• This report describes recent developments in our understanding of bipolar disorder. It is written for people who have received the diagnosis, people who feel it might apply to them, friends and relatives, mental health professionals and anyone else with an interest in this issue. The report is divided into five parts, covering the nature of the problem, causes, sources of help and treatment, recovery and how mental health services need to change.

    Key points:

    • This report is about those problems that are traditionally thought of as arising from a mental illness called ‘bipolar disorder’ (formerly called ‘manic depression’).
    • Many people experience periods of depression and also periods of elation and overactivity. Mood can affect how we feel about ourselves. For example, at times we may feel extremely positive or even grandiose about our own abilities, whereas at other times we may feel that we are a complete failure.
    • For some people, episodes of extreme mood are frequent and severe enough to lead them, or those around them to seek help. Within mental health services the problems are currently likely to be seen as a ‘disorder’ – bipolar disorder. It is only people who come into contact with mental health services who are likely to receive a diagnosis and be seen as having a mental illness.
    • However, not all mental health professionals accept the idea that these experiences are caused by an underlying illness.
    • There is increasing evidence that it may be more helpful to conceptualise these problems as being on a continuum: we are all subject to mood variation, but within this, people range from those who experience relatively few highs or lows to those who tend to experience more extreme mood states. There are both positives and negatives associated with both ends of the continuum. For example, individuals who experience extreme mood states tend to be very creative, at times have a great deal of energy and often can be high achievers. But they can also experience problems – for example, during periods of elation people sometimes do things that they later regret, such as spending too much money.
    • Each individual’s experiences are unique – no one person’s problems, or ways of coping with them, are exactly the same as anyone else’s.
    • Some people who experience extreme mood states find it useful to think of themselves as having an illness. Others prefer to think of their problems as, for example, an aspect of their personality which sometimes gets them into trouble but which they would not want to be without.
    • Mental health services have traditionally tended to assume that once someone experiences problems with unstable mood severe enough to bring them into contact with services, the problems are likely to recur. In fact this appears to be the case for fewer than half of those people.
    • Traditionally, medication has often been the only type of help offered. Some people, but not all, find it helpful. For those considering using medication, a ‘try it and see’ approach is needed in order to find which medication, if any, is helpful and in what dose. There is increasing evidence that talking treatments (particularly cognitive behaviour therapy), and self-help (especially supported by a worker or self-help group) can also be very useful.
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