You can also contact a psychiatric clinic. At many psychiatric hospitals, you can make a so-called self-registration. You can then either get a time for an initial assessment or be referred to a health care center.

You can contact many receptions by logging in.

Immediately contact a psychiatric emergency room if any of the following is true:

  • You have symptoms of mania or depression and feel so bad that the situation feels unbearable.
  • You are worried that you may be hurting yourself or someone else.
  • You are worried that a relative is feeling very bad or maybe harming himself or someone else.

If there is no psychiatric emergency room, contact a regular emergency room.

If it’s in a hurry

Investigations

When you come to the health center, you tell the doctor how you feel and what symptoms you have. The doctor usually asks questions, often based on one or more templates. You can also fill in one or more forms. 

If you suspect you have bipolar disorder, it is good if you state it when you seek care. For example, you may have several people in your family who have had or are living with bipolar disorder.

It can be good if you can bring a relative to the visit, for example, if you feel very bad.

The investigation is done at a psychiatric hospital

If the doctor at the health center considers you to have bipolar disorder, you will receive a referral to a psychiatric clinic. There you will meet a psychiatrist, ie a doctor who specializes in psychiatry, or an experienced doctor who is trained in psychiatry. 

You will be interviewed and told how you are doing now and how you have measured during different periods in your life. You can often fill in more forms and tell yourself in detail about your symptoms and complaints. It is common for you to see the psychiatrist a few times before getting an answer on whether you have bipolar disorder.

You can get a physical examination

Often, a physical examination is performed to rule out that there are other causes for your symptoms, and to know how you are feeling physically. Sometimes you may have blood tests.

Getting a sick message

Being diagnosed with bipolar disorder can make you feel both relief and sorrow. You may have had difficulties for a long time with a mood that can change quickly and did not know why. In such a situation it is often a relief to get a diagnosis. It may also feel like you are finally being understood and that the situation feels more hopeful.

Call support can help

But it can also be sad to have to accept that you have had a life-long illness. When you receive treatment and become free of symptoms, you may also feel a pang of sadness over what can be experienced as lost years. 

Then it is good to get help, such as call support. Talk to the healthcare staff at the reception who will treat you if you want to call support.

Support to make changes

Accepting that you have a disease that makes you more vulnerable to stress than others may feel difficult, but can also motivate you to make the changes needed to avoid getting sick again.

Treatment of the bipolar disorder

You are being treated at a psychiatric ward. There are many resorts in the country that have specialized psychiatric clinics for people with bipolar disorder. The purpose of the treatment is to protect you from the recurrence of the disease.

It is important that you get treatment of bipolar disorder early, as the disease can otherwise lead to serious consequences. Your behavior during a manic period can destroy both your relationships and your finances. In a depression, the risk of attempted suicide and suicide is very high.

Several types of treatment are needed

You often need several types of treatment of bipolar disorder:

  • Preventive treatment with drugs.
  • Psychoeducation – knowledge of the disease and early signs of relapse
  • Call support for you or your relatives.
  • Possible further psychological treatment.

You may need help with early sick leave. You may also need support in making changes to your planning, such as not taking on too many activities at one time. You need to go on regular checks of your medication.

It is important that you have good contact with your therapist. The treatment and support can reduce your mood swings. Getting to know your early signs can also mean you don’t have to get as sick as before.

Preventive treatment with drugs

You need to be treated with medication as soon as possible after being diagnosed with bipolar disorder. The same applies if you have stopped taking your medication and become ill again. 
Most importantly, you are given a drug that stabilizes your mood. Lithium is the most widely tested drug to stabilize mood in bipolar disorder.

Often it can be enough to make you feel better. There is no safe way to know in advance which treatment works best for you, but you usually need to try several drugs and consult your doctor before finding the right kind and dose.

You need to go for regular checks

The dose is determined by repeated blood tests to measure the level of lithium in the blood. It is important to find a level where the drug will help you. At the same time, the side effects should be as few as possible. 

Over time, the dose may need to be adjusted. It is important that you go for regular checks and blood tests, about three to four times a year. In addition to the lithium content in the blood, the doctor also checks the function of the kidneys and thyroid.

Drugs for depression

During a depression, you may need antidepressant medication. The antidepressant medication must always be combined with drugs that stabilize the mood. That’s because treatment with antidepressant-only drugs can trigger a mania if you have depression associated with bipolar disorder. 

Medicines for mania

Treatment in mania often involves a combination of sedative, antipsychotic medication, and drugs that stabilize the mood. You who have several days of sleep deprivation can get medicines that help you sleep. Often you may need hospital care.

