Bipolar disorder - a guide for professionals
Bipolar disorder (BD) is a mental health condition that affects how you feel. Sometimes you can feel low in mood or depressed but this can swing to feeling excitable and high in energy.
There is no research into how many autistic people have bipolar disorder.
Bipolar disorder can have a significant impact on a person’s life, but with treatment, it can be managed. This guide explores how BD might affect an autistic adult or child, and the treatment and support options.
What is bipolar disorder?
“Bipolar disorder is a mental health condition that affects your moods, which can swing from one extreme to another. It used to be known as manic depression. Bipolar usually means a person experiences episodes of mania (high energy, excitable) and depression (low energy and mood).” NHS (2019)
Symptoms of bipolar disorder can include:
- manic episodes
- hypomanic episodes (similar to mania but generally shorter episodes and can feel more manageable)
- depressive episodes
- mixed episodes of mania and depression
- psychotic symptoms (not everyone will experience these).
Anyone can be diagnosed with bipolar disorder. It usually develops in the late teens (15-19 years old) - it’s rare for it to develop after the age of 40. The exact cause of bipolar is unknown but some potential triggers include:
- extreme stress
- overwhelming problems (eg financial)
- life-changing events such as relationship breakdowns or the death of loved ones
- genetic factors
- drug use.
Bipolar can affect a person’s life in various ways, including:
- mood swings that are severe enough to affect everyday life
- driving (anyone diagnosed with BD must notify the DVLA)
- suicidal thoughts and self-harm
- difficulty with sleeping
- difficulty with eating
- strained relationships
- changing personality – making a usually calm person more agitated or aggressive.
Due to a lack of research, we don’t know if there are specific triggers for bipolar disorder in autistic people, or how many autistic people may have the condition. Some research suggests there are similarities between symptoms of bipolar disorder and autistic traits, making a diagnosis of both difficult. This is echoed in the personal accounts of autistic people and parents.
Bipolar disorder can be upsetting and distressing for the person experiencing it and can result in significant changes in behaviour and mood. Bipolar disorder can have a significant impact on relationships with friends, family and partners. Treatment and support is essential to help manage BD.
Getting help with bipolar disorder
If you work with an autistic person that you think may be experiencing some of the symptoms of bipolar disorder, you should advise them or their family members to contact their GP. The GP should be able to refer the person to a local mental health team for further help.
Mental health teams may ask the person to keep a diary to record their moods to rule out other possible conditions that could be causing their symptoms. When it comes to assessment, the team may ask questions such as:
- How many symptoms have they experienced?
- How long do their manic or depressive episodes last?
- How many episodes have they had, and how frequently do they occur?
- What impact do their symptoms have on their life?
- What is their family history of mental health conditions?
The full diagnosis process can take time, as doctors and psychiatrists may want to monitor symptoms over time to avoid misdiagnosis.
Visit our mental health support page for more information on counselling and therapy.
Treatment for bipolar disorder
There are no guidelines for the treatment and support for autistic people with a diagnosis of bipolar disorder. The National Institute for Health and Care Excellence (NICE) (2014) has general guidelines for the assessment and treatment of BD and recommends both medication and psychological treatments such as cognitive behavioural therapy (CBT) and individual therapy. Therapy should be adapted for autistic patients.
NICE recommends certain types of medications, specifically antipsychotic or mood stabilisers, which can be prescribed to manage BD. These include:
The NICE guidance also states that if antipsychotic medication is not sufficient, Lithium (adults only) or Valproate may be used (excluding women who may become pregnant), but it should not be the first course of treatment.
Organisations offering advice
There is no specific advice for autistic people with BD, but there are several charities and organisations that offer general help and information on BD, such as Mind and the NHS.
Useful resources
Personal accounts:
Some of the following accounts may share information and experiences that you may find distressing.