Bipolar Type 1 vs Type 2
| Feature | Bipolar I | Bipolar II |
|---|---|---|
| Mania | Full manic episodes (may need hospitalisation) | No full mania — hypomania only |
| Hypomania | May occur | Present |
| Depression | Present | Often predominant and severe |
| Psychosis | Can occur in mania | Rare |
| Severity | More severe manic episodes | Often underdiagnosed — depression dominated |
Signs of Mania / Hypomania
- Decreased need for sleep (2–3 hours and feeling fine)
- Racing thoughts and rapid speech
- Grandiosity or inflated self-esteem
- Increased energy and goal-directed activity
- Risky or impulsive behaviour (spending, sex, risky decisions)
- Irritability
Mania Warning SignsMania can escalate rapidly to psychosis, dangerous behaviour, and hospitalisation. Early warning signs: needing less sleep but feeling energetic, unusual confidence, rapid spending. Have an agreed crisis plan with your mental health team.
Blood Tests Before Starting Lithium
| Test | Why |
|---|---|
| Kidney function (eGFR, creatinine) | Lithium is excreted by kidneys — contraindicated in severe CKD |
| Thyroid (TSH) | Lithium causes hypothyroidism in 20–40% with long-term use |
| Calcium | Hyperparathyroidism with long-term lithium |
| FBC | Baseline |
| ECG | Lithium can cause T-wave changes |
| Pregnancy test | Lithium is teratogenic (Ebstein's anomaly) |
Ongoing Lithium Monitoring
| Test | Frequency | Target |
|---|---|---|
| Lithium level (trough) | Every 3–6 months | 0.6–0.8 mmol/L (maintenance) |
| Kidney function | Every 6 months | Monitor for decline |
| Thyroid (TSH) | Every 6 months | Treat hypothyroidism if develops |
| Calcium | Annually | Watch for hypercalcaemia |
Is bipolar disorder a lifelong condition?
Most people require long-term mood stabiliser treatment. However, with treatment, most achieve good stability and lead fulfilling lives. Some people have only occasional episodes decades apart.
What triggers bipolar episodes?
Common triggers: sleep disruption, significant life events (positive or negative), alcohol and recreational drugs, some antidepressants if taken without a mood stabiliser, seasonal changes.
Can antidepressants make bipolar worse?
Yes — antidepressants taken alone (without a mood stabiliser) can trigger a switch into mania or rapid cycling in bipolar disorder. Always take with a mood stabiliser if antidepressants are prescribed.
Medical Disclaimer: This page is for general education only and does not replace professional medical advice. Always consult a qualified healthcare provider.