Bipolar Affective Disorder

What is bipolar disorder?

Bipolar disorder used to be called ‘manic depression’. As the older name suggests, someone with bipolar disorder will have severe mood swings. These usually last several weeks or months and are far beyond what most of us experience. They are:

Low or 'depressive' feelings of intense depression and despair
High or 'manic' feelings of extreme happiness and despair
Mixed for example, depressed mood with the restlessness and overactivity of a manic episode

How common is bipolar disorder?

About 1 in every 100 adults has bipolar disorder at some point in their life. It usually starts during or after the teenage years. It is unusual for it to start after the age of 40. Men and women are affected equally.

What types are there?

Bipolar I

There has been at least one high, or manic episode, which has lasted for longer than one week. Some people with Bipolar I will have only manic episodes, although most will also have periods of depression.

Untreated, manic episodes generally last 3 to 6 months. Depressive episodes last rather longer - 6 to 12 months without treatment.

Bipolar II

There has been more than one episode of severe depression, but only mild manic episodes – these are called ‘hypomania’.

Rapid cycling

More than four mood swings happen in a 12 month period. This affects around 1 in 10 people with bipolar disorder, and can happen with both types I and II.

Cyclothymia

The mood swings are not as severe as those in full bipolar disorder, but can be longer. This can develop into full bipolar disorder.

What causes bipolar disorder

We don't understand this well, but research suggests that:
Bipolar disorder runs in families - it seems to have more to do with genes than with upbringing.
There may be a physical problem with the brain systems which control our moods - this is why bipolar disorder can often be controlled with medication.
Episodes can sometimes be brought on by stressful experiences or physical illness.

What does it feel like?

This depends on which way your mood has swung.

Depression

The feeling of depression is something we all experience from time to time. It can even help us to recognise and deal with problems in our lives but in clinical depression or bipolar disorder, the feeling of depression is worse. It goes on for longer and makes it difficult or impossible to deal with the normal things of life. If you become depressed, you will notice some of these changes:

Emotional

feelings of unhappiness that don't go away
feeling that you want to burst into tears for no reason
losing interest in things
being unable to enjoy things
feeling restless and agitated
losing self-confidence
feeling useless, inadequate and hopeless
feeling more irritable than usual
thinking of suicide

Thinking

can’t think positively or hopefully
finding it hard to make even simple decisions
difficulty in concentrating

Physical

losing appetite and weight
difficulty in getting to sleep
waking earlier than usual
feeling utterly tired
constipation
going off sex

Behaviour

difficulty in starting or completing things – even everyday chores
crying a lot – or feeling like you want to cry, but not being able to
avoiding contact with other people.

Mania

Mania is an extreme sense of well-being, energy and optimism. It can be so intense that it affects your thinking and judgement. You may believe strange things about yourself, make bad decisions, and behave in embarrassing, harmful and - occasionally - dangerous ways.

Like depression, it can make it difficult or impossible to deal with life in an effective way. A period of mania can affect both relationships and work.

When it isn't so extreme, it is called 'hypomania'.

If you become manic, you may notice that you are:

Emotional

very happy and excited
irritated with other people who don't share your optimistic outlook
feeling more important than usual

Thinking

full of new and exciting ideas
moving quickly from one idea to another
hearing voices that other people can't hear

Physical

full of energy
unable or unwilling to sleep
more interested in sex

Behaviour

making plans that are grandiose and unrealistic
very active, moving around very quickly
behaving unusually
talking very quickly - other people may find it hard to understand what you are talking about
making odd decisions on the spur of the moment, sometimes with disastrous consequences
recklessly spending your money
over-familiar or recklessly critical with other people
less inhibited in general

If you are in the middle of a manic episode for the first time, you may not realise that there is anything wrong – although your friends, family or colleagues will. You may even feel offended if someone tries to point this out to you. You increasingly lose touch with day-to-day issues – and with other people's feelings.

Psychotic symptoms

If an episode of mania or depression becomes very severe, you may develop psychotic symptoms.

In a manic episode - these will tend to be grandiose beliefs about yourself - that you are on an important mission or that you have special powers and abilities.

In a depressive episode - that you are uniquely guilty, that you are worse than anybody else, or even that you don't exist.

As well as these unusual beliefs, you might experience hallucinations - when you hear, smell, feel or see something, but there isn't anything (or anybody) there to account for it.

Between episodes

It used to be thought that if you had bipolar disorder, you would return to normal in between mood swings. We now know that this is not so for many people with bipolar disorder. You may continue to experience mild depressive symptoms and problems in thinking even when you seem to be better.

Treatments

There are some things you can try to control mood swings so that they stop short of becoming full-blown episodes of mania or depression. These are mentioned below, but medication is still often needed to:

keep your mood stable (prophylaxis);
treat a manic or depressive episode.

Stopping the mood swings - helping yourself

Self-monitoring

Learn how to recognise the signs that your mood is swinging out of control so you can get help early. You may be able to avoid both full-blown episodes and hospital admissions. Keeping a mood diary can help to identify the things in your life that help you – and those that don't.

Knowledge

Find out as much as you can about your illness - and what help there is.

Stress

Try to avoid particula rly stressful situations - these can trigger off a manic or depressive episode. It's impossible to avoid all stress, so it may be helpful to learn ways of handling it better. You can do relaxation training with CDs or DVDs, join a relaxation group, or seek advice from a clinical psychologist.

Relationships

Depression or mania can cause great strain on friends and family - you may have to rebuild some relationships after an episode.

It's helpful if you have at least one person that you can rely on and confide in. When you are well, try explaining the illness to people who are important to you. They need to understand what happens to you - and what they can do for you.

Activities

Try to balance your life and work, leisure, and relationships with your family and friends. If you get too busy you may bring on a manic episode.

Make sure that you have enough time to relax and unwind. If you are unemployed, think about taking a course, or doing some volunteer work that has nothing to do with mental illness.

Exercise

Reasonably intense exercise for 20 minutes or so, three times a week, seems to improve mood.

Fun

Make sure you regularly do things that you enjoy and that give your life meaning.

Continue with medication

You may want to stop your medication before your doctor thinks it is safe – unfortunately this often leads to another mood swing. Talk it over with your doctor and your family when you are well.

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