Tighter controls in pregnancy

If you are taking medicines for bipolar disorder and are pregnant or planning to have a baby, it is important that you tell your doctor. It may then be important to review your medication. 

Those who are pregnant and taking medicines for bipolar disorder also need frequent medical examinations. 

Important to learn to understand the disease

You who have bipolar disorder need to learn how to understand your illness. That part of the treatment is called psychopedagogical treatment or psychoeducation. It is a kind of education where you learn how the disease works. It is common for you to be offered training in groups. The meetings are usually appreciated and the participants often feel that it is valuable to meet others who live with the same diagnosis. 

During the training, you will also have the opportunity to discuss how the disease affects you, and relate to others who may have similar or different experiences.
Through the training, you can learn to recognize early when you start to feel bad. It’s called early signs. It is important to learn to recognize early signs to prevent relapse. 

You can also draw up a plan with your loved ones where you decide what to do if you start feeling bad again. It’s called an emergency plan. You can read more about what a crisis plan means in the chapter What can I do for myself?

Mood Diary can help

It might be a good idea to use a so-called mood diary. There you can write down your symptoms of bipolar disorder yourself, how long you sleep and other things that affect how you feel. 
A mood diary can help you in several ways. By regularly writing about how you feel, you can gain greater insight into the disease. It will be easier to answer the therapist’s questions.

Keeping track of your habits and how you feel from day to day makes it easier for you and your therapist to gain better control over the disease. Working with the mood diary can also help you recognize early signs.

You may need support calls

You may also need call support during certain periods. Feel free to talk to your therapist about it. You or your relatives can also contact the municipality if you need support from the social services. The municipality can sometimes also offer support in the form of call groups. 

There are patient associations and other associations that offer support online if you feel mentally ill. It can feel good to talk to someone who is listening and who does not make any demands. It can also be valuable to get in touch with others who have similar experiences.

Psychotherapy or other psychological treatment

An important complement can be psychotherapy or other psychological treatment of a bipolar disorder. For example, cognitive behavioral therapy, KBT, can work well in bipolar disorder. During therapy, you can learn to understand and change your behavior. KBT may contain other treatment methods, such as mindfulness.

In therapy, you can get help boosting your ability to communicate, resolve conflicts, and manage stress. It can have a big impact on how you feel and how long you are sick. It can also help you if you have anxiety or insomnia.

Early sick leave can have a good effect

It is important to learn to recognize early signs and to retire on time. It can allow you to recover sooner and get back to work or school more quickly. 

It is also good if together with your therapist you can go through your calendar and limit the number of activities, to avoid the risk of entering a manic period.

You need to meet the psychiatrist regularly

You need to see a psychiatrist at least once a year, even if you feel well and the treatment is working. 

At the annual check, you will receive questions about:

  • How you feel.
  • How drug treatment works. 
  • If you have side effects.
  • What results from your blood tests have shown.

You also usually get recipes for the next year. At the same time, you and your doctor are preparing a care plan for the next year. If you are not feeling well or if you have severe side effects of your medication, you need to come more often than once a year.

You may need to receive hospital care

During a severe mania or depression, you may need to receive hospital care. Severe depression can mean that you have difficulties coping with everyday life. For example, it can be difficult to eat, remember to wash and get out and move. The risk of suicide is high in severe depression. 

If you have severe depression or not getting better despite treatment with several drugs, you may receive electrical treatment. Electric treatment is always given in hospitals because you are anesthetized during treatment. 

Having a severe mania can make you very overactive, judgmental and sometimes aggressive. Then you may need to receive care in a psychiatric ward. 

Sometimes you who have type 1 bipolar disorder may need forced care. This may be because you risk injuring yourself or someone else during a manic or depressive period.

What is Bipolar Disease?

The reason you develop bipolar disorder depends on both the inheritance and the environment. The inheritance is more important than many other mental illnesses, but even external things can affect your sensitivity to developing bipolar disorder. 

Stressful life events can trigger the disease. For example, it could be a death, a separation or becoming unemployed. But there can also be changes that are really positive and longing, such as starting a new job, moving or becoming a parent.

Once you have developed bipolar disorder, your periods of illness can be triggered without any obvious external cause. Many circumstances can affect the disease in the long term. Many people with mental illness recover with time.

How can I avoid getting sick again?

There is much you can do to reduce the risk of feeling bad again:

  • It is good if you sleep at night and are awake during the day.
  • Feel free to have daily routines that you try not to change.
  • Avoid drinking alcohol.
  • Avoid having too much to do at once.
  • Touch you every day. Certainly for 30 minutes, but even shorter times can give effect.
  • Learn methods that counteract stress

Suffering from stressful life events and conflicts can increase the risk of becoming bad again, but is difficult to prevent yourself. However, it is good to learn about self-help methods. Mindfulness and relaxation exercises are examples of methods that can help you to cope better with stress.

