Bipolar Disorder: Everything You Need To Know

Bipolar Disorder (once known as Manic Depression) is a serious mental health condition characterised by intense mood swings.

Someone with Bipolar Disorder will experience both highs – known as mania, and lows – known as depression. These periods will often last for weeks, and can cause significant distress.

Sometimes, Bipolar Disorder can start as Depression, before exacerbating. The depressive periods of Bipolar feature long-term periods of low moods.

During the manic phase, an individual will typically feel happy, energetic and ambitious – and often act recklessly, or exhibit signs of psychosis.

There are different sub-types of Bipolar Disorder, based around the differing characteristics of each. Bipolar Disorder is normally a chronic condition. However, with treatment, the symptoms can be controlled far more, which should result in an improvement in quality of life.

Types of Bipolar Disorder

There are a few different types of Bipolar Disorder. It can be useful for patients to know the exact type of Bipolar Disorder they have. This can enable treatment to be tailored to their needs.

Bipolar I Disorder: This is the most well-known form of Bipolar Disorder – characterised by periods of mania and normally, depression. Mood swings are therefore extreme, and cause significant distress in life. Suicidal ideation during the depressive phase and psychosis during the manic phase is possible.

Bipolar II Disorder: This form of Bipolar Disorder applies to those who have encountered at least one episode of severe depression, while exhibiting symptoms of hypomania, as opposed to mania. Mood swings are still extreme, and this form of the condition also causes significant distress.

Rapid Cycling Bipolar: This form of Bipolar Disorder is characterised by an individual experiencing four or more depressive, manic, hypomanic or mixed episodes within the space of 12 months. Mood can change rapidly – potentially even on the same day. As a result of the symptoms, this form of Bipolar can cause significant distress.

Mixed Bipolar State: Sometimes referred to as Mixed Affective State, this form of Bipolar Disorder sees an individual experience symptoms of both mania and depression simultaneously. This causes substantial distress for an individual. Suicidal behaviour is seen as a risk of this condition – due to the toxic mix of low mood and impulsive behaviour occurring together.

Cyclothymia: While viewed as a somewhat milder form of Bipolar Disorder, Cyclothymia is still a serious condition which can have a significant impact on the life of an individual. An individual with Cyclothymia will often have experienced both hypomanic and depressed mood states, but their symptoms aren’t severe enough to be diagnosed with either Bipolar I or Bipolar II. Cyclothymia will sometimes develop into Bipolar Disorder.

Bipolar Disorder commonly runs comorbidly with other mental health conditions like personality disorders, anxiety, substance abuse or eating disorders.

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Symptoms of Bipolar Disorder

Bipolar Disorder is associated with periods of mania, hypomania and depression. Sometimes, these periods can run simultaneously.

The type of Bipolar Disorder determines which of these three periods are exhibited. Symptoms of these three periods include, but aren’t limited to:

Depression

• Sadness
• Hopelessness
• Lack of energy
• Loss of interest in formerly enjoyable activities
• Feelings of guilt
• Insomnia
• Low self-esteem
• Suicidal or Self-Harm Ideation

Mania

• Excessively happy feeling, euphoria
• Uncontrollably excited
• Racing thoughts
• Over-confidence
• Not needing much sleep
• Acting impulsively
• Taking risks
• Irritable
• Symptoms of psychosis

Hypomania

• Happy feeling, euphoria
• Excitable
• Racing thoughts
• Higher confidence than usual
• Not needing much sleep
• Acting impulsively
• Taking risks
• Irritable

These symptoms will typically lead to an individual behaving in a markedly different way from their normal self. For example, someone who is in a depressed state may feel suicidal, or avoid social activities wherever possible.

Conversely, an individual in a manic state may engage in risky behaviour like drug abuse, or go on a spending spree that has significant long-term ramifications. Sometimes, symptoms of psychosis can appear.

The symptoms of Mania and Hypomania are similar. It is important to mention that someone who is hypomanic will normally have more control than someone who is manic. Hypomanic episodes often last shorter than manic episodes, and psychosis will not be involved.

