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What is Bipolar Disorder?

Bipolar disorder is the name used to describe a set of ‘mood swing’ conditions, the most severe form of which used to be called ‘manic depression’.

Bipolar disorder I is the more severe disorder in terms of symptoms- with individuals being more likely to experience mania, have longer ‘highs’, be more likely to have psychotic experiences and be more likely to be hospitalised.

Bipolar disorder II is diagnosed when a person experiences the symptoms of a high but with no psychotic experiences. These hypomanic episodes tending to last a few hours or a few days, but longitudinal studies suggest impairment is often as severe as in bipolar I disorder.

The high moods are called mania or hypomania and the low mood is called depression.

However, it is important to note that everyone has mood swings from time to time. It is only when these moods become extreme and interfere with personal and professional life that bipolar disorder may be present and a psychiatric assessment may be warranted.

Other key points about bipolar disorder

    • Occasionally people can experience a mixture of both highs and lows at the same time, or switch during the day, giving a mixed picture.
    • Some people may only have one episode of mania once a decade, while others may have daily mood swings. For each individual the pattern is quite distinct.
    • People with bipolar disorder can experience normal moods in between their swings but the majority experience some low level symptoms between episodes..
    • Women and men develop bipolar I disorderat equal rates while the rate of bipolar II is somewhat higher in females.
    • Bipolar disorder can commence in childhood, but onset is commoner in the teens or early 20s. Some people develop their first episode in mid-to-late adulthood. Many people can go for years before it is accurately diagnosed or treated (see How to tell if you have bipolar disorder)
    • Women with bipolar disorder have a very high chance of a significant mood disturbance both during pregnancy and in the post-partum period – most commonly in the first four weeks. (Most will have a depressive episode, a significant proportion will have highs, and 10% will have mixed highs and lows.)

  • With the right treatment, the vast majority of people with bipolar disorder are able to live normal and productive lives.
  • Some people with bipolar disorder can become suicidal. It is very important that talk of suicide be taken seriously and for such people to be treated immediately by a mental health professional or other appropriate person. See Getting Help and Emergency Help.

Please note that the information in this section (or anywhere on this site) is not intended as a substitute for professional medical advice, so please see a qualified health provider if you have any health concerns.

What it’s like

Bipolar disorder is an illness that can be distressingly difficult to live with – although with the right treatment, and over time, people can become adept in managing the illness and are able to live full and productive lives.

People with bipolar disorder (especially bipolar II disorder) can describe the highs associated with the illness as enjoyable. Someone experiencing mania would usually be in very high spirits, and feel terrific, enthusiastic, confident and invincible (‘energised’ and ‘wired’). However, others have a different experience and instead become irritable and aggressive. In a state of mania, the mind works much faster than usual, and ideas come rapidly. Individuals tend to talk more, and much faster than is usual for them. Less sleep is required, and it is as if reserves of energy are discovered, so that they may stay up late to do housework or to begin a new project. In a state of mania, the world can seem to be a wonderful place, and no job or task seeming to be too difficult. A person with mania has described the experience as ‘bubbling with plans and enthusiasms’.

However, while people having mania seem to have a very positive outlook on life, their perspectives and beliefs about their own abilities are very unrealistic. Judgement is affected in a manic state, and this can cause serious problems for the individual and/or family members. For instance, people may engage in reckless spending sprees, gambling, or in sexual activity they would not normally engage in, without thinking of the consequences.

Experiencing a ‘high’ has been described as a feeling that your brakes have failed – that you are going too far and too fast.

Once an episode of mania has passed, people can also feel significant embarrassment or shame about what they did or said to others during their period of mania. They may avoid social contact for a time after their mania has subsided. However, whether or not someone remembers what they did or said during an episode of mania will depend upon the degree of their mania, and, upon any medications that are taken.

The lows – or depressive episodes – experienced by people with bipolar disorder can be extremely difficult to cope with and are particularly emotionally painful, reflecting the very biological ‘type’ of depression. We have described elsewhere what it’s like having depression – so you might like to look at this section if you haven’t done so already. Depression can also lead to suicidal thoughts and feelings in some people. In this instance it is very important to get immediate treatment (see Getting Help).

