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What is bipolar disorder? 04 What types of bipolar are there? 06 What are bipolar states? 08 What causes bipolar disorder? 12 How does a diagnosis get made? 14 What treatments can help? 16 What is available? 20 How can I help myself cope? 24 How can friends and family help? 28 Useful contacts This resource explains what 32 bipolar disorder is, what kinds of treatment are available, and how you can help yourself cope. It also provides guidance on what friends and family can do to help.

Further information To read or print SAMH’s information booklets visit samh.org.uk. If you require this information in word document format for compatibility with screen readers, please email [email protected]

For more information visit: samh.org.uk 3 Bipolar Disorder What is bipolar disoreder?

What is bipolar disorder? Bipolar disorder and stigma

Bipolar disorder is a problem that mainly affects Many people have heard of bipolar But it’s important to remember that you your mood. If you have bipolar disorder, you are likely to have disorder, but this doesn’t mean they aren’t alone, and you don’t have to put up times where you experience: understand the diagnosis fully. You might with people treating you badly. find that some people have misconceptions about you or have a Here are some options for you to think • manic or hypomanic episodes Everyone has variations in their mood, but negative or inaccurate image of bipolar about: (feeling high) in bipolar disorder these changes can be disorder. This can be very upsetting, • depressive episodes (feeling low) very distressing and have a big impact on especially if someone who feels this way • Show people this information to help your life. You may feel that your high and low • potentially some psychotic symptoms is a friend, colleague, family member or them understand more about what your moods are extreme, and that swings in your during manic or depressed episodes a health care professional. diagnosis really means. mood are overwhelming. You might hear these different experiences Depending on the way you experience referred to as mood states, and you can • Know your rights. Our pages on legal these mood states, and how severely they read more about them in our page on rights provide more information. affect you, your doctor may diagnose you bipolar moods and symptoms. with a particular type of bipolar disorder.

‘What helps me the most is the ongoing Bipolar disorder or manic ? realisation and acceptance that the The term ‘bipolar’ refers to the way your mood can change between two very way in which my different states – and depression. In the past, bipolar disorder was referred bipolar disorder manifests itself, and to as manic depression, so you might still hear people use this term. Some health care the symptoms I professionals may also use the term bipolar affective disorder (‘affective’ means display, are not the disorder relates to mood or emotions). personality traits or ‘bad behaviour.’

‘It’s an emotional amplifier: when my mood is high I feel far quicker, funnier, smarter and livelier than anyone; when my mood is low I take on the suffering of the whole world.’

4 For more information visit: samh.org.uk 5 Bipolar Disorder What type of bipolar is there?

What types of bipolar are there? How often do bipolar episodes occur? Rapid cycling This can depend on a lot of things, such as: Depending on the way you experience different bipolar moods and symptoms, and how severely they affect you, your doctor may diagnose • your exact diagnosis You may be told your bipolar is rapid you with a particular type of bipolar disorder. The table below explains some • how well you’re able to manage your cycling if you have experienced four or terms your doctor might use. symptoms more depressive, manic, hypomanic • whether certain situations or or mixed episodes within a year. experiences can trigger your episodes (for example, you might find that getting This might mean you feel stable for a few Diagnosis What it means weeks between episodes, or that your very little sleep while going through a mood can change as quickly as within the Bipolar I You may be told you have bipolar I if you have experienced: stressful life event could trigger an same day, or even the same hour. • at least one episode of mania which has lasted longer episode of mania) than a week • how you define an episode personally Currently, rapid cycling is not officially You might also have experienced depressive episodes, considered a separate type of bipolar although not everyone does. What’s normal for you can also change over disorder, but more research is needed to

time. However, many people find that: know for sure or to better understand it. Bipolar II You may get a diagnosis of bipolar II if you have experienced both: • mania can start suddenly and last • at least one episode of severe depression between two weeks and four or five (For more information on rapid cycling, • symptoms of months see the Bipolar Scotland website.) • depressive episodes can last Cyclothymia You may get a diagnosis of cyclothymia if: longer – sometimes for several months • you have experienced both hypomanic and depressive mood states over the course of two years or more • your symptoms aren’t severe enough to meet the criteria It’s also common to have stable or neutral periods in between episodes. This doesn’t for a diagnosis of bipolar I or bipolar II mean that you have no emotions during this time – just that you’re not currently experiencing mania, hypomania or depression, or that you’re managing your symptoms This can be a difficult diagnosis to receive, because you may effectively. You might find you feel stable for years in between episodes, although for feel that you are being told your symptoms are ‘not serious some people periods of stability can be much shorter. enough’, but this is not the case. Mental health is a spectrum that encompasses lots of different experiences and cyclothymia can have a serious impact on your life. ‘It’s a lot harder coming to terms with being stable [...] than I could have imagined. I’ve had to struggle with a ‘new’ identity and way of life after spending Using these terms can help both you and health professionals discuss your diagnosis so many years thinking the ups and downs and treatment more specifically. If your doctor ever uses words or phrases you don’t of bipolar are ‘normal.’ understand, you can ask them to explain.

