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Information on Bipolar Disorder

What is Bipolar Disorder?

Bipolar Disorder is an illness which causes extreme changes in mood, energy and behaviour.

Also known as Manic Depression, it involves alternating moods between extreme highs (manic or mania) and extreme lows (depression) called 'cycling'. There is no set time pattern to these cycles - some people may go for up to 2 years between episodes, others may experience these more often. Episodes may last from 3 to 6 months. Four or more episodes in a 12 month period is called 'rapid cycling'.

Bipolar Disorder usually begins in adolescence or early adulthood and continues throughout life. Men and women are affected equally, although men tend to have more manic episodes and women have more depressive episodes.

Bipolar Disorder can affect anyone. Some people are very well known. Brilliant lawyers, artists, actors, writers and political leaders are among those who have Bipolar Disorder.

People with Bipolar Disorder can experience periods of mania, hypomania, depression or mixed episodes or dysphoric mania - this is where both manic and depressive symptoms are happening in the same episode. Moods may switch from mania to depression or there may be a period of normal mood in between.

The features of Bipolar Depression are much the same as major depression, but the episodes of hypomania and mania distinguish it from major depressive disorder. Mania may merge into psychosis causing patients to be incorrectly diagnosed with schizophrenia or a personality disorder. Psychosis can also accompany severe depression with delusions and/or hallucinations during episodes.

Many patients remain undiagnosed for years, sometimes leading to great suffering, hardhship and relationship breakdown.

Is Bipolar Disorder Treatable?

Very effective treatments exist for Bipolar Disorder, these include medications and counselling or psychotherapy. Early diagnosis and treatment is very important to good prognosis.

Bipolar Disorder can not be cured however successful management with proper treatment allows most patients to return to productive lives. Good quality of life is usually possible.

The outlook for those with Bipolar Disorder is optimistic with many new and promising treatments being developed.

Causes of Bipolar Disorder:

The exact cause is not known and there is no test available that will confirm a diagnosis of Bipolar Disorder.

Genetics and heredity is a major factor as Bipolar Disorder tends to run in families. A number of genes may be linked to this disorder.

Psychological stress may be a trigger as susceptible people appear to have difficulty 'switching off' so that excessive excitement builds into mania and setbacks may degrade into depression.

Episodes of mania or depression can sometimes be triggered by stressful life events such as a death in the family, relationship difficulties, and loss of job or career.

Disrupted sleep patterns can trigger chemicals that affect your wellbeing and can trigger mood episodes.

Bipolar Depression:

Bipolar Depression is severe in its impact, especially if it is experienced immediately following mania with no 'normal' period in between. Having experienced the euphoria of an extreme high the person is plunged into the opposite extreme of a deep depressive episode.

Bipolar Depression is equal in severity to major depressive disorder or psychotic depression and requires urgent treatment.

Families and carers should be aware that there is a risk of suicide for sufferers especially during depressive episodes.

Mania:

There are various aspects of mania someone with Bipolar Disorder may exhibit which would lead to a diagnosis of Bipolar disorder as opposed to Depression which is unipolar (low mood only).

Mania is not only being in a hyped-up mood which is a false impression held by many people and hasn't been helped by movies depicting irrational and super-charged characters doing incredible feats driven by extreme optimism.

Anger and aggression are also classified as Mania, so a person may never exhibit a 'happy' high - but may become increasingly angry, aggressive, verbal and/or violent. These outbursts may be over some perceived wrong-doing by a partner or someone else. There may be absolutely no substance to the accusations and the person may be quite delusional or have imagined the whole thing, however to the person on the receiving end, the anger and aggression is very real.

Mania is also exhibited by grandiose feelings. The person may believe they are famous, super intelligent or rich. They may take unnecessary risks due to feelings of being indestructible. They may take on jobs they are not qualified for.

They may do things out of character like stealing, or driving dangerously because they think they can't be caught or hurt. They may gamble away their homes and possessions absolutely believing they are going to win. They may purchase expensive property, cars, jewellery or gifts without regard to how they will pay for them.

They may take out large loans, invest in business or finance grandiose ideas. You may wonder how someone suffering mania would manage to get a loan but these people can be very convincing because they absolutely believe what they are saying is true and their optimism is infectious.

People suffering with mania can certainly come across as confident, savy, inspired go-getters even though there may in fact be absolutely no substance to their claims.

Mania can cause other problems. There is a very real danger of serious physical injury occasioned by risk-taking activities that may unintentionally affect others as well. If someone you know is suffering from mania urgent intervention is needed, your action may save their life or the life of someone else.

Types of Bipolar Disorder:

In recent years additional classifications for forms of Bipolar Disorder have been created to differentiate the patterns of symptoms present or absent which do not fit the traditional criteria for Bipolar disorder. Prior to this it was expected that all sufferers of Bipolar disorder experienced mania, hallucinations, delusions and degrees of paranoia. It is now accepted that not all sufferers of Bipolar disorder experience all of these things.

