Bipolar disorder

About 1 in every 100 adults have bipolar disorder, formerly known as manic depression, at some point in their life with the majority of people developing this condition between the ages of 15-19.1

Bipolar disorder is a mood disorder characterised by swings in a person’s mood from high to low – euphoric to depressed.2

In the high phase (mania or hypomania), someone with bipolar disorder may have huge amounts of energy and feel little need for sleep. They may think and talk faster than usual, and their thoughts may jump rapidly from one subject to another, making them easily distracted and conversation difficult.

They may also experience what are called ‘grandiose’ ideas or delusions about their abilities and powers, and a loss of judgement. People in a high phase can be increasingly goal directed, meaning they can get themselves into difficulties that they would normally avoid – they may leave their job, spend money they don’t have, engage in high-risk situations or give away possessions.3

In a low (or depressive) phase, people have feelings of depression which can leave them feeling hopeless; despairing and lethargic; full of self-blame and self-doubt; and have difficulty concentrating. This can make it difficult to cope with everyday life. People may withdraw from friends and social contacts, and they may feel suicidal.4

What are the signs and symptoms of bipolar disorder?

Symptoms of mania and hypomania include:

  • increased energy, activity and restlessness
  • extreme irritability
  • racing thoughts and talking very fast
  • little sleep needed
  • unrealistic beliefs about one’s abilities and powers
  • a lasting period of behaviour which is different from the usual
  • provocative, intrusive and aggressive behaviour
  • spending sprees.

Symptoms of depression and dysthyma include:

  • lasting sad, anxious or empty mood
  • feelings of guilt, worthlessness, or helplessness
  • decreased energy, a feeling of fatigue or of being slowed down
  • difficulty concentrating, remembering, making decisions
  • restlessness or irritability
  • sleeping too much, or can’t sleep
  • change in appetite and/or unintended weight loss or gain
  • thoughts of death or suicide, or suicide attempts.

Other symptoms can include:

  • hallucinations (hearing, seeing, or otherwise sensing the presence of things that are not actually there and cannot be sensed by others)
  • delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person’s usual cultural concepts)
  • inability to communicate due to markedly speeded up, slowed down or distorted speech (thought disorder, flight of ideas, psychomotor slowing).5

The different types of bipolar

There are different types of bipolar disorder: 

Bipolar I
  • If you have had at least one high or manic episode, which has lasted for longer than one week.
  • You may only have manic episodes, although most people with Bipolar I also have periods of depression.
  • Untreated, a manic episode will generally last 3 to 6 months.
  • Depressive episodes last rather longer – 6 to 12 months without treatment.
Bipolar II

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

Rapid Cycling

If you have more than four mood swings in a 12 month period. This affects around 1 in 10 people with bipolar disorder, and can happen with both type I and type 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.

How common is bipolar?

About one in 100 people are diagnosed as having bipolar disorder7. While most people with bipolar disorder will experience a manic episode at least once along with a depressed phase, some people experience only 'pure depression' and do not experience the mania associated with bipolar disorder, or they may experience 'pure mania' and do not experience depressive symptoms or may only experience mild depression.8,9

What causes bipolar?

The cause of bipolar disorder is not entirely known. What we do know is that biological, psychological and social factors interact with one another and play a role in the onset and progression of bipolar disorder.

Genetic factors

Approximately half of people with bipolar disorder have a family member with a mood disorder, such as depression.10 However, just because there is an association to a family history of mental health problems this doesn’t necessarily mean it causes bipolar disorder. 

Brain chemicals

Studies have shown that there is a relationship between brain chemistry and bipolar disorder and that bipolar disorder may be triggered by external factors such as psychological stress and social circumstances which can impact on certain neurotransmitters or chemical messengers in the brain.11

Environmental factors

Those with bipolar disorder may find that they can link the start of an episode to a period of great stress, such as childbirth, a relationship breakdown, money problems or a career change.
Some experts believe bipolar disorder is linked to the experience of severe emotional trauma in early life, such as physical, sexual or emotional abuse.

Grief, loss, trauma and neglect can all be contributing factors.12

Treatment and support

There are several approaches available for the treatment of bipolar disorder, which most often include a combination of medication and psychotherapy. The main treatment for an episode of mania or hypomania is typically antipsychotic medications, while treatment for depression in people with bipolar may be psychological therapy on its own or combined with medication.13

Medication

There are different medications that have been found to be effective for people with bipolar disorder to manage symptoms. It’s important to discuss medication with a psychiatrist and to explore the different options that may be available, including any side effects.14

Some of the options are:

  • Lithium: this is the most common and effective type of mood stabiliser used for treating bipolar disorder. The difficulty is getting the level of lithium in the body right. Too low and it won’t work, too high and it becomes toxic. You will need regular blood tests in the first few weeks to make sure you are getting the right dose. Some of the side effects that can occur with taking lithium can include feeling thirsty, passing more urine than usual and weight gain. 
  • Anti-convulsant drugs: examples of these include, sodium valproate and lamotrigine (used to treat epilepsy) have also been found to be effective in controlling moods. It’s important to discuss with your doctor if you are pregnant or planning to have a baby as valproate and lamotrigine can have negative side effects. 
  • Anti-psychotic medication: examples of these include, olanzapine and quetiapine.15

Talking Therapies

Cognitive behavioural therapy (CBT) works best for handling specific 'thought errors' and behaviours. For example, if a teenager with bipolar disorder tends to catastrophize when depressed, seeing only the negative side of everything and then becoming further depressed as a result, cognitive therapy can help them find strategies for breaking this negative thought pattern.

