Synapse - reconnecting lives

Bipolar affective disorder, also known as manic depression, is a mood disorder in which the sufferer experiences marked mood swings which are beyond what most people experience.

These extremes of mood may include the lows of depression as well as the highs of a very elated mood (known as mania). The number and frequency of these periods of depression and mania vary from person to person.

Between one and two percent of the population suffer from bipolar affective disorder at some point in their lives. Some people will experience just one or two episodes, whereas others will have many episodes of depression or mania.

It is a serious condition but can be helped with the right treatment.

What causes bipolar affective disorder?

The causes of bipolar affective disorder are not well understood. As with any mental illness, differences in people's genetic makeup can make them more vulnerable to develop bipolar affective disorder. Stressful events, illness or lack of support can trigger individual episodes of mania or depression.

What are the symptoms of mania?

Mania is typically a period of a week or more where a person feels abnormally good, high, excited, hyperactive or irritable. This can be so extreme that the sufferer loses contact with reality and starts to believe strange things, have poor judgement and behave in embarrassing, harmful or even dangerous ways. This may be accompanied by:
   

• an elevated mood beyond what is normal for the circumstances
• an overwhelming sense of wellbeing and self-importance
• increased energy and overactivity
• increased speech, often rapid and louder than usual
• a reduced need for sleep
• loss of inhibitions with possible inappropriate and impulsive behaviour
• the expression of grand, over-optimistic ideas and plans
• an increase in sexual thoughts, feelings and behaviours
• risk-taking behaviour, including financially, sexually or physically.

In severe cases sufferers may develop 'psychotic' symptoms of delusions and hallucinations.

What are the symptoms of a major depressive episode?
A depressive episode is when you have either a depressed mood or the loss of interest or pleasure in nearly all activities lasting for at least two weeks. Symptoms include:

• lack of interest in day-to-day life
• unusual levels of fatigue and exhaustion
• no appetite or an increased appetite with changes in body weight
• feeling worthless or guilty
• difficulty concentrating.

What are the types of bipolar disorder?

Bipolar affective disorder is not one single disorder. Instead, there are four distinct types.

Bipolar I disorder is marked by experiencing one or more manic episodes or mixed episodes and often one or more major depressive episodes. Each depressive episode can last for several weeks or months, alternating with intense symptoms of mania that can last just as long. Between these extremes, there may be no symptoms at all.

Bipolar II disorder is marked by experiencing one or more major depressive episodes, along with at least one hypomanic episode. Hypomanic episodes have symptoms similar to manic episodes, but are not as severe. Between episodes, there might be periods of normal functioning.

Cyclothymic disorder is a chronic fluctuating mood pattern which involves periods of hypomanic symptoms and periods of depressive symptoms. The symptoms do not have to be severe enough to be labelled as mania or depression - it is a milder form of bipolar disorder in which the symptoms are less severe, less regular and don't last as long.

Bipolar disorder not otherwise specified  is when the symptoms don't fit any other type, it is a treatable disorder, but it is not as regular or as clear-cut as the other types and experiences vary more widely from person to person. Symptoms may be as severe as the other types, but not last as long, or may be too far apart to be classified as cyclothymic disorder, or there may be recurrent hypomanic episodes without depressive episodes.

All these four types of bipolar disorder have the potential to seriously disrupt someone's work, school, social or personal life. Thankfully, they are also all treatable.

Treatment

Depressive episodes are treated in the same way as other episodes of depression. This includes psychological therapy and antidepressant medication. Episodes of mania are usually treated with antipsychotic medication (e.g. chlorpromazine and haloperidol).

If the episodes of either mania or depression are severe enough to place the person at risk, or to endanger the lives of others, they may need to be admitted to hospital in order to be treated.

Often, during acute episodes of illness, mood-stabilizing medicines are used such as lithium, sodium valproate (Epilim), carbamazepine (Tegretol) and olanzapine (Zyprexa).These are also used for longer-term preventive therapy, the aim of which is to prevent relapses.

These medications treat the symptoms, not the cause, and are also used in cases where a brain injury leads to extremes of mood that are not classed as a mental illness.

Managing bipolar disorder in everyday life

Learn to recognize the warning signs. Episodes of both mania and

depression have early-warning signs, such as feeling sluggish, tearful or hopeless (depression) or being impulsive or caustic to others (mania). Also learn to recognize triggers, and avoid them where possible.

Set routines and keep to them. Changes in patterns such as sleeping and eating, and stressful events, are often triggers for manic episodes and should be avoided where possible.

Make sure that you take your medication according to your doctor's instructions, and if it isn't working talk to your doctor about this rather than modifying the dosages yourself.

Keep a mood diary, which will help to identify triggers, warning signs and helpful strategies.

Avoid any mood-altering chemicals that are not prescribed for you. This includes caffeine in coffee and tea, alcohol, and nicotine in tobacco. Exercise regularly. Regular physical exercise helps with most psychiatric illnesses.

Find relaxation methods that work for you. Guided imagery, taking a bath or yoga are some techniques that may help. Find someone you can trust to talk to. This might be your GP, a counsellor, friend or family member. They should be someone who will help you work through emotions or fears and be able to provide emotional support when needed.

Join a support group. Many people with mood disorders find that support groups or internet forums provide them with most of their social and emotional support.

Prognosis for bipolar disorder

Like diabetes or heart disease, Bipolar Disorder is often a long-term illness that must be carefully managed throughout a person's life.

Episodes of mania and depression typically recur across the life span. Between episodes, most people are free of symptoms, but as many as one third of people have some residual symptoms. A small percentage of people experience chronic unremitting symptoms despite treatment.

Without treatment, however, the natural course of bipolar disorder tends to worsen. Over time a person may suffer more frequent (more rapid-cycling) and more severe manic and depressive episodes than those experienced when the illness first appeared. But in most cases, proper treatment can help reduce the frequency and severity of episodes and can help people with bipolar disorder maintain good quality of life.