A person who has been depressed may misread the onset of mania as a sign that their depression is lifting, rather than as another part of the illness.

Causes

While we don’t yet know exactly what causes bipolar disorder, we do know that it appears to have primarily biological underpinnings. However, its onset is often linked to a stressful life event.

And while the causes of bipolar disorder are still unknown, there are a number of factors that are believed to play a role, including genetics, brain chemicals, environmental factors and sometimes medical illnesses.

Genetics

Bipolar disorder is frequently inherited, with genetic factors accounting for approximately 80% of the cause of the condition.

If one parent has bipolar disorder, there is a 10 per cent chance that his or her child will develop the illness. If both parents have bipolar disorder the likelihood of their child developing the illness rises to 40 per cent.

However, just because one family member has the illness, it is not necessarily the case that other family members will also develop the illness. Other factors also come into play.

Brain chemicals

A recent theory about the cause of bipolar disorder is that it is related to abnormal serotonin chemistry in the brain. Serotonin is one of the neurotransmitters in the brain, and one that strongly affects a person’s mood. It is thought that abnormal serotonin chemistry causes mood swings because of its feedback effect on other brain chemicals. It is unlikely, however, that serotonin is the only neurotransmitter involved.

Environmental

While the onset of bipolar disorder may be linked to a stressful life event, it is unlikely that stress itself is a cause of bipolar disorder. Notwithstanding this, people who suffer from bipolar disorder often find it beneficial to find ways of managing and reducing stress in their lives (as do people without the disorder!).

Again – while not a cause – seasonal factors appear to play a role in the onset of bipolar disorder, with the chance of onset increasing in spring. The rapid increase in hours of bright sunshine is thought to trigger depression and mania by affecting the pineal gland.

Medical illness

Medical illness is not a cause of bipolar disorder, but in some instances can cause symptoms that could be confused with mania or hypomania. Some medications and certain illicit stimulant drugs can also cause manic and hypomanic symptoms.

Antidepressants can trigger manic or hypomanic episodes in susceptible people it is important to report any unusual symptoms to your prescribing docotr while on these medications.

Pregnancy

For women who are genetically or otherwise biologically predisposed to developing bipolar disorder, the postnatal period can coincide with a first episode of bipolar disorder. Read about treatments for bipolar disorder during pregnancy.

What is the future for someone with bipolar disorder?

Like any other medical condition, such as heart disease or diabetes, bipolar disorder is an illness that requires careful management.

While there is no known cure for bipolar disorder, the good news is that its severity and the frequency of episodes can be reduced or prevented with medication and other supports, such as psychological therapies.

Treatments

Bipolar disorder involves episodes of depression and episodes of mania or hypomania. Therefore its management usually involves two parts:

  • Treating the current episode of mania or depression, and
  • Preventing the long-term recurrence of mania and depression.

In this section we cover the main treatment approaches for bipolar disorder.

Key points about treatments

  • Bipolar disorder is an illness which can require long-term treatment.
  • Everyone is different and therefore the appropriate treatment for a particular individual is a matter for a skilled medical practitioner
  • Physical treatments are necessary for bipolar disorder – psychological approaches by themselves are not sufficient but, alongside drug treatments, serve a valuable complementary role.
  • With the right medical management people with bipolar disorder can achieve stability and live successful and productive lives.
  • While the great majority of people with bipolar disorder will benefit from treatment, it is difficult to know beforehand;
    • which drug regime will be of most benefit to any particular individual, and
    • how long it will take to bring the mood swings under control.
  • Therefore, keeping a Daily Mood Graph can be of fundamental importance to your clinician in assessing the impact of differing treatments on your mood swings over time, and will be of great benefit to you.
  • Having a ‘Wellbeing Plan’ is an important psychological tool for maintaining wellness between highs and lows and for preventing the exacerbation of low level symptoms into full-blown episodes.
  • Recognisingyour ‘Relapse Signature’ can help to recognise signs and symptoms that are indicative of a possible episode of hypomania, mania or depression.