What is bipolar disorder? Everything you need to know

Photo credit: Marjan_Apostolovic - Getty Images
Photo credit: Marjan_Apostolovic - Getty Images

From Netdoctor

Bipolar disorder is a mental health condition characterised by extreme mood swings. Symptoms may include episodes of mania, where you feel overactive or elevated, and episodes of depression, where you feel low and lethargic.

It is thought that somewhere between one and two per cent of the UK population have bipolar disorder, but often it may go undiagnosed. Most new cases are diagnosed between aged 20 and 30.

Dr Louise Wiseman looks at what bipolar is, the symptoms of bipolar and treatment options available.

What is bipolar disorder?

Bipolar affective disorder is a mood disorder, which is also sometimes called ‘manic depression’. Unlike the diagnosis of depression, bipolar disorder also includes a history of what we call a ‘manic’ or ‘hypomanic’ episode or episodes on a background of depression.

Bipolar disorder is characterised by extreme mood swings from extreme highs (mania) to extreme lows (depression) and the episodes can last from weeks to months.

Most people have ups and downs in their life, depending on what is going on and their general health but this is more serious and affects behaviour and thoughts significantly.

Bipolar disorder symptoms

People with bipolar disorder may experience three main symptoms:

• Mania

• Hypomania

• Depression.

Most people with bipolar disorder have more depressive episodes than manic. There might be periods of normal mood in between or some people repeatedly swing between low and high phases. Some people veer between the two states and have very ‘rapid cycling’ between them, experiencing four or more episodes in a year. Sometimes it is a ‘mixed state’ with symptoms of both states – such as feeling down but very overactive.

Sometimes after a severe episode a patient may be shocked by what happened during the manic episode. Insight varies over time and people seem to have less insight in pure mania episodes, often being more aware of the illness in depressed phases.

If undiagnosed and untreated, every facet of life can understandably be affected by bipolar disorder: home, work, relationships, finances and so on. The danger of a high manic state is that you may not realise you are unwell until the symptoms are very severe and could put yourself and others in danger.



What is a manic episode?

A manic episode is an abnormally elevated or irritable mood and the patient can show some or all of the following types of symptoms:

• Feeling very happy or overjoyed

• Easily distractible and acting on impulse

• Poor judgement and doing things that may have poor consequences (e.g. excessive spending which one can’t afford, unprotected sex)

• Grandiosity (feeling full of oneself or self-important – full of great ideas and important plans)

• Flight of ideas

• Hyperactivity

• Decreased need for sleep

• Excessive talkativeness

• Delusions (believing things that are irrational which we also call psychosis), hallucinations (seeing, hearing or smelling things that aren’t there) or disturbed thinking (these can also be in a depressed phase).

What is a depressive episode?

Just like depression as part of any clinical diagnosis this can include

• Feeling down, sad, hopeless or irritable

• Low energy or little motivation

• No interest in things that would normally make you happy

• Feeling worthless, low self-esteem

• Change of appetite or weight

• Difficulty concentrating or remembering things

Poor sleep

• Waking up early

• Suicidal thoughts

Photo credit: Sky_melody - Getty Images
Photo credit: Sky_melody - Getty Images

Bipolar disorder symptoms in women vs men

There are genuine differences in terms of how bipolar disorder affects men and women.

Bipolar tends to start later in life in women than men. The initial depressive or manic episode in men may be about five years earlier on average (22 years compared to 26 to 27 years).

Women may also experience late onset bipolar that is associated with the menopause.

Women are more likely to have a seasonal pattern of the mood disturbance. Women have depressive episodes, mixed mania and rapid cycling more than men.

Having other disease states as triggers or to exacerbate bipolar is also more common in women. Things like thyroid disease, migraine, obesity and anxiety can all mean it is more difficult for recover from episodes whereas for men the clinical pattern is often triggered by substance misuse.

There is very careful shared care of women with BPD in pregnancy and lactation as medication can affect the developing baby and sometimes the period just after birth can be a trigger for a relapse so has to be watched carefully.

The gender difference does not however affect how well medication can work to treat symptoms though.

