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Dr Shelagh Wright - Systemic and Family Psychotherapist and Family Mediator

I've Been Thinking - Dr Shelagh's Blog


Our moods are rarely completely stable and the world would be a very boring place if they were. But in bipolar disorder, mood swings aren't like normal highs and lows, they are much more intense.

It's not the recurring pattern of these moods that causes problems; it's their severity. Bipolar disorder is characterised by extreme mood swings, from deep depression to extreme elation or 'highs'.

The severe highs and lows may alternate, or there may be long periods of stability between them. Some people with bipolar disorder mainly experience depression, with only occasional manic phases.

During a manic phase, people feel enormously energetic and powerful and tend to become hyperactive, going without sleep and embarking on totally unrealistic schemes or projects.

Some people find they're very creative.

However, problems arise when their high mood spins out of control and the person behaves in ways they later find deeply embarrassing. It's quite common for someone to lose touch with reality and, for example, run up enormous debts or invite complete strangers to their home. There can also be unfortunate consequences of decisions taken while in a manic phase.

The depressive phase is similar to other forms of depression. It's characterised by a lack of energy and interest in life, low self-esteem, and feelings of guilt and despair.

Sometimes people feel suicidal.

What are the causes?

The exact causes of bipolar disorder aren't known, but stressful life events, irresolvable problems, or emotional damage in childhood may play a part, possibly combined with genetic factors.

What are the symptoms?

It's important to distinguish between the three elements of this condition:

Symptoms of mania can include:

Then there's the cycle in which these sets of symptoms can occur. This can come in several varieties:

How common is it?

Between one and two per cent of the UK population has bipolar disorder. If you have a relative with bipolar disorder, then your chance of developing it is higher.


With any condition that goes in a cycle, half the battle of managing it is monitoring what point the cycle is at any time.

To cope, it's sometimes useful to think about bipolar disorder in the same way as asthma or diabetes in that taking certain daily measure enables planning for the day.

Similarly, with bipolar disorder, monitoring mood thoughts can help to spot changes in mood that might come before a relapse. It's still possible that a relapse may happen, but this can be planned for.

It's important to have a trusted friend or carer. You can make an agreement that whenever they spot the warning signs of a relapse they will warn you, and you can both take certain pre-agreed steps.

These could be taking a couple of days' rest, reviewing whether you've taken on too much lately and shedding some of it, or seeing a community mental health team member.

Symptoms of Depression?

As with many mental health problems, there are a number of symptoms of depression and it's very rare for all of them to occur in one person. They include feeling generally miserable, as well as:

This presents a very bleak picture. However, it's important to remember that depression isn't an absolute - it's not simply a case of either you're depressed or you're not. There's a progression from feeling blue to the full clinical illness described above. Even then, you won't suffer from every symptom.

How common is it?

Seven to 12 per cent of men suffer from diagnosable depression, and 20 to 25 per cent of women. There are many theories as to why the figure is higher for women. The incidence of postnatal depression certainly contributes to the higher figure.

Monitoring mood

This is the starting point for managing depression. It will helps to learn to spot an episode of depression before it's too late. Using the thought-monitoring technique, a decision can be made about which thoughts represent an accurate picture of what's going on and which are unrealistic and created by the mood beginning to fall. It is often helpful to have a close friend help monitor mood changes, as they can often be able to recognise the early signs of depression.