Bipolar disorder
Also known as: bipolar disorder, bipolar affective disorder, bipolar I disorder, bipolar II disorder, cyclothymic disorder, mania, hypomania, bipolar depression, mixed mood episode, manic depression, manic-depressive illness
Bipolar disorder is a mood disorder characterised by episodes of mania or hypomania and episodes of depression, with periods of more stable mood occurring between episodes for many people. Bipolar I disorder involves at least one manic episode, which may be preceded or followed by hypomanic or depressive episodes. Bipolar II disorder involves hypomanic episodes and major depressive episodes without a history of full mania. Mania is more severe than hypomania and causes marked functional impairment, may require hospital treatment and can include psychosis. Symptoms may include unusually elevated or irritable mood, increased energy, markedly reduced need for sleep, rapid speech, racing thoughts, distractibility, inflated confidence, agitation, excessive spending, unsafe driving, sexual risk-taking, substance use and unrealistic plans. Bipolar depression may include persistent low mood, loss of interest, fatigue, slowed or agitated movement, impaired concentration, guilt, hopelessness, sleep or appetite changes and suicidal thinking. Mixed features can combine depressive distress with agitation, energy, impulsivity or racing thoughts and may carry significant suicide risk. Diagnosis requires a detailed longitudinal history because bipolar depression can resemble unipolar depression, trauma-related disorders, attention-deficit hyperactivity disorder, personality disorders, substance-induced mood symptoms, thyroid disease, medication effects and other psychiatric or neurological conditions. Treatment may involve lithium, valproate, lamotrigine, antipsychotic medicines and other psychiatric medicines selected according to the episode, pregnancy potential, physical health and individual treatment history. Psychological interventions, psychoeducation, sleep and routine stabilisation, substance-use treatment, family support and relapse-prevention planning are also important. Antidepressants can trigger mania, mixed symptoms or rapid cycling in some patients and should not be initiated or discontinued without appropriate clinical supervision. Acupuncture may be considered only as adjunctive support for stable patients experiencing stress, sleep disturbance or medication-associated discomfort. It cannot terminate mania, treat psychosis, prevent suicide, replace mood-stabilising medicines or provide safe crisis containment. Chinese herbal medicine has clinically important risks because products may stimulate the nervous system, disturb sleep, alter mood, affect lithium concentration, interact with psychiatric medicines or cause liver, kidney and cardiovascular toxicity. [1][2][3][4][5][6][7]
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Lifestyle & Diet
- •Take prescribed mood-stabilising and antipsychotic medicines exactly as directed.
- •Do not stop psychiatric medicines abruptly without medical advice.
- •Keep regular appointments with the treating psychiatrist, general practitioner and mental-health team.
- •Create a written relapse-prevention and crisis plan.
- •Identify personal early warning signs of mania, depression and mixed symptoms.
- •Track sleep, mood, energy, irritability and medicine adherence when recommended.
- •Maintain a consistent waking and sleeping schedule.
- •Treat a reduced need for sleep as a potential warning sign even when the person does not feel tired.
- •Seek early clinical advice after one or more nights of markedly reduced sleep combined with increasing energy or impulsivity.
- •Avoid deliberate sleep deprivation, overnight work or repeated time-zone disruption when these trigger episodes.
- •Use regular meals and adequate hydration.
- •Maintain stable salt and fluid intake when taking lithium unless the treating clinician advises otherwise.
- •Seek medical advice during vomiting, diarrhoea, fever, heavy sweating or dehydration when taking lithium.
- •Check before using anti-inflammatory medicines, diuretics, ACE inhibitors or other medicines that may raise lithium concentrations.
- •Attend scheduled lithium levels and kidney, thyroid and calcium monitoring.
- •Attend liver, blood-count and metabolic monitoring for other psychiatric medicines as directed.
- •Discuss weight, glucose, cholesterol and cardiovascular risk associated with some antipsychotic medicines.
- •Avoid recreational stimulants, methamphetamine, cocaine and other substances that can trigger mania or psychosis.
- •Limit or avoid alcohol and cannabis when they destabilise mood, sleep or judgement.
- •Avoid excessive caffeine and energy drinks.
- •Do not begin antidepressants, St John's wort or stimulating supplements without psychiatric review.
- •Use evidence-based psychological treatment and psychoeducation.
- •Involve trusted family members, carers or supporters in relapse planning when the patient agrees or safety law requires it.
- •During emerging mania, consider safeguards around spending, credit cards, driving, gambling and high-risk decisions.
- •Delay major financial, legal, relationship or business decisions during an unstable mood episode.
- •Do not drive when severely sleep-deprived, manic, sedated or otherwise unsafe.
- •Maintain regular physical activity appropriate to physical health and mood state.
- •Use structured daily routines without excessive overcommitment.
- •Plan pregnancy with psychiatric, obstetric and primary-care clinicians.
- •Do not stop lithium, valproate or another medicine suddenly because pregnancy is suspected.
- •Valproate requires strict specialist review in people who could become pregnant because of serious fetal risks.
- •Arrange urgent perinatal mental-health care for mania, psychosis or severe insomnia after childbirth.
- •Seek immediate help for suicidal thoughts, severe self-neglect or thoughts of harming another person.
- •In Australia, call Lifeline on 13 11 14 for crisis support or triple zero (000) when danger is immediate.
Cautions & Contraindications
- •Do not claim that acupuncture or Chinese herbal medicine cures bipolar disorder.
- •Do not use acupuncture or herbs as substitutes for mood stabilisers, antipsychotics, psychiatric assessment or hospital treatment.
