Bipolar disorder, symptoms and prevention

This leaflet is for anyone who wants to know more about bipolar disorder sometimes called bipolar affective disorder or manic depression. It is especially helpful for anyone who has bipolar disorder, their friends and relatives. Many patients prefer the term ‘bipolar’ rather than ‘bipolar disorder’ as they have an illness, not a disorder.

What is bipolar disorder?

Bipolar disorder used to be called ‘manic depression’. As the older name suggests, someone with bipolar disorder will have severe mood swings. These usually last several weeks or months and are far beyond what most of us experience. They are:

feeling of extreme happiness and elationexample depressed mood with the restlessness and overactivity of a manic episode

example depressed mood with the restlessness and overactivity of a manic episode

How common is bipolar disorder?

About 1 in every 100 adults has bipolar disorder at some point in their life. It usually starts between the ages of 15 to 19 – and it rarely starts after the age of 40. Men and women are affected equally.

What types are there?

Bipolar I

• If you have had at least one high or manic episode, which has lasted for longer than one week.
• You may only have manic episodes, although most people with Bipolar I also have periods of depression.
• Untreated, a manic episode will generally last 3 to 6 months.
• Depressive episodes last rather longer – 6 to 12 months without treatment.

Bipolar II

• If you have had more than one episode of severe depression, but only mild manic episodes – these are called ‘hypomania’.

Rapid cycling

• If you have more than four mood swings in a 12 month period. This affects around 1 in 10 people with bipolar disorder and can happen with both types I and II.

Cyclothymia

• The mood swings are not as severe as those in full bipolar disorder but can be longer. This can develop into full bipolar disorder.

What causes bipolar disorder?

We don’t understand this well, but research suggests that:

• Bipolar disorder runs in families – it seems to have more to do with genes than with upbringing.
• There may be a physical problem with the brain systems which control our moods – this is why bipolar disorder can often be controlled with medication.
• But – mood swings can be brought on by stressful experiences or physical illness.

What does it feel like?

This depends on which way your mood has swung.

Depression

The feeling of depression is something we all experience from time to time. It can even help us to recognize and deal with problems in our lives. In the clinical depression or bipolar disorder, the feeling of depression is much worse. It goes on for longer and makes it difficult or impossible to deal with the normal things of life. If you become depressed, you will notice some of these changes:

Emotional

• feelings of unhappiness that don’t go away
• feeling that you want to burst into tears for no reason
• losing interest in things
• being unable to enjoy things
• feeling restless and agitated
• losing self-confidence
• feeling useless, inadequate and hopeless
• feeling more irritable than usual
• Thinking of suicide.

Thinking

• can’t think positively or hopefully
• finding it hard to make even simple decisions
• Difficulty in concentrating.

Physical

• losing appetite and weight
• difficulty in getting to sleep
• waking earlier than usual
• feeling utterly tired
• constipation
• Going off sex.

Behaviour

• difficulty in starting or completing things – even everyday chores
• crying a lot – or feeling like you want to cry, but not being able to
• Avoiding contact with other people.

Treatments

There are some things you can try to control mood swings so that they stop short of becoming full-blown episodes of mania or depression. These are mentioned below, but medication is still often needed to:

• keep your mood stable (prophylaxis)
• Treat a manic or depressive episode.

Medications to stabilize mood

There are several mood stabilizers, some of which are also used to treat epilepsy or schizophrenia. Your psychiatrist may need to use more than one medication to control mood swings effectively.

Taking care of yourself

• Eat a well-balanced diet.
• Drink unsweetened fluids regularly. This helps to keep your body salts and fluids in balance.
• Eat regularly – this will also help to maintain your fluid balance.
• Watch out for caffeine – in tea, coffee or cola. This makes you urinate more, and so can upset your Lithium level.

Psychological treatments

In between episodes of mania or depression, psychological treatments can be helpful. Treatment usually involves around 16 one-hour sessions over a period of 6 to 9 months.

Psychological treatment should include:

• psycho-education – finding out more about bipolar disorder
• mood monitoring – helps you to pick up when your mood is swinging
• help to develop general coping skills
• Cognitive behavioral therapy (CBT) to prevent a full-blown or depressive episode.

Looking after children

If you become manic or depressed, you may temporarily not be able to look after your children properly. Your partner, or another family member, will need to organize the children’s care while you are unwell. It can be helpful to make plans for this in advance when you are well.

You may find that your child may feel anxious and confused when you are not well. If they cannot express their distress in words, toddlers can become difficult or clingy, and older children will show it in other ways.

Children will find it helpful if the adults around them are sensitive, understanding, and can respond to their difficulties in a calm, consistent and supportive way. Adults can help them to understand why their parent is behaving differently. Questions will need to be answered calmly, factually and in language, they can understand. They will feel better if they can keep to their usual daily routine.

Explaining bipolar disorder to children

Older children may worry that they have caused the illness – that it is their fault. They need to be reassured that they are not to blame, but also to be shown what they can do to help. When an older child takes responsibility for caring for a sick parent, they will need particular understanding and practical support.

Stopping the mood swings – helping yourself

Self-monitoring

Learn how to recognize the signs that your mood is swinging out of control so you can get help early. You may be able to avoid both full-blown episodes and hospital admissions. Keeping a mood diary can help to identify the things in your life that help you – and those that don’t.

Knowledge

Find out as much as you can about your illness – and what help there is.

Stress

Try to avoid particularly stressful situations – these can trigger off a manic or depressive episode. It’s impossible to avoid all stress, so it may be helpful to learn ways of handling it better. You can do relaxation training with CDs or DVDs, join a relaxation group, or seek advice from a clinical psychologist.

Relationships

• Depression or mania can cause great strain on friends and family – you may have to rebuild some relationships after an episode.
• It’s helpful if you have at least one person that you can rely on and confide in. When you are well, try explaining the illness to people who are important to you. They need to understand what happens to you – and what they can do for you.

Activities

Try to balance your life and work, leisure, and relationships with your family and friends. If you get too busy you may bring on a manic episode.Make sure that you have enough time to relax and unwind. If you are unemployed, think about taking a course, or doing some volunteer work that has nothing to do with mental illness.

Exercise

Reasonably intense exercise for 20 minutes or so, three times a week, seems to improve mood.

Fun

Make sure you regularly do things that you enjoy and that give your life meaning.

Continue with medication

You may want to stop your medication before your doctor thinks it is safe – unfortunately, this often leads to another mood swing. Talk it over with your doctor and your family when you are well.