It is important that you get enough sleep

If you notice that you are getting worse, it is good if you can reduce stress and sleep the time you need. If you have trouble sleeping, you can use relaxation methods or medicines. If you do not get better, it is important to seek care well in advance.

Get to know early signs

It is important that you learn to recognize early signs that you are getting sick. Early signs are often mild symptoms of mania or depression. 

It is good if you and your relatives describe what the early signs are, and discuss it with your therapist. Then you can help recognize the symptoms and make sure you get psychiatric care and treatment at an early stage before the symptoms of the bipolar disorder become severe. 

Establish a crisis plan

It is good to have a so-called crisis plan. A crisis plan is about agreeing with therapists and doctors about what applies at early signs. In the emergency plan, you and your loved ones can plan ahead and decide what will happen if you start to get sick. 

It may be that one or more relatives can decide when you need to seek care. It can be a great help to be reminded of what you agreed on in the emergency plan on the day you get sick and may have lost sight of the disease.

A crisis plan can also mean that you ask someone close to take care of your finances so that you cannot make excessive withdrawals, for example during a manic period. This document is not a legal act but can be a good support when it comes to it.

Influence and participate in your care

Being able to influence and participate in your care is a right that is regulated by the Patient Act. In order for you to be involved in your health care, it is important that you understand what the health care provider says.

Ask if you do not understand

Ask questions if you don’t understand. Once you have received information about the treatment you can give your consent or express a yes in another way. You can also refuse treatment. Someone who does not give their consent can only be treated if they receive care with the support of the Psychiatric Compulsory Care Act.

Fixed care contact and interpreter can be a good support

You are entitled to a so-called permanent care contact if you meet many different people in connection with your care. It is a person who among other things helps to coordinate your care.

The interpreter can often be booked by the health care center or reception that treats you. It is good to inform the healthcare provider at the first contact if you need interpretation. The interpreter has a duty of confidentiality  just like everyone else who works in the health care sector. This means that they are not allowed to disclose information about you.

You can get a care plan

A care plan is a document where you and your therapist together plan what will happen during your care at the ward or at the reception. It should be designed according to your needs and conditions. It is good if you show a care plan and emergency plan for relatives so that they can help you if you need to.

It is important that you participate in the decisions

It is important to use so-called shared decision-making for all decisions that are in the care plan. This means that you, together with your doctor or therapist, decide what to do. It is important that you feel motivated by the decisions, and that they feel good. What is part of your plan should not increase your concern and you should feel that the sub-goals that you have decided on are achievable for you. The goals of the care plan should be small so that you can meet them.

Coordinated individual plan – SIP

Coordinated individual plan, SIP, is a plan that will contain the care, treatment, and support you need. It can be good to have a SIP if you have interventions from both psychiatry and social services, and maybe other health care interventions. Then you can help by coordinating the various efforts. The purpose is to make it clear who is responsible for ensuring that you get the help you need.

To get a SIP, you need to give your consent. You also need to be involved in deciding what to do. If something changes, you need to give your consent. The plan may not be changed unless you are a member.

SIP is a right that has been enacted since 2010 in both the Health Care Act and the Social Services Act.

Related to someone with bipolar disorder

It can sometimes be stressful to live close to a person with bipolar disorder. Some periods are more difficult than others. 

You who are close relatives may need to make difficult decisions when the sick person is manic or deeply depressed. It can be difficult to plan activities together because it is difficult to know in advance how someone who has bipolar disorder will feel at a certain time. 

Long sick leave can lead to financial difficulties. In a manic period, the sick person can make a lot of money, which can have serious consequences. 

Get medical help

Life is often much easier if you are a close relative and the person with bipolar disorder has good contact with your doctor. Together you can agree on when it is time to contact the care provider and who is the contact person at the reception.

Sometimes you who are related and the person who has the disease may need to improve communication with each other. Healthcare can often support those who need such help.

Contact an affiliate or support line

It may be good to seek support from others who have similar experiences. There are associations for patients and close associates, such as the Association Balance or IBIS, the association for bipolar disorder. The associations have different self-help groups where patients can exchange experiences, build networks and support each other.

It may also be a good idea to call a phone call. There is someone who listens and can provide advice and support on how to proceed and where to turn for help. You can always call anonymously.

You who are a child or a teenager can be affected in different ways if the adult who takes care of you feels ill.

Ehtisham Nadeem

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