Living Well With Bipolar Disorder: The Approaches Required to Achieve Long‐Term Stability

ABSTRACT

Introduction and Aim

Bipolar disorder is a lifelong condition where many individuals experience difficulty getting well and staying well with ongoing symptoms and frequent relapses reflecting the limitation of current treatment approaches. Living with bipolar disorder touches every aspect of the individual's life and access to more effective treatments is necessary. The aim of this paper is to describe the impact of receiving a bipolar specific psychological intervention, Interpersonal and Social Rhythm therapy.

Methods

This paper is a first‐person narrative that reflects my experience of bipolar disorder including the different treatment approaches and their impact.

Findings

This Lived Experience Narrative reflects the significant limitations of medication focused and crisis short‐term driven treatment which created an imbalanced approach limiting my ability to achieve significant periods of wellness. Having access to Interpersonal and Social Rhythm therapy fundamentally changed the approach to managing bipolar disorder. Over time this led to me having an increased sense of control, where bipolar disorder was something to work with rather than an external force controlling life and decisions, resulting in greater periods of wellness and stability.

Discussion

This narrative highlights the critical importance of having access to bipolar disorder specific interventions that go beyond medication and acute treatment approaches. Interpersonal and Social Rhythm therapy provides an understanding and approach that enables the individual with bipolar disorder to implement strategies and tools to more effectively manage their condition and to navigate a meaningful future.

Summary.

• What is known on the subject?

  • ○
    Access to services for bipolar disorder typically focuses on crisis intervention and medication management.
  • ○
    The condition has high relapse rates, impacting quality of life, health outcomes and life expectancy.
• What the paper adds to existing knowledge?

  • ○
    Given bipolar disorder's ongoing, episodic nature, improving outcomes requires access to meaningful education and therapy during periods of stability, not just crises.
  • ○
    Therapies like IPSRT that include comprehensive education should be considered essential parts of treatment, not only supplementary to medication, be accessible, and remain so for a sufficient duration.
  • ○
    Understanding and identifying triggers can be complex, highly individual and destabilising.
  • ○
    A deeper understanding and access to therapies tailored for individuals with bipolar can significantly improve quality of life, health outcomes, self‐advocacy and empower individuals to take an active role in treatment.
• What are the implications for mental health nursing?

  • ○
    Educating people on the biological and psychological basis of treatments, interventions and symptoms enables informed decision‐making and active engagement. Oversimplification limits understanding and disempowers individuals.
  • ○
    Side effects from medication may impact a person's functioning at certain times of day, their social rhythms, triggers and interventions.
  • ○
    Broad healthy lifestyle advice, without context or adequate understanding of how circadian/social rhythms and bipolar disorder interact, risks destabilisation.

1. Introduction

Living with bipolar disorder has touched every aspect of my life, much of which is unseen by others. While the challenges have at times felt insurmountable, by learning to understand my condition, my body and who I am on a deeper level, I am now creating a life which feels like my own and holds meaning and purpose. I have learned that while treatment often focuses on crisis intervention and medication management, truly living well requires much more. It demands a deeper understanding and active participation in treatment. However, the reality is that access to resources and the focus of treatment is often limited, which creates additional barriers to achieving long‐term wellness and stability.

2. Early Years

My struggles with mental health began in childhood and intensified during my teenage years. I experienced severe depressive episodes and recurring suicidal thoughts, punctuated by periods of mood elevation and mixed states. Sometimes these shifts were accompanied by agitation, paranoia, or distortions of sound and vision—things would start to look strange, colours seemed unnatural and too intense, and I would have an unshakable feeling that something was wrong.

Throughout these years, I worked constantly to keep up appearances. During low periods, I would miss school, often claiming physical illness, hardly leaving my bed, and missing meals. Though my attempts to hide what was happening would start to fail, and family concerns grew, I would inevitably “come right”, sometimes gradually, other times suddenly and seeming better than ever. Earlier concerns would be brushed aside, and the cycle would continue. I felt extremely alone, carrying deep shame for both my visible struggles and unseen experiences, as well as my behaviour. It's hard to explain just how pervasive an undiagnosed or unmanaged mental health condition can be, but the cost was enormous. The energy I spent trying to hold things together and manage my internal world drained what should have gone into social development, figuring out who I was, and navigating the challenges of being a teenager.

