Bipolar affective disorder

Published by Bupa's Health Information Team, September 2010.

This factsheet is for people who have bipolar affective disorder, or who would like information about it.

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

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

About bipolar affective disorder

Bipolar affective disorder affects your mood and behaviour. If you have bipolar affective disorder you will experience extremes of emotion, from excessive energy and elation to depression and suicidal thoughts. Your moods will swing between the two extremes.

One in every 100 adults is affected by bipolar affective disorder at some point during their life. The disorder is most likely to affect you between your mid teens and mid 20s. Men and women are equally likely to develop bipolar affective disorder.

Types of bipolar affective disorder

If you have bipolar affective disorder you may be diagnosed with a certain type of the condition.

• If you have an episode of elevated mood followed by depression, you may be diagnosed with bipolar affective disorder I.
  
• If you have depressive episodes followed by a milder manic episode (hypomania), you may be diagnosed with bipolar affective disorder II.
  
• If your mood moves from mania to depression very quickly, and then back again, you may be diagnosed with rapid cycling bipolar affective disorder.

Symptoms of bipolar affective disorder

The symptoms of bipolar affective disorder usually appear for a set amount of time (an episode) and include certain patterns of behaviour.

Mania and hypomania (mild mania)

If you experience mania, you may:

• have an unusually elevated mood
  
• be irritable
  
• have increased self-confidence
  
• be more talkative
  
• be easily distracted
  
• have poor judgement
  
• not need much sleep

Episodes of mania can last for long periods of time, for example a few months. This can lead to physical exhaustion, excessive spending and unwise or inappropriate relationships.

Depression

If you experience depression, you may:

• feel unhappy and negative about life
  
• lose interest in others and the things around you
  
• lose confidence
  
• feel unable to make decisions
  
• have difficulty sleeping
  
• feel tired
  
• cry much of the time
  
• isolate yourself from your friends
  
• think of suicide

Mixed

About four in 10 people with bipolar affective disorder have mixed symptoms. These people have feelings of mania and depression at the same time. For example, you may feel sad but also have lots of energy.

Psychosis

As well as mania or depression, you may have delusions (false beliefs), hallucinations (hearing, seeing, smelling or feeling things that aren't there), and you may find it hard to communicate with people.

Cyclothymia

Cyclothymia is the name given to mood swings that aren't as severe as those in bipolar affective disorder I or II, but may last longer. Cyclothymia may be an early symptom of bipolar affective disorder.

Causes of bipolar affective disorder

The exact reasons why you may develop bipolar affective disorder aren't fully understood at present. It may be triggered by changes in the nerves or chemicals in your brain. However it's thought there may be a number of different mechanisms involved.

There are some factors that may make bipolar affective disorder more likely.

• Having a close relative with bipolar affective disorder I may increase your risk. If your mother, father, brother or sister has the condition, there is about a six in 100 chance that you may get bipolar affective disorder I and about a three in 100 chance that you may get bipolar affective disorder II.
  
• Stressful events, such as the breakdown of a relationship or physical illness, may cause bipolar affective disorder.
  
• Chemical imbalance in your brain.
  
• Structural differences in your brain.

Diagnosis of bipolar affective disorder

If you or a friend or relative thinks you have symptoms of bipolar affective disorder, you should visit your GP. A friend or relative may realise you have bipolar affective disorder before you do as they may be more aware of the changes in your behaviour.

Your GP will ask about your symptoms and talk to you about your medical history and how you're feeling. He or she may refer you to a psychiatrist (a doctor who specialises in mental health) or a community mental health team.

Treatment of bipolar affective disorder

Treatment helps to keep your mood constant and reduce the symptoms of mania or depression.

Self help

Keeping track of your moods by recording them in a mood diary can help you to find out how severe your symptoms are and recognise when they are getting out of control. This may help you to prevent episodes of mania or depression and ask for support when you need it.

Learning how to deal with stress can help to prevent episodes. Maintaining a good work-life balance and doing things that you enjoy can help you to relax and feel well. Regular exercise and a healthy diet are also helpful.

Medicines

Antipsychotics
If you're having a manic episode, your doctor may prescribe an antipsychotic medicine such as olanzapine or quetiapine to treat your symptoms in the short-term or before you're given a mood stabilising medicine. Side-effects of these medicines include weight gain and dizziness.

Mood stabilisers
To help prevent mood swings, your doctor may prescribe you mood stabilising medicines such as lithium. Your doctor will ask you to have blood tests to make sure you're getting the right dose. It can take around three months for lithium to start working properly. Side-effects can include weight gain, tremors and feeling thirsty.

If you have too much lithium in your body you may be sick, slur your speech and stagger. If you have these symptoms you should contact your doctor immediately. When taking lithium you should eat regularly, drink plenty of unsweetened fluids and not drink caffeinated drinks, as this can affect your medicine.

Your doctor may prescribe a medicine called valproic acid to treat the manic episodes of bipolar affective disorder. Side-effects of this medicine can include feeling sick, diarrhoea, tremors and stomach problems.

Always ask your doctor for advice and read the patient information leaflet that comes with your medicine. Continue taking your medicine as advised by your doctor, even if you start to feel well. You shouldn't stop taking your medicine without speaking to your doctor first, as this may cause your symptoms to come back.

Antidepressants
Your doctor may advise you to take a short course of antidepressants to treat an episode of depression. Antidepressants called selective serotonin reuptake inhibitors (SSRI), for example citalopram and fluoxetine, are commonly prescribed.

There is a risk that you may switch from depressive to manic symptoms when taking these medicines. Some can be taken with mood stabilisers to stop this happening. Side-effects can include palpitations, sleep problems and confusion.

Talking therapies

Cognitive behavioural therapy is a talking treatment that helps to change the way you think, feel and behave. This can help treat the depressive symptoms of bipolar affective disorder.

Talking and thinking about your bipolar affective disorder with a counsellor or psychologist may help prevent your symptoms returning.

Hospital treatment

If your psychotic or manic symptoms are severe, you may need to be admitted to a hospital to have the care you need, supervised by a psychiatrist.

You may not want to have treatment because you don't realise you're unwell. If you're unwilling to have treatment, the Mental Health Act gives doctors certain powers to keep you in hospital for treatment. Usually, this is only imposed if there is a risk to your health or safety, or that of others.

Special considerations

Women and pregnancy

Certain medicines for bipolar affective disorder, such as the mood stabilizing medicine carbamazepine, can interfere with the contraceptive pill. You may need to use additional barrier methods of contraception to prevent pregnancy. Speak to your doctor if you're taking the contraceptive pill.

Some medicines such as lithium and valproic acid can increase the risk of development problems in unborn babies. Ask your doctor for advice if you're planning to have a baby or have become pregnant while taking medicines prescribed for bipolar affective disorder. During pregnancy, you may need to change your medicine or stop taking it. Let your midwife know if you have bipolar affective disorder.

Help and support

It may be helpful to give your family and friends some information about bipolar affective disorder so that they know what to expect if you have an episode. Your family and friends can help by understanding the condition and how it affects you.

There may be times when you need help or support immediately. This may be because you aren't eating or drinking during an episode, which can affect your medicine. You may even behave in a way that puts you or others at risk of harm. You will usually have contact with a key worker (a social worker or community psychiatric nurse). You should consider giving friends or family your key worker's contact details in case of an emergency situation.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.