6 For more information visit: samh.org.uk 7 Bipolar Disorder What type of bipolar is there?

What are bipolar mood states? About hypomanic episodes This section provides information on: Hypomania is similar to mania, but has a • it lasts for a shorter time few key differences: • it doesn’t include any psychotic • manic episodes (feeling high) Going through any of these experiences • it can feel more manageable – symptoms • hypomanic episodes (feeling high) can be extremely difficult to cope with, for example, you might feel able to go While hypomania is less severe than mania, so it’s worth thinking about how you can • depressive episodes (feeling low) to work and socialise without any it can still have a disruptive effect on your look after yourself, and what kind of • mixed episodes (feeling high and low at major problems life and people may notice a change in your treatment could help. It’s also worth mood and behaviour. the same time) planning ahead for a crisis. • psychotic symptoms Symptoms of hypomania can include: About manic episodes Mania can last for a week or more and has a severe negative impact on your ability How you might feel How you might behave to do your usual day-to-day activities - often disrupting or stopping these completely. Severe mania is very serious and often needs to be treated in hospital. • happy, euphoric or a sense of wellbeing • more active than usual • very excited, like you can’t get your • talking a lot or speaking very quickly Here are some things you might experience during a manic episode: words out fast enough • being very friendly • irritable and agitated • sleeping very little • increased sexual energy • spending money excessively How you might feel How you might behave • easily distracted, like your thoughts are • losing social inhibitions or taking risks racing, or you can’t concentrate • happy, euphoric or a sense of • more active than usual • confident or adventurous wellbeing • talking a lot, speaking very quickly, • uncontrollably excited, like you can’t or not making sense to other people get your words out fast enough • being very friendly • irritable and agitated • saying or doing things that are • increased sexual energy inappropriate and out of character After a manic or hypomanic episode you • easily distracted, like your thoughts are • sleeping very little or not at all ‘The hardest thing might: racing, or you can’t concentrate • being rude or aggressive to explain is the • very confident or adventurous • misusing drugs or alcohol • feel very unhappy or ashamed about • like you are untouchable or can’t be • spending money excessively or in how you behaved when I’m manic. It’s harmed a way that is unusual for you • have made commitments or taken on like I’ve got four • like you can perform physical and • losing social inhibitions responsibilities that now feel brains and they’re mental tasks better than normal • taking serious risks with your safety unmanageable all on overdrive... • like you understand, see or hear things • have only a few clear memories of that other people can’t what happened while you were manic, it can be scary but or none at all also euphoric at the • feel very tired and need a lot of sleep same time.’ and rest

8 For more information visit: samh.org.uk 9 Bipolar Disorder What type of bipolar is there?

About depressive episodes About mixed episodes About psychotic symptoms Here are some things you might experience during a depressive episode: Mixed episodes (also called ‘mixed states’) Psychotic symptoms can include: are when you experience symptoms of • , such as depression and mania or hypomania at the • , such as hearing voices same time or quickly one after the other. This can be particularly difficult to cope How you might feel How you might behave Not everyone with a diagnosis of bipolar with, as: disorder experiences , but some • down, upset or tearful • not doing things you normally enjoy • it can be harder to work out what people do. It’s more common during • tired or sluggish • having trouble sleeping, or sleeping you’re feeling manic episodes, but can happen during • not being interested in or finding too much • it can be harder to identify what help depressive episodes too. These kinds of enjoyment in things you used to • eating too little or too much you need experiences can feel very real to you at • low self-esteem and lacking in • misusing drugs or alcohol • it might feel even more challenging the time, which may make it hard to confidence • being withdrawn or avoiding people and exhausting to manage your understand other people’s concerns • guilty, worthless or hopeless • being less physically active than usual emotions about you. • agitated and tense • self-harming, or attempting • suicidal • you may be more likely to act on suicidal thoughts and feelings (See our pages on psychosis for • your friends, family or doctor might more information.) struggle to know how they can support you best Many people find that a depressive episode can feel harder to deal with than manic or hypomanic episodes. The contrast between your high and low moods may make your depression seem even deeper.