3. Diagnosis and Navigating Treatment: Frustrations and Missteps

When I received a diagnosis of bipolar disorder after finishing school I was initially relieved; there was a name for what I had been experiencing. However, this soon turned to frustration. It did not come with the long‐term or ongoing support I needed to manage my condition. I found myself trying to distinguish between what was my authentic self and the self‐influenced by my condition. All the things I had tried to keep hidden were being brought to light and I lacked the tools to deal with this. Diagnosis meant facing years of masking and a fragmented sense of self.

However, the support I received was centred on medication. While medication has and continues to play a role in managing my condition, in the beginning it was presented as essentially the sole treatment, with other recommendations feeling like add‐ons. There was no meaningful discussion about side effects, how the medications work, or long‐term management strategies beyond generic advice around sleep, diet and exercise—the type of advice anyone would receive signing up for something like a gym membership.

The initial medications I tried left me emotionally dulled, cognitively impaired, and disrupted my sleep and appetite, making it impossible to follow even the most basic lifestyle advice. The precarious balance I was maintaining felt like it was crumbling. When I voiced these effects, my concerns were often dismissed or minimised. I was met with frustration and felt perceived as difficult, unwilling, and unrealistic.

I encountered what felt like an imbalanced approach to my care: an overemphasis on pharmacology without biological education, paired with emotional processing without practical stability tools that worked for me. In addition to medication management, and high‐level advice around routine and healthy living, I was prompted to explore how my diagnosis affected my feelings, relationships and sense of self. While these aspects are undoubtedly a large part of coming to terms with living with bipolar disorder, what I desperately needed first was something to slow the roller coaster, effective concrete tools to establish basic stability before processing the emotional impact. I needed to experience consistent periods of wellness before tackling deep‐set psychological patterns and emotional long‐term impact of living with a mental health condition like bipolar disorder. Some of these emotional aspects were also connected to much more than just the impact of bipolar on my life, and without first establishing greater stability, deeper emotional work and prompting felt premature and unsustainable, especially given the lack of long‐term follow‐up care. Some aspects of self‐esteem, self‐worth and other feelings relating to my sense of self would change so dramatically depending on mood episodes, also making it hard to work on these without first achieving longer periods of wellness and stability.

In these early interactions, a deeper and more focused understanding of the nuanced triggers of my condition and how these relate to my body, brain, and symptoms would have given me a sense of agency and control, and ways to take direct action. Learning how bipolar disorder interacts with sleep, circadian rhythms, cognition, immune function, and energy would have also helped provide context to advice around routine and healthy lifestyle, making work in those areas feel more purposeful. A deeper understanding may have also strengthened my ability to identify subtle individual patterns and behaviours and provided tools for when new patterns emerged or changed as life circumstances changed. Without comprehending how suggested strategies impacted me physically and why they were particularly relevant for bipolar disorder, progress felt fragile and unpredictable. I found myself just going along with suggestions as to what my patterns might be and ways to manage these, rather than feeling engaged and like I was gaining tools for long‐term management.

When services ended, my medication difficulties remained unaddressed, making adherence challenging. Strategies and advice for long‐term management and lifestyle were not sufficiently personalised. I was also left grappling with complex emotional issues that had only been touched upon due to limitations in available health system services and long‐term therapy which was needed in this respect. With a lack of meaningful education or sustained support I felt unprepared, unsupported, and this deepened my struggles.

4. Finding Balance Through Interpersonal and Social Rhythm Therapy

It wasn't until I participated in a structured therapy programme as part of a clinical research programme that things began to shift. This involved medication management alongside Interpersonal and Social Rhythm Therapy (IPSRT), which offered something I had been missing—a framework beyond broad advice for understanding how bipolar disorder affected my daily functioning and tools to work with these patterns. IPSRT is BD specific therapy combining interpersonal psychotherapy addressing interpersonal stressors with a behavioural intervention, social rhythm therapy focusing on developing regular daily rhythms particularly the sleep–wake cycle (Frank 2005; Novick et al. 2024).

