When the Highs and Lows Won't Level OuT
Part of our 10 for when series:
BIPOLAR DISORDER
When moods shift beyond your control, it could be more than stress.
Learn what bipolar disorder really is, what triggers episodes, and how to find support.
Mental Health Requires Active Attention
Mental health, like physical health, is not something we can be passive about and expect the best outcomes.
And similar to dealing with physical injuries or chronic conditions, maintaining our mental health can require extra time, energy, and effort to manage depending on what we’re dealing with. Unlike many physical health conditions though, mental health challenges are not always visible to others. They are primarily felt from within, which can make them that much harder to address.
With mental health conditions still being widely stigmatized, many individuals suffer silently, and carry internalized shame alone. But according to the World Health Organization, mental health disorders affect more than 1 billion people worldwide — making it highly unlikely that you or someone you know has not been affected, either directly or indirectly.
10 for When is a monthly series dedicated to one mental health topic at a time, offering ten practical resources you can save, share, and return to whenever you need them most.
This month’s focus: BIPOLAR DISORDER
What Is Bipolar Disorder?
If you’ve ever seen bipolar disorder portrayed in TV or the movies, you know it is often either misrepresented as extreme emotional volatility, unpredictable violence, eccentric genius, or oversimplified as “mood swings.” These portrayals can be harmful and misleading, particularly for those seeking to understand their own experience or that of someone they care about.
Bipolar disorder is a mood disorder characterized by episodes of mania, hypomania, and depression. While the exact cause of bipolar disorder is not fully understood, the World Health Organization identifies a combination of genetic, psychological, social, and structural factors as likely contributors. Family history is a major contributor, with 80% to 90% of individuals with bipolar disorder having a relative with bipolar disorder or depression. Other key factors are imbalances in neurotransmitters, structural brain differences, and high-stress life events.
It is a complex and often misunderstood condition — not a character flaw.
When we can look at individual experiences, remove the stigma and shame, and accept its presence, we can better manage it through meeting our needs and seeking support both from professionals and from our friends and family. Bipolar disorder is often managed with medication and therapy.
Mental Health America recognizes the following types:
Primary:
Bipolar I
Bipolar II
Cyclothymic Disorder
Other Specified:
Rapid-cycling bipolar disorder
Mixed features bipolar disorder
These types differ in the severity, duration, and pattern of manic, hypomanic, and depressive episodes, and how significantly they impact daily functioning.
What Triggers Bipolar Episodes?
As humans, we have layered needs, including: biological, psychological, social, and spiritual. Meeting these needs requires consistent attention to sleep, nutrition, hydration, movement, emotional regulation, relationships, community, safety, and a sense of meaning and purpose. When these needs go unmet — often due to systemic barriers, life circumstances, or the disorders themselves — our bodies respond in a multitude of ways.
For people with autoimmune conditions, they may experience a flare up of symptoms like skin issues or fatigue. People with chronic pain may experience an increase in pain, or pain in a new area. And for people with bipolar disorder, they are likely to experience mood episodes like mania, hypomania, and depression.
Common triggers for bipolar episodes include:
Sleep disruption
Blood sugar instability
Dehydration
Stress
Sedentary behavior or overexertion
Medications or medication non-adherence
Substance use
Seasonal changes
Hormonal fluctuations, including pregnancy and postpartum
Social isolation
Loss of purpose or meaning
This list might seem overwhelming, as these can be easy things to overlook in day to day life when we’re simply living, working, and maintaining relationships with friends, family, and significant others. And it is challenging, but it is also important – and more importantly, it is possible given the right systems and support in place.
Living With Bipolar Disorder
Living with bipolar disorder can be challenging not only due to the increased effort that individuals must put into meeting their needs, but also due to the unpredictability of episodes and the intensity of mood shifts that can occur.
During manic or hypomanic episodes, a person may experience elevated or irritable mood, impulsivity, hypersexuality, racing thoughts, decreased need for sleep, increased energy, agitation, reduced appetite, or grandiosity that can escalate to delusional thinking. Following a manic episode, individuals often face real-world consequences — strained relationships, financial difficulties, job loss, or substance use — while simultaneously entering a depressive episode.
Depressive episodes in bipolar disorder can involve disrupted sleep, changes in appetite, low energy, loss of interest or pleasure, difficulty concentrating, and in some cases suicidal ideation. It is important to take any expression of suicidal thoughts seriously and seek professional support immediately.
