About bipolar Could it be bipolar? Diagnosing Bipolar Could it be bipolar? Take our Mood Disorder Questionnaire How to get a diagnosis Delayed diagnosis — a common problem Preparing for appointments After your bipolar diagnosis Evaluation survey Could it be bipolar? There are many symptoms of bipolar that can often be overlooked for something else. Have you experienced periods of low mood, little energy and no interest in things that you usually enjoy followed by periods when you’ve been highly energised, productive, restless and/or irritable? Have there been times when you got very little sleep, have taken more risks and/or made impulsive decisions? Is there a history of bipolar in your family? Have you been told you have treatment-resistant depression? Have you tried different formulations and doses of antidepressants that don’t seem to help much, if at all? Then it’s worth asking the question: could it be bipolar? Everyone has ups and downs, and times when they feel happier or sadder than usual. But when you have bipolar, you have extreme mood swings. They can really change your behaviour and have a big impact on your life. Most people with bipolar also have periods of stable mood in between. No two people with bipolar are the same. Our Mood Scale is a simple way of thinking about different mood states and energy levels. Most people sit between 4 and 6 most of the time. If you have bipolar, you move up and down the scale, although you may also have stable periods in the middle of the Mood Scale. Depression — sometimes called ‘unipolar’ depression to distinguish it from bipolar — is very common. GPs see about ten times more people with it compared with bipolar. The two share some symptoms and it can be difficult to tell the difference between them. This is one of the main reasons a bipolar diagnosis is often delayed. The key point is that in depression you have the low but not the high moods. The tell-tale sign of bipolar is moving between extreme high and low moods. Take our Mood Disorder Questionnaire This Mood Disorder Questionnaire (MDQ) can give you an idea of whether or not you might have bipolar. It doesn’t diagnose bipolar — only a psychiatrist can do that. But it can give you some helpful information to take to your GP. Once you have completed the MDQ, please fill in this short survey so we can help more people living with undiagnosed bipolar get a diagnosis. Next steps If you got a 'you may have bipolar' result: Read the info about getting a diagnosis further down this page Download the Mood Tracker app Use the app to track your mood for the next few weeks Make an appointment with your GP and show them your mood graphs on the app and your MDQ results If you or someone you know has taken the MDQ, complete this short survey so we can help more people living with undiagnosed bipolar get a diagnosis If you got a 'it is unlikely that you have bipolar' result and you are still concerned: Download the Mood Tracker app Use the app to track your mood for the next few weeks Retake the Mood Disorder Questionnaire If you still get a 'it is unlikely that you have bipolar' result, make an appointment with your GP, show them your mood graphs on the app and tell them why you're concerned If you or someone you know has taken the MDQ, complete this short survey so we can help more people living with undiagnosed bipolar get a diagnosis How to get a diagnosis If you’ve taken the Mood Disorder Questionnaire above and it’s recommended you get a medical assessment for bipolar, use the Mood Tracker app for a few weeks and then make an appointment with your GP. If they think it’s appropriate, they will refer you to a psychiatrist. Although this sounds simple, it often isn’t. We know people with bipolar often go backwards and forwards to their GP for a long time before they get a referral. Delayed diagnosis — a common problem Bipolar is one of the most prevalent severe mental health conditions in the UK. It’s estimated 1 million people are affected — that’s 2% of the population. Some research suggests 56% of people living with bipolar in the UK don’t have a diagnosis. On average, there’s a 9.5-year delay between someone seeing a doctor about a symptom of bipolar and getting an accurate diagnosis. Any delay in diagnosis can mean you don’t get the treatment you need. In a survey, 60% of people said the delay in diagnosis had a significant impact on their lives. Diagnosis — what often happens A common road to diagnosis #1 You see a doctor with symptoms of depression You may be prescribed psychological therapies, such as cognitive behavioural therapy (CBT), or advised to make lifestyle changes You may feel well for a while but then the symptoms of depression return so you see your GP again (maybe several times) You’re diagnosed with ‘unipolar’ depression — this is when someone has low mood but not the highs linked with bipolar, and GPs see this about ten times more often than they see bipolar You’re prescribed an antidepressant You have a manic episode, which may have been triggered by the antidepressant. Nearly one in five people we surveyed said an antidepressant triggered their first manic episode You’re sectioned and admitted to hospital You’re diagnosed with bipolar in hospital by a psychiatrist A common road to diagnosis #2 You see a doctor with symptoms of depression You may