Bipolar disorder

Also known as bipolar affective disorder

Bipolar disorder is another name for what was once known as manic depression.

The word bipolar describes the mood fluctuations – from the extremely elated mood (mania) to the very low mood (depression) – that people with this condition may experience.

There is now far more knowledge and understanding about how to treat and support people with bipolar disorder to live full and meaningful lives. Some of the greatest writers, medical people, musicians, artists and scientists in history are thought to have experienced bipolar disorder, such as Sir Isaac Newton, Florence Nightingale and Mark Twain. 

We all experience mood swings and have times of feeling low or excited. With bipolar disorder, these mood swings are more extreme and impact on a person's ability to carry out their normal daily tasks.

Unlike depression, where people experience prolonged low mood, with bipolar disorder people have both strong lows and highs in terms of mood swings. These mood swings can last days through to months.

If you think you have, or someone you care about has, bipolar disorder visit your family doctor who may refer to a psychologist or psychiatrist. With medical help and support from family and friends, most people learn to manage their bipolar disorder and get on with life.

Key points:

  1. It is a mental illness that tends to first arise in people under 20 years of age.
  2. Most people with the condition remain well for long periods.
  3. Occasionally, an episode of the illness is triggered for no apparent reason and medical help is the best means to a quick recovery.
  4. Different medications are used to treat acute episodes of mania and of depression, and other medications (mood stabilisers) are used to keep episodes at bay or to help treat acute treatments.
  5. Psychological therapies by themselves are unlikely to be effective, but with medications can be helpful.
  6. Taking your medications every day as directed is important for keeping well long-term.

It is thought that between 1–5 in 100 people might have some form of bipolar disorder.

Causes

The cause for bipolar disorder remains unclear. However, there are a number of factors that are believed to play a role. These include genetics, brain chemicals, environmental factors and sometimes medical illnesses. Sometimes its onset can be linked to a stressful life event.

Genetic factors are thought to account for approximately 80% of the cause of the condition. 

  • If one parent has bipolar disorder, there is a 10 per cent chance that his or her child will develop the illness.
  • If both parents have bipolar disorder the likelihood of their child developing the illness rises to 40 per cent.

Symptoms

Bipolar mood changes are called mood episodes. People may have manic episodes, depressive episodes, or mixed episodes (which include both manic and depressive symptoms).

Elated mood can range from fairly mild (hypomania) through to extremely elated mood, known as mania. Signs of mania can include a lack of need for sleep, pressured speech, excess spending, agitation and racing thoughts. 

Depression might be identified by extreme tiredness despite sleeping a lot, bouts of uncontrollable crying, loss of interest and motivation, feeling hopeless, helpless or worthless for some time and having thoughts about dying.

These behaviours may develop slowly, so it can be hard to tell whether some are part of the person's normal character. In extreme cases, the symptoms are very intense and you may put yourself or others at risk or feel ashamed after you have recovered. Talking to your doctor will help you understand your moods and regain control of your life. The earlier a diagnosis is made, the better the recovery usually is.

Symptoms of mania

People having a manic episode may:

  • feel very up or high
  • feel jump or wired
  • talk really fast about a lot of different things
  • be agitated, irritable, or touchy
  • have trouble relaxing or sleeping
  • think they can do a lot of things at once and are more active than usual
  • do risky things, like spend a lot of money or have reckless sex.

Symptoms of depression

People having a depressive episode may:

  • feel very down or sad
  • feel worried and empty
  • have trouble concentrating
  • forget things a lot
  • lose interest in fun activities and become less active
  • feel tired or slowed down
  • have trouble sleeping
  • think about death or suicide.

Take a test

Self test for bipolar disorder Black Dog Institute.

Diagnosis

The illness is commonly subdivided into Bipolar I and Bipolar II disorder and the criteria for making a diagnosis of bipolar disorder, as defined by the Diagnostic and Statistical Manual (DSM), are:

Bipolar I: Occurrence over a lifetime of at least one manic episode or at least one mixed episode.
Bipolar II: One or more major depressive episodes accompanied by at least one hypomanic episode (not manic episodes).

Most people experience multiple episodes at an average of one episode each two to three years, with each phase lasting about three to six months. If a person has four or more episodes in a 12-month period, their condition is termed ‘rapid cycling’ bipolar disorder.

