Bipolar Disorder: who to see and what helps

Bipolar Disorder · Kitchener, Waterloo & Cambridge

Bipolar disorder is a medical condition in which a person cycles through periods of depression and periods of elevated mood, called mania or hypomania. It is diagnosed and treated by a psychiatrist or physician, and medication comes first: Canada’s bipolar guideline calls it essential. CARESPACE does not treat the illness itself. We offer support alongside that medical care, starting with counselling from a Registered Psychotherapist or Registered Social Worker. If you are thinking about suicide, go to the urgent section now.

What bipolar disorder is

The mood changes of bipolar disorder are extreme and usually last days or weeks, with stable periods between them that can last weeks, months or years. In that well state, says the Centre for Addiction and Mental Health (CAMH) in Toronto, many people feel normal and function well.

Bipolar I involves full manic episodes; bipolar II involves the milder highs called hypomania, together with episodes of full depression. The average age at which it begins is 25, when many people in Waterloo Region are at university or college, or settling into a first job.

Symptoms of bipolar disorder

Mania is a mood that is continuously high, happy and euphoric, or irritable, angry and aggressive, for at least a week, together with at least three of these:

• Exaggerated self-esteem or a feeling of grandeur
• Less need for sleep
• Talking more than usual
• Racing thoughts
• Being easily distracted
• Excessive energy for activities
• Risky behaviour or poor judgement

Hypomania is a less intense form in which life is usually not seriously disrupted. It can progress to full mania or to a severe depression, so it needs treatment too.

The depressive phase means at least five of the following, on most days, for at least two weeks:

• Depressed mood
• Loss of interest or pleasure in things that used to be enjoyable
• Weight loss or gain
• Difficulty sleeping, or sleeping too much
• Apathy or agitation
• Loss of energy
• Feelings of worthlessness and guilt
• Inability to concentrate
• Thoughts of suicide, which should always be taken seriously

Manic and depressive symptoms can occur together, in a mixed episode, and some people have hallucinations or delusions.

What causes bipolar disorder

The precise causes are unknown. There is strong evidence that biology, including genetics, plays an important part, and having a parent, brother or sister with the condition raises the risk. Stress and difficult family relationships do not cause the illness, but they may trigger an episode in someone who already has it. Childhood trauma or abuse and recreational drugs such as cannabis or cocaine are also listed as risk factors.

How bipolar disorder is diagnosed

By a clinical assessment with a psychiatrist; ask a family physician or nurse practitioner about a referral. No laboratory test detects it. People tend to look for help when they are depressed, not when they are high, so the most frequent misdiagnosis is depression, and Canada’s guideline notes that many people are not accurately diagnosed until up to 10 years after their symptoms began.

So if you are being treated for depression and have ever had a stretch of days when you were overactive or uninhibited, say so: UK guidance asks clinicians to consider a specialist assessment when such a period has lasted four days or more.

Moods that swing within hours, not days, fit a different pattern, described on our Emotional Regulation and Borderline Personality Disorder pages. Registered Psychotherapists and Registered Social Workers provide counselling and do not diagnose or prescribe.

When it is urgent

Call 911 or go to the nearest emergency department if you, or someone you are with, is in danger of harming themselves or anyone else.

Mania and severe depression need urgent assessment as well. The UK guideline tells family doctors to refer urgently, not routinely, when either is suspected. In Ontario terms: contact the psychiatrist or physician who looks after the bipolar disorder that same day, or go to an emergency department.

If you are thinking about suicide, or you do not feel safe, do not wait for an appointment: use the numbers below.

If you are in crisis or thinking about suicide, help is available right now.

• Call or text 9-8-8, the Suicide Crisis Helpline, at any hour.
• Call Here 24/7 at 1-844-437-3247 for addictions, mental health and crisis services in Waterloo Region, at any hour. here247.ca
• Call 911 or go to the nearest emergency department if you or someone else is in immediate danger.

