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What is bipolar affective disorder

What is bipolar disorder

Bipolar affective disorder is often called manic depression. It is a mood disorder, where your moods can swing from extremes: very very high (mania) to very very low (depression). The high and low phases of the illness are called episodes and can be so extreme that they can interfere with your daily life.

The exact cause of bipolar disorder is not fully understood, but the condition seems to run in families. Both men and women can get it. People from all sorts of backgrounds can get it.

Bipolar disorder is relatively common. Around 1 person in 100 are diagnosed as having bipolar disorder. Often, the depressive phase comes first. You may be diagnosed with clinical depression to begin with, only to have a mania experience some time later (in some cases, years later) and the diagnosis might change.

There are great variations in the pattern of mood swings in bipolar disorder. For example, some people find that the mood swings happen every few days and other people might have long periods with no mood swings at all. On average, someone with bipolar disorder will have five or six episodes over a 20-year period.

Bipolar disorder can be treated effectively (see treatments section) and lots of people live normal, healthy lives while managing the condition.

Symptoms of bipolar disorder

The main symptoms of bipolar disorder are mood swings from extremely happy (mania) to extremely sad (depression). The periods of mania and depression are extreme and without treatment, can interfere with everyday life.

In the depressive (low) phase symptoms may include:

  • Feeling very sad and hopeless
  • Mental and physical slowing
  • Lack of energy
  • Finding it difficult to concentrate
  • Losing interest in everyday activities
  • Feeling of emptiness or worthlessness
  • Feeling pessimistic about everything
  • Feeling of serious self-doubt
  • Difficulty sleeping, waking up early
  • Thoughts of suicide

The manic phase usually comes after two to four periods of depression and may include:

  • Feeling extremely happy, elated or euphoric
  • Feeling full of energy
  • Not feeling like sleeping
  • Feeling full of great new ideas
  • Feeling important

Other people often see this differently and might think you are:

  • Speaking very quickly
  • Changing the subject frequently
  • Generally behaving in a strange, unusual and uninhibited way
  • Appear unable to sit still or relax
  • Making decisions without thinking things through
  • Doing things or spending money recklessly

If you are having a manic episode, you often can’t tell that anything is wrong. It can seem like other people are being critical, negative or unhelpful.

During both the manic and depressive periods of the illness you might also experience strange sensations such as seeing, hearing or smelling things that are not there (hallucinations). Or you might believe things that seem irrational to other people (delusions). This is called psychosis or a psychotic episode.

What causes are?

The exact cause of bipolar disorder is not fully understood. It does seem to run in families, which suggests that genetics are involved. Around 10-15 % of the nearest relatives of people with bipolar disorder also have a mood disorder.

It is also known that very stressful life events and physical illness can bring on (trigger) periods of the illness, so the causes are far from simple.

Research has found that there are changes to the brain’s chemistry during manic and depressive episodes. This includes changes to hormone levels and chemicals that transmit signals within the brain (neurotransmitters). Understanding how this works can help in finding ways to treat and manage the condition.

Diagnosis of a bipolar disorder

To be diagnosed as having bipolar disorder, you will normally be referred to a specialist. Often this will be a psychiatrist.

Usually, psychiatrists will use a set of guidelines developed by the American Psychiatric Association to make a diagnosis. This is called the Diagnostic and Statistical Manual of Mental Disorders (usually referred to as DSM).

It sets out the symptoms that have to be present for a doctor to make a firm diagnosis.

The psychiatrist will also ask questions about your family history and background to see if other people in your family may have had the condition. They may also take notes of your age, when you first experienced the symptoms, and details of the exact symptoms you have had before making a diagnosis.

All this information is important in helping you to make decisions about your treatment.

Bipolar disorder treatment

Treatment for bipolar disorder usually involves a combination of approaches:

  • Treatments to stabilize mood swings
  • Learning to recognize things that might trigger an episode of depression or mania
  • Learning to recognize the signs of an approaching episode
  • Treatments for the main symptoms (depression and mania) if they do occur

Stabilizing mood swings

A number of drug treatments are available that can help in stabilizing mood swings.

Lithium carbonate: this is an older mood stabilizing drug that is still widely used. It can have unpleasant side effects and regular blood tests are important as high levels of lithium in the blood can be dangerous

Anticonvulsant drugs (eg valproate, carbamazepine): Some anticonvulsant drugs also help to stabilise mood swings. They are sometimes used where the condition does not respond to treatment with lithium.

Sometimes anticonvulsant drugs may be combined with lithium to make them more effective.

Learning to recognize triggers

Over time it is possible to find out the kind of things that can trigger a manic or a depressive episode. Often the trigger may be stress, overworking or tiredness.

Although it is not possible to remove all stress from your life, you can take steps to keep it to a minimum. This might mean taking time for relaxation, taking regular gentle exercise, making sure you don’t work long hours too often and that you take regular holidays from work.

For your general well-being it is good to have a realistic balance between your life and work, to take regular exercise and eat a healthy balanced diet.

Learning to recognize signs of an approaching episode

If you have bipolar disorder, it is possible to learn to recognize the warning signs of a manic or a depressive episode. This will not stop the episode, but it will mean that you can get help in time and reduce the severity of the episode. This might mean you can get help and treatment early so that the episode is less severe.

In practice this might involve making some changes to your treatment, perhaps adding an antidepressant or an anti-psychotic drug to the mood stabilizing drugs you are already taking.

Although it can be difficult to learn to recognize these warning signs, it can help you to manage the condition more effectively in the long-term.

Treatment for depression episodes

The depression episodes of bipolar disorder may be treated in a similar way to clinical depression. This includes the use of antidepressant drugs (see article on depression).

Common antidepressants include:

  • Selective Serotonin / Noradrenaline Reuptake Inhibitors (SSRIs / SNRIs). Eg fluoxetine, venlafaxine, reboxetine. These are newer drugs and have fewer side effects. However, SSRIs should not be prescribed to children and adolescents under the age of 18, with the exception of fluoxetine which can be prescribed if specialist advice is obtained.
  • Tricyclic drugs. Eg dothiepin, imipramine, amitryptyline. These are older drugs that may have unpleasant side effects
  • Monoamine Oxidase Inhibitors (MAOIs). Eg phenelzene, isocarboxazid. These are older drugs that can only be used with care
  • Sometimes non-drug treatments such as cognitive behaviour therapy (CBT) may also be used. CBT involves discussing your condition in detail with a trained therapist and it can help to find ways of coping with and managing your condition.

Treatment for manic episodes

The manic episodes of bipolar disorder are often treated using antipsychotic drugs (sometimes called neuroleptics). These drugs have a calming and soothing effect, but may have unpleasant side effects. Examples include risperidone, fluphenazine, sulpiride.

Making treatment decisions

You should be able to talk over your options for treatment with your GP and any specialist that you are referred to.

If you are taking any drugs or medicines, you should continue with the full course of treatment unless you agree with your doctor to make changes to the drug or dosage. If you have any unpleasant side effects or are worried about your treatment, you should discus this with your doctor.

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