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If you think that you, or a person you care for, may have bipolar disorder, see your doctor. Getting the right diagnosis is the first step to getting good treatments and being able to live a normal life.

Doctors often find it hard to diagnose bipolar disorder. And you need the right diagnosis to get the right treatment. One study found that people went eight years, on average, between their first mood problems and being diagnosed with bipolar disorder.¹

This is partly because people are more likely to visit their doctor when they have depression (a very low mood) than when they have mania (a very high mood).² If your doctor doesn't know that you also get mania, he or she might think you have ordinary depression.

But the treatments for ordinary depression are different from the ones for bipolar disorder. So be sure to tell your doctor about all of your mood problems, not just the times when you feel depressed.

If your doctor thinks that you might have bipolar disorder, he or she will probably send you to a hospital or clinic. There, you will usually see a professional who specializes in mental health conditions. That person may be a psychiatrist, a psychiatric nurse or a psychologist. You probably won't need to stay in the hospital.

One of these professionals may fill out a form or a questionnaire to get some information about what has been happening to you.² This can help tell if you have bipolar disorder.

There aren't any blood tests or scans for bipolar disorder. But you may have tests or scans to check for other medical conditions that can cause mood problems. For example, you might have blood tests to see if your thyroid gland is too active or too sluggish.

Your doctor may also test your blood or urine for illegal drugs. This isn't to get you into trouble. It's because lots of people with bipolar disorder have problems with illegal drugs. If you are using them, it may affect your condition and your treatment. So your doctor needs to know about it.³

The most reliable way of diagnosing bipolar disorder is to have a psychiatric exam by a psychiatrist.² Normally, your psychiatrist makes the diagnosis after talking to you.

He or she will do an exam called a mental state examination. This is to check if you have mania or depression. During this exam, he or she will:

• Check how you look and behave
• Listen to the way you speak and what you say
• Watch how you move
• Note how much energy you have
• Ask about your mood and how you feel about yourself
• Ask about how you are thinking, if your thoughts are racing or coming slowly
• Try to work out if you are having beliefs that aren't true (delusions) or seeing or hearing things that aren't there (hallucinations)
• If you are having delusions or hallucinations, try to work out if you know what you believe or perceive is not real.

Your psychiatrist will also want to hear about the course of your problems. He or she may ask:

• When you first got mood problems
• What it feels like when you had very low moods
• What it feels like when you had very high moods
• How your moods affect your life, including your studies or work
• How long each bout lasts
• What happens afterward.

Your psychiatrist will ask about any other problems with mental or physical health you have had. He or she will also ask if anybody else in your family has had mental health problems.

If a friend or relative has come with you to the hospital or the clinic, your doctor may ask them what they have noticed about your condition.

When your psychiatrist has gathered all the information about your symptoms, he or she will see if they fit with bipolar disorder.

There are two basic types of bipolar disorder. They are called bipolar type 1 disorder and bipolar type 2 disorder.⁴ Type 1 is more serious.

• Bipolar type 1 disorder. This means you have had at least one bout of mania, either on its own or with depression at the same time. Usually, people with type I also have one or more bouts of depression too. If your mania is caused by prescription or illegal drugs, or by another medical condition, it does not count as bipolar disorder.
• Bipolar type 2 disorder. This means you have had at least one bout of depression plus at least one bout of mild mania. That kind of mania is called hypomania.

Doctors use a checklist of symptoms for bouts of mania and bouts of depression. For more, see What are the symptoms of bipolar disorder?

Usually, you won't need to stay in the hospital when doctors are working out your diagnosis. But you may have to in some cases. For example, you may need to stay if you are having a bad bout of mania.

Rarely, you may need to be taken to the hospital for examination against your wishes. This will only happen if you are so sick that you are behaving in a way that is dangerous for you or for other people. The government has strict rules about this.

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.