Bipolar disorder: key
factsWhat is
bipolar disorder?
A condition in which you have severe mood
swings. These usually last several weeks or months and can be:
- low mood, intense depression and despair
- high or ‘manic’ feelings of joy, over-activity and loss of
inhibitions
- a 'mixed state' such as a depressed mood with the
restlessness and over-activity of a manic episode.
What causes bipolar disorder?
- It seems to run in families, so genes seem to
be important.
- There may be a physical problem with the brain systems which
control mood - so bipolar disorder can often be controlled with
medication.
- Stress can trigger mood swings.
Types of bipolar disorder
There has been at least one high, or manic
episode, which has lasted for longer than one week. You may have
only manic episodes, although most people will also have periods of
depression.
If you have had more than one episode of
severe depression, but only mild manic episodes (called
‘hypomania’).
You have had more than four mood swings happen
in a 12 month period. This affects around 1 in 10 people with
bipolar disorder.
The mood swings are not as bad, but are often
longer.
How does it feel to have bipolar
disorder?
Depression
- Feelings of unhappiness that don't go away
- Agitation and restlessness
- Loss of self-confidence
- Feeling useless, inadequate and hopeless
- Thoughts of suicide
- Not able to think positively or hopefully
- Can't make even simple decisions
- Can't concentrate, lose interest
- Can't eat, lose weight
- Can't sleep properly, wake early in the morning
- Go off sex
- Avoid other people.
Mania
- Very happy and excited
- Feel more important than usual
- Full of new and exciting ideas; move quickly from one idea to
another
- Full of energy
- Don't want to sleep
- More interested in sex
- Make unrealistic plans
- Very overactive, talking quickly
- Irritable with other people who can't go along with your mood
and ideas
- Recklessly spending your money.
Psychotic symptoms
If a mood swing becomes very severe, you may
have 'psychotic symptoms'.
- When depressed, you may feel that you are uniquely guilty, that
you are worse than anybody else, or even that you don't exist.
- When manic, you may feel that you are on an important mission
or that you have special powers and abilities.
- You might also experience hallucinations - when you hear,
smell, feel or see something that isn’t there.
Can treatment help?
There are three groups of mood
stabilisers. They can take several months to work
properly.
This is used to treat both manic and
depressive episodes. This can be harmful if the dose is too high,
so regular blood tests are needed.. The side-effects include
feeling thirsty, passing lots of urine and weight gain.
These medications are usually used in
epilepsy. They include sodium valproate, Lamotrigine and
Carbamazepine.
- ‘Atypical’ antipsychotics
These medications are usually used for
schizophrenia and include Olanzapine, Quetiapine and
Risperidone.
Psychological treatments
These can be particularly helpful in
between episodes of mania or depression. They include:
- psychoeducation – finding out more about bipolar disorder
- mood monitoring – to help you pick up when your mood is
swinging
- mood strategies – to help you stop your mood swinging into a
full-blown manic or depressive episode
- developing general coping skills
- cognitive behavioural therapy (CBT) for depression.
Treating a mood swing
As well as any mood stabiliser you are taking,
you will usually also need:
An SSRI antidepressant medication. They can
take between 2 and 6 weeks to work and should be continued for at
least 8 weeks after the depression has improved - and then reduced
slowly.
An antipsychotic medication.
Self help
- Recognise the signs that your mood is swinging out of control
so you can get help early.
- Find out as much as you can about bipolar disorder.
- Avoid particularly stressful situations
- Have at least one person that you can rely on and confide in.
When you are well, make sure that they understand about bipolar
disorder.
- Balance your life and work, leisure, and relationships.
- Exercise for 20 minutes or so, three times a week, as this
seems to improve mood.
- Do things that you enjoy and that give your life meaning.
- Don't stop medication suddenly – this can trigger another mood
swing.
- You may want to write an ‘advance directive’ with your doctor
and family to say how you want to be treated if you become unwell
again.
Helping someone else
- When someone is depressed, it can be difficult to know what to
say. They see everything in a negative light and may not be able to
say what they want you to do. Listen and try to be patient and
understanding.
- During mania, the person will appear to be happy, energetic and
outgoing. But the excitement of any social situations will tend to
push their mood even higher. Try to steer them away from parties or
heated discussions, and try to persuade them to get help.
- In between mood episodes, find out more about bipolar disorder
yourself. Go to appointments with them (if they are happy for you
to do this). Make sure you give yourself space and time to recharge
your batteries.
This leaflet is made available through the generosity of the
Charitable Monies Allocation Committee of the mental health charity
St Andrew's, Northampton
© Royal College of Psychiatrists.
Updated November 2008.
Due for review: November 2010. This is an
abridged version of our main leaflet.
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