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Causes of Bipolar Disorder

Bipolar Disorder is a very complex illness. Its cause isn’t entirely known. It appears that certain risk factors are involved, while several factors or events appear to be capable of triggering Bipolar Disorder. Possible causes include:

• Genetics: It appears that Bipolar Disorder does run in families. Inheriting Bipolar Disorder appears to be possible, or at the least this acts as a risk factor.
• Chemical Imbalance: Most people have heard the term ‘chemical imbalance’ in terms of explaining a range of mental health conditions. Imbalances in key neurotransmitters in the brain like Serotonin, dopamine or norepinephrine can lead to a mental health condition developing. However, the effect of chemical imbalances isn’t fully understood.
• Childhood Events: A traumatic event or poor upbringing in childhood can contribute towards Bipolar Disorder developing. Some form of abuse or the death of a parent can lead to Bipolar Disorder developing. Childhood events help shape the personality of an individual.
• Abuse: Physical, sexual or emotional abuse can lead to Bipolar Disorder developing, with trauma capable of affecting an individual in many ways.
• Major Life Event: Major life events, such as a relationship breakdown, divorce, losing a job or money worries can lead to the onset of symptoms associated with Bipolar Disorder.
• Antidepressants: When someone with Bipolar Disorder has been misdiagnosed with Depression, their antidepressant medication can actually cause an episode of either Mania or Hypomania.
• Other Mental Health Conditions: Bipolar Disorder can arise as a result of a similar condition, like Depression, worsening. Bipolar Disorder often runs comorbidly with other conditions like eating disorders or Personality disorders.

It is possible that a combination of some of the above factors may lead to the onset of Bipolar Disorder. Sometimes, it isn’t known what causes the condition.

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Diagnosis of Bipolar Disorder

Bipolar Disorder cannot be diagnosed through a laboratory test or other medical examination. Instead, an individual will need to speak to a Doctor regarding their symptoms.

The doctor will ask the individual questions regarding their symptoms, and any other pertinent information. If Bipolar Disorder is suspected, the individual will normally be referred to a mental health specialist for diagnosis.

When meeting a mental health specialist, a full assessment of the individual’s condition will be conducted. This will include more detailed questions regarding the symptoms – as well as any feelings in the build up to an episode.

Each type of Bipolar Disorder has a differing diagnostic criteria. Full criteria is available on each condition’s main page. Below is a quick summary:

• Bipolar I Disorder requires at least one manic episode to have been experienced – with depressive episodes often accompanying them.
• Bipolar II Disorder involves at least one hypomanic episode to have been experienced, along with depressive phases. Bipolar II Disorder is notoriously difficult to diagnose.
• Cyclothymia can be diagnosed if an individual experiences more milder hypomania and depressive episodes.
• Rapid Cycling Bipolar Disorder involves numerous mood swings in a short space of time – featuring both mania/hypomania and depressive phases.
• Mixed Bipolar Disorder involves a simultaneous bout of depression and mania/hypomania.

A diagnosis is seldom made over one appointment. A specialist may want to observe the behaviour of an individual over a period of time, due to risks of misdiagnosis.

Bipolar Disorder can easily be confused with other conditions like Depression, Schizophrenia and various Personality Disorders. Sometimes, one of these conditions will be diagnosed instead.

By getting a full picture of how Bipolar Disorder affects an individual, the specialist can tailor a treatment plan to fit the specific symptoms.

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Treatment of Bipolar Disorder

Treatment is available for Bipolar Disorder. The intention of treatment is to help a patient control their symptoms more, and wherever possible, give them a better quality of life.

Treatment does vary slightly in each type of Bipolar Disorder, but similar treatments are used.

In the absence of treatment, depressive episodes can last for several months, sometimes up to a year. Manic and hypomanic episodes can last several months too.

Therefore, treatment is important – and it can help to stabilise mood. Treatment typically includes:

• Talking Therapy: Talking therapy is often used in the early stages of Bipolar Disorder, as an individual attempts to come to terms with their condition. There are many different types of therapy that can be used. Talking therapy can be particularly useful for helping an individual to recognise episode triggers, and to come up with healthy coping mechanisms.

Psychoanalytical Psychotherapy: Psychoanalytical Psychotherapy is a talking therapy that aims to help uncover and resolve unconscious beliefs that cause psychiatric conditions. Traumatic experiences that may or may not be buried in the unconscious mind can be highlighted and processed. Psychoanalytical psychotherapy involves talking to a trained therapist. The therapist can show the individual how early memories and past traumas have affected their thinking, behaviour and attitude in the modern day. Psychoanalytical psychotherapy is especially useful for any condition that involves past trauma. Renowned neurologist Sigmund Freud developed this therapy, which is typically completed over a long-term basis.

Psychodynamic Psychotherapy: Psychodynamic Psychotherapy is a talking therapy that is closely related to Psychoanalytical psychotherapy, though combines more areas into the therapy process. This talking therapy aims to bring to light thoughts and memories in the unconscious mind. It works on the idea that past trauma is pushed to the back of the mind, with the conscious mind neglecting to process them. This may cause long-term problems though, when a person develops defence mechanisms to cope with the issues. This tends to be a shorter-term therapy than others.