be prescribed psychological therapies, such as cognitive behavioural therapy (CBT), or advised to make lifestyle changes You may feel well for a while but then the symptoms of depression return so you see your GP again (maybe several times) You’re diagnosed with ‘unipolar’ depression — this is when someone has low mood but not the highs linked with bipolar, and GPs see this about ten times more often than they see bipolar You’re prescribed an antidepressant The antidepressant doesn’t work so your GP adjusts the dose The new dose doesn’t work so your GP recommends a different antidepressant You feel well for a while but then you again experience depression, and this time may even have suicidal thoughts You’re prescribed yet another different antidepressant The antidepressant doesn’t work so you’re diagnosed with ‘treatment-resistant’ depression until eventually you’re referred to a psychiatrist and you’re diagnosed with bipolar In both these scenarios undiagnosed bipolar may have caused havoc in your life, affected your relationships with family and friends, and possibly resulted in long-term consequences. ‘I was diagnosed with depression and prescribed antidepressants in May 2000 following a suicide attempt. I was then diagnosed with bipolar in September 2000 and my life changed for ever. That four-month climb to the heights of mania, when I was sectioned, irreparably damaged relationships and left me broke.’ GW Why bipolar can be missed Diagnosis isn’t straightforward. There isn’t a blood test, brain scan or other test that clearly shows whether someone has bipolar. Instead, bipolar has to be diagnosed based on symptoms. The symptoms that can be red flags for bipolar are sudden, specific changes in mood and behaviour that can’t be explained by other things, such as alcohol misuse. It can be challenging for GPs to pick up on warning signs. In a short appointment, a busy GP may struggle to get complex mental health information from someone. They may not have time to ask all the questions they need to ask. Misdiagnosis is very common. Usually this comes from doctors treating the depression symptoms. Overlapping symptoms can cause confusion. Some people may have another mental health condition alongside bipolar, such as anxiety, depression, post-traumatic stress disorder (PTSD) and panic disorder (this is known as a dual diagnosis). Some people with undiagnosed bipolar self-medicate with alcohol or other substances. This can mean there’s often a lot going on for them, and that can make it difficult for a GP to pick up on the red flag symptoms in a brief appointment. Screening questions depend on you having some insight into symptoms. Lots of people don’t realise periods of hypomania can be a sign of bipolar. And if you’re going back over the past few years, you may not remember everything that’s important to tell your GP. On top of that, a lot of people don’t go to the doctor when their symptoms are severe because they don’t feel unwell. Lack of access to mental health specialists can cause delays. Even if your GP realises bipolar may be causing your symptoms, it can be difficult to get a referral to a psychiatrist. A diagnosis of bipolar still carries a stigma. For some people a diagnosis can feel like the start of a road you don’t want to go down, and you may have concerns about how a diagnosis may affect your life, including your work and relationships. The family and cultural background you come from can also affect how you feel about being diagnosed. And you may be facing other types of stigma already — for example, because of your race, gender, disability or sexuality. This can make the idea of a severe mental health diagnosis even more challenging. These feelings are understandable but most people with bipolar tell us getting a diagnosis has been helpful for them. 'When I got my diagnosis it was like a weight was lifted off my shoulders because it kind of helps me and others understand why I do certain things. It was a relief.' CS Why diagnosis matters We understand that even thinking about being diagnosed with bipolar may feel overwhelming. But the reality of getting diagnosed may be more positive than you might expect, and 84% of people living with bipolar say it’s been either helpful or very helpful. Here are some of the reasons why getting a diagnosis can be positive. You can start treatment. You’ll only be able to get specialist medicines and access to support services once you have a diagnosis of bipolar. A self-management programme is another important part of treatment. This includes steps to manage bipolar through ‘protective factors’, such as having a regular sleep pattern and exercising regularly. It can help explain past experiences — 81% of people with bipolar say this is the top benefit of getting a diagnosis. Like lots of people with bipolar, you may have shame and regret about things you’ve said or done when you’ve been going through a period of mania or deep depression. You may not understand why you behaved this way, which can feel lonely and confusing. Having a diagnosis can help you make sense of things. It can help others understand you better. Nearly half of people with bipolar say having a diagnosis helps others understand them. During episodes you may behave in ways that are challenging for your friends, relatives and colleagues. This can put a strain on your relationships. Having a diagnosis can mean other people understand you better. You may find it easier to get the right support. Once you have a diagnosis you can link up with other people with bipolar through our peer support groups and eCommunity. A diagnosis may also help you get support and understanding from your loved ones, friends and colleagues. 