Bipolar affective disorder (manic depression):
information for parents, carers and anyone who works with
young people
About this leaflet
This is one in a series of leaflets for parents, teachers and young
people entitled Mental Health and Growing Up. The aims of
these leaflets are to provide practical, up-to-date information
about mental health problems (emotional, behavioural and
psychiatric disorders) that can affect children and young people.
This leaflet gives some background detail about the symptoms and
effects of bipolar affective disorder (manic depression) and gives
some practical advice on how to get help for this problem.
Introduction
What is bipolar affective disorder?
Bipolar affective disorder (BPD) is a condition in which a young
person will have extreme changes of mood - periods of being
unusually `high' or manic, and periods of being unusually `low' or
depressed. It is sometimes called manic depressive
disorder. The mood-swings are way beyond what would be
considered normal for a particular individual, and are out of
keeping with their personality. Sometimes a mixture of depressive
and manic symptoms are present at the same time.
How common is bipolar affective
disorder?
BPD affects fewer than one in 100 people. It is extremely rare
before puberty, but becomes more common during teenage years and
adult life.
Although the causes are not fully understood, BPD tends to run
in families, and physical illness or stressful events might trigger
an episode.
The condition can be hard to recognise in adolescence because
more extreme behaviour can be part of this stage of life.
What are the signs?
If someone has some of these feelings or shows some of these signs,
they might have BPD:
- depression, moodiness, irritability, excitement or elation
- very rapid speech and changes of subject
- loss of energy or excessive energy
- change in appetite and weight
- sleep disturbance
- neglect of personal care
- withrawal from family and friends, or excessive
sociability
- feelings of guilt, hopelessness, worthlessness, or inflated
ideas about themselves or their abilities
- reckless behaviour, spending excessive amounts of money, sexual
promiscuity
- unusual or bizarre ideas, beliefs or experiences
- preoccupations with death, suicide attempts.
Between the `highs' and `lows', there are usually normal
periods that may last for weeks or months.
What effects can it have?
The exaggeration of thoughts, feelings and behaviour affects many
areas of the young person's life. For example, it can lead
to:
- problems in relationships with friends and family
- interference with concentration at school or work
- behaviour that places the young person's health or life at
risk
- a loss of confidence and a loss of the sense of control the
person feels over their life.
The longer the condition continues without treatment, the more
harmful it is likely to be to the life of the young person and to
their family.
Where can I get help?
The first step towards getting help is to recognise that there
might be a problem. Seeking medical advice early on is very
important. If the bipolar illness can be identified and treated
quickly, this reduces its harmful effects.
You should contact your general practitioner first. If
necessary, a referral can then be made to a child and adolescent
psychiatrist based in the local child and adolescent mental health
service. (see
leaflet 31 on child and
adolescent psychiatrists).
Effective treatments
The goal of treatment is to improve the symptoms, prevent the
illness from returning and help the young person lead a normal
life.
Medication
Medication usually plays an important role in the treatment of
bipolar disorder. In the initial stages of the illness, an
antidepressant and/or an antipsychotic drug will often be
prescribed.
If the young person has had more than one episode of illness,
a `mood-stabilising' drug may also be needed. This reduces the risk
of further episodes. Medication will be needed for at least a year,
and sometimes much longer. The psychiatrist will want to review the
medication regularly with the young person to make sure that the
dose is right and that there are no side-effects.
Side-effects of the medication can occur. The psychiatrist
will be able to advise about what they are, and about what can be
done to help. The risk of side-effects needs to be balanced against
the risk of the damaging effects of the illness on a person's life.
It is crucial that drug treatments are combined with practical help
for the young person and their family.
Help with understanding the illness
(psychoeducation)
It is very important that the young person with bipolar disorder
and their family are helped to understand the condition, how best
to cope and what to do to reduce the chances of it recurring.
Help to resume education or start work
An episode of bipolar disorder can interfere with education because
it is difficult to learn when you are unwell. An important part of
recovery is to begin to plan starting school, college or university
or to think about work.
Help with family relationships
Stress in the family can make a relapse more likely, and families
may benefit from help to recognise the triggers and how best to
support the young person with bipolar disorder. As is normal for
all young people, this may include helping a young person to leave
home and to live independently.
References
- Carr, A. (ed.) (2000) 'What Works with Children and
Adolescents?' - A Critical Review of Psychological Interventions
with Children, Adolescents and their Families. London:
Brunner-Routledge.
- Rutter, M. & Taylor, E. (eds) (2002) 'Child and
Adolescent Psychiatry' (4th edn). London: Blackwell.
- Scott, A., Shaw, M. & Joughin, C. (eds) (2001) 'Finding
the Evidence' - A Gateway to the Literature in Child and Adolescent
Mental Health (2nd edn). London: Gaskell.
Sources of further information
© [2004]
Royal College of Psychiatrists. This leaflet may be downloaded,
printed out, photocopied and distributed free of charge as long as
the Royal College of Psychiatrists is properly credited and no
profit is gained from its use. Permission to reproduce it in any
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