Bipolar Disorder


Bipolar disorder is a serious, chronic (long-term) condition where you have periods of depression (lows) and periods of mania or hypomania (highs). Treatment with mood stabiliser medicines such as lithium, anticonvulsants or antipsychotic medicines aims to keep your mood within normal limits.

What is bipolar disorder?

Bipolar disorder is sometimes called manic depression In this condition you have periods where your mood is in one extreme or another.

One extreme is called depression, where you feel low and have other symptoms.

The other extreme is called mania (or hypomania if symptoms are less severe), where you feel high or elated along with other symptoms.

It is usually for several weeks at a time or longer. Bipolar disorder is very different from the mood swings that moody people have which last a few minutes or hours.
You can have any number of episodes of highs and lows throughout your life. In between episodes of highs or lows there may be gaps of weeks, months or years when your mood is normal. However, some people swing from highs to lows quite quickly without a period of normal mood in between. people with bipolar disorder can have periods where they have mixed symptoms where they quickly alternate between depressive symptoms and manic symptoms (usually within a few hours). This is known as a mixed bipolar episode.

Who gets bipolar disorder?

About 1 in 100 people develop this condition. It can occur at any age but most commonly first develops between the ages of 17 and 29. It occurs in the same number of men as women. The rapid cycling form of the condition occurs in about 1 in 6 cases. mania occur in only a small number of people who develop depression. It is much more common to just have depression without episodes of mania.

What causes bipolar disorder?

The exact cause is not known. However, your genetic make-up seems to play a part, as your chance of developing this condition is higher than average if other members of your family are affected. Stressful situations may trigger an episode of mania or depression in people prone to this condition. It is thought that an imbalance of some chemicals in the brain may also be present in people with bipolar disorder.

What are the symptoms of mania?

Mania causes an abnormally high or irritable mood which lasts at least one week - but usually lasts much longer than this.

  • Grand ideas about yourself and your own self-importance.
  • Increased energy. You also tend to move quickly and need less sleep than usual.
  • Be more talkative than usual. You tend to talk quickly.
  • Flight of ideas. This means that you tend to change quickly from one idea to another. You may feel as if your thoughts are racing.
  • Easily distracted. Your attention is easily drawn to unimportant or irrelevant things.
  • Full of new ideas and plans. Often the plans are grandiose and unrealistic.
  • Irritation or agitation, aggression towards people.
  • Be less inhibited about your sexual behaviour.
  • Make rash decisions, often on the spur of the moment. These can be about jobs, relationships, money, health, etc and are often disastrous.
  • Take part in risky exciting adventures.
  • Drink a lot of alcohol, or take illegal drugs.
  • Severe mania may also cause psychotic symptoms where you lose touch with reality. For example, you may hear voices which are not real (hallucinations), or have false beliefs (delusions). These tend to be delusions of importance (such as believing that you are a famous celebrity).
  • Usually, you do not realise that you have a problem when you are high. But, as the the illness develops, to others your behaviour can be bizarre. Family and friends tend to be the ones who realise that there is a problem. But, if someone tries to point out that you are behaving oddly, you tend to become irritated as you can feel really good.
  • If mania is not treated, the bizarre and uninhibited behaviour may cause great damage to your relationships, job, career and finances.

What are the symptoms of depression?

With true depression, you have low mood and other symptoms each day for at least two weeks. Symptoms also become severe enough to interfere with day-to-day functions. The following is a list of common symptoms of depression.

  • Low mood for most of the day, nearly every day.
  • Loss of enjoyment and interest in life, even for activities that you normally enjoy.
  • Abnormal sadness, often with weepiness.
  • Feeling guilty, worthless, or useless.
  • Poor motivation. Even simple tasks seem difficult.
  • Poor concentration. It may be difficult to read, work, etc.
  • Difficulty in getting off to sleep, or waking early and unable to get back to sleep.
  • Sleeping too much sometimes occurs.
  • Lacking in energy, always feeling tired.
  • Difficulty with affection, low or absent sexual desire.
  • Poor appetite and weight loss. Sometimes the reverse happens with comfort eating and weight gain.
  • Being irritable, agitated, or restless.
  • Symptoms often seem worse first thing each day.
  • Physical symptoms such as headaches, palpitations, chest pains and aches and pains.
  • Recurrent thoughts of death. Some people get suicidal ideas too.

How is bipolar disorder diagnosed?

As discussed above, if you have symptoms of mania, often you do not realise that there is anything wrong. It is often your friends or family who are the ones that can see that you are not your usual and may encourage you to see your doctor who can usually diagnose an episode of mania from your typical symptoms and the way that you are behaving.

