Bipolar Disorder

One more in my series on the most common psychological disorders in Australia.


Charlie* had sought treatment following a suicide attempt. “I’d gambled away all our savings been caught cheating on my wife, I felt worthless”. Charlie was living in his parents’ spare room at the time of referral. He had been in a manic state and believed that he had worked out a system to beat the casino. “When it all came crashing down, I realised I was living a lie”.

Ashwin* is a mechanic and 28-year-old father of one. He has always been the life of the party but has also always been extraordinarily moody. His family had called him “Four seasons in one day”. As an adult, Ashwin had been diagnosed with depression and given antidepressants. Diagnosed with ADHD as a child, Ashwin was no stranger to psychiatrists and medication. However, the antidepressants that he took made him hyperalert, energic and paranoid.


The fundamental characteristic of bipolar disorder is extreme emotional swings. For most people, a changeable mood is normal, not exceptional. A person with mood that changes between very low (depressed) and very high/hyper (manic or hypomanic) may have bipolar only if they have clinically significant impairment and distress as a result. The pattern of mania and depression can have devastating effects on people’s work, financial, relationship and social functioning.

Bipolar disorder can be classed as Bipolar I or Bipolar II. Bipolar I involves a manic episode. Bipolar II involves a hypo-manic episode. Hypo means less than usual, and a hypomanic state is less severe than mania. On top of this, an episode could be “Mixed” meaning the characteristic of both mania and depression are present simultaneously.

Bipolar I: Manic Episode

A manic episode is a mood state that is elevated or expansive. People often demonstrate very high self-esteem and talk and think in a grandiose manner. They have a decreased need for sleep. Their speech is often pressured, and they are very chatty. And what they say might be hard to follow. It is common for them to race and jump from topic to topic. They tend to be very distractable.

People in a manic episode tend toward goal-directed and pleasure-seeking activities. Activities such as gambling, risky business ventures, risky sexual escapades and grandiose gestures like extravagant gift giving. These ventures can take on a delusional quality. Painful consequences are common for people in manic episodes – money loss, relationship difficulties and legal troubles often follow.

Charlie found himself in a manic episode. He had become convinced that only he was smart enough to beat the system. He even had a delusional belief that ASIO wanted him to win big and bring down the people behind the casino who were funding terrorism and organised crime. Despite several large losses he continued to gamble. He rationalised smaller losses away until he finally lost it all.

Bipolar II: Hypomanic Episode

A hypomanic episode might have the same symptoms as a manic episode, but it is by definition shorter and is typically less intense.  A hypomanic episode may last for as little as 4 days. More intense than a good mood, these episodes must also cause clinically significant distress or impairment.

Ashwin was diagnosed with Bipolar II after he ceased antidepressants. When reviewing his history, his psychiatrist determined that he had experienced many hypomanic episodes previously. These episodes had been written off as part of his extreme personality or his ADHD. However, he had ruined several friendships and injured himself quite badly whilst in these states. He also felt a deep shame about his actions.

Major Depressive Episode

What comes up, must come down.

A depressive episode has the same symptomatic criteria as normal depression. Depression without mania or hypomania is called Major Depressive Disorder or Unipolar Depression. A depressive episode includes some of these symptoms: low mood, lack of pleasure, fatigue, sleep or dietary disturbances, motivation, thinking or energy changes.

Like Aswin and Charlie, people with bipolar disorders often feel deep shame and guilt once out of the intoxicating spell of mania. These emotions fuel the decent to depression. The depressed self is often left to pick up the pieces from the mess made by the manic explosion. Repairing friendships, paying bills, regaining trust. These problems make the depressive burden ever harder.


Medication is the correct first line treatment for bipolar. Because some medications for other psychological disorders can make bipolar worse, it is worth talking to a GP about a referral to a psychiatrist.

Psychologists can help too. Psychologists can help with strategies to level out the lows and the highs. It is often the case that people with bipolar have experienced difficult or traumatic lives, which sometimes are worth processing with a psychologist.


* Names and key details changed

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