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Bipolar affective disorder

Bipolar affective disorder is a mental health condition that causes severe mood swings. Your mood can vary from excitement and elation, known as mania, to depression and despair.

About one in 100 people get bipolar affective disorder at some point in their life. You’re most likely to get bipolar affective disorder in your mid teens to your mid 20s. Both men and women develop it in pretty much equal numbers.

Bipolar affective disorder is also known as manic depression, or sometimes just bipolar disorder.

Bipolar affective disorder affects your mood and behaviour and you have extremes of emotion. These moods are different from the normal ups and downs that we all go through from time to time. They may last several weeks and will swing between the two extremes. You may also have mixed emotions. For example, you might feel depressed but at the same time restless and overactive. In between episodes of mood swings you might not have any symptoms at all.

The symptoms of bipolar affective disorder usually appear for a set length of time and include certain patterns of behaviour. See ‘Symptoms of bipolar affective disorder’ for more information about these.

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  • Types Types of bipolar affective disorder

    There are four main types of bipolar affective disorder.

    • Bipolar affective disorder I. This is when you’ve had at least one ‘episode’ of having an elevated mood that’s lasted for at least a week. You might also have periods when you feel depressed.
    • Bipolar affective disorder II. If you have one or more periods of feeling really depressed, followed by a milder, manic episode, you may have bipolar affective disorder II.
    • Cyclothymia or cyclothymic disorder. This is a milder form of bipolar affective disorder where your mood swings aren’t as bad as full bipolar affective disorder but last longer. However, it may develop into a full bipolar affective disorder.
    • Rapid cycling bipolar disorder. If your mood swings from feeling manic to depressed very quickly and then back again, you might have rapid cycling bipolar affective disorder. Usually, you’ll have these mood swings at least four times over a year. These symptoms can also be caused by another mental health condition called an emotionally unstable personality disorder.
  • Symptoms Symptoms of bipolar affective disorder

    Mania and mild mania (hypomania)

    If you get mania, you may:

    • feel incredibly happy and have an unusually elevated mood
    • be irritable and sometimes aggressive
    • be more talkative, and talk very fast
    • be easily distracted
    • have poor judgement
    • not need much sleep
    • have more interest in sex
    • demonstrate extreme behaviour, such as going on a spending spree or thinking up extravagant or impractical schemes

    During an episode of mania, you may not be aware of any changes in your behaviour. It’s more likely that it’ll be your friends, family or colleagues who notice changes.

    Depression

    If you get depression, you may:

    • feel sad and negative about life
    • lose interest in others, and the things around you
    • feel worthless and lose confidence in yourself
    • feel unable to make decisions
    • have difficulty sleeping
    • have less energy, and feel tired
    • isolate yourself from your friends
    • think of suicide
    • feel guilty
    • change your eating habits, for example, you may eat more or less than you normally would

    Mixed

    You may have feelings of mania and depression at the same time or rapidly switch between them (within a few hours). For example, you may feel sad but also have lots of energy.

    Psychosis

    As well as mania or depression, you may have delusions, which are false beliefs. You may hear, see, smell or feel things that aren’t there. It can be hard to communicate with people during this time. You may also have feelings of guilt and think that you’re worthless.

  • Diagnosis Diagnosis of bipolar affective disorder

    It’s important to diagnose bipolar affective disorder so you can adapt your lifestyle to control your episodes as much as possible. If you think you have symptoms of bipolar affective disorder, visit your GP. A friend or relative may realise you have bipolar affective disorder before you do as they may be more aware of changes in your behaviour.

    Your GP will ask about your symptoms and talk to you about your medical history and how you’re feeling. They may refer you to see a psychiatrist (a doctor who specialises in mental health) or a specialist mental health service.

    Depending on what symptoms you have, your GP may suggest some tests to rule out other conditions.

  • Treatment Treatment of bipolar affective disorder

    Bipolar affective disorder is a chronic illness. This means it lasts a long time, sometimes for the rest of your life. There isn’t a cure for bipolar affective disorder yet but there are treatments to keep your mood constant and control your symptoms.

    Self-help

    You might find it helpful to keep a track of your moods by recording them in a diary. This may highlight any things in your life that help you manage your symptoms. It may also help you recognise when things are getting out of control and if anything might have triggered this. If you know what helps and what doesn’t, you may be better able to prevent episodes of mania or depression. It could also prompt you to ask for support when you need it.

    Sticking to a regular schedule may help to control your symptoms. This includes going to sleep and getting up at the same time each day and sticking to set mealtimes. And there’s good evidence that doing exercise regularly can help.

