This article is for anyone who wants to know more about bipolar disorder (sometimes called bipolar affective disorder or manic depression). It is especially helpful for anyone who has bipolar disorder, their friends and relatives. Many patients prefer the term ‘bipolar’ rather than ‘bipolar disorder’ as they have an illness not a disorder.

This article describes:

• the disorder
• some of the problems it can create
• ways of coping
• some of the treatments available.

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 elation
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.

D

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.

• In severe mania, a person can become hostile, suspicious and verbally or physically explosive.
• In severe depression, a person may start to think of suicide.

If you find that they are:

• seriously neglecting themselves by not eating or drinking
• behaving in a way that places them, or others, at risk
• talking of harming or killing themselves, medical intervention must be sought immediately

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.

Bipolar disorder may result in you having to stop driving for a while. Visit the DVLA website for further information.

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.

Bipolar disorder is a treatable medical condition.

People who recognise these symptoms either in themselves or in other’s close to them should try and get medical help at the earliest convenience and appropriate assessment and medication can be prescribed. However, drugs must only be taken under prescription and proper medical supervision.

Help and support for Bipolar sufferers is available from:

Bipolar UK

email: mdf@mdf.org.uk.

Provides support, advice and information for people with bipolar disorder, their friends and carers.

Depression Alliance

Tel: 0845 123 23 20; email: information@depressionalliance.org. Information, support and understanding for people who suffer with depression, and for relatives who want to help. Self-help groups, information, and raising awareness for depression.

With permission from Royal College of Psychiatrists. January 2014. Due for review: January 2016.