Bipolar disorder

Bipolar disorder is a long-term condition in which mood shifts between highs and lows. It can be managed, and with the right treatment and support, most people with bipolar disorder live full lives. This page covers what the condition involves, the role of therapy and medication, and where to start.

If you need help now

If things are moving too fast to keep up with, or you’re worried about what you might do, get help now. A hospital emergency department can see you at any time. If you’re in a low period and having thoughts of suicide, the numbers at the end of this page are there any time. In an emergency, call 000.

What it involves

About 1 in 50 Australians has bipolar disorder, and it often starts in the teenage years or early adulthood (healthdirect).

• The highs. Doctors call a high mania, or hypomania when it’s milder. A high can bring a lot more energy than usual and much less need for sleep. Thoughts can race, and you might talk fast and jump from topic to topic. You might spend money or take risks in ways you normally wouldn’t, and feel very happy or very irritable. Mania lasts at least a week.
• The lows are periods of depression: low mood, losing interest in things, changes in sleep, and feeling worthless. They last at least two weeks, and can bring thoughts of suicide.

The main kinds of bipolar disorder are:

• Bipolar I, which involves mania, and usually depression too.
• Bipolar II, which involves hypomania and depression.
• Cyclothymia, which involves milder ups and downs that still get in the way of life.

Only a proper assessment can say whether it fits, and a diagnosis describes a pattern you’re living with, not who you are.

Many people feel very good during a high, and it’s often the people around them who notice first. Others say I’m not okay and I think I’m fine is about when other people are worried and you’re not.

Getting diagnosed

A doctor asks about your moods, what’s happened in your life and how long the changes have lasted, and checks for physical causes. Across 27 studies, the time between bipolar disorder starting and people getting treatment for it averaged close to six years. It varied a lot between studies (Dagani and colleagues, 2017).

If you were treated for depression for years before anyone asked about highs, that’s a common path. If you’ve only ever been treated for low periods, tell your GPGP (general practitioner) For most people, where getting help starts. A GP can write a Mental Health Treatment Plan, prescribe medication and refer you on, and some are trained to deliver a small number of structured therapy sessions themselves. More in the jargon decoder Close about any highs too.

Medication is usually the foundation

Treatment usually combines medications, talking therapy, and looking after things like sleep and stress. Mood stabilisers are medications that help prevent highs and lows.

Tell whoever prescribes your medication about any highs as well as lows, because it can change which medications suit you. Don’t stop or change a medication without talking to them first. Therapy and medication covers who can prescribe medication, and talking to them before changing anything.

What talking therapy adds

Talking therapy works best as an addition to medication, and the therapies built for bipolar disorder have good evidence for helping people stay well. On their own, talking therapies may not be enough (Black Dog Institute).

Australia’s guideline for mood disorders recommends that everyone diagnosed with bipolar disorder is offered education about the condition (Royal Australian and New Zealand College of Psychiatrists, 2020). This is often called psychoeducation, and it’s for you and the people close to you. It usually covers what can trigger an episode, the early warning signs that one is starting, how medications work and their side effects, and looking after things like sleep.

Some people write a plan for staying well, noting their triggers, early signs, what helps, and what to change, such as sleep and caffeine. Some keep a daily record of their mood, which can help them and their doctor see patterns.

A review of 39 trials looked at talking therapy provided alongside medication (Miklowitz and colleagues, 2021). People who had a structured therapy built for bipolar disorder were less likely to have another episode than people who had usual care. Learning about the condition and practising the skills to manage it, provided in a group or family setting, prevented more episodes than the same approachApproach (modality) The kind of therapy someone uses, such as CBT or psychodynamic therapy. You'll also see it called a modality. More in the jargon decoder Close provided to individuals. Cognitive behavioural therapy (CBT) helped with the low periods over a year. The studies varied a lot in who took part, how long the therapy ran and how long people were followed, and some findings were uncertain.

