Bipolar disorder
Bipolar disorder is a mental health condition that used to be called manic depression. It can lead to extreme changes in mood, energy, and ability to function.
There are two distinct parts of the illness: periods of feeling depressed and low, and then huge emotional highs – called mania - where the person can be incredibly overactive. Unlike daily mood swings, people with bipolar may be in one state of either mania or depression for weeks or months at a time. In between these episodes, the person may feel normal and well. (Less commonly, some people with bipolar disorder can have what is known as a mixed bipolar episode, where they can alternate between depression and manic symptoms in a matter of hours). Bipolar symptoms can be severe and may affect your daily life, work, studies and relationships and is very different from the normal mood swings we can all have from time to time. If you have less severe mania symptoms, this is known as hypomania.
There are two types of bipolar disorder – Type I and Type II. Type I usually starts with manic symptoms, often mixed with depression whereas Type II only involves hypomania.
Around 2% of people develop bipolar disorder at some time in their life and it can occur at any age although it usually presents between the ages of 18 and 30. Men and women are equally affected.
The average length of a manic episode is four months, and six months for the depressive phase. It’s impossible to predict how long each manic depressive cycle will last, and the average number of episodes you may experience in your life if you have bipolar disorder is ten. Three quarters of people who have an episode of bipolar disorder have another one within four years.
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Depression and mania
It is quite common to receive a diagnosis of depression first, as these symptoms tend to be present for longer periods of time than the manic episodes. In severe cases, depression can lead people to feel worthless, without hope, and suffering thoughts of suicide or self-harm.
If you’re feeling suicidal your doctor would want to know. If your doctor is not available you can call the emergency services for help, or go to your local emergency department as a place of safety.
An episode of mania that appears after previous depressive episodes may make the diagnosis of bipolar more obvious. People experiencing a manic episode can feel elated and happy, sexually disinhibited, feel full of an excessive amount of energy, feel they don't need food or sleep, and they can have grandiose plans, sometimes spending large sums of money they may not be able to afford, or making big rash decisions. There's often a lack of insight that anything is wrong, especially as some people report feeling more creative during manic episodes - and this makes them reluctant to seek treatment.
Am I at risk of bipolar disorder?
The cause of bipolar disorder remains unclear although there does seem to be a family link, with an increased chance of developing it if someone in your immediate family has been diagnosed with it. Difficult life events and extreme stress may also increase your risk of developing bipolar disorder.
How is bipolar disorder managed?
Bipolar disorder is a lifelong condition and managing it, like any long-term condition, is difficult, but there are lots of things that can be useful. Starting small is the best first step, and eating a healthy diet, getting a good amount of sleep, doing regular exercise, avoiding alcohol or recreational drugs and practicing relaxation techniques will all help.
You will normally be looked after by your family doctor, possibly with input from the psychiatry team when needed. Talking therapies can be useful, and these may be accessed through your doctor or from your psychiatrist if you have one.
Medications will help manage some aspects of your condition. Your psychiatry team can suggest medications that help prevent big mood swings from high to low, keeping your mood stable. There may also be additional medications if you are having a particularly difficult high or low period for a short time. Depression is sometimes the bigger factor, and antidepressants such as fluoxetine may be appropriate as the mainstay of treatment.
The most commonly used medication for bipolar disorder is lithium, although it’s not clear how this works. Anticonvulsant medication such as sodium valproate, carbamazepine or lamotrigine can also be used to treat episodes of mania, as can antipsychotic major tranquillizers such as olanzapine or quetiapine.
When should I see my doctor?
If you’re worried that you have symptoms of bipolar disorder, the best thing is to book a routine appointment with your doctor to discuss this. If your symptoms are severe, request an urgent appointment.
If you’re feeling suicidal, your doctor would want to know. If your doctor is not available you can call the emergency services for help, or go to your local emergency department for a place of safety.
If you are concerned that one of your family or close friends is manic, you should try to persuade them to seek help from their doctor or the emergency department. If they are very unwell but unwilling to engage, you should call 911 for an ambulance, or police if there is a risk to their safety or that of others.
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