About this leaflet
This leaflet gives some basic information
about bipolar affective disorder and some practical advice on how
to get help.
What is bipolar affective disorder?
Bipolar affective disorder, also known as
bipolar mood disorder or manic depression, is an illness in which
there are extreme changes or swings in mood.
Everyone has times in life when they feel very
happy or very sad, but this condition is unusual because the mood
changes can be extreme, ranging from being very happy or irritable
(known as mania or hypomania) to being very sad (depression). Some
people have a mixture of both extremes (mixed episode).
These mood swings feel very different to how
you normally feel.
How common is it?
Bipolar affective disorder is quite rare in
young people. In adults it affects fewer than 1 in 100 people. It
is extremely rare in young children but becomes more common during
teenage years and early adult life.
The cause is unclear but it tends to run in
families.
What are the symptoms of bipolar affective
disorder?
In bipolar affective disorder a person can have (1)
manic/hypomanic episodes, (2) depressive episodes or (3) mixed
episodes. Below is a list of the symptoms in each episode. You need
to have had at least one manic or hypomanic episode to have bipolar
affective disorder.
There need to be several of these symptoms
happening at the same time for at least several days. If there is
just one symptom then it is unlikely to be bipolar affective
disorder.
The mood changes can sometimes occur very
rapidly within hours or days.
In between the highs and lows, there are
steady periods that can last for a long time.
Symptoms during manic/hypomanic episodes
- feeling 'high' in mood, uncontrolled
excitement
- irritability
- increased talkativeness
- racing thoughts
- increased activity and restlessness
- difficulty in concentration or
distractibility, constant changes in plans
- over confidence and inflated ideas about
yourself or your abilities
- decreased need for sleep
- neglect of personal care
- increased sociability or
over-familiarity
- increased sexual energy
- overspending of money or other types of
reckless or extreme behaviour.
At the extreme end, some people also develop
something called psychosis. This is when someone
has strong, unusual beliefs e.g. that they have superhuman powers
or are being watched or followed.
Symptoms during depressive episode
- low mood
- decreased energy and activity
- loss of pleasure
- decreased appetite
- disturbed sleep
- thoughts of self harm.
Symptoms during mixed episodes
- A mixture of manic/hypomanic symptoms and
depressive symptoms at the same time.
Why is bipolar affective disorder described as a type
of mental illness?
This is because, for some people, it can
interfere with activities and tasks in daily life.
With appropriate help, many people gain
control over the symptoms as they get older. The symptoms do not
stop them living successfully and some do not even see it as a
mental illness.
What effects can it have?
The exaggerated thoughts, feelings and
behaviours can impact on many aspects of life, for example:
- loss of confidence
- loss of sense of control a person feels over their life
- poor concentration with studies
- problems with relationships with family and friends
- behaviour that places a young person's health or life at
risk.
Where can I get help?
The first step is recognising that there might
be a problem. Other people are likely to have noticed that you seem
different from your usual self, particularly those who live with
you. Speak to people who might know you well, such as family and
friends.
It is recommended that you first visit
your GP to talk about your concerns. The GP can then refer you
to your local child and adolescent
mental health service (CAMHS) who can offer more
specialist help.
If you have a school counsellor, they could
also be a useful person to talk to. The counsellor can also refer
you to the local child and adolescent mental health service.
Effective treatments
The goal of treatment is to help you have a
healthy, balanced and productive life.
Treatment includes understanding the
condition, improving the symptoms, and preventing the problem from
recurring.
Understanding yourself
The key to good health is understanding
yourself and recognising any patterns that you may have when you
become unwell.
Think of yourself as a see-saw. Every person
has a point of balance at which life is steady.
- Do you notice your see-saw tipping to one
side too heavily?
- Are there any triggers, such as stressful
relationships or places?
Think about what you can do to keep the
balance. Everyone is different and does this differently.
Families and carers
It is important that the people around you
understand about bipolar affective disorder. This will help them to
recognise it, notice any triggers, support you and to seek help for
you if necessary.
Stress at home can worsen the situation and
can even trigger another episode of illness.
Talking therapy
Talking to a therapist can help support you.
It can be useful to share your worries with someone rather than to
keep them to yourself.
Medication
Medication plays an important role in the
treatment of bipolar affective disorder by helping to reduce the
symptoms. The choice of medication can depend upon the phase of
illness that you may be in i.e. manic phase or depressed phase.
The two main types of medication that are
helpful are (1) antipsychotic medication and (2) mood stabilisers.
Lithium and sodium
valproate are types of mood stabiliser.
Side-effects of the medication can occur, some
of which are quite serious. The risk of side-effects needs to be
balanced against the risk of the damaging effects of the illness in
your life.
Everyone is different and so the type of
medication that is recommended will also be different.
A lot of people only take medication when the
problems are serious. Some people may, under medical supervision,
be able to stop their medication when they have recovered and have
felt well for a while. If the episodes of ill health are very
damaging and frequent, then people tend to take medication on a
long-term basis.
No young person should be taking medication
unless they are reviewed by a health professional regularly. This
is to monitor the dose of the drug and to check for
side-effects.
It is important that drug treatments are not
given alone but are combined with practical help.
Hospital care
Some young people may need to go into hospital
for intensive support if the symptoms are severe.
Recovery
It is important to recognise that you are not
alone and to keep up hope.
Many people only have a few mood swings and
then the problem goes away. For others it becomes a life long
pattern, which they learn to live with and manage.
An important part of recovery is to begin
planning a return to your usual activities, such as returning to
school or college, when you start to feel better.
Useful websites
Young Minds is
the UK's leading charity committed to improving the emotional well
being and mental health of children and young people. Tel: 0207 336
8445
Manic Depression
Fellowship supports people with a diagnosis of manic
depression and their families.
Rethink is a national
charity which helps people affected by a severe mental illness to
recover a better quality of life. There is a section on the website
for young people.
Sane is a national
charity which improves the quality of life for people
affected by mental illness.
Useful book
The Young Mind: an essential guide to mental health for
young adults, parents and teachers. Edited by Bailey,
S. and Shooter, M. (2009)
This is an accessible, user-friendly handbook produced by the
Royal College of Psychiatrists.
References
Rutter, M. (2008) ‘Rutter’s Child and Adolescent
Psychiatry' (5th edn). Wiley- Blackwell
World Health Organisation (1992) ‘ICD-10 : The ICD-10
Classification of Mental and Behavioural Disorders : Clinical
Descriptions and Diagnostic Guidelines’.
With grateful thanks to Dr
Mona Freeman and Dr Milly Biswas.
Series Editor: The Child and
Family Public Education Editorial Board chaired by Professor
Ann Le Couteur.
© December 2009. Due for review: December 2011
Royal College of Psychiatrists. This leaflet may be downloaded,
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