Bipolar affective disorder

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Also known as manic depression

Experiencing bipolar disorder is one of the most overwhelming, frightening, isolating and debilitating experiences you can have.

If you are in crisis, you may feel your world has fallen apart, that everything is black, that nothing makes sense or that you are in danger.

Having bipolar is more than a temporary feeling of being depressed when you are stressed out, or of feeling great when something goes really well. The difference with bipolar is that these feelings are extreme and continual, and you can either feel really happy, energetic and “high” or really miserable and depressed, or “low”.  People with bipolar disorder usually experience more lows than highs. Some of the extreme phases of bipolar disorder make everyday life difficult and can include a loss of touch with reality (psychosis).

Bipolar generally begins between the ages of 15 and 40 years and occurs equally across all cultures. Most people return to their usual level of functioning after periods of illness. Some will have some ongoing difficulties.

Even if you continue to have bipolar episodes, with treatment and support from friends and family you can still experience recovery and live a happy, worthwhile life.

What causes bipolar disorder?

The exact cause of bipolar isn't known, although there is a family tie (genetic inheritance) to bipolar. If someone in your family/whānau has bipolar, there is an increased chance of developing it. Researchers are still working out exact causes. In the meantime, we do know that stressful life events and other factors can trigger bipolar affective disorder in some people.

For example, things like money or relationship worries, substance abuse, certain medication, unemployment or lack of sleep can all start a period of illness. You will hear these factors called “triggers” and any of these triggers can set off a new period of the disorder.

Types of bipolar

There are two types of bipolar disorder. They are called type 1 and type 2.

  • Bipolar type 1 disorder means you get bouts of mania and bouts of depression.
  • Bipolar type 2 disorder also means you get bouts of mania and bouts of depression. But the mania is milder. It is sometimes called hypomania. It’s slightly more common than type 1.

Signs to look for (symptoms)

The symptoms of bipolar affective disorder fall into three categories: 

  • symptoms of mania
  • symptoms of depression
  • mixed symptoms of mania and depression.  

Symptoms of mania

If you experience mania, you won't complain of problems. You feel fantastic. It’s others around you who see you aren't yourself. Mania symptoms vary, between people and, over time, in one person.

Your elevated mood can be infectious and it's as though you're the life of the party. You'll tell friends you're feeling great or never been better. However, your behaviour will be recognised as excessive by friends or family. You may also be irritable and experience rapidly changing emotions from laughter to tears to anger and back.

You may also find you need less sleep or won't sleep for days, yet be full of energy and have an increased appetite for food, sex or other pleasurable past times. Or you might have a sudden need to spring clean the house, mow the lawn and paint a wall - all in one morning. With severe mania there may also be signs of psychosis (loss of touch with reality). 

Experiencing mania can also change how you process thoughts, or your ability to concentrate. For example, you may feel like your thoughts are racing and friends may notice you constantly changing the topic of conversation or that you are easily distracted.

With these changes comes an increased sense of self-importance that may start out as increased self-confidence. But then, you start to lose touch with reality. For example, you might borrow money and start a business in a field where you have no experience. If the mania is severe, you may lose touch with reality, believing perhaps, that you have a special relationship with God, Jesus, the Queen or that you have special powers.

A characteristic and early feature of bipolar is the loss of insight − losing awareness that your behaviour and experiences are due to illness.

Symptoms of psychosis – similar to mania, but more extreme

Psychosis usually takes the form of an exaggeration of some symptoms, for example your thoughts may race so fast your speech is incomprehensible. Over-activity and easy distraction may result in total disorganisation. Similar to mania symptoms, you may feel like not only do you have a special tie with a famous figure, but that you can control events in the world or have a destiny to save the world. Sometimes these beliefs or voices may take on a more paranoid form. You might believe you are being persecuted, perhaps because of your special powers or status.

Symptoms of depression

Signs of depression also vary. Not everyone with depression will complain of sadness or a persistent low mood. You may have other signs of depression such as sleep problems − difficulty getting to sleep or waking and being unable to get back to sleep as well as feeling constantly tired. Or you might find you eat much less, or much more, than usual.