If you go to see your doctor because you have an episode of depression, it can be more difficult to diagnose bipolar disorder. Bipolar disorder is commonly under diagnosed in people who see a doctor because of depression. This is because depression is common and you may not recognize that in the past you may have had some of the symptoms of mania

Your Doctor may ask you to complete a simple mood questionnaire to look for possible bipolar disorder.. Your doctor may also ask if there is a history in your family of bipolar disorder as this can make it more likely for you.

What is the usual pattern and outcome of bipolar disorder?

Bipolar affective disorder is a lifelong condition.

Without treatment

  • The average length for an episode of mania is four months. But for some people it can last much longer.
  • Some people's mood recovers completely between episodes of mania or depression. In others, their mood does not completely recover.The average length for an episode of depression is six months but, again, it can be longer.You cannot predict how often episodes of mania and depression will occur.
  • After recovering from aepisode, a further episode of mania or depression occurs within one year in about half of cases.
  • The average number of episodes in a lifetime is ten.
  • Some people have more frequent and severe episodes than others. Because of the nature of the condition, your chance of holding down a job is less than average. Relationships can be strained. Also, you have an increased risk of suicide if depression becomes severe and an increased risk of death from risky adventures during mania. The outlook is worse if you take drugs or drink a lot of alcohol.

With treatment

The course, pattern and outlook of the condition can be improved. However, there is no cure. Treatment means that episodes of mania or depression are shorter and/or may be prevented.

What is the treatment for bipolar disorder?

Medicines that aim to prevent episodes of mania and depression.. You take these every day, long-term. Not needed in everyone. They may be considered, for example, if you have had two episodes of mania, or if you have had suicidal thoughts, or if bipolar disorder is severely affecting your life. You will usually continue treatment for at least two years, and often longer.

Treating episodes of mania, hypomania and depression when they occur.


Lithium is the most commonly used medicine for bipolar disorder. Lithium often works well but does not work for everyone. It tends to prevent episodes of mania better than episodes of depression. One problem with lithium is that the dose for an individual has to be just right. Too low a dose has little effect. Too high a dose, and side-effects can be a problem. So, if you take lithium, you need to have blood tests from time to time .

Anticonvulsant medicines

Sodium valproate, carbamazepine and lamotrigine are used to treat episodes of mania.Sometimes one of these medicines is used alone. Some people take an anticonvulsant in addition to lithium.

Antipsychotic medicines

One of these may be used to treat an episode of mania. Another name for these is major tranquillisers. They include olanzapine, quetiapine and risperidone - Some are more sedating than others. Once these medicines is started, the symptoms of mania often settle within a week or so.

Treating episodes of depression

The treatment of depression in people with bipolar affective disorder is similar to that for people who develop depression without episodes of mania. Antidepressant medicines are commonly prescribed. Antidepressants work well to relieve symptoms for about 7 out of 10 people.It takes 2-4 weeks before their effect builds up fully. A normal course of antidepressants is for six months or more after the symptoms of depression have eased. If you stop them too soon the depression may quickly return.

Lithium may also be used to treat depression as well as being a long-term mood stabiliser. A combination of lithium and an antidepressant may be used to treat an episode of depression.

Regular exercise may also help to ease symptoms of depression.

Compulsory treatment

When you have an episode of mania, usually you do not realise that you are ill. It is sometimes necessary to give treatment against your will if you have symptoms which are putting you, or other people, at risk of harm. A short admission to hospital is sometimes needed.

Other treatments and new developments

Electroconvulsive therapy (ECT) in which a mild electrical current is passed through the brain, is recommended for severe bipolar disorder which does not respond to treatment with medicines.

Self-help for bipolar disorder

  • Try to avoid stressful situations which may trigger an episode of mania or depression.
  • Change in lifestyle may be appropriate for some people
  • Try to establish a daily routine, and schedule daily activities so that you have things to occupy your time. Make sure that you are eating regularly and healthily and getting plenty of sleep.
  • Try to do some regular relaxing Try not to drink much alcohol or take any street drugs. These may trigger an episode of mania.
  • If you are prescribed a medicine, take it regularly.
  • Consider being quite open to family and friends about your condition. If they understand the condition, they may be able to tell if you are becoming ill, even if you do not realise it yourself - particularly, if you are developing an episode of mania. Rather than thinking of you as bizarre they may think of you as ill and may encourage you to get help.
  • Consider joining a self-help or patient group. They are a great source of advice, information, support and help.
  • If you are the main or only carer of children (for example, if you are a single parent), it is important that someone else who knows you well should be aware that you may become ill quite quickly and not be able to care for your children properly.

Pregnancy and bipolar disorder

If you are planning to become pregnant, or if you have an unplanned pregnancy, you should contact your doctor or specialist mental health team as soon as possible. You may need a change to your medication. This is because there may be a risk to the development of your unborn baby with some of the medicines used to treat bipolar disorder. However, do not stop any medication abruptly without first speaking to a doctor.

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