Initial screening assessment

An initial clinical assessment of a possible hypomanic /manic episode will usually assess:

  • severity of symptoms
  • level of functional impairment
  • degree of insight
  • presence/absence of psychosis
  • risk to self (financial, sexual, reputation) or others (violence)
  • amount/quality of family/whanau support and/or community services.

Treatment

There is no need to struggle alone. See your GP or a psychiatrist for support and treatment advice. People with bipolar disorder experience times when they are well and times when they are unwell. The treatment offered by your doctor or psychiatrist is tailored to your needs to help you recover from periods of illness – to regain your normal moods and behaviours – and then it is adjusted to help you remain well. Most people return to their usual level of functioning after times of illness, although about one in five will have some ongoing difficulties.

There are several drugs that have been shown to be helpful in relieving depression and others that are useful in stabilising moods. It is quite common for people with bipolar disorder to be taking some medication(s) long term. Your doctor can help you find the ones that suit you best without causing unnecessary side effects.

Treatment for bipolar disorder can be tricky, when compared to treating (unipolar) depression, because taking an antidepressant drug at the wrong time runs the risk of 'flipping' the person's depression straight over into a manic mood. This means that mood stabiliser drugs and antidepressants are used carefully, and introduced gradually.

You may be referred to a psychiatrist so that your mood problems and the best treatment for you can be worked out early on. Even so, there may be some trial and error until the best combination for you is worked out.

Commonly used mood stabilising medications:

  • lithium*, valproate,
  • sometimes antipsychotic drugs or sedatives are also useful.*Patients using lithium need regular blood tests to check the right amount is being given. The mood benefits may take a few months to really be noticed. If the lithium level in your blood gets too high you may notice shakes and twitches, weakness, slurred speech, sleepiness, stomach cramps, loss of appetite and vomiting. Contact your doctor, psychiatrist or practice nurse right away. Stop the lithium if you cannot contact your doctor.

Commonly used antidepressant drugs:

  • fluoxetine, paroxetine, citalopram.

If your medications cause you problems you must talk to your doctor, nurse or psychiatrist. They can check you have the most appropriate medication at the right dose. Your doctor will be happy to talk about any medication side effects that might be a problem. Depending on the drug, these can include weight gain, stomach problems, slowed thinking, tremors (shakes, twitches) or nausea.

Depending on the nature of the illness and how it is managed, hospitalisation can sometimes be required.

The use of medications during pregnancy is an extremely important issue and needs consultation with an expert.

Self care

There is much you and your family can do to help you develop skills and strategies for reducing mood swings and keeping well. Take a look at some of these ideas and resources including online self-help programmes. Also talk with your GP and mental health team.

  • Exercise helps your mental as well as physical wellbeing (the benefits can be substantial).
  • Avoid all alcohol and illicit drugs (they cause mood changes).
  • Eat a healthy diet  fish oils (omega-3) may help.
  • Get a good sleep every night  a few nights of poor sleep can trigger a manic episode, so if sleep is a problem ask your doctor about ways to help you sleep (which may include medication).
  • Ask about psychotherapy – this can help you deal with any emotions of guilt, anger or shame.
  • Confide in trusted friends and relatives – talk with those closest to you about bipolar disorder so they can be there for you when you need it.
  • Keep a Daily Mood Swing diary (see below) to rate moods from 1–10 and record factors affecting mood/sleep. This helps detect changes early on and helps your doctor. 
  • Find out if there is a self-management programme near you. 

Stories

Personal stories about staying well Black Dog Institute

Learn more

Online directory Linkage, NZ
Need help right now? Crisis directory Mental Health Foundation of NZ
Causes Black Dog Institute (NZ), 2013
What treatments work for bipolar disorder? Evidence based view Best Health (UK) 
Black Dog books - books on depression, bipolar disorder and more Black Dog Institute (Australia), 2014

References

  1. Bipolar disorder: New Zealand Treatment Guide for Consumers and Carers Royal Australian and New Zealand College of Psychiatrists, March 2005
  2. Bipolar disorder section Black Dog Institute
  3. What is bipolar disorder? National Institute of Mental Health, USA.
Credits: Health Navigator Team, February 2015.