Evidence-based supports include:
Consistent sleep routines
Blood sugar regulation through balanced nutrition
Stress management practices
Medication, as prescribed and monitored by a provider
Psychotherapy, including Cognitive Behavioral Therapy (CBT) and Interpersonal and Social Rhythm Therapy (IPSRT)
Limited or no substance use
Ongoing mood and behavior monitoring through journaling or mood-tracking tools
Bipolar disorder does not have to mean a constant cycle of extremes. With consistent, appropriate support, many people with bipolar disorder live stable, fulfilling lives.
Supporting Someone With Bipolar Disorder
Supporting someone with bipolar disorder requires patience, consistency, and realistic expectations. There is currently no cure for bipolar disorder, but with the right supports in place, effective management is entirely possible.
Support should never involve force or coercion. The most helpful things you can offer are:
Patience and non-judgment
Genuine care and consistency
A willingness to stay informed about the condition
Encouraging open, honest communication
Recommending professional help when appropriate
When someone you care about is struggling, it can be instinctive to want to step in and fix things — but this can inadvertently undermine the safety and trust you've built. That said, there are situations where professional intervention is necessary. It's worth having a calm, collaborative conversation with your loved one during a stable period to create an agreed-upon plan for how to respond during a crisis — one that feels safe and respectful to both of you.
A Real Story
The following is an example of what it can look like to support a loved one with bipolar disorder over time, not as a ‘how to’ but as a way of showing what's possible.
When a relative of mine was diagnosed with bipolar disorder at 19, he assumed it was a misdiagnosis due to extenuating circumstances. When he was in his mid-20s he suffered from a major depressive episode and began to seek treatment, though he was still unsure that what he was experiencing was bipolar. At 27, during the pandemic, he made a risky financial decision and purchased a home, and the financial stress built up over the next two years which triggered a major manic episode – causing him to take a leave from work, followed by a major depressive episode that took many months to recover from. But, he finally accepted his diagnosis.
The most recent manic and depressive episode was eye-opening for both him and our family. Rather than trying to help him from afar, or one on one, we finally decided that the best option would be to work together to support him as much as possible, and it has truly made a difference.
Now that we openly communicate as a family, we are able to notice the warning signs of mania and depression before they become too extreme – and offer support in whatever ways are needed. Sometimes this involves the doctors he has found, sometimes this involves lifestyle adjustments, and other times it involves just talking.
The moral of the story here is that with the right support, my relative is able to live his life. But this is only possible because:
He accepted his diagnosis.
He is aware of his triggers and actively works to prevent them.
He willingly and openly communicates with his family about his experience and what he is feeling.
He is committed to getting professional support.
No one in our family thinks this person is a problem that needs to be fixed, nor do we attempt to make monitoring him our full time job. Instead we offer presence, support, and communication whenever needed, and otherwise we don’t overly involve ourselves.
Let's Talk About It
My relative's story is not unique in its challenges — but it is also not unique in its possibility. Because of the stigma and misconceptions surrounding bipolar disorder, many people hesitate to share their diagnosis with those closest to them. But staying silent removes the opportunity for the people in your life to truly know you, and to show up for you when you need it.
Talking openly about mental health — with family, friends, or within a support community — helps reduce stigma and the isolation that so often accompanies it. You don't have to navigate this alone.
Every experience with bipolar disorder is different.
But awareness, acceptance, open communication, and a willingness to seek support — those seem to matter across all of them.
if you’re struggling with BIPOLAR DISOrder, view our list of 10 for When.
10 for When is your go-to swipe sheet of tools, resources, and support for the moments when the hard stuff shows up, because it will. Consider this your standing invitation to be a little more ready than you were yesterday.
Disclaimer: This blog is not meant as professional advice or counseling. If you are in emotional distress or experiencing thoughts of harm to yourself or others, help is available 24/7:
If in crisis, call 988
Text HELLO to 741741 to connect with a Crisis Text Line counselor
Call the National Suicide Prevention Lifeline:
1–800–273–8255 (TALK) Spanish & English
Deaf & Hard of Hearing TTY 800–799–4889
Call 911
If you need mental health treatment but cannot afford it, contact Rise Above The Disorder, a 501(c)(3) non-profit dedicated to making mental health care accessible to everyone: YouAreRAD.org