These strategies might include the use of affirmations, consulting with the therapist or another trusted adult to double-check negative thoughts, or mentally substituting positive thoughts for the negative ones. CBT has also shown effectiveness for educating bipolar patients about monitoring their mood cycles and symptoms, and for encouraging treatment compliance.16

Peer support and self-management

Peer support and self-management can have a positive impact on mental health and as medical treatment for people with mental health problems, including those experiencing bi-polar disorder. The Mental Health Foundation’s peer-led self-management training, which was developed and delivered by mental health service users for people with psychiatric conditions (including those with bipolar) showed improvements in wellbeing and health promoting lifestyle activity as well as the potential for long-term health outcomes.17

References

  1. Smith, D.J., Nicholl, B.I., Cullen, B., Martin, D., Ul-Haq, Z., Evans, J., Gill, J.M.R., Roberts, B., Gallacher, J., MacKay, D., Hotopf, M., Deary, I., Craddock, N. & Pell, J.P. (2013). Prevalence and Characteristics of Probable Major Depression and Bipolar Disorder within UK Biobank: Cross-Sectional Study of 172,751 Participants. Plos, 8 (11): e75362. DOI:10.1371/journal.pone.0075362
  2. NHS Choices. Bipolar Disorder. Available at: http://www.nhs.uk/Conditions/Bipolar-disorder/Pages/Introduction.aspx [Accessed on 21/03/16].
  3. American Psychiatric Association. (2013). Diagnostic Statistical Manual of mental disorders (5th Ed). Washington, DC: Author. 
  4. American Psychiatric Association. (2013). Diagnostic Statistical Manual of mental disorders (5th Ed). Washington, DC: Author.
  5. NHS Choices. Bipolar disorder – Symptoms. Available at: http://www.nhs.uk/Conditions/Bipolar-disorder/Pages/Symptoms.aspx [Accessed on 21/03/16].
  6. Bipolar UK. Are there different types of bipolar? Available at: http://www.bipolaruk.org/Pages/FAQs/Category/what-is-bipolar [Accessed on: 21/03/16]
  7. Perala, J. et al. (2007). Lifetime Prevalence of Psychotic and Bipolar I Disorders in a General Population. Arch Gen Psychiatry, 64 (1), 19-28.
  8. Swann, A.C. et al. (2013). Bipolar Mixed States: An International Society for Bipolar Disorders Task Force Report of Symptom Structure, Course of Illness, and Diagnosis. American Journal of Psychiatry, 170 (1), 31-42.
  9. Mazza, M. et al. (2011). Bipolar disorder: “pure” versus mixed depression over a 1-year follow-up. International Journal of Psychiatry in Clinical Practice, 1-8.
  10. Craddock, N. & Sklar, P. (2013). Genetics of bipolar disorder. The Lancet, 381 (9878), 1654-1662.
  11. PsychCentral (2013). The Causes of Bipolar Disorder (Manic Depression). Available at http://psychcentral.com/lib/the-causes-of-bipolar-disorder-manic-depress... [accessed September 2015]
  12. NHS Choices. Causes. Available at: http://www.nhs.uk/Conditions/Bipolar-disorder/Pages/Causes.aspx [Accessed on 21/03/16].
  13. NICE (2014). Bipolar disorder: assessment and management. NICE guidelines [CG185]. Available at: https://www.nice.org.uk/guidance/cg185 [Accessed on 21/03/16].
  14. Geddes, J.R. & Miklowitz, D.J. (2013). Treatment of bipolar disorder. The Lancet, 381 (9878), 10.1016/S1040-6736(13)60857-0.
  15. Royal College of Psychiatrists (2015). Bipolar Disorder. Available at http://www.rcpsych.ac.uk/healthadvice/problemsdisorders/bipolardisorder.... [accessed September 2015]
  16. NICE (2014). Bipolar disorder: assessment and management. NICE guidelines [CG185]. Available at: https://www.nice.org.uk/guidance/cg185 [Accessed on 21/03/16].
  17. Cyhlarova, E., Crepaz-Keay, D., Reeves, R., Morgan, K., lemmi, V., and Knapp, M. (2015). An evaluation of peer-led self-management training for people with severe psychiatric diagnoses,The Journal of Mental Health Training, Education and Practice, 10(1) , 10.1108/JMHTEP-08-2014-0020.