(See our pages on depression for more information.) ‘Then [with mania] comes the paranoia, the shadows, the voices, the thought someone is behind ‘The lows can be flat and me following me devoid of colour, or intense everywhere I go, and torturous. Sometimes it’s ready to get me.’ full of demons, and pain inside so bad nothing physical could hurt you.’

10 For more information visit: samh.org.uk 11 Bipolar Disorder What causes bipolar disorder?

What causes bipolar disorder? No one knows exactly what causes bipolar disorder. Researchers suggest that a Genetic inheritance ‘The biggest combination of different factors, including physical, environmental and social, If you experience bipolar disorder, you thing for me is increase your chance of developing the condition. are more likely to have a family member On this page you can find information on: who also experiences bipolar moods and making time for symptoms (though they might not have a myself; it is very • childhood trauma diagnosis). This suggests that bipolar • stressful life events disorder might be passed on through easy to feel • brain chemistry families. guilty about However, this does not necessarily mean making time, and Childhood trauma Brain chemistry that there is a ‘bipolar gene’ – family links are very difficult Some experts believe that experiencing Evidence shows that bipolar symptoms likely to be much more complex. to do on a a lot of emotional distress as a child can can be treated with certain psychiatric For example, researchers think that cause you to develop bipolar disorder. , which are known to act on the environmental factors can also be triggers practical level.’ This can include experiences like: neurotransmitters (messenger chemicals) for experiencing symptoms of bipolar • sexual or physical abuse in your brain. disorder. And for most people, family • neglect This suggests that bipolar disorder may members are an influential part of your • traumatic events be related to problems with the function environment as you grow up. • losing someone very close to you, of these neurotransmitters – and this is such as a parent or carer supported by some research. However, no Can drugs cause bipolar disorder? one knows for certain exactly how these

This could be because experiencing neurotransmitters work and whether Medication, drugs or alcohol can’t cause you to develop bipolar disorder, but they can trauma and distress as a child can have a problems with these are a cause or a result cause you to experience some bipolar moods and symptoms. For example: big effect on your ability to regulate your of bipolar disorder. emotions. • Some antidepressants can cause mania or hypomania as a side effect when you are taking them or as a withdrawal effect when you are coming off them. If you begin Stressful life events to experience mania after taking or after coming off antidepressants for depression, You may be able to link the start of your this might lead your doctor to give you an incorrect diagnosis of bipolar disorder, symptoms to a very stressful period in your or prescribe you more medication. But in this case it’s usually worth waiting to see life, such as: if your symptoms pass without treatment first. • a relationship breakdown • money worries and poverty • Alcohol or street drugs can cause you to experience symptoms similar to • experiencing a traumatic loss both mania and depression. It can often be difficult to distinguish the effects of alcohol and drugs from your mental health symptoms. Although lower levels of are unlikely to cause bipolar disorder, for some people If you’re concerned about the effects of medication, alcohol or street drugs on your they can trigger an episode of mania or mental health, it’s important to discuss it with your doctor. depression.

12 For more information visit: samh.org.uk 13 Bipolar Disorder How do you get a diagnosis get made?

How does a diagnosis get made? How long will diagnosis take? To make a diagnosis your doctor will ask you about: Because bipolar disorder involves changes in your moods over time, your doctor may want to observe you for a while • how many symptoms you experience They may also: before making a diagnosis. Bipolar disorder • how long your manic or depressive • ask you to keep a diary of your moods to also has some symptoms in common with episodes last help them assess you other mental health diagnoses (such as • how many episodes you’ve had, and how • check for any physical health problems, depression, personality disorders , frequently they occur such as thyroid problems which can and • the impact your symptoms have on cause mania-like symptoms ), so your doctor may your life want to take care that they diagnose you correctly. • your family history You can only be diagnosed with bipolar disorder by a mental health professional, Because of this it might take a long time

such as a psychiatrist – not by your GP. to get a correct diagnosis – sometimes it However, if you’re experiencing bipolar can take years. moods and symptoms, discussing it with your GP can be a good first step. They can What can I do if I disagree with refer you to a psychiatrist, who will be my diagnosis? able to assess you. If you feel the diagnosis you’ve been given doesn’t fit the way you feel, it’s important to discuss it with your doctor. You can seek a second opinion and take action if you’re not happy with your doctor. Advocacy organisations can provide advice and ‘Once properly support on how you can do this. diagnosed, I knew the cause. ‘I was diagnosed I understood with BPD first that I was because of the someone with overlap in an illness. I was symptoms not a failure, between bipolar II not a bad person.’ and BPD.’