    Medicines

    There is a range of medicines to treat bipolar affective disorder. You might need to try out a number of these before you find the ones that work best for you. It’s a good idea to track how well different medicines work for you in your diary. If your symptoms change or you get bad side-effects, your doctor may switch or add medicines to your treatment plan.

    Antipsychotics

    If you’re having a manic episode, your doctor may prescribe an antipsychotic medicine, such as olanzapine or quetiapine. Side-effects of these medicines can be serious and include putting on a lot of weight and affecting your risk of cardiovascular disease. Other side-effects include pain in your joints, blurred vision, a dry mouth and constipation. Your doctor will want to keep a close eye on you and do regular health checks after prescribing you antipsychotics.

    Mood stabilisers

    To help prevent mood swings or treat a manic episode, your doctor may prescribe you mood stabilising medicines, such as lithium. You may take these on their own or in combination with antipsychotic medicines. You’ll need to have blood tests to make sure you’re getting the right dose. Bear in mind that it can take around six months to a year for lithium to work properly. Side-effects can include either putting on or losing weight, tremors (shaking) and feeling thirsty.

    While you’re taking lithium, it’s important to drink enough fluids. If you get diarrhoea or are sick while taking lithium, contact your GP. It’s best not to take some other medicines while on lithium, such as ibuprofen – ask your doctor or pharmacist for more information.

    If you can’t take lithium for some reason, you may be prescribed what’s called an anticonvulsant medicine, such as valproic acid. This can also treat manic episodes of bipolar affective disorder. Side-effects can include feeling or being sick, diarrhoea, tremors and putting on weight. Valproic acid can also damage your liver and pancreas – talk to your doctor about all the risks and benefits of taking this medicine.

    It’s important to carry on taking your medicine and follow your doctor’s advice, even if you start to feel well. Don’t stop taking your medicine without speaking to your doctor first, as this may cause your symptoms to come back.

    Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist or GP for advice.

    Antidepressants

    Your doctor may recommend you take a short course of antidepressants if you have depression. People with bipolar affective disorder usually take a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI), such as fluoxetine.

    There’s a risk that you may switch from depressive to manic symptoms when taking these medicines. You’ll probably take them with antipsychotic medicines or mood stabilisers to stop this from happening. Side-effects of antidepressant medicines can include restlessness, increased anxiety and agitation.

    Talking therapies

    Talking and thinking about your bipolar affective disorder with a counsellor or psychologist may help your symptoms, particularly if you feel depressed.

    Cognitive behavioural therapy (CBT) is one type of talking treatment that helps to change the way you think, feel and behave. You’ll have a course of treatment that lasts at least three months.

    Hospital treatment

    If your symptoms are so severe that your GP thinks you might harm yourself or others, you may need to go into hospital. You’ll be able to get the care you need there and a specialist doctor will support you.

    Because of the nature of bipolar affective disorder and how it affects you, you may not realise you’re unwell. This may mean that you don’t want to have treatment. In this situation, the Mental Health Act gives doctors certain powers to keep you in hospital for treatment. Usually, this is only used if there is a risk to your health or safety, or that of others.

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  • Causes Causes of bipolar affective disorder

    The exact reasons why you develop bipolar affective disorder aren’t fully understood yet but some things can make you more likely to develop it.

    • Having a close relative (for example a parent or sibling) with bipolar affective disorder means you’re five to 10 times more likely to get it.
    • Stressful events, such as the breakdown of a relationship, may trigger bipolar affective disorder episodes. Emotionally difficult experiences as a child, such as physical, sexual or emotional abuse, can also increase your risk of developing it.
    • Taking certain illegal drugs, such as cocaine and amphetamines, or alcohol may make bipolar affective disorder worse.
  • Considerations Special considerations

    Pregnancy

    Certain medicines for bipolar affective disorder, such as the mood stabilising medicine carbamazepine, can stop the contraceptive pill working properly. You may need to use barrier methods of contraception (such as condoms) instead. Speak to your GP for advice.

    Some medicines, such as lithium and valproic acid, can increase the risk of developmental problems in babies. Ask your GP for advice if you're considering getting pregnant. You may need to change your medicine or stop taking medicines altogether and have another treatment, such as a talking therapy, instead. Let your midwife know if you have bipolar affective disorder too. If you’re pregnant, your GP may ask to see you more often to monitor you and your baby more closely.

  • Help and support Help and support

    It may help to give your family and friends some information about bipolar affective disorder. This will help them know what to expect if you have an episode. Your family and friends can also help you develop your care plan with your doctor or mental health service. They can then help you reach your goals and stick to your treatment.