The therapist who facilitated my IPSRT sessions created a space where I could explore both the biological (role of circadian rhythms) and interpersonal aspects of my condition. There was also more time available to track my daily activities and energy fluctuations in the detail required for patterns to start to emerge. While the impact wasn't immediately apparent, this approach marked a significant turning point. I started recognising how deeply bipolar disorder affects biological rhythms and daily functioning. This wasn't immediate—it took months and many setbacks for patterns to emerge and then trial and error to find effective ways to intervene and manage those.

IPSRT helped me discover subtle connections overlooked in my previous care. I also began to understand why certain medication side effects impacted me more significantly than their apparent severity suggested. Morning grogginess might seem minor compared to other side effects, but tracking my energy and patterns revealed it had significant ripple effects. Mid afternoon or evening exercise disrupted my sleep and eating, both high‐risk factors for me. I was often too drained after work to exercise, and when my mood dipped, motivation became an added barrier which strengthened as the day went on. Evenings were also important for unwinding and managing home life, making morning exercise a crucial anchor in my day to day wellbeing.

Disrupting that morning routine had a domino effect on my wellbeing. What seemed like a small issue to others was actually preventing a key stabilising activity. These subtle connections weren't acknowledged in my earlier mental health care. When I raised concerns about side effects or unhelpful changes, they were often dismissed or left unexplored. Without support to identify these links, I followed generic advice that didn't work for me, which added to my shame and left me feeling like I was failing when I really needed more tailored guidance.

Although maintaining structure in the face of bipolar disorder's inherent unpredictability is challenging, I eventually started to see evidence that I could influence parts of my life. For example, I was aware that routine played a significant role in reducing the frequency and severity of episodes. During the study I was able to apply this to my own experiences. I identified several key factors that can destabilise me, including irregular wake up times, skipped meals, exercising late in the day, excessive light exposure in the evenings, or socialising at certain times of the day or week. Over time, I have also started to recognise which parts of my routine I can be more flexible with and those I cannot. This understanding sparked an ongoing desire to learn more about circadian rhythms and the biological mechanisms behind symptoms, triggers, strategies and treatment. The more I learned, the better equipped I became to work with these patterns effectively.

The social rhythm component of IPSRT provided the foundation that made everything else possible. Tracking daily routines, identifying triggers, energy levels, and establishing patterns, then looking at ways to manage these. This initial focus on social daily rhythms has had a lasting impact on me, in many ways that I didn't realise until much later, particularly in regard to the severity and frequency of elevated and mixed mood episodes. It provided glimpses of how I might be able to influence some areas of my life after all. Prior to this, I felt as though life was simply happening to me, that I had no control over my experiences. This feeling of having no influence or control over my life had extended to how my bipolar had been treated medically following diagnosis, where a lack of understanding and feeling discouraged from raising concerns or deeper questioning had also left me feeling lost with no clear path forward.

Participating in therapy was not without its challenges and during this period, I experienced a depressive episode that led to a suicide attempt and hospitalisation. While the therapy provided valuable tools, it also forced me to confront the full impact of bipolar disorder on my life. Facing these realities head‐on I felt as though there were too many challenges in too many areas of my life to effect any impactful change.

It is quite challenging to identify specific changes related to the interpersonal aspect of IPSRT. Most of my interpersonal progress came later by self‐exploration and, particularly in more recent years, through regular therapy. Progress has been from a combination of approaches through therapy as opposed to a specific focus on interpersonal issues and relates to aspects of my life and experiences, past and present, beyond bipolar disorder. The greater stability achieved from IPSRT, however, gave me energy, time, and a stronger emotional foundation which I needed to engage more effectively in therapy, fully explore recommendations, and develop confidence in knowing my needs and setting boundaries with people. There are many areas in my life I struggle with to this day and continue to actively work on, interpersonally and in relation to how I feel about myself. At times it is still difficult to work on these things without becoming overwhelmed which can have flow‐on destabilising effects for my mood. I often need to switch focus back to the foundations of basic functioning and stabilising daily rhythms if I notice changes in mood, or if I am under a lot of stress, to avoid triggering or worsening mood symptoms. At times progress can feel slow, but the gains feel more permanent due to prioritising the basics and having built a stronger foundation of stability.