Bipolar I

Bipolar I describes the traditional symptoms of at least one manic episode and can include hallucinations, delusions and paranoia. The person almost always experiences periods of depression or mixed episodes.

Bipolar II

Bipolar II describes the symptoms of hypomania and depression. Hypomania is 'low' mania, a milder presentation of the symptoms of mania. In hypomania there is generally an absence of hallucinations and delusions which can be associated with mania.

In some cases hypomania may be mistaken for being in a 'great mood' or just a generally very positive outlook in life. Essentially hypomania may go unnoticed to the point where the person only seeks help for the depressive episodes. This can lead to treatment with antidepressants alone which may trigger episodes of mania. This is why it is important to have a full history for the patient so the correct diagnosis can be made.

The Symptoms

Acute Mania:


Depression:


Mixed Episode:

A mixed episode involves the symptoms of mania and depression occuring at the same time or these symptoms can alternate thoughout the day. The sufferer can be excited and/or agitated as in mania but irritable and depressed instead of feeling euphoric and on top of the world.

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Treatments:

Diagnosis:

Proper diagnosis is essential for effective treatment. Your GP should be able to provide you with a referral to a psychiatrist or psychologist experienced in treating Bipolar Disorder.

Obtaining a thorough past and present history is the key to proper diagnosis. The main source of information will be the patient together with contributions by family members.

Diagnosis may be overlooked if the patient presents during a depressive episode. Thorough investigation is required to ascertain a history of manic or hypomanic episodes to avoid misdiagnosis of a depressive disorder.

Similarly, symptoms of severe mania with psychosis may be difficult to distinguish from schizophrenia and once again a full history is needed to disclose the clinical course of the illness.

Medication:

Core drug treatments are with mood stablisers. Lithium, Valproate, Lamotrigine, Carbamazapine all have different qualities and will be prescribed depending on the phase of the illness.

Antipsychotics may be used if the patient is suffering from psychosis.
Acute management of depression and mania is usually with medication.

Adherance to Medication:

It is important that the patient continues to take medicines as directed, even if they have felt better for a long time.

Adherance to medication is crucial to remain symptom free and discontinuation of medicines is the most common cause of relapse which usually occurs within months.

It is normal for patients to have thoughts about the necessity of continuing with medications, especially when they have been well for quite some time. If you are having these thoughts we urge you to see your doctor who can address any concerns or issues you may have.

Never quit taking your medication on your own, in the event of relapse symptoms can be much more difficult to treat and may not respond to treatment in the same way as before. Each episode can worsen your chances of returning to a prior level of wellness.

Other Treatments:

Successful treatment of Bipolar Disorder and its varying symptoms requires inclusion of a broad range of interventions from health professionals, family and friends.

Support groups are an important feature enabling the sufferer to gain knowledge about their illness, assist in finding methods to help maintain medication compliance and provide a forum for solving difficulties in interpersonal relationships.

Psychological treatments are effective in conjunction with medication although they are best commenced during a period when the patient is feeling relatively well. These treatments are more useful in treating depression than mania.

Useful psycotherapy treatments include Cognitive Behavioural Therapy, Interpersonal Therapy, Group Therapy, Family Focussed Therapy, and Psycho-Education.

Psychotherapy will only be of benefit if the patient keeps their appointments, does their homework and provides open and honest feedback to the therapist.

Education of family members is very important in providing a strong support base for patients.

For information on these specific treatments please go to our Treatments page.

Early Warning Signs:

For those with established Bipolar Disorder, involving your family in the watch for early warning signs of an episode can be very helpful, particularly if you have difficulty noticing changes in yourself.

Sometimes a lack of insight into your own behaviour is the first indication of mania.

Warning signs will depend on the individual and are different for mania and depression.

Slight changes in mood, sleep, energy, concentration, sexual interest, self-esteem, thoughts of death or sudden optimism, changes in manner of dress or personal grooming may all be indicators of an impending high or low.

If the patient's pattern of sleep changes substantially this is a common indicator that an episode may be on its way.

Self Help:

Things you can do to stay well:

  • Learn all you can and become an expert on your illness and accepted treatments.
  • Involve family and those close to you in the learning process to enhance support.
  • Pay attention to your general health by:
    • Maintaining a regular sleep pattern.
    • Maintain a regular pattern of activity, don't overdo things!
    • Avoid alcohol and illicit drugs - they can trigger episodes by upsetting brain chemistry.
    • Do engage in Psychotherapy and include those who support you.
    • Minimise stress at work and at home.
    • Join a Support Group and find out what other people do to maintain good health.
    • Engage in activities which make you feel good.
    • Make sure your living space is comfortable and safe and you feel happy there.
    • Take good care of yourself; exercise, eat well and avoid caffeine, sugar and very salty foods.
    • Keep track of your health and treatment progress by using diaries and planners.
    • Get regular sunshine.
    • Make regular health care appointments and keep them.
    • Act on symptoms early and seek help.
    • Develop a 'crisis plan' for family and friends who can take over decisions for you if you are really unwell, such as removing credit cards, access to bank accounts and car keys.

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