Bipolar disorder

Get help straight away if

These are uncommon, but they need same-day care — go to an emergency department, do not wait for an appointment.

• Thoughts of ending your life, or of harming yourself or someone elseCall 911, or call or text 988 for the Suicide Crisis Helpline. You do not need to be certain you would act on it to be worth talking to someone.
• Hearing or seeing things others do not, or holding beliefs those around you find alarmingGo to an emergency department, or call 911 if the person is at risk.

Contact us promptly if

Not an emergency, but worth being seen sooner rather than waiting it out.

• Needing much less sleep than usual for several nights and not feeling tiredThis is the most reliable early sign that an episode is starting, and it is worth acting on before anything else changes.
• Spending, driving, or taking risks in a way that is unlike you
• Having stopped your medication, or being about toWorth a conversation first — stopping suddenly is a common trigger for a relapse, and if the reason is side effects there are usually alternatives.

What usually happens

The word has drifted in everyday use, and it now often means moods that change quickly within a day. That is not what bipolar disorder is. The episodes last days to weeks, they represent a sustained change from your usual self, and other people generally notice them.

Reduced need for sleep is the most useful early warning there is — not insomnia and exhaustion, but sleeping four hours and feeling energetic. If you and someone who knows you well agree to watch for that one thing, you gain days of warning.

Depression is where most of the time is spent and most of the harm happens, which is worth saying because the condition is discussed almost entirely in terms of the highs.

Antidepressants on their own can destabilise bipolar disorder and tip people towards an elevated episode. It is a common reason a diagnosis of depression gets revised, and a reason we ask about past periods of high energy before starting anything.

Regular sleep and a regular daily routine are not filler advice here. Sleep loss is both a symptom and a trigger, and protecting it is one of the more effective things available.

At your appointment

We will ask about periods of elevated mood and energy in the past, including ones that felt good at the time and never seemed like a problem. Those are easy to leave out and they change the diagnosis.

With your agreement, we will ask what someone close to you has noticed, since episodes are frequently clearer from the outside.

Blood tests and a review of your other medications, since thyroid problems, steroids and some other drugs can produce a similar picture.

A plan for what happens early in an episode — what you do, what we do, and who else gets told — agreed while things are steady rather than improvised when they are not.

Worth asking

• —What are my own early warning signs likely to be?
• —What should I do if I notice them starting?
• —How long should I expect to stay on treatment?
• —Who should I contact out of hours, and how?