Bipolar disorder in children

Making this diagnosis in children is controversial and symptoms can overlap with other childhood symptoms and disorders.

Moods and behaviours in children by their nature may not fit the strict criteria used in the adult classification of bipolar so this is a complex subject handled delicately by the psychiatry team using their experienced professional judgement.



Bipolar disorder causes

Factors within the body and outside are thought to make bipolar more likely. It is thought that in many cases it is a combination of many of these internal and external factors that combine to trigger bipolar disorder.

Internal factors

• Genetics

We know that genetic factors are involved in many cases and if you have a parent or a sibling with the condition the chance of developing bipolar rises from 1 to 10 per cent. There are possibly susceptible genes that may be faulty in the condition and these could be the target for future treatment.

• Chemical change

Because behaviour, sleep, circadian rhythm, appetite, anger and so on are disrupted in bipolar it stands to reason that the condition could be linked to changes in the chemical transmitters in the brain (noradrenaline, serotonin, dopamine, acetylcholine) that regulate these. These chemicals and their receptors and enzymes associated also provide a target for drug therapies.

• Brain anatomy

Brain structure may affect risk and having abnormalities in structure or function of the brain may be relevant.

External factors

Stress in extreme, e.g. bereavement

• Traumatic experiences

• Physical illness

Photo credit: Getty Images
Photo credit: Getty Images

Types of bipolar disorder

There are three main types of bipolar disorder:

Bipolar I

This is defined by having at least one manic episode that lasted longer than a week and the patient may have hypomanic or major depressive episodes before and after. This is equally common in men and women

Bipolar II

There is one major depressive episode for at least 2 weeks and then at least one hypomanic episode for about four days. This is more common in women.

Cyclothymia

If you have mood swings that cycle between high and low but are not severe enough to have true bipolar as a diagnosis, a diagnosis of something called ‘cyclothymia’ may be made.

The UK charity mind.org.uk has a wealth of information for sufferers and their families and support network to read.



Bipolar disorder diagnosis

A GP will ask you about your symptoms, your family history, how long each period lasts and what impact this has had on your life.

Sometimes it will be helpful to keep a diary of your moods for the next appointment.

The doctor will check for any physical problems e.g. thyroid disease that may be triggering mania symptoms. They will look at alcohol and drug use that may have affected things.

You will probably first chat to your GP about your symptoms. A GP then will refer you to a Psychiatrist as the GP cannot make the formal diagnosis, only a mental health professional.

The Psychiatrist makes a careful assessment of diagnosis following The Diagnostic and Statistical Manual of Mental Disorders (DSM) guidelines.

Because of the delicate way the mind works and how symptoms can overlap between conditions, it may take a little while to get a diagnosis and to exclude other causes like depression, schizophrenia or a personality disorder.

Bipolar disorder treatment

Medicine

Antidepressant medication can be used for the depressive phases.

Antipsychotic medication (e.g. olanzapine, risperidone, haloperidol) or mood stabilisers (e.g. lithium, valproate) used for episodes of mania.

Mood stabilising drugs help to reduce exacerbations long term e.g. lithium which requires regular blood monitoring. Other examples are valproate and olanzapine.

Further medications may be prescribed by the psychiatric team and regular monitoring with blood tests is essential in all cases.

In severe cases ECT may be considered.

Psychotherapy

This can be an important support for many and to help carers of someone affected.

Lifestyle changes

Exercising, improving sleep patterns, nutrition will all help.

Taking care around alcohol use and avoiding drugs is imperative and in this you will be supported by your psychiatric team and your GP.



Key takeaways

You will need to inform the DVLA if you have a diagnosis of bipolar.

Bipolar UK supports those diagnosed and their carers.

Recognising early signs and avoiding triggers that cause relapse can help.

If you are feeling very depressed or concerned you may have a depression or bipolar diagnosis that has not been recognised contact your GP or care-coordinator or mental health crisis team if you are known to them, or call NHS 11 for immediate assessment. The Samaritans provide a confidential listener on 116 123 or via their website.


Last updated: 25-08-2020

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