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Living with bipolar disorder is hard. Most of the time, you can keep your symptoms under control by taking medication. But many people find their symptoms come back. This might be because they stop taking their drugs. Or it might be because the drugs don't work as well as hoped.

Studies show that 9 in 10 people who have a bout of mania have another one at some point in their lives.¹

But it's hard to say how many bouts of mania or depression you will have in your life. It varies a lot from person to person. Here is what we know.

• The average number of bouts is 10.
• Between 10 and 15 in 100 people with bipolar disorder have more than 10 bouts of mania or depression in their lives.¹
• Between 10 and 15 in 100 people with bipolar disorder have more than three bouts in a year.

But between bouts, most people with bipolar disorder don't have any symptoms. With support from your doctor and health care team, you may be able to lead a normal life.²

It can help a lot to have a supportive family and friends too. But caring for someone with bipolar disorder isn't easy. This illness can put a real strain on relationships. If you are caring for someone with bipolar disorder, it may be hard to see them very depressed or to see them behave in a way they will regret.

If you have bipolar disorder, you can still live a full and productive life. But this condition is very hard to live with. It can get in the way of doing the things you want to do. And it can make it hard for you to get along with people. Some people with bipolar disorder say it makes them feel very alone.³ They also say it's hard to tell others what they are feeling, especially while they are depressed.

People with bipolar disorder are much more likely to try to kill themselves than other people, especially while they are depressed.⁴ As many as 1 in 3 people with bipolar disorder try to kill themselves.⁵

That is why it is so important to work with your doctor to stop your symptoms from coming back. When they come back, doctors say you have a relapse.

One of the main aims of treatment is to stop you from getting to the point where you might kill yourself. Call your doctor right away if you notice your symptoms coming back or if you are thinking about harming yourself. If you live with or care for someone who has bipolar disorder, watch for signs that they might be in trouble. If you think they may harm themselves, call their doctor right away.

Even if you have been well for some time, your mania or depression may start up again. If this happens, you may not be able to think clearly about what sort of care you need. Sometimes, you may feel that you don't want treatment, even though you may be putting yourself in danger.

While you are well, talk to your psychiatrist about the sort of care you want if you have a relapse. This could include working out:

• Who should be told about your condition (for example, friends or family members)
• Where you want to go for treatment, if you need to be looked after in a hospital or clinic
• Which drugs you want to be given.

This plan is sometimes called an advance directive. Your psychiatrist can help you draw it up. It can be kept with your medical records. Then it can be used if you have a relapse.

You may need to be treated in the hospital while you are having a bad bout of mania or depression. Rarely, you may have to be taken to the hospital for treatment against your wishes. 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.