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Bipolar Affective Disorder


Mental Illness - Bipolar Affective Disorder


Bipolar disorder formerly known as manic-depression is a condition that affects your moods, which can swing from one extreme to another.

People with bipolar disorder have periods or episodes of -

  • depression – feeling very low and lethargic
  • mania – feeling very high and overactive (less severe mania is known as hypomania)


Psychiatric Hospital in Mumbai

Bipolar disorder is characterized by extreme mood swings. These can range from extreme highs (mania) to extreme lows (depression).

Depression

During a period of depression, your symptoms may include:

  • feeling sad, hopeless or irritable most of the time
  • lacking energy
  • difficulty concentrating and remembering things
  • loss of interest in everyday activities
  • feelings of emptiness or worthlessness
  • feelings of guilt and despair
  • feeling pessimistic about everything
  • lack of appetite, difficulty sleeping, early morning awakening
  • suicidal thoughts

Mania

The manic phase of bipolar disorder may include -

  • feeling very happy, elated or overjoyed
  • talking very quickly
  • feeling full of energy, need for sleep reduced
  • feeling full of great new ideas and having important plans
  • being easily distracted
  • being easily irritated or agitated
  • doing things that often have disastrous consequences – such as spending large sums of money on expensive and sometimes unaffordable items
  • making decisions or saying things that are out of character and that others see as being risky or harmful

Bipolar I - If you have bipolar I disorder, you may have episodes of depression more regularly than episodes of mania, or vice versa. Between episodes of depression and mania, you may have periods of a "normal" mood.

Bipolar II - There are episodes of depression & hypo mania, or vice versa.

Rapid cycling - where a person with bipolar disorder repeatedly swings from a high to low phase quickly without having a "normal" period in between

Mixed state - where a person with bipolar disorder experiences symptoms of depression and mania together; for example, overactivity with a depressed mood

Cyclothymia - If your mood swings last a long time but aren't severe enough to be classed as bipolar disorder, you may be diagnosed with (a mild form of bipolar disorder).

The exact cause of bipolar disorder is unknown.

These are thought to be a complex mix of physical, environmental and social factors.

Chemical imbalance in the brain

Bipolar disorder is widely believed to be the result of chemical imbalances in the brain, called neurotransmitters which include noradrenaline, serotonin and dopamine.

For example, there's evidence that episodes of mania may occur when levels of noradrenaline are too high, and episodes of depression may be the result of noradrenaline levels becoming too low.

Genetics

It's also thought bipolar disorder is linked to genetics, as the condition seems to run in families. The family members of a person with the condition have an increased risk of developing it themselves.
However, no single gene is responsible for bipolar disorder. Instead, a number of genetic and environmental factors are thought to act as triggers.

Triggers

A stressful circumstance or situation often triggers the symptoms of bipolar disorder. Examples of stressful triggers include -

  • the breakdown of a relationship
  • physical, sexual or emotional abuse
  • the death of a close family member or loved one
  • physical illness
  • sleep disturbances
  • overwhelming problems in everyday life –;such as problems with money, work or relationships
You need to consult a psychiatrist for diagnosis of bipolar disorder.

You'll be assessed by the psychiatrist at your appointment. They'll ask you a few questions to determine if you have bipolar disorder. If you do, they'll decide what treatments are most suitable.
During the assessment, you'll be asked about your symptoms and when you first experienced them. The psychiatrist will also ask about how you feel leading up to and during an episode of mania or depression, and if you have thoughts about harming yourself.
The psychiatrist will also want to know about your medical background and family history, especially whether any of your relatives have had bipolar disorder.

Other tests

Blood tests like TFT (Thyroid Function Tests) to rule out underactive thyroid or an overactive thyroid. Or other blood test to rule out any physical problem before starting of treatment.

Treatment for bipolar disorder aims to reduce the severity and number of episodes of depression and mania to allow as normal a life as possible.

Treatment options for bipolar disorder

If a person isn't treated, episodes of bipolar-related mania can last for between three to six months. Episodes of depression tend to last longer, for between six to 12 months.

However, with effective treatment, episodes usually improve within about three months.

Most people with bipolar disorder can be treated using a combination of different treatments. These can include one or more of the following:

  • medication to prevent episodes of mania, hypomania (less severe mania) and depression – these are known as mood stabilizers and are taken every day on a long-term basis
  • medication to treat the main symptoms of depression and mania when they occur
  • learning to recognize the triggers and signs of an episode of depression or mania
  • psychological treatment – such as talking therapies, which help you deal with depression and provide advice on how to improve relationships
  • lifestyle advice – such as doing regular exercise, planning activities you enjoy that give you a sense of achievement, and advice on improving your diet and getting more sleep

However, hospital treatment may be needed if your symptoms are severe, or if there's a danger you may self-harm or hurt others.

Medication

Several medications are available to help stabilize mood swings. These are commonly referred to as mood stabilizers and include -

  • lithium carbonate
  • anticonvulsant medicines
  • antipsychotic medicines

Episodes of depression are treated slightly differently in bipolar disorder, as the use of antidepressants alone may lead to a hypo manic relapse.

