What is Bipolar? (Take the quiz)

Bipolar disorder is a mood disorder which is characterized by  mood swings & was, until a few years ago, known as 'manic depression', because of the extreme swings in mood from mania to depression, experienced by it's sufferers. Between a persons high moods 'mania' and their low moods 'depression' the person is usually completely well this is referred to as 'euthymia'.

Bipolar  Disorder is thought to have a genetic component. It is thought that if there is bipolar or other mental illnesses in your family history you may have  higher risk of developing bipolar disorder as well as other mental health illnesses such as anxiety and panic disorders. It is thought to be caused by an imbalance in the brain biochemical's called neurotransmitters, which send messages between the nerves. Too few or too many neurotransmitters are believed to cause extreme changes in mood.

Most people who are diagnosed with bipolar disorder need to work at  long term management of the illnesses as it is a recurrent disorder and having just the one episode is unlikely. Although there is no known cure for bipolar disorder, it is one of the most treatable mental illnesses.

Bipolar disorder is an illness that affects thoughts, feelings, perceptions and behaviour ... even how a person feels physically. It's probably caused by electrical and chemical elements in the brain not functioning properly and is usually found in people whose families have a history of one or more mental illnesses. (While we're at it, let's be clear about something: a "mental illness" is one that affects the mind, not one that's all in the mind.)

Bipolar has one of the highest mortality rates of all mental illnesses. One in 5 patients die by suicide. Often alcohol & substance abuse are common in patients with bipolar disorder. Panic disorder, ADHD (attention deficit hyperactive disorder) & BPD (borderline personality disorder) are also associated with bipolar.

Most often, a person with manic-depression (bipolar) experiences moods that shift from high to low and back again in varying degrees of severity. The two poles of bipolar disorder are mania and depression. This is the least complicated form of the illness. There are also mixed episodes & rapid cycling.

Signs of Mania

Mania might include:

• Feeling like you can do anything, even something unsafe or illegal
• rapid speech, racing thoughts
• Increased irritability
• Needing very little sleep, yet never feeling tired
• Dressing flamboyantly, spending money extravagantly, living recklessly
• Seeking pleasure without regard to consequences, reckless behaviour or poor judgement
• Hyper sexuality & sexual promiscuity
• Spending sprees
• Experiencing hallucinations or delusions
• Heaps of energy
• Euphoria
• Increased self esteem

In children it is more likely characterized by irritability & destructive outbursts rather than euphoria or elation.

Psychotic features,i.e. hallucinations & delusions, may be present in manic or mixed episodes. Compulsions or obsessions may also be present.

Signs of Depression

Depression might be identified by:

• Difficulty getting out of bed for days on end
• Extreme sadness
• Anxiety or agitated
• Anger or apathy
• Change in sleep pattern
• Being tired all the time but unable to sleep
• Bouts of uncontrollable crying
• Uninterested in things you once enjoyed 
• Feeling hopeless, helpless or worthless, inappropriate guilt
• Pessimistic
• Difficulty  making simple decisions
• Significant changes in appetite or weight
• Loss of concentration
• Wanting to die, thought of suicide

Signs of Hypermania

Hypomania - a less extreme form of manic episode - could include:

• Having total confidence in yourself
• Being able to focus well on projects
• Feeling extra creative or innovative
• Being able to brush off problems that would paralyse you during depression
• Feeling "on top of the world" but without going over the top.

Hypomania does not include hallucinations or delusions, but a hypomanic person still might exhibit some reckless or inappropriate behaviour. A person who has moods of depression and hypomania is said to have Bipolar II.

Mixed episodes

These are episodes that have both mania & depression present at the same time or rapidly alternating (rapid cycling).

Diagnosis

It is often difficult to diagnose Bipolar Disorder as the state at which a person presents to their medical practitioner may affect the diagnosis. For example a person may be diagnosed with schizophrenia when they are actually experiencing a delirious manic state. Your GP will normally check there are no physical conditions causing your symptoms, especially thyroid problems as these can mimic bipolar disorder. If all this is clear, then they may  give you a mental health evaluation & then refer you to a psychiatrist for a further assessment who will make the diagnosis and determine which treatments are appropriate.

