Symptoms of depression are not required for a bipolar diagnosis, but bipolar should be a potential consideration for anyone presenting with mania, hypomania, depression or a mix of such symptoms.⁷

NICE recommends GPs should ask patients presenting with depression whether there have been previous periods of overactivity or disinhibited behaviour. If this type of behaviour lasted for 4 days or more, it may be appropriate to refer the patient for a specialist mental health assessment. An urgent referral should be made if mania or severe depressions is suspected.⁸

Referral to a psychiatrist usually means the patient gets to meet other members of the community mental health team (CMHT). This will open up access to services such as emotional support, information, psychological interventions, and help with sorting out practical matters. Young people may be referred to the Child and Adolescent Mental Health Services (CAMHS).^3,5