Most guidelines suggest depression in bipolar disorder can be treated with just a mood stabilizer. However, antidepressants are commonly used alongside a mood stabilizer or antipsychotic.

Lithium carbonate

Lithium carbonate (often referred to as just lithium) is the medication most commonly used to treat bipolar disorder.
Lithium is a long-term method of treatment for episodes of mania, hypomania and depression.
If you're prescribed lithium, stick to the prescribed dose and don't stop taking it. You'll need regular blood tests at least every three months while taking lithium. This is to make sure your lithium levels aren't too high or too low. Your kidney and thyroid function will also need to be checked every two to three months if the dose of lithium is being adjusted, and every 12 months in all other cases.
While you're taking lithium, avoid using non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen

Anticonvulsant medicines

Anticonvulsant medicines include -

  • valproate
  • carbamazepine
  • lamotrigine

These medicines are sometimes used to treat episodes of mania. They're also long-term mood stabilisers.
Anticonvulsant medicines are often used to treat epilepsy, but they're also effective in treating bipolar disorder. A single anticonvulsant medicine may be used, or they may be used in combination with lithium when the condition doesn't respond to lithium on its own.

Valproate

Valproate isn't usually prescribed for women of childbearing age because there's a risk of physical defects to babies such as spina bifida, heart abnormalities and cleft lip. There may also be an increased risk of developmental problems such as lower intellectual abilities, poor speaking and understanding, memory problems, autistic spectrum disorders and delayed walking and talking.
If you're prescribed valproate, you'll need to visit your GP to have a blood count when you begin the medication, and then again six months later.

Carbamazepine

Carbamazepine is usually only prescribed on the advice of an expert in bipolar disorder. To begin with, the dose will be low and then gradually increased. Your progress will be carefully monitored if you're taking other medication, including the contraceptive pill. Blood tests to check your liver and kidney function will be carried out when you start taking carbamazepine, and again after six months.

Lamotrigine

If you're prescribed Lamotrigine, you'll usually be started on a low dose, which will be increased gradually. See your Psychiatrist immediately if you're taking lamotrigine and develop a rash.

Antipsychotic medicines

Antipsychotic medicines are sometimes prescribed to treat episodes of mania or hypomania. Antipsychotic medicines include -

  • aripiprazole
  • olanzapine
  • quetiapine
  • risperidone

They may also be used as a long-term mood stabiliser. Quetiapine may also be used for long-term bipolar depression.
Antipsychotic medicines can be particularly useful if symptoms are severe or behaviour is disturbed. If you're prescribed an antipsychotic medicine, you'll need to have regular health checks. If your symptoms don't improve, you may be offered lithium and valproate as well. Aripiprazole is also recommended by the National Institute for Health and Care Excellence (NICE) as an option for treating moderate to severe manic episodes in adolescents with bipolar disorder.

Rapid cycling

You may be prescribed a combination of lithium and valproate if you experience rapid cycling (where you quickly change from highs to lows without a "normal" period in between).
If this doesn't help, you may be offered lithium on its own or a combination of lithium, valproate and lamotrigine.

If you have bipolar disorder, you can learn to recognize the warning signs of an approaching episode of mania or depression.

This won't prevent the episode occurring, but it will allow you to get help in time.

This may mean making some changes to your treatment, perhaps by adding an antidepressant or antipsychotic medicine to the mood-stabilizing medication you're already taking.

Some symptoms -

  • Loss of sleep
  • Increased irritability
  • Racing Thoughts
  • Increased energy
  • Suspiciousness
  • Depressed thoughts etc.

Psychological treatment

Some people find psychological treatment helpful when used alongside medication in between episodes of mania or depression. This may include -

  • Psychoeducation - to find out more about ;bipolar disorder
  • cognitive behavioural therapy (CBT) – this is most useful when treating depression
  • family therapy – a type of psychotherapy that focuses on family relationships (such as marriage) and encourages everyone within the family or relationship to work together to improve mental health

Living with bipolar disorder

The high and low phases of bipolar disorder are often so extreme that they interfere with everyday life.
However, there are several options for treating bipolar disorder that can make a difference. They aim to control the effects of an episode and help someone with bipolar disorder live life as normally as possible.
The following treatment options are available -

  • Medication to prevent episodes of mania, hypomania (less severe mania) and depression – these are known as mood stabilisers and are taken every day on a long-term basis
  • Medication to treat the main symptoms of depression and mania when they occur
  • Learning to recognise the triggers and signs of an episode of depression or mania
  • Psychological treatment – such as talking therapy, which can help you deal with depression, and provides advice about how to improve your relationships
  • Lifestyle advice – such as doing regular exercise, planning activities you enjoy that give you a sense of achievement, as well as advice on improving your diet and getting more sleep

It's thought using a combination of different treatment methods is the best way to control bipolar disorder.

Jagruti self help group for Bipolar Disorder - This includes self-help and self-management advice, and learning to deal with the practical aspects of a long-term condition.