The reality is stability and wellness are not linear and sometimes there are no identifiable triggers or warning signs and attempts at intervening early may be ineffective. Unfortunately, sometimes it's only through becoming unwell that I have identified certain triggers or aspects of my life that impact stability. Maintaining stability is an ongoing process of adjustment and readjustment. Some days I manage well, others I need to reset and try again. It's not about achieving perfection but about understanding my patterns well enough to make informed choices about risks and trade‐offs. But with knowledge and understanding, I started to regain some control over my life. Times of wellness are longer and the severity when I am unwell has reduced overall. There is no doubt in my mind that without the knowledge I now have and how that influences my actions, my life would continue to be dictated and controlled by bipolar disorder, or I may not be here to describe my experiences at all. What I gained through IPSRT was the foundation for where I am today—the knowledge that I could take control of parts of my life, which slowly but fundamentally changed my approach to managing my condition.

Change has been gradual and ongoing rather than marked by specific moments of change. It wasn't until years later that I could effectively work on co‐existing conditions and other issues. The improvements aren't “fixed” issues but rather represent continuous work integrated across different areas of my life.

5. Education Beyond Symptoms

Living with bipolar disorder is often framed around emotional (mood) states and their symptoms. However, rarely is the biological basis explained or the effects different episodes can have on the body, during and after. Drawing parallels to physical illnesses is sometimes used, but these comparisons often lack meaningful education or depth about what a person with bipolar disorder is experiencing and why.

The reality is things like sleep deprivation, intense physical restlessness, increased activity or lack of movement, spending more time indoors, cognitive strain, and dramatic changes to diet are just a few of the ways brain function, nervous system, and overall physical health are impacted. I have had muscle aches, sleep disruption, a weakened immune system, cognitive difficulties, exhaustion, tremors, digestive issues, and significant changes in my weight and fitness level last for a significant period after a reduction in mood symptoms, varying with the episode's type and severity. This also increases the risk of becoming unwell again due to prolonged disruption of social and circadian rhythms.

By educating myself about the body, brain, and nervous system (both generally and in relation to bipolar disorder) I've developed greater self‐compassion and more realistic expectations of myself. This knowledge has also helped me adopt practical, accessible tools for maintaining stability. For example, understanding circadian rhythms more deeply has made me prioritise light exposure earlier in the day and limit light exposure in the evening—moving these things from just “nice‐to‐have” wellness habits to daily, intentional practices which play a significant role in my wellness and stability. The more I learn, the more committed I become to the strategies that support my stability. It's much harder to become complacent when I consider the physical consequences my future self is likely to face, if I don't stay vigilant.

This deeper understanding has transformed how I advocate for myself. I can now confidently explain my needs to healthcare providers with clear, physiological reasoning and articulate when things need attention. What might seem insignificant when taken at face value may carry the risk of destabilising me, and I am now able to both recognise and explain subtle warning signs or triggers. These interactions are unrecognisable from my early experiences following diagnosis. Back then, I lacked the understanding to advocate for myself effectively. Now, with understanding, I can communicate with clarity and authority, which has dramatically changed the care I receive. While this knowledge has empowered me to better advocate for myself with healthcare providers, navigating support systems and relationships has presented its own unique set of challenges.

6. Overcoming Barriers and Navigating Support

Navigating support from loved ones has been one of the most difficult yet important aspects of my journey. While people often express compassion when discussing mental health in general terms, this doesn't always translate into meaningful action when faced with the challenging reality of someone who is struggling. Some catastrophise minor setbacks, while others overlook the immense effort required to maintain stability when well. I have found that understanding is often reduced to symptoms or behaviours with generalised recommendations for non‐medication advice. This has resulted in loved ones becoming fixated on certain symptoms or adding pressure on certain recommendations that weren't reflective of my unique experience, creating more difficulty.