The emergency departments in Waterloo Region are:

• WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
• WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
• Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

What the evidence says about treating bipolar disorder

• Where these points come from. Canada’s 2018 guideline from the Canadian Network for Mood and Anxiety Treatments (CANMAT), which ranks treatments as first-, second- or third-line, and the UK’s national guideline (NICE), last updated in September 2025. The rankings reflect each panel’s judgment, including safety and tolerability, not only the quality of the trials.
• Medication is the foundation. CANMAT calls it essential, and CAMH notes that medication is usually needed first to bring symptoms under control. Talking therapies are added to it.
• Psychoeducation is the first-line talking treatment for staying well. It means structured teaching, one to one over at least five sessions or in a group, on detecting the early signs of an episode, managing stress, taking medication as prescribed and keeping sleep and wake times regular.
• CBT and family-focused therapy are second-line, for staying well and for bipolar depression, with the caution that CBT trials in bipolar disorder have had mixed results. For bipolar depression, NICE says to offer a psychological therapy designed for bipolar disorder, or a choice of CBT, interpersonal therapy or behavioural couples therapy.
• No talking therapy is recommended for acute mania. No evidence was found for one.
• Physical health needs watching. A 2022 analysis of earlier studies (we read its summary) found nearly 1.6 times the risk of type 2 diabetes in people with bipolar disorder compared with people the same age and gender without it; the studies varied a good deal. NICE says people with bipolar disorder, especially those taking antipsychotics and long-term medication, should be offered a combined healthy eating and physical activity programme by their mental healthcare provider.

What a doctor may offer

CARESPACE counsellors do not prescribe; a psychiatrist or another prescriber chooses and adjusts the medicines. Canada’s guideline (CANMAT) and the UK’s rank some medicines differently. Where they differ, this page follows CANMAT:

• For staying well: lithium, quetiapine, divalproex and lamotrigine are first-line and have the strongest support; asenapine and aripiprazole are first-line too. The UK guideline names only lithium as first-line.
• For mania: lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone and cariprazine are first-line. Olanzapine and haloperidol, both on the UK’s list, are second-line here because of safety or tolerability risks. If mania develops on an antidepressant, the antidepressant should be discontinued: by the prescriber, not on your own.

Three safety points. Do not stop a medicine without a doctor’s advice: under the UK guideline, doses are reduced gradually, over at least four weeks. If you take lithium, seek medical attention if you develop diarrhoea or vomiting or become acutely ill for any reason, keep up your fluid intake, and do not take over-the-counter anti-inflammatory painkillers (NSAIDs); a pharmacist can tell you which products those are. And talk to your doctor as soon as possible if you become pregnant or are planning a pregnancy, because some of these medicines are not safe in pregnancy. Health Canada’s recommendation, quoted in CANMAT, is that valproate products, which include divalproex, should not be used by girls, or by women who are pregnant or could become pregnant, unless other treatments are ineffective or not tolerated. That is something to raise with your prescriber, not a reason to stop on your own.

How CARESPACE helps with bipolar disorder

Counselling & Psychotherapy

Counselling is an addition to medical treatment, for the periods between episodes and for bipolar depression, with your prescriber still in charge. With a counsellor you can map your own early warning signs and triggers, chart your mood, work on handling stress, and set out whom you will contact if the signs appear. CARESPACE counsellors offer cognitive behavioural therapy (CBT), which both guidelines name. The UK’s adds that therapists should have training in, and experience of, working with people with bipolar disorder, so ask for that when you book. Counselling is not a treatment for mania.

See our counselling team →

More about cognitive behavioural therapy (CBT) →

Nurse Practitioner

In Ontario a Nurse Practitioner is authorized to diagnose, to order and interpret tests, and to prescribe. Canada’s guideline says everyone with bipolar disorder should have access to a primary care provider for their mental and physical health needs. The UK guideline gives primary care a physical health check at least once a year, with kidney, thyroid and calcium tests added for people on long-term lithium. Ask when you book what a Nurse Practitioner can take on alongside your psychiatrist.

See our nurse practitioner team →

Nutrition and Personal Training

The healthy eating and physical activity programme in the evidence list is one the UK guideline wants offered by the mental health team. A dietitian and a personal trainer are not that programme, but they can work toward the same aims. A Registered Dietitian can go through how you eat now, including caffeine, which people with bipolar disorder are advised to keep to a minimum. A personal trainer can build exercise around fixed times in your week, which suits the advice to keep a regular routine. If you take lithium, tell your trainer: the advice to keep up your fluids applies particularly after sweating. Neither service adjusts medicines.

See our nutrition team →

See our personal training team →

Other services people ask about

Acupuncture, massage and herbal products do not appear in either guideline, for or against. Canada’s does rank a few supplements and light therapy. It does not recommend omega-3 fatty acids for mania: they have not been shown to work against it. For bipolar depression it lists one omega-3 (EPA), N-acetylcysteine and light therapy as third-line options, the lowest of its three ranks, used in addition to other medication. Tell your prescriber or pharmacist before using a herbal product or supplement: the UK guideline asks clinicians to explain that non-prescription medicines can interfere with prescribed medication.