14 For more information visit: samh.org.uk 15 Bipolar Disorder What treatments can help?

What treatments can help? What can I do in the longer term? If you are receiving a talking therapy, you might set some of these goals with your The National Institute for Health and Care Excellence (NICE) – The aim of treatment should be to help you maintain stable moods and manage your therapist. You should share these goals with the organisation that produces guidelines on best practice in health symptoms well. As you start to feel more your GP. You may also want to share them care – suggests that treatment for bipolar disorder should include stable, the majority of your support could with your family, friends and carer if you both talking therapies and medication. come from a Community Mental Health have one. Team (CMHT) or your GP, although your GP should arrange for you to still be in touch This section covers: What treatment could I get to manage with a mental health specialist. • What treatment could I get to manage a current episode? a current episode? What can I do in the This will usually depend on what kind of Your health professionals should work with longer term? episode you’re experiencing. you to help you identify: • Which talking therapies might I be • Clear emotional and social recovery offered? During depressive episodes goals for you to work towards and • How can talking therapies help in the • You’re likely to be offered regularly reflect on and revise with your long term? medication – this might be new doctor. medication or adjusting your current • What treatment can I get in a crisis? • A crisis plan, so you know what to do if medication. you experience any of your early warning The exact combination of treatments • You might also be offered a structured signs or triggers, or begin to feel very you’re offered will depend on whether psychological treatment that’s proven distressed. to help with depression, such as you’re managing a current bipolar episode, • How you feel day-to-day, so you can Cognitive Behavioural Therapy (CBT). or managing your mental health in the be aware of how best to manage your long term. mood and notice any changes.

(See our pages on depression for more • A medication plan, including dates where information on treatments and self-care you can review your dose, how well the tips for depression.) medication is working and any side ‘I find the effects that you experience. biggest step is During manic or hypomanic episodes • You’re likely to be offered accepting that medication – this might be new is who you are. medication or adjusting your current ‘It has been 13 years since Changing your medication. I was Hospitalised or ways with meds • You’re unlikely to be offered a talking therapy if you are currently sectioned, and [I’ve] done and therapy is a experiencing a manic or hypomanic so well. My medication hard slog.’ episode. is working.’

16 For more information visit: samh.org.uk 17 Bipolar Disorder What treatments can help?

Which talking therapies might Other types of talking therapies How can talking therapies help What treatment can I get I be offered? you may be offered are: in the long term? in a crisis? There are several talking therapies you • Enhanced relapse prevention/ individual Talking therapies can help you: If you start to feel very unwell, or if an might be offered to help you manage your psychoeducation – this is a brief • understand or make sense or meaning episode of depression or mania is lasting bipolar disorder in the long term. These are intervention to help you learn coping out of your bipolar disorder, and reflect for a long time and your regular treatment a few that have been tested and shown to strategies. on the impact it has had throughout isn’t working, you may need to access crisis work well for some people, although other • Group psychoeducation – this involves your life services to help you get through it. therapies may work too: working in a group of people with shared • identify early warning signs and This may include: experiences, led by a trained therapist, symptoms to build up knowledge about bipolar • emergency support, such as going to A&E • Cognitive behavioural therapy • develop strategies to cope with disorder and self-management. (CBT) – looks at how your feelings, early symptoms, triggers and episodes • getting support from a crisis resolution thoughts and behaviour influence • Family-focused therapy – this involves and home treatment (CRHT) team • make a crisis plan each other and how you can change working as a family to look at behavioural • hospital admission these patterns. traits, identify risks and build • set goals and plans for staying well • Interpersonal therapy – focuses on communication and problem-solving your relationships with other people and skills. how your thoughts, feelings and Is ECT ever used to treat bipolar disorder? behaviour are affected by your Some of these treatments are more widely relationships, and how they affect your available than others. What you are offered Electroconvulsive therapy (ECT) should only be considered a treatment option for relationships in turn. can also depend on what you and your bipolar disorder in extreme circumstances. According to NICE guidelines, this could • Behavioural couples therapy - doctor agree would be most useful for you. be if: focuses on recognising and trying to • you’re experiencing a long and severe period of depression, or a long period resolve the emotional problems that of mania, AND can happen between partners. • other treatments have not worked, or the situation is life-threatening.