- •Do not treat acute mania, psychosis or suicidal crisis as a routine outpatient TCM pattern.
- •Do not provide elective acupuncture when the patient cannot provide valid consent or remain physically safe.
- •Do not use restraint, coercion, shaming or confrontation.
- •Do not reinforce delusions, grandiosity, paranoia or hallucinations as supernatural fact.
- •Do not advise abrupt withdrawal of lithium, valproate, lamotrigine, antipsychotics, antidepressants or benzodiazepines.
- •Do not recommend antidepressant herbs without psychiatric approval.
- •St John's wort may trigger mania, reduce the effectiveness of many medicines and contribute to serotonin toxicity.
- •Avoid stimulating herbs and supplements such as high-dose Rén Shēn, Má Huáng, concentrated caffeine, guarana and yohimbe in patients vulnerable to mania, agitation or insomnia.
- •Má Huáng may cause hypertension, tachycardia, agitation, insomnia and serious medicine interactions.
- •Rén Shēn may be activating and may interact with anticoagulants, diabetes medicines and stimulants.
- •Gān Cǎo may cause hypertension, fluid retention and hypokalaemia and may alter cardiovascular risk.
- •Fù Zǐ and related aconite herbs carry potentially fatal cardiac and neurological toxicity.
- •Dān Shēn, Dāng Guī, Táo Rén, Hóng Huā and Chuān Xiōng may increase bleeding risk.
- •Kava may cause sedation and has been associated with serious liver injury.
- •Valerian, Suān Zǎo Rén and other sedating products may increase sedation when combined with antipsychotics, benzodiazepines, antihistamines or alcohol.
- •Diuretic and purgative herbs may alter hydration, sodium balance and lithium concentration.
- •Do not prescribe herbs that cause diarrhoea or dehydration to a person taking lithium without medical coordination.
- •Avoid unregulated detoxification, nootropic, psychedelic, microdosing or mood-enhancement products.
- •Cannabis, psychedelic substances and stimulant products may worsen mania, psychosis, anxiety or medication adherence.
- •Do not use Aristolochia species or products containing aristolochic acid.
- •Review all herbal products for pregnancy, breastfeeding, liver disease, kidney disease and psychiatric medicine interactions.
- •Do not describe escalating insomnia, impulsivity, agitation or psychosis as a positive energetic transformation.
- •Do not interpret worsening mood, suicidality, tremor, confusion, rash or fever as detoxification or healing.
Frequently Asked Questions
What is bipolar disorder?+
Bipolar disorder is a mood disorder involving episodes of mania or hypomania and episodes of depression [8].
What is the difference between mania and hypomania?+
Mania causes marked impairment, may involve psychosis and can require hospital treatment. Hypomania is less severe but still represents a significant change from usual functioning [8].
What are common signs of mania?+
Signs include reduced need for sleep, increased energy, rapid speech, racing thoughts, irritability, grandiosity, impulsivity and high-risk behaviour [8].
Can bipolar depression cause suicidal thoughts?+
Yes. Bipolar depression and mixed episodes can involve serious suicide risk and require direct assessment and appropriate treatment [8].
How is bipolar disorder treated?+
Treatment commonly combines mood-stabilising or antipsychotic medicines, psychological therapy, sleep and routine management, monitoring and relapse-prevention planning [8].
Can antidepressants trigger mania?+
Antidepressants can trigger mania, mixed symptoms or rapid cycling in some people and should be used under appropriate psychiatric supervision [8].
Can acupuncture stop a manic episode?+
No. Mania requires psychiatric assessment, risk management and appropriate medical treatment [8].
Can acupuncture help sleep or anxiety in bipolar disorder?+
It may be considered as adjunctive support in a stable patient, but reduced sleep can be an early sign of mania and must be monitored clinically [8].
Are Chinese herbs safe with lithium?+
Not automatically. Diuretic, purgative and dehydrating herbs may alter fluid or sodium balance and potentially increase lithium-toxicity risk [8].
When is bipolar disorder an emergency?+
Emergency help is needed for immediate suicide or violence risk, severe mania, psychosis, dangerous behaviour, inability to care for basic needs or suspected medicine toxicity [8].
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Sources & Further Reading
Clinical guidance, red flags and safety notes on this page draw on the following current sources alongside the classical references above.
- Healthdirect Australia · 2025
Australian overview of bipolar symptoms, diagnosis, complications, acute treatment and long-term management.
- Healthdirect Australia · 2025
Australian information on mood stabilisers, antipsychotic medicines, antidepressants, monitoring and medicine safety.
- Healthdirect Australia · 2026
Australian information on lithium use, monitoring, toxicity and emergency symptoms.
- World Health Organization · 2025
International overview of manic and depressive episodes, disability, suicide risk, treatment and psychosocial care.
- National Institute for Health and Care Excellence · 2025
Clinical guidance covering assessment, mania, bipolar depression, long-term treatment, risk management and pregnancy considerations.
- National Institute of Mental Health · 2025
Authoritative information on bipolar subtypes, symptoms, diagnosis and treatment.
- Black Dog Institute · 2026
Australian education and support resources concerning mania, depression and long-term management.
- World Health Organization · 2008
Standard acupuncture-point nomenclature and anatomical-location methodology.
- World Health Organization · 2021
International reference for acupuncture competence, consent, infection control and clinical safety.
Educational reference for licensed practitioners. Not a substitute for individual clinical assessment. Refer to conventional care for any red-flag or undiagnosed presentation.