Guidelines in the UK recommend offering adults with bipolar disorder a talking therapy to help prevent another episode: one built for bipolar disorder, or CBTCognitive behavioural therapy (CBT) A structured, practical form of talking therapy. It's built on a simple idea: what you think affects how you feel, and both affect what you do. More in the jargon decoder Close (UK guidelines, 2014). It can be one to one, in a group, or with family. For a low period, they recommend a therapy built for bipolar disorder, or one of the therapies used for depression, such as CBT.

If you’re looking for a therapist, ask whether they’ve worked with people who have bipolar disorder, and whether they’d work alongside whoever prescribes your medication.

Looking after the basics

Looking after your sleep and managing stress are part of treatment too, alongside medication and therapy.

Finding help and paying for it

A GP is the usual first step, and can refer you to a psychiatristPsychiatrist A medical doctor who has specialised in mental health. Psychiatrists can diagnose, prescribe and do therapy, though many spend most of their time on medication and diagnosis rather than weekly sessions. More in the jargon decoder Close and a psychologistPsychologist Someone trained to assess mental health problems and treat them with therapy. It takes at least six years of study and supervised practice, and they're registered with Ahpra, the national regulator. Psychologists can't prescribe medication. More in the jargon decoder Close.

There are several ways to pay for therapy:

• Full fee. Seeing a private psychologist, counsellorCounsellor Someone trained to help people talk through and work on difficulties. The title isn't protected in Australia, so it's worth checking a counsellor's training and registration. Medicare doesn't give a rebate for counsellors. More in the jargon decoder Close or psychotherapistPsychotherapist Someone trained in therapy, often for longer-standing patterns. Like counsellor, the title isn't protected in Australia, and Medicare doesn't give a rebate for psychotherapists. More in the jargon decoder Close directly. MedicareMedicare Australia's public health insurance scheme. For mental health, it gives rebates on sessions with psychologists and some other professionals, usually through a Mental Health Treatment Plan. More in the jargon decoder Close doesn’t cover counsellors or psychotherapists.
• Workplace programs. Many employers pay for a few sessions for their staff.
• Community services. Non-profit organisations and local community health centres provide low-cost care.
• headspaceheadspace A national youth mental health service for anyone aged 12 to 25, with centres around Australia and support online and by phone. It's free or close to it, you don't need a referral or a parent, and you can book it yourself. More in the jargon decoder Close. headspace offers free or low-cost support for people aged 12 to 25.
• Groups. Group therapyGroup therapy A trained professional, sometimes two, working with several people at once. It's a way of running therapy, and many approaches work in groups. More in the jargon decoder Close programs, which usually cost less per session.
• A Mental Health Treatment PlanMental Health Treatment Plan A document your GP writes with you. It makes you eligible for a Medicare rebate on up to ten individual sessions a calendar year: six, then a review with your GP, then the remaining four. The plan itself isn't therapy. More in the jargon decoder Close. Your GP assesses whether a plan suits you. A plan gives you a Medicare rebateRebate The amount Medicare pays back towards a session. It comes back to you after you've paid, so what you pay yourself is the fee minus the rebate. More in the jargon decoder Close on up to ten sessions a calendar year.

Free and low-cost options has more on each of these.

If you’re under 18, Kids Helpline is there to talk to any time, and a GP or headspace can help you find someone to see.

If you’re worried about someone who won’t get help, what you can do when someone won’t get help covers your side of this.

If you’ve had thoughts of hurting yourself, or of suicide, the numbers below are there any time.

Kids Helpline is on 1800 55 1800, any time, for anyone aged 5 to 25. Lifeline is on 13 11 14 and, if you’re 15 or over, the Suicide Call Back Service is on 1300 659 467. In an emergency, call 000. Crisis and emergency support has the full list.

Where next

However good the treatment, how well you and your therapist work together matters a great deal. Why who you see matters more than what they do explains why.