If you feel like you’re in this situation, your doctor should discuss this option with you in a clear and accessible way before you make any decisions.

‘Bipolar disorder is one of those things that if you have it and it’s well controlled, you can use it productively... it’s in [my] best interest to take [my] meds, see [my] shrink regularly and stay well.’

18 For more information visit: samh.org.uk 19 Bipolar Disorder What medication is available?

What medication is available? Before you take any medication If you are diagnosed with bipolar disorder, it’s likely that Before you decide to take any medication, The National Institute for Health and Care you should make sure you have all the facts Excellence (NICE) treatment guidelines your psychiatrist or GP will offer to prescribe medication. you need to feel confident about your recommend the following : decision. • Haloperidol (Dozic, Haldol, Haldol This might include: Which medication you are offered will decanoate, Serenace) • antipsychotics depend on: Antipsychotics for bipolar disorder • Olanzapine (Zalasta, Zyprexa, • • Your current symptoms, for example, You are most likely to be prescribed an ZypAdhera) if you are currently experiencing a • if you have an episode of • Quetiapine (Atrolak, Biquelle, Ebesque, manic or depressive episode. mania or severe depression in which you • antidepressants Seroquel, Tenprolide, Zaluron) experience psychotic symptoms, such • Your past symptoms, such as • Risperidone (Risperdal, Risperdal whether you are mainly manic or mainly as hearing voices. However, some Consta) depressed, and how long the episodes antipsychotics are increasingly prescribed have lasted. even if you haven’t had psychotic If your first antipsychotic doesn’t work, symptoms, as their side effects might be you should be offered a different one from • How you have responded to the list above. If the second antipsychotic treatments in the past. less unpleasant, and they’re safer in pregnancy. doesn’t work you may be offered lithium to • The risk of another episode, and what take together with an antipsychotic. has triggered episodes in the past. If you’re prescribed an antipsychotic, you’ll • Your physical health, in particular whether need to have regular health checks with you have kidney problems, weight your doctor. problems or diabetes. • How likely you are to take the medication consistently. • Your sex and age (for example, if you could become pregnant your doctor shouldn’t offer you , as it carries significant risks to your baby). • In older people, a test of mental processes such as the one used to diagnose .

20 For more information visit: samh.org.uk 21 Bipolar Disorder What medication is available?

Lithium for bipolar disorder Anticonvulsants for bipolar disorder Antidepressants for bipolar disorder Lithium can be effective for reducing the There are three drugs used In some circumstances you might also be likelihood of: as mood stabilisers which are licensed to offered antidepressant medication, such • mania treat bipolar disorder: as selective serotonin reuptake inhibitors • recurrent depression • (SSRIs) – a commonly prescribed type of • further mood episodes • Valproate antidepressant. You might be offered • suicidal feelings • antidepressants in combination with one of the medications described above. It is typically a long-term method of Carbamazepine (Tegretol) is also treatment, usually prescribed for at least sometimes prescribed to treat episodes six months. For lithium to be effective, the Remember: You should always check of mania. It can be prescribed if lithium is dosage must be correct. You’ll need with your doctor or pharmacist before ineffective or unsuitable for you. regular blood and health checks while taking any drugs together, or closely taking lithium, to make sure your lithium Valproate (Depakote, Epilim) can be used following one another, in case they could levels are right for you. to treat episodes of mania and is typically a interact with each other badly. For example, long- term method of treatment. It can be combining lithium with SSRI prescribed if lithium is ineffective or antidepressants can increase the risk of unsuitable for you. However, if you could serotonin syndrome (a serious side effect). become pregnant your doctor shouldn’t offer you Valproate unless there is a pregnancy prevention programme in place, as it carries significant risks to your baby.

Lamotrigine (Lamictal) has antidepressant effects and is licensed to treat severe depression in bipolar disorder. NICE guidelines recommend that it is not used to treat mania. If you are pregnant and taking Lamotrigine, NICE recommends ‘Lithium helps [me cope] you are checked regularly. and I just have to keep reminding myself that whichever feeling I’m going through won’t last forever.’