'For years I took antidepressants but still struggled with low moods. And at times I was spending too much, and I was irritable and angry. Then three years ago, a psychiatrist diagnosed bipolar, put me on a mood stabiliser and adjusted the dose of the antidepressant. Everybody around me noticed the difference straight away. Getting a diagnosis has had quite a dramatic effect on me.' AT Preparing for appointments Both the GP and psychiatrist will ask you lots of questions about your mood, thoughts, behaviour and family history. Preparing for your appointments may give you a better chance of being diagnosed quickly if you have bipolar — and ruling it out if you don’t. Monitor your moods and behaviour. Using our Mood Tracker app to record your daily mood, sleep and emotions means you can show your doctor weekly and monthly snapshots of what you’ve been experiencing. Or if you prefer to use a pen and paper, use our Mood Scale and Mood Diary. Think about family history. Bipolar is a genetic condition meaning it can be passed down through families. If there are cases in your family, this is useful information that can help with diagnosis. Remember that it used to be called ‘manic depression’. Or you may know of family members who were considered to have unusual behaviour at times, or highs and lows. These could be clues. Don’t worry if you can’t gather much information on family history — it can help doctors build a fuller picture but isn’t essential. Write down questions. Remember, this is your appointment. You could prepare for things you think the doctor might say, especially if you’ve talked to them before about your mental health. During appointments You may want to ask someone to go with you to your appointments. They can prompt you to ask questions, write notes to help you remember what was said afterwards and offer moral support. But if you feel more comfortable going on your own, that’s fine too. Ask if you haven’t understood anything the doctor’s said. GPs and psychiatrists sometimes use clinical language that can be confusing. You can ask them to go over something again if you haven’t understood, or you can repeat what you think they said to check you’ve got it right. Most doctors will be happy to go over things. After your bipolar diagnosis It’s normal to have a range of different feelings when you’re diagnosed with bipolar. For some, being diagnosed can be a real shock. You may have heard negative stories about famous people with bipolar, or know people in your own family with it. This may lead to concerns you’re going to be like them. It’s natural to worry about how it might affect your life, from your work to your relationships. For some people, diagnosis can lead to a kind of grieving for a future they thought they’d have. Some dislike the idea of having a ‘label’. Other people tell us having a diagnosis was a relief, especially if they’ve been living with undiagnosed bipolar for a long time. Having a diagnosis means you can finally get the right treatment. It can help you make sense of your life and can give you some hope for the future. You may feel a mixture of different emotions in the days and weeks after your diagnosis. It’s all completely natural and many people with bipolar tell us they’ve been through this. What next? Bipolar is a long-term condition you’ll need to manage for the rest of your life. This may feel daunting at first, but your psychiatric team and doctor will support you with the next steps. You can also ask them to help you create a self-management plan to help you live well with bipolar. You may also find it helpful to read our ‘Understanding bipolar’ section on the website. Bipolar UK is here to support you Being diagnosed with bipolar, or waiting for a diagnosis, can be stressful and overwhelming. But you’re not on your own. We have lots of support to help you, whatever your situation. Our 20-minute eLearning course is a good starting place to help you and the people around you understand bipolar better Our peer support groups can link you up with other people with bipolar in your area who will understand what you’re going through and can share their experiences Our peer support line is a confidential service where you can get info and advice from someone who is affected by bipolar and trained to help people If you prefer to chat online, try our friendly moderated eCommunity that’s open 24/7 Subscribe to our eNewsletter, follow us on Facebook and Twitter and keep informed with all the latest news from us Take our short evaluation survey Our aim is to empower people affected by bipolar. If you have completed the Mood Disorder Questionnaire and could benefit from further medical assessment, please take this short survey. This will help us to ensure more people get the support they need to get a diagnosis of bipolar. take our short survey For personal stories about getting a diagnosis, read about one individual’s experience of what undiagnosed bipolar can feel like.