    There may be times when you need urgent help or support. Your care plan will include key clinical contacts for you in case of an emergency. It’s a good idea to give friends or family these details too.

  • FAQs FAQs

    Can bipolar affective disorder be cured?

    Answer

    At the moment there isn’t a cure for bipolar affective disorder, but there are treatments to help control your symptoms.

    Explanation

    Bipolar affective disorder can affect people in different ways. You might recover completely between episodes without treatment, or need to take medicines for the rest of your life to control your symptoms.

    You’ll always be vulnerable to the symptoms of bipolar affective disorder if you’ve had an episode. About half of people who have a manic episode will have a further episode of bipolar affective disorder within a year.

    Finding the best way to manage your condition can help to control your mood swings and ease your symptoms. There are a range of treatments that can do this, which include medicines and talking therapies.

    Can I drive if I have bipolar affective disorder?

    Answer

    If you have bipolar affective disorder, legally you may not be allowed to drive. Tell the Driver and Vehicle Licensing Agency (DVLA) about your condition and they will let you know whether you can or not.

    Explanation

    Don’t drive during an episode as it isn’t safe and may put you and others at risk. If it’s your first episode, you’ll usually be allowed to drive again if you:

    • don’t have another episode for at least three months
    • are having treatment for bipolar affective disorder
    • don’t have any side-effects from your medicine that might affect your driving
    • receive a medical report from your doctor saying you’re fit to drive

    If you’ve had four or more mood swings within a year, don’t drive for at least six months or until your symptoms are under control. Speak to your doctor or the DVLA for more information and tell your insurance company about your condition.

  • Resources Resources

    Further information

    Bipolar UK Bipolar UK is a charity specifically for people with the condition offering not only information but also details of local support groups. This page gives answers to some of the questions that are most commonly asked about bipolar disorder.
    Mental Health Foundation The Mental Health Foundation is a charity that carries out research and offers information about many areas of mental health. They have a helpful overview of bipolar disorder with tips on things you can do to help manage low phases and prevent highs.
    Mind The charity Mind has information to support people with a mental health condition and those who care for them. This page on bipolar disorder has a video of people who have it talking about what it’s like living with the condition. There are also personal accounts written by people with bipolar disorder about their experiences.
      This page has information about mania and hypomania. You can get these on their own, as well as with the periods of depression that characterises bipolar disorder.
     Rethink This charity has support groups, runs campaigns and can direct you to local mental health services, as well as providing information. Their factsheet on bipolar disorder explains some of the key guidelines around treatment that apply to you so you can get what’s right for you.
     CALM CALM (Campaign Against Living Miserably) is a charity that exists primarily to prevent male suicide. Through their confidential helpline and website, they offer support for all men when things go wrong. Their information about bipolar disorder has first person accounts from people living with the condition.

    Sources

    • Bipolar disorder: the assessment and management of bipolar disorder in adults, children and young people in primary and secondary care. National Institute for Health and Care Excellence (NICE), September 2014. www.nice.org.uk
    • Bipolar affective disorder (manic depression): information for parents, carers and anyone who works with young people. Royal College of Psychiatrists. www.rcpsych.ac.uk, published January 2012
    • Bipolar affective disorder. Medscape. www.emedicine.medscape.com, published 18 August 2014
    • Bipolar disorder. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published November 2014
    • Bipolar disorder in adults. BMJ Best Practice. www.bestpractice.bmj.com, published 24 December 2013
    • Cyclothymic disorder. The Merck Manuals. www.merckmanuals.com, published November 2013
    • Bipolar disorder. Royal College of Psychiatrists. www.rcpsych.ac.uk, published February 2015
    • Personality disorders and psychopathy. PatientPlus. www.patient.co.uk/patientplus, reviewed 14 December 2011
    • Bipolar disorder. International view. London: Map of medicine; 2014 (issue 1). Map of Medicine
    • What is bipolar disorder? National Institute of Mental Health. www.nimh.nih.gov, published 13 January 2015
    • Bipolar disorder in adults. National Institute of Mental Health. www.nimh.nih.gov, published 2012
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 31 March 2015
    • Bipolar disorders. The Merck Manuals. www.merckmanuals.com, published November 2013
    • Antenatal and postnatal mental health: clinical management and service guidance. National Institute for Health and Care Excellence (NICE), December 2014. www.nice.org.uk
    • For medical practitioners: at a glance guide to the current medical standards of fitness to drive. Driver and Vehicle Licensing Agency. www.gov.uk, published November 2014
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