What is bipolar disorder?

Bipolar disorder (manic depression) affects a person's mood in a complex way that is difficult to understand and to cope with. Unlike straightforward (unipolar) depression, bipolar disorder means you can have strong and unpredictable moods or rapid mood swings - from depression (very low mood) to manic behaviour (extremely elated mood; mania) or hypomania (less severe mania).

Most people have mood swings, but not on the same scale as in bipolar disorder. Mania is often accompanied by a lack of need for sleep and other symptoms. With medical help, people usually learn to manage their bipolar disorder and get on with life.

Is bipolar disorder common?

Between one and five in 100 people might have some form of bipolar disorder. It is a mental illness that tends to first arise in people under 20 years of age. Most people with the condition remain well for long periods. Occasionally, an episode of the illness is triggered, sometimes for reasons that are hard to pinpoint, and medical help is the best means to a quick recovery.

What causes bipolar disorder?

There is no known cause for bipolar disorder. It may be partly inherited as it tends to run in families; but for some, there is no family history.

How is it diagnosed?

There is no one test - a doctor or psychiatrist (mental health specialist) must assess your symptoms. The person may show signs of depression, manic behaviour or a combination. Often a period of manic behaviour is followed by a spell of depression, and vice versa.
 
Signs of mania might include:

• feeling filled with energy
• feeling powerful/important, like you can do anything, even something unsafe or illegal
• needing very little sleep, yet never feeling tired
• finding it hard to concentrate, being easily distracted or talking/thinking so fast others cannot follow
• being irritable or argumentative
• behaving in ways others find socially unacceptable
• dressing flamboyantly, spending money extravagantly, living recklessly
• having increased sexual desires, perhaps even indulging in risky sexual behaviours
• psychosis: hallucinations or delusions (false beliefs).

Depression might be identified by:

• refusing to get out of bed for days on end
• sleeping much more than usual
• being tired all the time but unable to sleep
• having bouts of uncontrollable crying
• being entirely uninterested in things you once enjoyed
• paying no attention to daily responsibilities
• feeling hopeless, helpless or worthless for some time
• becoming unable to make simple decisions
• wanting to die.

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, 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.

Can bipolar disorder be treated?

People with bipolar disorder have their life divided into times when they are well and times when they are unwell. Most people return to their usual level of functioning after times of illness, although about one in five will have some ongoing difficulties.

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.

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, carbamazepine
• 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.

What things can I do to help myself?

• 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)
• Keep a daily mood diary (rate moods from 1-10, record factors affecting mood/sleep) - this helps detect changes early on and helps your doctor
• Ask about psychotherapy - this can help you deal with any emotions of guilt, anger or shame
• Confide in trusted friends and relatives - educate those closest to you about bipolar disorder so they can be there for you when you need it.

Original material compiled by everybody, 2004.