22 For more information visit: samh.org.uk 23 Bipolar Disorder How can I help myself cope?

How can I help myself cope? Take practical steps Bipolar disorder can make you feel like you have little control. • Stick to a routine. Having a routine can • Manage stress. Stress can trigger both help you feel calmer if your mood is high, manic and depressive episodes. However, there are lots of things you can do to manage your motivated if your mood is low, and more There are lots of things you can do to symptoms and increase your wellbeing: stable in general. make sure you don’t get stressed or Your routine could include: look after yourself when you do • get to know your moods This could be: encounter stress. • day-to-day activities, such as when • take practical steps • changes in your sleeping pattern you eat meals and go to sleep • Manage your finances. You can contact National Debtline for free, impartial • look after your physical health • changes in your eating patterns or • time for relaxation or mindfulness • build a support network appetite financial advice. • time for hobbies and social plans • changes in your behaviour • Plan ahead for a crisis. When you’re in Get to know your moods • taking any medication at the same time the middle of a crisis it can be difficult to each day – this can also help you manage let others know what kind of help you Monitor your mood. It can be helpful to Being aware that you are about to have a side effects and make sure that you keep track of your moods over a period change in mood can help you make sure would find most helpful, so it can be have a consistent level of medication useful to make a plan while you are of time. You could try using a mood diary you have support systems in place and that in your system: (there are many freely available, such as you can focus on looking after yourself. well for how you want to be treated when the one from Bipolar Scotland). you are unwell. • Understand your triggers. For example, It can also help to discuss any warning signs if you often feel high after a late night or with family and friends, so they can low when facing a deadline, it can help help you. ‘I have an alarm to recognise these patterns. Then you can take action to avoid the trigger, set on my phone or minimise its impact. ‘have to be so I take my meds • Learn your warning signs. You may start to notice that there is a pattern to careful how at the same time how you feel before an episode. much social every day.’ contact I have – too much can send me high. I have to start saying ‘no’ to demands.’

24 For more information visit: samh.org.uk 25 Bipolar Disorder How can I help myself cope?

Look after your physical health Build a support network Peer support • Get enough sleep. For lots of people Building a support network can be really Making connections with people with similar with bipolar disorder, disturbed sleep valuable in helping you manage your mood. or shared experiences can be really helpful. can be both a trigger and a symptom of You could try talking to other people who episodes. Getting enough sleep can A support network might include friends, have bipolar disorder to share your feelings, help you keep your mood stable or family or other people in your life who you experiences and ideas for looking after shorten an episode. trust and are able to talk to. yourself. For example: • Eat a healthy diet. Eating a balanced • try an online peer support community, and nutritious diet can help you feel well, The kind of support they can offer includes: such as Elefriends think clearly and calm your mood. • being able to recognise signs that you • find a local support group through an • Exercise regularly. Exercise can help may be manic or depressed organisation such as Bipolar Scotland by using up energy when you’re feeling • helping you look after yourself by keeping high and releasing endorphins a routine or thinking about diet (‘feel-good’ chemicals in the brain) If you’re seeking peer support on the when you’re feeling low. Gentle exercise, • listening and offering understanding internet, it’s important to look after your like yoga or swimming, can also help • helping you reflect on and remember online wellbeing. you relax and manage stress. what has happened during a manic episode • helping you plan for a crisis

‘The trick for me is not to be seduced by ‘No two people’s experience the ‘high’ and to look is the same but there’s after myself – get a peace and joy in not enough sleep, good having to explain. Of shared nutrition.’ understanding. Of coming home.’

