bipolar disorder



Bipolar, otherwise known as manic depression, now exists largely within common consciousness and understanding, thanks to high profile stigma-busting publicity.

Characterised by episodic shifts in a person’s mood (between manic and depressed states), as well as their energy and activity levels, which can significantly impact their daily functioning, bipolar is estimated to affect 1% of the population across the lifetime. However, this figure rises to over 4% if you include those who experience more than one episode of sub-threshold manic (or ‘hypomanic’) symptoms.

What we know already

Anxiety is unsurprisingly common in people living with bipolar. Similarly, substance abuse is frequently reported.

Whilst there is no cure, there are several well-established treatment options. Bipolar is usually treated using mood-stabiliser, atypical anti-psychotic and/or antidepressant medications, alongside psychological, and diet and lifestyle interventions. We know, for example, that bipolar can be well managed using regular monitoring of mood, keeping stress levels to a minimum, and ensuring good sleep.

Areas of uncertainty 

Like many mental health difficulties, the precise causes of bipolar are unknown, though they are likely multi-faceted. Research shows that you are more likely to develop bipolar if it exists in your family. Although most children with such circumstances will not go on to develop bipolar, there appears to be a strong genetic component. Environmental factors such as stressful life events are also thought to play an important role.

Recent research suggests that, whilst it appears beneficial to treat bipolar with psychological interventions, the heterogeneity of the evidence makes it difficult to decide which treatments (such as CBT, Mindfulness etc) work best.

What’s in the pipeline?

Large-scale studies, such as the U.S-based Bipolar Disorder Phenome Database, are seeking to better understand the complex genetic picture.

Advances in brain imaging will no doubt provide rich information regarding the neurochemical and neurostructural profile of bipolar. Similarly, technological advances are enabling more sophisticated ways of promoting self-management in conditions such as bipolar.


Merikangas, K.R., Akiskal, H.S., Angst, J., et al. (2007) Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication. Archives of General Psychiatry, 64, 543-552. [Abstract]

Stratford, H.J., Cooper, M.J., Di Simplicio, M., Blackwell, S.E. and Holmes, E.A. (2015) Psychological therapy for anxiety in bipolar spectrum disorders: a systematic review. Clinical Psychology Review, 35, 19-34. [Abstract]


Written by: Patrick Kennedy-Williams
Reviewed by:
Last updated: Sep 2015
Review due: Sep 2016

Our bipolar disorder Blogs

Bipolar disorder in older men linked to increased risk of dementia


Elena Marcus presents a recent study that shows how older Australian men with bipolar disorder have an increased risk of dementia and early death.

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Exercise in severe mental illness: barriers and motivating factors

classic vintage racing bike

Joanne Wallace considers a recent systematic review of exercise in severe mental illness, which focuses on the factors that motivate people to exercise, and the barriers that can prevent physical activity.

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The side-effects of antipsychotics: let’s systematically assess, discuss and act! #NPNR2016


A live blog published at the 22nd International Network for Psychiatric Nursing Research conference in Nottingham.

Written by John Baker, Lucy Brazener, Wendy Cross, Vanessa Garrity, Andrew Grundy, Cher Hallett, Ben Hannigan, Elaine Hanzak and Alan Simpson.

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Integrated care for the physical health of people with severe mental illness: no easy answers


Liz Hughes summarises a recent rapid review on integrated care to address the physical health needs of people with severe mental illness.

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Supported employment for people with severe mental illness


Raphael Underwood highlights a recent international systematic review of individual placement and support for people with serious mental illness who are seeking to return to work.

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Lithium for bipolar disorder: the best maintenance mood stabiliser protection against self-harm and suicide?


Michael Ostacher provides a robust appraisal of a recent UK cohort study that suggests bipolar disorder patients taking lithium had reduced self-harm and unintentional injury rates, when compared with patients taking valproate, olanzapine or quetiapine.

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Can pharmacotherapy help smokers with severe mental disorders?


Andrew Jones reports on an ecological pragmatic clinical trial, which suggests that it is feasible to support smoking cessation in people with severe mental disorders such as bipolar disorder and schizophrenia.

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Evidence-based guidelines for treating bipolar disorder


Joseph Hayes summarises the recent British Association for Psychopharmacology guidelines for the treatment of bipolar disorder, and compares their recommendations with those found in the NICE bipolar disorder guidance from 2014.

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#PreventableHarm discussion 20/7/16: Can risk assessment in mental health be evidence-based?


Can risk assessment in mental health be evidence-based? Join us for the #PreventableHarm discussion in London on Wed 20th July 2016. This free open ‘question time’ style debate is being organised by the UCL Division of Psychiatry, The Lancet Psychiatry and the National Elf Service.

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Psychiatric disorders: what’s the significance of non-random mating?


Marcus Munafo considers the implications of a recent Swedish population study, which explores patterns of non-random mating within and across 11 major psychiatric disorders.

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