What is bipolar disorder?

A condition in which you have severe mood swings. These usually last several weeks or months and can be:

  • low mood, intense depression and despair
  • high or ‘manic’ feelings of joy, over-activity and loss of inhibitions
  • a ‘mixed state’ such as a depressed mood with the restlessness and over-activity of a manic episode.

What causes bipolar disorder?

  • It seems to run in families, so genes seem to be important.
  • There may be a physical problem with the brain systems which control mood – so bipolar disorder can often be controlled with medication.
  • Stress can trigger mood swings.

Types of bipolar disorder

  • Bipolar I

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

  • Bipolar II

If you have had more than one episode of severe depression, but only mild manic episodes (called ‘hypomania’).

You have had more than four mood swings happen in a 12 month period. This affects around 1 in 10 people with bipolar disorder.

  • Cyclothymia

The mood swings are not as bad, but are often longer.

How does it feel to have bipolar disorder?

Depression

  • Feelings of unhappiness that don’t go away
  • Agitation and restlessness
  • Loss of self-confidence
  • Feeling useless, inadequate and hopeless
  • Thoughts of suicide
  • Not able to think positively or hopefully
  • Can’t make even simple decisions
  • Can’t concentrate, lose interest
  • Can’t eat, lose weight
  • Can’t sleep properly, wake early in the morning
  • Go off sex
  • Avoid other people.

Mania

  • Very happy and excited
  • Feel more important than usual
  • Full of new and exciting ideas; move quickly from one idea to another
  • Full of energy
  • Don’t want to sleep
  • More interested in sex
  • Make unrealistic plans
  • Very overactive, talking quickly
  • Irritable with other people who can’t go along with your mood and ideas
  • Recklessly spending your money.

Psychotic symptoms

If a mood swing becomes very severe, you may have ‘psychotic symptoms’.

  • When depressed, you may feel that you are uniquely guilty, that you are worse than anybody else, or even that you don’t exist.
  • When manic, you may feel that you are on an important mission or that you have special powers and abilities.
  • You might also experience hallucinations – when you hear, smell, feel or see something that isn’t there.

Can treatment help?

There are three groups of mood stabilisers.  They can take several months to work properly.

This is used to treat both manic and depressive episodes. This can be harmful if the dose is too high, so regular blood tests are needed.. The side-effects include feeling thirsty, passing lots of urine and weight gain.

  • Anticonvulsants

These medications are usually used in epilepsy. They include sodium valproate, Lamotrigine and Carbamazepine.

  • ‘Atypical’ antipsychotics

These medications are usually used for schizophrenia and include Olanzapine, Quetiapine and Risperidone.

Psychological treatments

These can be particularly helpful in between episodes of mania or depression. They include:

  • psychoeducation – finding out more about bipolar disorder
  • mood monitoring – to help you pick up when your mood is swinging
  • mood strategies – to help you stop your mood swinging into a full-blown manic or depressive episode
  • developing general coping skills
  • cognitive behavioural therapy (CBT) for depression.

Treating a mood swing

As well as any mood stabiliser you are taking, you will usually also need:

  • Depressive swing

An SSRI antidepressant medication. They can take between 2 and 6 weeks to work and should be continued for at least 8 weeks after the depression has improved – and then reduced slowly.

  • Manic swing

An antipsychotic medication.

Self help

  • Recognise the signs that your mood is swinging out of control so you can get help early.
  • Find out as much as you can about bipolar disorder.
  • Avoid particularly stressful situations
  • Have at least one person that you can rely on and confide in. When you are well, make sure that they understand about bipolar disorder.
  • Balance your life and work, leisure, and relationships.
  • Exercise for 20 minutes or so, three times a week, as this seems to improve mood.
  • Do things that you enjoy and that give your life meaning.
  • Don’t stop medication suddenly – this can trigger another mood swing.
  • You may want to write an ‘advance directive’ with your doctor and family to say how you want to be treated if you become unwell again.

Helping someone else

  • When someone is depressed, it can be difficult to know what to say. They see everything in a negative light and may not be able to say what they want you to do. Listen and try to be patient and understanding.
  • During mania, the person will appear to be happy, energetic and outgoing. But the excitement of any social situations will tend to push their mood even higher. Try to steer them away from parties or heated discussions, and try to persuade them to get help.
  • In between mood episodes, find out more about bipolar disorder yourself. Go to appointments with them (if they are happy for you to do this). Make sure you give yourself space and time to recharge your batteries.