Early on, I also faced strong criticism from family regarding medication. Their focus on side effects, though a concern I shared, felt dismissive rather than supportive as we all lacked the knowledge to properly weigh risks against benefits, making medication adherence even more challenging. Without adequate understanding but with the daily burden of support, misunderstandings persisted and deepened despite diagnosis, creating conflict. I often felt unsupported, facing unrealistic expectations, misunderstandings or judgement that significantly impacted my wellness. I also had unfair expectations of support they weren't equipped to provide. More comprehensive education could have helped bridge these gaps.

Like many aspects of managing bipolar disorder, support systems are highly individual and are unlikely to be sustainable if dependent on loved ones performing roles they misunderstand or lack the capacity to maintain which can lead to resentment or conflict. Everyone has their own limits, communication styles, beliefs and stressors and conversations around support systems need to be grounded in this reality to avoid unrealistic expectations or misunderstandings.

My family and I could have benefitted from guided and structured conversations to identify practical steps, actions, limits and boundaries in relation to things such as conversations around medication, aspects of daily life and routine, or an agreement for loved ones to step away without guilt or resentment if they were feeling overwhelmed including how these things could be identified and communicated in the moment. Being prompted and encouraged to identify and acknowledge what individual limitations might exist, without judgement, and to honestly assess what type of support was realistic would have also helped build a stronger foundation of trust and understanding.

Over time, I've learned to rely on professionals for clinical guidance including regular therapy while reframing the role of loved ones in my life. I now seek their support for everyday challenges rather than expecting them to navigate the complexities of bipolar disorder. However, many people do not have the means or ability to access the professional support they may require. Limited healthcare resources often require people to rely heavily on loved ones who, despite their care and good intentions, may lack the knowledge, time, or emotional capacity to provide this level of support. With time, I have reached a place of acceptance and appreciation of what my personal support system can realistically provide, despite limitations or where it may fall short of ideals. This acceptance has led to actively seeking ways to fill the gaps that exist, rather than wishing things were different or placing unrealistic expectations on others. This change in perspective means I now have a wider range of tools within my control for self‐management and I have gained greater confidence in my understanding of what living with bipolar looks like for me. This has improved my ability to set and maintain firm boundaries, decline well‐intended but unhelpful support, and identify when professional guidance is needed.

7. Acceptance: A Lifelong Process

Understanding and accepting my condition has been fundamental to my growth, though it remains a work in progress. Initially, accepting my diagnosis felt like admitting defeat—resigning myself to a future dictated by bipolar disorder. Over time, I've learnt that acceptance isn't about giving up; it's about working with reality rather than against it. Through acceptance, I can honestly assess what I can change and let go of struggling against what I can't. Understanding my limitations has also helped me see possibilities. I'm now able to set firm boundaries that prioritise stability, becoming less influenced by others' judgement or expectations when they don't understand my decisions or inflexibility in certain areas.

I've let go of my idealised self—that seemingly unstoppable version brimming with energy and creativity, needing neither food nor sleep, with unshakeable confidence. While alluring, what inevitably follows isn't worth the cost—it's unsustainable and the destabilising effects are too serious. I'm learning to set realistic, sustainable goals that account for the natural fluctuations in mood and energy that come with bipolar disorder. Sometimes this means making decisions based on whether I could cope if my mood dips, even when I know something is within my capabilities when stable.

8. Looking Towards a Meaningful Future

While bipolar disorder will always be something I have to consider and manage, it now feels more like something I can work with rather than an external force controlling my life and decisions. I have reclaimed parts of myself and can see possibilities for the future—something unimaginable just years ago. Though my life might appear smaller or more limited to others compared to when I was less stable, reaching this point feels monumental. Through ongoing education, self‐management, and professional support, I continue to build a life that feels both grounded and meaningful despite these challenges.

