Bipolar Disorder

What is bipolar disorder?

Bipolar Disorder is a group of brain disorders that can cause extreme fluctuation in a person’s mood, energy and ability to function. A person with bipolar disorder may experience periods of great excitement, overactivity, delusions and euphoria, often referred to as mania or hypomanic episodes. Or they may experience periods of extreme sadness and hopelessness, often referred to as depressive episodes with potentially some psychotic symptoms during these episodes.

There are 3 types of bipolar disorder:

• Bipolar I: Usually consists of severe hypomanic symptoms and sometimes depressive episodes which may or may not be accompanied by psychotic episodes. Sometimes the manic episodes are so severe that an individual requires immediate hospital care. A person may get a diagnosis of bipolar I, if they have experienced at least one episode of mania that has lasted longer than a week.

• Bipolar II: Consists of depressive and manic episodes which alternate and are less severe than those found in Bipolar 1, and do not inhibit functions. A person may get a diagnosis of Bipolar II if they have experienced at least one episode of severe depression and symptoms of hypomania.

• Cyclothymia: Consists of brief episodes of hypomania and depression. A person may get a diagnosis of Cyclothymia disorder if they have experienced both hypomanic and depressive states over the course of 2 years or more, or if their symptoms aren’t severe enough to meet the criteria for a diagnosis of Bipolar I or Bipolar II.

What are the signs and symptoms?

Experiencing Mania, Hypomanic episodes, or Depressive episodes for long periods of time are signs of bipolar disorder. Here are examples of what it is like experiencing these episodes:

Experiencing Manic or Hypomanic episodes:

Mania is the elevated, expansive, or irritable mood that lasts for at least one week and perhaps is present nearly every day. Signs of Mania could include:

• Inflated self-esteem or grandiosity.
• Decreased need for sleep.
• Increased talkativeness.
• Racing thoughts.
• Distracted easily.
• Increased goal-directed activity or psychomotor agitation.
• Engaging in activities that hold potential for painful consequences, e.g. unrestrained buying sprees.

Experiencing depressive episodes:

A depressive state is a sense of feeling extreme sadness and hopelessness. They may perhaps lose interest or pleasure in life and experience at least 5 of these symptoms in 2 weeks:

• Depressed mood most of the day, nearly every day.
• Loss of interest or pleasure in all or almost all activities.
• Significant weight change due to a decrease or increase in appetite.
• Engaging in purposeless movements, such as pacing the room.
• Fatigue or loss of energy.
• Feelings of worthlessness or guilt.
• Diminished ability to think or concentrate, or indecisiveness.
• Recurrent thoughts of death or recurrent suicidal ideation without a specific plan or a suicide attempt.

What are the causes of bipolar disorder?

Like many psychiatric conditions, bipolar disorder is caused by a range of interacting genetic and environmental factors.  The genetic risk factors can predispose them to develop the disorder if combined with adverse environmental factors such as childhood trauma or stressful life events.

These could include:

Genetic inheritance

There is strong evidence to suggest that if a person experiences symptoms related to bipolar disorder, it is more likely that another family member will experience bipolar moods and symptoms, too.  Researchers have shown that genes that affect calcium signalling are altered in the brain, which in turn will affect the function of neurotransmitters.  However, no single gene is thought to cause the disorder.

Childhood trauma:

Emotional distress as a child can increase the chance of developing bipolar disorder. This can include:

• Sexual or physical abuse.
• Neglect.
• Traumatic events.
• Losing someone very close to them e.g. a parent or carer.

Stressful life events:

Overwhelming stressful events can increase the risk of developing bipolar disorder. Events such as bereavement or living problems such as money worries or homelessness

What are the common treatments for bipolar disorder?

Treatment is best guided by a medical doctor who specialises in diagnosing and treating mental health conditions. Bipolar Disorder is a lifelong condition and therefore treatment is directed at managing symptoms. These are some of the treatments they may receive:

Medications

Finding the right medication or medications may likely be trial and error. It may require patience but a person’s GP or psychiatrist will be there to guide them. These are examples of medications used for bipolar disorder:

Mood Stabilizers

These medications help control manic or hypomanic episodes. Lithium is the main medicine used in the UK. Regular blood tests are required while taking Lithium. Other examples of mood stabilizers are valproate, carbamazepine and lamotrigine.

Antipsychotics

This type of medication is only used if symptoms of mania persist in spite of treatment using other medications. Examples of antipsychotics are olanzapine, risperidone, quetiapine, aripiprazole, ziprasidone, lurasidone.

Antidepressants

This medication can be used to help manage depression, although in some individuals, mania may be triggered, so careful consideration of drug therapy is necessary.

Anti-anxiety medications

Medications such as benzodiazepines may help with anxiety and improve sleep but are generally used short-term.

Psychotherapy

Psychotherapy is a vital part of bipolar disorder treatment. Examples include:

CBT - Cognitive Behavioural Therapy

The focus is identifying unhealthy, negative beliefs and behaviours and replacing them with healthy positive ones. CBT can help identify what triggers bipolar episodes and can help people learn effective strategies to manage stress and to cope with upsetting situations. Digital technologies (Apps) are increasingly being used to track mood.

Psychoeducation

Learning about bipolar disorder can help a person and their loved ones understand the condition. Knowing what is going on can help them get the best support, identify issues, and make a plan to deal with an episode.

Family-focused therapy

Family support and communication can help a person stick with their treatment plan and help them and their loved ones recognize and manage warning signs of mood swings.

What help and resources are available for people who need support or further advice?

GP or Psychiatrist

The most important help out there is to talk to a doctor or mental health professional as this is the first step in identifying Bipolar Disorder. During this process, people may have a physical evaluation to rule out any other conditions which might be causing their symptoms. If no other illness is present, doctors conduct a comprehensive mental health evaluation.

For more advice:

• Mind (See here)
• Bipolar UK (See here)

Support Groups:

It is important to know you are not alone. Having a support group sharing helpful ideas may help. Here are some of the support groups that people may consider:

• Carers UK (See here)
• Rethink (See here)
• Samaritans (See here)
• SANE (See here)

Apps

Daylio

To help keep track of a person’s mood and monitor their fluctuations – this helps determine whether events or situations in their life are causing their mood swings or if they appear without cause.

Self-Management UK

They run courses for mild-to-moderate mental health conditions if they feel distressed and uncertain about bipolar disorder. This helps them take an active part in their recovery, so they are not controlled by their illness.

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