Depression can cause you to lose interest in usual activities, become irritable, find it hard to concentrate or make everyday decisions. This condition can also make thinking clearly quite difficult; you may lose confidence, feel excessively guilty for minor wrongs and have thoughts of hopelessness, death and suicide.

Mixed mood symptoms

This is when there is a mixture of symptoms of mania and depression. Mood alternates between high and irritable, and depressed. You  may be unable to sleep; be overactive but feel tired; be agitated, and swing between feeling hopeless and feeling overconfident.

How the doctor tests for bipolar affective disorder (diagnosis)

There is no test to diagnose bipolar affective disorder. A diagnosis is made when you have some or all of the symptoms mentioned above. For this reason it is very important for a health professional to get a full understanding of the difficulties you have had, from both you and your family/whānau or others who know you well, if there are any symptoms of mood disorder.

Before bipolar affective disorder can be diagnosed there must have been symptoms of mania for at least one week. If you have previously had depression, bipolar affective disorder is only diagnosed if you have an episode of mania at some point.

Treatment options

Treatment of bipolar disorder can take many different forms: medication, talking therapies, complementary therapies, education sessions, workshops and sometimes respite care in the community is useful. Usually a combination of these is the best solution if you have been diagnosed with bipolar disorder.

Medicines

In treating bipolar, medicines are most often used for making your mood more stable and for helping with depression (anti-depressants).

If you are prescribed medication, you are entitled to know the names of the medicines; what symptoms they are supposed to treat; how long it will be before they take effect; how long you will have to take them for and understand the side effects.

Finding the right medication can be a matter of trial and error. There is no way to predict exactly how medicines will affect you.

Talking therapies and counselling

Talking therapies are effective in the treatment of bipolar, especially for the treatment of depressive symptoms. Sessions may be held on a one to one basis, sometimes include partners or family, or be held in a group. The focus of psychological therapy or counselling in the treatment of bipolar is on education and support for you to understand what is happening to you, to learn coping strategies and to pursue a path of recovery. Sessions help you regain the confidence and belief in yourself that is critical to recovery.

All types of therapy/counselling should be provided in a manner that is respectful to you and with which you feel comfortable and free to ask questions. It should be consistent with and incorporate your cultural beliefs and practices.

Education

Education about bipolar can be extremely important to help you, your whānau and supporters. This might include how to work together to communicate effectively, solve problems and deal with stress. It could also mean learning about treatment, understanding symptoms and behaviour and how to support the recovery process. It's important those close to you become part of your recovery team if they want to.

In the longer term, the mental health professional your doctor refers you to, and who supervises your recovery and education, could include help finding you housing, paid employment or accessing workshops to help you build different skills such as stress management or relaxation techniques.

Remember it’s important to continue treatment even when you feel well, to prevent new episodes of bipolar and to stay symptom-free.

Complementary therapies

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and that may be used to complement and support it. Certain complementary therapies may enhance your life and help you to maintain wellbeing. In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress.

Physical health

It is also really important to look after your physical wellbeing. Make sure you get an annual check up with your doctor. Being in good physical health will also help your mental health. 

Keeping yourself well

When you are well and your mood is stable, you'll want to stay that way as long as possible. If your symptoms of mania or bipolar depression come back, doctors say you have had a relapse.

The most common reason to get a relapse is not taking your medicine. You might have been feeling well, and decided you didn’t want the medicine any more. Or you might be fed up with side effects. But if you stop suddenly, you are much more likely to have a relapse. It’s best to discuss changing your medicine with your doctor first. Your doctor may be able to prescribe a lower dose, or switch you to another medicine with fewer side effects.

Relapses can be triggered by things that happen in your life. For example:

  • Stressful situations like exams, problems in relationships, or difficulties at work
  • Sleeping too little or too much
  • Taking illegal drugs or drinking too much alcohol.

Therefore working out ways to avoid your triggers and keep yourself well is important.

Thanks to Janet Peters, registered psychologist, and Lisa Ducat, Like Minds, Like Mine mental health promoter, for reviewing this content. Date last reviewed:  September, 2014.