Health Insights · Mental Health
Bipolar disorder: understanding mood highs and lows
Bipolar disorder involves episodes of depression alternating with periods of elevated or irritable mood. It takes an average of several years to diagnose, because people seek help when depressed and rarely mention the periods when they felt unusually well — and treating bipolar depression as ordinary depression can make things worse.
Seek urgent help — call 999 or a crisis team — if there is
- thoughts of harming yourself or others, or making plans
- hearing or seeing things others cannot, or strongly held unusual beliefs
- not sleeping at all for several nights while feeling energetic
- behaviour putting you at serious risk — spending, driving, sexual risk, confrontation
- severe agitation or confusion
- these symptoms in pregnancy or after giving birth — postpartum psychosis is an emergency
Mania with psychotic features and postpartum psychosis are psychiatric emergencies requiring same-day assessment. If you are having thoughts of harming yourself or ending your life, help is available now. Call 999 or go to an emergency department if you have already harmed yourself or feel unable to stay safe. Otherwise call Samaritans free on 116 123 at any hour, text SHOUT to 85258, or call NHS 111 and select the mental health option.
Recognising the highs
Hypomania feels good, which is why it is not reported. Look for a distinct period of several days or more, noticeably different from your normal self, with:
- Reduced need for sleep — three or four hours and feeling fine. This is the single most useful marker.
- Racing thoughts and rapid speech; people struggle to interrupt you
- Increased energy, activity and confidence; starting many projects
- Irritability — which is at least as common as euphoria, and often what others notice
- Impulsive decisions — spending, resigning, travel, sexual risk, gambling
- Mania is the same but severe enough to cause serious consequences or require hospital care, sometimes with psychosis
Antidepressants alone can make bipolar worse
Given without a mood stabiliser, antidepressants can trigger a switch into mania or produce rapid cycling between states. This is why the diagnosis matters, and why anyone whose depression has not responded to several antidepressants, or who felt unusually energised on one, should be asked carefully about periods of elevated mood. If you have ever had a period of days feeling unusually good, energetic and needing little sleep, mention it — even if it was years ago and even if it felt like the best you have ever been.
The types
- Bipolar I — at least one episode of mania, usually with depression too.
- Bipolar II — hypomania and depression, without full mania. Depression dominates, which is why it is so often diagnosed as unipolar depression.
- Cyclothymia — chronic milder mood fluctuation.
- Family history is significant, and it typically begins in late teens or early twenties.
Treatment
- Mood stabilisers — lithium remains the most effective for preventing both relapse and suicide, requiring regular blood monitoring of levels, kidney and thyroid function.
- Anticonvulsant mood stabilisers and some antipsychotics are alternatives. Valproate must not be used in anyone able to become pregnant because of severe risks to the baby.
- Bipolar depression is treated differently from ordinary depression — specific agents rather than an antidepressant alone.
- Psychological therapy — CBT, family-focused therapy and psychoeducation reduce relapse meaningfully.
- Do not stop lithium suddenly — abrupt withdrawal carries a high risk of rebound mania.
Staying well
Protective
- Regular sleep and a consistent daily routine — sleep disruption is the commonest trigger
- Mood monitoring, so early changes are caught
- A written plan agreed with family for what to do if warning signs appear
- Avoiding alcohol and stimulants
- Taking medication consistently, including when well
Common triggers
- Night shifts, long-haul travel and jet lag
- Stopping medication because you feel well
- Alcohol, cannabis and stimulants
- Major life events, including positive ones
- Antidepressants without a mood stabiliser
Why come to us. The commonest failure is bipolar being treated as depression for years. We offer unhurried psychiatric assessment that asks properly about periods of elevated mood — often the first time anyone has — usually within weeks rather than months. We take thyroid function, kidney function and full blood count in-house, prescribe and monitor mood stabilisers including lithium levels, and provide psychology alongside. No GP referral needed, 7 days a week.
Private psychiatric assessment for bipolar disorder in London
Bipolar disorder involves episodes of low mood and periods of elevated or irritable mood, and accurate diagnosis and treatment make a major difference. Our private psychiatry team can assess you, and a private GP in East London can help you access care. If you or someone else is at risk of harm, seek urgent help — contact us, call 111, or 999 in an emergency. Tower Bridge Hospital is on Whitechapel Road in East London, a short journey from Canary Wharf and the City, with same-day appointments and no referral required.
Bipolar disorder in London: common questions
How is bipolar disorder diagnosed?
Through a careful psychiatric assessment of your mood history over time; it is often mistaken for depression alone, so specialist review helps.
How is it treated?
With mood-stabilising treatment, psychological support and lifestyle strategies; care is individualised and reviewed over time.
Can I be seen quickly?
Yes — private psychiatric assessment can usually be arranged promptly, and a GP can see you the same day.
When is it an emergency?
Thoughts of harming yourself or others, or being unable to stay safe, need urgent help — call 999 or 111.
Assessed by a psychiatrist within weeks
Lithium monitoring and bloods in-house. No referral needed.