Where most people start

With a psychiatrist or physician, not with us. If you have never been assessed, or you are in an episode now, medical care comes first. For the support that goes alongside it, start with counselling.

How your team works together

The lead is outside CARESPACE: your psychiatrist or physician. Here, a counsellor can be the main contact, with a dietitian or personal trainer added for physical health.

Browse by service: counselling, nurse practitioner, nutrition and personal training.

What to expect at your first visit

At a first counselling visit the counsellor works to understand your concern and comes up with a plan. You decide what to talk about. Things that are useful to bring or think over:

1. Who looks after your treatment, and your medicines, if you are comfortable sharing them.
2. How episodes have gone before: the first signs, and what helped.
3. Any plan you already have for early warning signs or a crisis.
4. What you want from counselling now.

What you can do at home

• Keep a regular routine, with regular times for sleeping and waking.
• Chart your mood. It can help identify the early warning signs of relapse.
• Exercise regularly and eat a healthy diet.
• Avoid recreational drugs, smoking, heavy drinking and large amounts of caffeine.
• Where possible, avoid shift work, long hours, night flights and crossing time zones.

That last item is hard to follow in a region where plants, warehouses and hospitals run on rotating shifts. If your schedule is a problem, tell your physician.

Outlook

Bipolar disorder cannot be cured, but it can be managed. Like hypertension or diabetes, it is controlled by combining treatment with a healthy lifestyle. Treatment is long-term, and under UK guidance anyone who comes off medication entirely is monitored for two years afterwards.

Bipolar disorder support in Kitchener, Waterloo and Cambridge

Kitchener. Counselling in Kitchener, Nutrition in Kitchener and Personal Training in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Counselling in Waterloo, Nurse Practitioner in Waterloo, Nutrition in Waterloo and Personal Training in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Counselling in Cambridge and Nutrition in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

Can counselling treat bipolar disorder without medication?

No. Medication is essential, and talking therapies are additions to it. Counselling’s part is helping you stay well and get through depression.

How long do bipolar episodes last?

Moods usually last a few days or weeks. By definition, mania lasts at least a week and the depressive phase at least two.

What is the difference between bipolar disorder and borderline personality disorder?

Mainly timing. Bipolar moods hold for days or weeks, with well periods between them. In borderline personality disorder, moods can swing within a few hours, alongside unstable relationships. A person can have both, and telling them apart is a job for a psychiatrist.

Should my family be involved?

The guidelines favour it. The UK’s says to offer a family intervention to people who live with, or are in close contact with, their family, and to offer carers an education and support programme of their own. To have someone join a counselling session, ask when you book.

Can I get support for bipolar disorder in Cambridge?

Yes: Counselling in Cambridge and Nutrition in Cambridge. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening. In a crisis, use the numbers in the urgent section, not the booking line.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

• Yatham LN, Kennedy SH, Parikh SV, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disorders, 2018. We read sections 1 to 5 (foundations of management, psychosocial treatment, acute mania, bipolar depression and maintenance) and the parts of sections 7 and 8 on pregnancy, monitoring and physical health.
• National Institute for Health and Care Excellence (UK). Bipolar disorder: assessment and management (CG185). Published 2014, last updated September 2025.
• Centre for Addiction and Mental Health. Bipolar Disorder. Viewed November 2026.
• NHS. Bipolar disorder. Reviewed October 2024.
• Liu YK, Ling S, Lui LMW, et al. Prevalence of type 2 diabetes mellitus, impaired fasting glucose, general obesity, and abdominal obesity in patients with bipolar disorder: a systematic review and meta-analysis. Journal of Affective Disorders, 2022 (summary read).
• College of Nurses of Ontario. NP Practice Resources (what Nurse Practitioners are authorized to do), viewed November 2026.
• NHS. Borderline personality disorder: symptoms and Centre for Addiction and Mental Health, Borderline Personality Disorder (for the comparison with bipolar disorder). The NHS page was reviewed in November 2022; its next review was due in November 2025.

Related conditions

Depression
Borderline Personality Disorder
Emotional Regulation
ADHD

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Book online with a counsellor, or call 519-208-2273 and our Central Reception Team will match you with the right person and the closest location.

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