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 -
During a period of depression, your symptoms may include:
The manic phase of bipolar disorder may include -
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.
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.
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.
A stressful circumstance or situation often triggers the symptoms of bipolar disorder. Examples of stressful triggers include -
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.
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.
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:
However, hospital treatment may be needed if your symptoms are severe, or if there's a danger you may self-harm or hurt others.
Several medications are available to help stabilize mood swings. These are commonly referred to as mood stabilizers and include -
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 (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 include -
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 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 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.
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 are sometimes prescribed to treat episodes of mania or hypomania. Antipsychotic medicines include -
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.
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 -
Some people find psychological treatment helpful when used alongside medication in between episodes of mania or depression. This may include -
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 -
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.