26 For more information visit: samh.org.uk 27 Bipolar Disorder How can friends and family help?

How can friends and family help? Discuss behaviour you find challenging Learn their warning signs and triggers This page is for friends and family who want to help someone • If someone is hearing or seeing things • Most people will have some warning you don’t, they might feel angry, signs that they are about to experience who has bipolar disorder. annoyed or confused if you don’t share an episode of mania or depression. their beliefs. It’s helpful to stay calm, The best way to learn what these are for Seeing someone you care about going Make a plan for manic episodes and let them know that, although you your friend or family member is to talk to through the moods and symptoms of When your friend or family member is don’t share the belief, you understand them about these and explore together bipolar disorder can be distressing. feeling well, try talking to them about how that it feels real for them. Or, if possible, what they might be. If you have noticed But there are lots of steps you can take to you can support them if they have a try to focus on supporting them with how certain behaviours that normally happen offer support, while also looking after hypomanic or manic episode. This can help they are feeling rather than confirming before an episode, you can gently let your own wellbeing. both of you feel more stable and in control or challenging their perception of reality them know. of what’s happening. You could discuss - what feels real for them is real in • Many people will also have triggers, Be open about bipolar disorder ideas such as: those moments. such as stress, which can bring on an Being open to talking to someone about • enjoying being creative together • If someone becomes very disinhibited episode. You can try to understand what their experiences can help them feel while manic, they may do things that feel these triggers are for your friend or family • offering a second opinion about projects supported and accepted. If you find it hard embarrassing, strange or upsetting to member, and how you can help avoid or or commitments, to help someone not to talk about your experiences or want to you. It can be helpful to calmly discuss manage them. take on too much learn more, you can visit the Bipolar your feelings with them when they are Scotland website. • if they would like you to, helping to feeling more stable. Try not to be manage money while they are unwell judgemental or overly critical; focus on • helping them keep a routine, including explaining how specific things they’ve regular meals and a good sleep pattern done make you feel, rather than making general statements or accusations about their actions. ‘What feels real is real for him in that moment. It helps when I respect that ‘Having a father with bipolar and comfort him is definitely a worry; you ride rather than the highs and lows with them. trying to Looking out for patterns, explain it’s not talking, remaining calm and ‘real’ for everyone else.’ supportive is essential.’

28 For more information visit: samh.org.uk 29 Bipolar Disorder How can friends and family help?

Try not to make assumptions Look after yourself It’s understandable that you might find It’s important to invest some time and ‘If those yourself constantly on the lookout for signs energy into looking after yourself. You may that your friend or family member is starting feel very worried about your friend or family a bipolar episode, but remember that this member, but making sure that you stay well around me are might not be the most helpful way to will enable you to continue to offer support. support them. (You can find out more about looking after concerned • Always keep in mind that it’s possible yourself in our booklet on how to cope when for anyone to have a range of emotions supporting someone else. You can also visit about whether and behaviour while still feeling stable the Carers Trust Scotland website). overall. • Try not to assume that any change in changes are mood is a sign that someone is unwell. If you’re not sure, talking to your friend or symptomatic family member is the best way to check. of relapse [I encourage them] to ask, not assume.’

30 For more information visit: samh.org.uk 31 Bipolar Disorder Useful contacts for work?

Useful contacts

Bipolar Scotland Give Us A Shout NHS Choices T: 0141 560 2050 T: 85258 (text only) W: nhs.uk/conditions/bipolar-disorder W: Bipolarscotand.org.uk W: giveusashout.org Provides information on bipolar Support for people with bipolar (including 24/7 crisis text line. disorder and details of treatment. hypomania) and their family and friends. Mental Welfare Commission Samaritans for Scotland Carers Trust Scotland T: 116 123 T: 0800 389 6809 T: 0300 772 7701 W: samaritans.org Service Users and Carers Line W: carers.org/country/carers-trust- E: [email protected] W: mwcscot.org.uk scotland Freepost: RSRB-KKBY-CYJK, Chris, Offers advice and guidance on mental Information, support and advice on PO Box 9090, Stirling, FK8 2SA health care and treatment. all aspects of caring. A 24-hour free telephone helpline. Money Advice Scotland Citizens Advice Scotland See Me T: 0800 731 4722 T: 0808 800 9060 W: Moneyadvicescotland.org.uk W: seemescotland.org W: citizensadvice.org.uk/debt-and-money Offers confidential advice concerning National programme to tackle mental Advice on legal issues, money and other debts. health stigma and discrimination. problems. National Institute for Health and Elefriends Care Excellence (NICE) W: elefriends.org.uk W: nice.org.uk A friendly online community for people Offers guidelines on treatment for experiencing a mental health problem. bipolar disorder.

32 For more information visit: samh.org.uk 33 Since 1923, SAMH has represented the voice of people affected by mental health problems in Scotland. We are here to provide help, information and support.

Follow us on Twitter: @SAMHtweets Follow us on Facebook: facebook.com/ SAMHmentalhealth Follow us on Instagram: @samhscotland samh.org.uk

SAMH is the Scottish Association for Mental Health Scottish Charity: No. SC-008897 Registered Office: Brunswick House, 51 Wilson Street, Glasgow, G1 1UZ