• Medication: Medication plays an important role in the treatment of Bipolar Disorder, and is the primary component of treatment. There is an array of medicines that can be used in treatment for Bipolar Disorder. Mood stabilisers, such as Lithium Carbonate, are predominantly used. They need to be taken on a long-term basis. Some anticonvulsants (primarily used for epilepsy), also have mood-stabilising properties. These include Valproate, Lamotrigine and Carbamazepine. Sometimes, both Lithium and an anticonvulsant can be prescribed together. Valproate shouldn’t ever be prescribed to women who are at a childbearing age due to a high risk of physical and mental defects in an unborn child. In cases where mania is present, antipsychotics may also provide relief. Antipsychotics can be used. Antidepressants shouldn’t be used as a standalone medication for any form of Bipolar Disorder. However, it appears that some antidepressants can help reduce the severity of depressive symptoms of those with Bipolar disorder, when used in conjunction with either a mood stabiliser or antipsychotic.

Antidepressants: Antidepressants can help to improve and regulate mood. They should improve motivation and restore energy. SSRI Antidepressants are the most commonly prescribed. They act on the brain chemical serotonin – which is thought to help in regulating mood and emotion. They may include side-effects such as a dry mouth, sexual problems and nausea, though these should hopefully be short-term. Other classes of antidepressants are available in the event of an inadequate reaction.

Antipsychotics: Antipsychotics (also known as neuroleptics) block the effect of dopamine – a chemical in the brain that is heavily linked to psychotic symptoms like hallucinations. They can also be useful for stabilising mood, and treating anxiety. They are not suitable for everyone however, and are often associated with many side effects like weight gain, dizziness and dry mouth.

Mood Stabilisers: Mood stabilisers can help level out moods, meaning fewer lows, and fewer euphoric highs are felt. Lithium Carbonate is the best-known mood stabiliser. Valproate is a well-known anticonvulsant which is often used as a stabiliser for people who cannot take Lithium Carbonate.

• Other: In severe cases, Electroconvulsive Therapy can be used. This can only ever be used in Bipolar Disorder when an individual has failed to respond adequately to a range of treatments, is experiencing a long and severe period of depression or mania, and is in a life-threatening situation.

Electroconvulsive Therapy (ECT): Electroconvulsive Therapy (commonly referred to as shock treatment) is a treatment that sees an electric current sent through the brain of an individual. The aim is to trigger an epileptic seizure, with the ultimate objective to relieve symptoms of a mental health problem. The human body is fully restrained during the procedure, which also involves a general anaesthetic. Electroconvulsive therapy is normally a last resort. Despite this, ECT actually has an impressive efficacy rate, with many people finding it helps immeasurably.

In the majority of cases, treatment can be conducted outside of the realms of a secure hospital. On occasion though, especially where cases of Bipolar involve psychosis, sometimes treatment will need to take place in a hospital.

This is especially relevant if an individual appears to be at risk of harming themselves or someone else. This doesn’t necessarily mean that an individual will need to remain overnight at the hospital.

While Bipolar Disorder is a very difficult condition to live with, there are many potential treatment courses available, which should lead to an improved level of functioning in day-to-day life.

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Living with Bipolar Disorder

Bipolar disorder is an incredibly difficult condition to live with. It is highly likely that it will cause disruption to family and friends of someone who is suffering from the condition.

The depressive phases of bipolar can lead to an individual becoming devoid of motivation and a will to live. Meanwhile the manic phase can see reckless spending and a general loss of control.

Appreciation of what the individual is going through is important. It should be noted that the individual suffering from the condition won’t often be aware they are going through the manic phase, and therefore will need guidance.

Bipolar disorder leads to complications in relationships, jobs can be difficult to undertake, and there is an increased risk of suicide. It is highly important that someone suffering from bipolar disorder takes medication prescribed for them regularly.

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Prognosis

Bipolar Disorder is associated with a poor prognosis. While some people will experience very few manic/hypomanic/depressive episodes, some people will have recurrent episodes for life.

Accessing treatment early, tolerance to key medication and the level of functional impairment are all important factors that effect the prognosis.

Unfortunately, Bipolar Disorder is associated with high suicide rates, making accessing treatment of imperative importance.

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See Also

• Bipolar Disorder Homepage
• A-Z of Mental Health Conditions
• Therapy Home
• Mental Health General Homepage