9. Reflections on Supporting People Living With Bipolar Disorder: Recommendations for Mental Health Nursing Practice

Mental health nurses have an important role in treating and supporting individuals with bipolar disorder, particularly as they are involved at multiple junctures and at different phases of illness, from acute care through to the recovery process. Mental health nurses can promote a move away from crisis‐driven care and implement nuanced individualised approaches and support needed to maintain long‐term stability. Without this, patients and families are left to navigate alone, armed with little more than fragmented understanding, generalised guidance, and scarce resources.

To truly empower those living with bipolar disorder to live well, interactions around care should be approached as a partnership. Individuals deserve to have their unique experiences heard and acted on and/or acknowledged without judgement. Working in partnership, mental health nurses can develop personalised strategies and deeper, meaningful education which can help empower people to step into a more active role in managing their condition rather than being a passive recipient of care. It is crucial to establish strategies that account for individual capacities, daily rhythms, and the imperfect humanity of their support networks, not just textbook symptom management, generalised advice, and medication adherence. Lasting systematic change requires shifting focus to provide access to resources, tools, and support which prioritise prevention, staying well, and quality of life on the same level as crisis intervention and survival.

Based on my personal experience living with bipolar disorder, I offer the following reflections to guide mental health nurses and other clinicians in their practice. These insights are intended to complement clinical knowledge with the lived realities of navigating living well with bipolar disorder over time:

• Beyond medication, developing self‐management strategies may require a sequential rather than parallel approach. When I was still struggling with basic stability, emotional processing was overwhelming. Deeper understanding and establishing an effective plan for greater stability provided the foundation needed before I could begin to engage meaningfully with deeper psychological and emotional work. Early conversations around identity, shame, and emotional reflection did not always immediately reflect how complex or emotionally demanding these issues were to address.

• Ground strategies and treatment in meaningful education. Understanding some of the biological functions happening alongside symptoms of bipolar disorder or impacted by recommended self‐management strategies such as functions of the brain, circadian and nervous systems helped make sense of my experience and gave meaning to advice. This kind of education, shared with both patients and family, may provide a more objective foundation to understanding than an emphasis on just mood or behaviour. It can help reduce shame and make my experience feel valid and grounded in reality, rather than a personal failing or just my interpretation of what was happening.

• Side effects can matter more than they seem. What may appear to be mild or tolerable medication side effects can seriously disrupt the biological and social rhythms that underpin stability. For me, even small disruptions had outsized impacts on my ability to function and maintain daily routines. These effects need to be taken seriously and explored in partnership.

• Small, meaningful interventions which are personalised are most effective. Broad advice around “healthy lifestyle changes” often felt overwhelming or impractical. What helped were small, specific interventions that were clearly explained and adapted to my specific day to day life. Achievable, relevant and realistic steps helped build confidence and momentum over time.

• Support systems need to be realistic. Ideal support is not always available. Work with patients and their support networks by prompting them to develop realistic expectations and boundaries that will work when needed, even if this may fall short of ideals. Generic advice which seemed reasonable in theory often fell apart in practice and at times created unrealistic expectations leading to conflict.

• Seemingly minor details can have major effects. Subtle shifts in the timing of daily activities such as exercise, meals, work meetings and social interactions had flow‐on effects. These patterns affect sleep, mood, and overall functioning.

• Help prepare for misunderstandings. Many people will not understand what living with bipolar is like, and misunderstandings can extend beyond personal relationships to interactions within the healthcare system. Education and a deeper understanding have helped me to explain my experiences with more clarity not only to people in my personal life but also when advocating for myself in interactions with healthcare providers.

• Education can help reduce feelings of shame. The more I understood, the more I could put my experiences in context. This helped reduce self‐blame and allowed me to focus on what I could influence, rather than feeling at the mercy of things I could not control.

• Advocate for changes within the system for greater access to services and therapy for those who are living with long‐term mental health conditions such as bipolar disorder to improve quality of life and self‐management.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

Data sharing is not applicable to this article as no new data were created or analyzed in this study.