Bipolar disorder is made up of distinct episodes of depression & mania (except for in the case of mixed episodes).

For an episode to be considered a new episode it must meet the following conditions:-

• There must be a lapse of time or shift in mood, i.e. depression to mania, or mania followed by a period of normal mood & then another manic episode.
• Episodes must occur spontaneously. Ie not caused by a physical condition.
• Psychotic disorders ie schizophrenia must be ruled out.

Types of Bipolar

Bipolar 1 - requires at least one manic or mixed episode. This category is divided into six sections.

1. single episode

2. multiple episodes - whether the last episode was -hypomanic,

3.                                                                                             manic,

4.                                                                                             mixed,

5.                                                                                             depressed or

6.                                                                                             unspecified

 

Bipolar II - at least one episode of hypomania & one episode of major depression. Also the patient must never have had a manic or mixed episode.

 

Cyclothymia - cycling between lows in mood & hypomania. These episodes are milder than Bipola1 or Bipolar II, however it is a chronic condition which often lasts for at least 2 yrs with no lapse in symptoms for more than 2 mths at a time.

 

Non specified Bipolar - Any type of bipolar that does not fit into the above categories.

 

Medication

Although there is no known cure for bipolar disorder, it is one of the most treatable mental illnesses.

Bipolar is often treated with a combination of medications which may include: Mood stabilizers, antidepressants & sometimes antipsychotics. Some antidepressants can cause or worsen manic episodes, so have to be used with care. The safest  ones for bipolar sufferers are  selective serotonin reuptake inhibitors, also known as SSRI inhibitors (eg. prozac, paxil, zoloft); or Monoamine oxidase inhibitors also known as MAOI antidepressants (Nardil, Parnate); The mood stabilisers are either lithium or anticonvulsants. These help to even out the highs & lows. Some of these anticonvulsants are: Depakote, Tegretol, Keppra, Neurontin, Topomax, Lamactil & Trileptal. Lithium is used most often. For more information about a particular medication please refer to your chemist or doctor. Your Dr will often need to adjust the dosage or change the initial medication to achieve the best results.

In severe cases a person with bipolar who is experiencing major depression may be treated with electroconvulsive therapy (ECT). Patients are given an anaesthetic and muscle relaxants and then a low level electrical current is passed through the brain. The most common side effect of ECT is short term memory loss, however this is normally mild. You must give your consent before they can use this form of treatment.

Complementary Therapies

Supportive treatments such as psychotherapy are often used to treat depressive symptoms. These therapies may be useful in assisting the person in understanding the illness and the symptoms they experience when an episode is imminent. There are many variations of psychotherapy however the most those most commonly used to treat depression are interpersonal therapy, cognitive therapy, behavioural therapy, or cognitive-behavioural therapy (CBT). It is also highly beneficial to join a community or peer support group, such as Even Keel, where you can meet and share with other.

Interpersonal therapy - These forms of therapies look at the interpersonal relationships that a person has in order to identify areas of conflict. The therapy then focuses on changing the conflict so that the relationship becomes more supportive rather than stressful. This also includes family therapy & Social rhythm therapy. Social rhythm therapy teaches you how to normalize your daily routine & sleep schedules to help control your condition.

Cognitive therapy - These therapies aim challenge a persons self-defeating thinking and to encourage themselves to view themselves & life in a more positive way.

Behavioural therapy - These therapies focus less on self awareness and more on modifying the problem behaviours.

Cognitive-Behavioural therapy - These therapies are a combination of cognitive therapy and behavioural therapy. Therefore the aim of the therapy is to modify problem behaviours whilst still focusing on self awareness and challenging self-defeating thinking, it teaches the patient to control & change inappropriate behaviours & thought patterns.

Also it has been found that Omega 3 fatty acids  may be of benefit when used in conjunction with conventional medicine. Be very careful of herbal or dietary supplements, speak to your dr before using these, they often interact with prescribed medications or have other serious effects. For example St John's Wort has been shown to induce mania in people with bipolar.

Questions for your Dr about Bipolar Disorder - go to FAQ