What is Bipolar Affective Disorder?

The word bipolar (also known as manic depressive) means 2 opposite poles, the 2 poles of bipolar are depression and mania. If you have bipolar affective disorder you will have periods of elation and seem to have endless energy and also periods of depression where you have no energy and barely able to complete simple tasks.

You can have any number of episodes of highs and lows throughout your life and in between them there may be gaps of weeks, months or years when your mood is normal. However, some people swing from highs to lows quite quickly without a period of normal mood in between. This is called rapid cycling. (If you have the rapid cycling form of the condition you have at least four mood swings per year.)

What Causes Bipolar Affective Disorder?

The exact cause is not known. However, your genetic 'makeup' seems to play a part, as your chance of developing this condition is higher than average if other members of your family are affected. Stressful situations may trigger an episode of mania or depression in people prone to this condition. It is thought that an imbalance of some chemicals in the brain may also be present in people with bipolar disorder.

Symptoms

Mania

Mania causes an abnormally high or irritable mood which lasts at least one week - but usually lasts much longer than this. It can develop quite quickly - over a few days or so. When you are high you will usually have at least three or four of the following:

  • grand ideas about yourself and your own self-importance

  • increased energy; you also tend to move quickly and need less sleep than usual

  • being more talkative than usual; you tend to talk quickly

  • flight of ideas.; this means that you tend to change quickly from one idea to another. you may feel as if your thoughts are racing

  • easily distracted; your attention is easily drawn to unimportant or irrelevant things

  • full of new ideas and plans; often the plans are grandiose and unrealistic

  • irritation or agitation, particularly with people who do not seem to understand your great ideas and plans which can sometimes make you aggressive towards people

  • wanting to do lots of pleasurable things (but these can often lead to painful consequences), for example, you may spend a lot if money that you can't afford, take sexual risks, make spur of the moment decisions about jobs relationships money or health or drink too alcohol or take drugs

Severe mania may also cause psychotic symptoms where you lose touch with reality. For example, you may hear voices which are not real (hallucinations), or have false beliefs (delusions). These tend to be delusions of importance (such as believing that you are a famous celebrity).

Usually, you do not realise that you have a problem when you are high. But, as the illness develops, to others your behaviour can be bizarre. Family and friends tend to be the ones who realise that there is a problem. But, if someone tries to point out that you are behaving oddly, you tend to become irritated as you can feel really good.

If mania is not treated, the bizarre and uninhibited behaviour may cause great damage to your relationships, job, career and finances. When you recover from an episode of mania you often regret many of the things that you did when you were high.

Depression

With depression, you will have a low mood and other symptoms each day for at least two weeks. Symptoms also become severe enough to interfere with day-to-day functions. The following is a list of common symptoms of depression. You may not have them all but you usually develop several if you have depression:

  • low mood for most of the day, nearly every day

  • loss of enjoyment and interest in life, even for activities that you normally enjoy

  • abnormal sadness, often with weepiness

  • feeling guilty, worthless, or useless

  • poor motivation, even simple tasks seem difficult

  • poor concentration, it may be difficult to read, work, etc

  • sleeping problems, such as getting to sleep, waking up and not getting back to sleep or in some cases too much sleep

  • lacking in energy, always feeling tired

  • difficulty with affection, including going off sex

  • poor appetite and weight loss, sometimes the reverse happens with comfort eating and weight gain

  • being irritable, agitated, or restless

  • symptoms often seem worse first thing each day

  • physical symptoms such as headaches, a 'thumping heart' (palpitations), chest pains and aches and pains

  • repeated (recurrent) thoughts of death; this is not usually a fear of death, more a preoccupation with death and dying. Some people get suicidal ideas - "life's not worth living"

Some people do not realise when they develop depression. They may know that they are not right and are not functioning well but don't know why. Some people think that they have a physical illness - for example, if they lose weight.

Self Help

There are a few things you can try to help your bipolar such as:

  • joining a self help group, taking to other people can really help

  • avoid stressful situations as it may trigger an episode or either mania or depression

  • try and establish a daily routine

  • try and do some relaxation activities either at home or join a club

  • reduce your alcohol intake

  • learn about your condition and consider speaking to your friends and family about it as well

  • learn to recognise your warning signs

Medical Treatment

The first point of contact should be with your GP, they will be able to refer you to a psychiatrist for expert advice and help. The psychiatrist will do an initial assessment which usually last an hour. Support is also available from the local mental health team with ongoing contact. You also may be allocated a community psychiatric nurse who will keep a check on you to see that you are OK as they will be the first to notice a change in your behaviour.

The majority of treatment is done though outpatients appointments, however, if time in hospital is required this will be agreed by you and your family. Although sometimes admission under a section of the Mental Health Act requires you to be in hospital because your symptoms are severe and extreme.

Your GP may also prescribe medication to help however it isn't a cure.

Recovery

There are many people living with bipolar affective disorder and some get a sense of achievement out of learning to recognise and control their symptoms. Many people lead a full life and have very successful careers, however not everyone is able to do so. You will work out what the best way is to cope with your own symptoms and, by making some adjustments, you can lead as fulfilling a life as possible.

NHS Choices - Bipolar Disorder