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Worcestershire Health and Care NHS Trust

What is Bipolar Disorder?

‘Bipolar disorder’ (which used to be called manic depression in the past) describes swings in mood from periods of overactive, excited behaviour known as ‘mania’ to deep ‘depression’. These changes in mood are often referred to as ‘cycles’ or ‘episodes’. Everybody can have ups and downs in their mood from time to time in daily life. With bipolar disorder, these changes tend to be much more extreme and may affect day-to-day tasks, relationships, impair job or school performance or lead to risky behaviour. In between mood swings, young people with bipolar disorder are able to function normally, go to college, hold a job, and have a normal family life.

Some people have very few bipolar disorder episodes, with years of stability in between them; others experience many more. Episodes can vary in both length and frequency from days to months, with varying lengths of time in between. Although many people cope very well in between episodes, some people experience low-level symptoms in these relatively ‘stable’ periods which can impact on their daily lives.

Some people may also see or hear things that others around them don't (known as having visual or auditory hallucinations) or hold false fixed beliefs about themselves, their abilities or other people(known as delusions). These are called  ‘psychotic symptoms’ and  tend to reflect the person's extreme mood. For example, psychotic symptoms when someone is in a manic episode may include believing they are famous, have a lot of money, or special powers. In the same way, a person having a depressive episode may believe they are ruined and penniless, or have committed a crime.

Manic episodes

In a manic episode, three or more of the following are present and have lasted for more than a week. Symptoms may include:

  • Feeling very happy, elated or overjoyed.

  • Talking very quickly.

  • Feeling full of energy.

  • Feeling self-important.

  • Feeling full of great new ideas and having important plans.

  • Being easily distracted.

  • Being easily irritated or agitated.

  • Being delusional, having hallucinations and disturbed or illogical thinking.

  • Not feeling like sleeping.

  • Not eating.

  • Doing things that may be risky and impulsive, such as spending sprees, reckless behaviour socially, at work or sexually, driving very fast.

  • Making decisions or saying things that are out of character and that others see as being risky or harmful. 

A person may be quite unaware of these changes in their attitude or behaviour. After a manic phase is over, they may be quite shocked at what they've done and the effect their behaviour may have had.

Sometimes, people experience a milder form (less severe and for shorter periods) of mania known as ‘hypomania’. During these periods people can become very productive and creative and may see these experiences as positive and valuable.

Depressive episodes

Five or more of the following have been present during the same 2-week period (depressed mood or loss of interest or pleasure must be one of the symptoms).

Symptoms may include:

  • Feeling sad and hopeless.

  • Lacking energy.

  • Difficulty concentrating and remembering things.

  • Loss of interest in everyday activities.

  • Feelings of emptiness or worthlessness.

  • Feelings of guilt and despair.

  • Feeling pessimistic about everything.

  • Self-doubt.

  • Being delusional, having hallucinations and disturbed or illogical thinking.

  • Lack of appetite.

  • Difficulty sleeping.

  • Waking up early.

  • Suicidal thoughts.

Types of bipolar disorder:

Bipolar Illness is usually grouped into two types: Bipolar I and Bipolar II.

Bipolar I: People with Bipolar I Disorder experience manic episodes that last at least seven days, or manic symptoms that are so severe that the person may require hospital care. Usually, the person also has depressive episodes, typically lasting at least two weeks. The symptoms of mania or depression involve a major change from the person's normal behaviour.

Bipolar II: People with Bipolar II Disorder experience episodes of depression plus episodes of a mild form of mania called ‘hypomania’. In hypomania, a person may have increased energy and activity levels that are not as severe as typical mania, last less than a week and do not disrupt daily functioning or require emergency care. A person having a hypomanic episode may feel very good, be highly productive, and function well. This person may not feel that anything is wrong.

Some people with bipolar disorder can repeatedly swing from a high to low phase quickly without having a "normal" period in between. This is known as ‘rapid cycling’. In rapid cycling, a person will have four or more episodes of symptoms within a year although some people can experience more than one episode in a week, or even within one day. Rapid cycling may be more common in people who have their first episode at a younger age. Rapid cycling affects more women than men.

Some people can experience a ‘mixed state’ where they experience feelings of depression and elation at the same time. During a mixed state, symptoms often include agitation, trouble sleeping, changes in appetite, and suicidal thinking. People in a mixed state can feel very sad or hopeless while also feeling extremely energized.

Who can develop bipolar disorder?

About 1-2% of people can develop bipolar disorder (roughly equal numbers of men and women) in their lifetime. It often develops in a person's late teens or early adult years. At least half of all cases start before age 25. Some people may have their first symptoms during childhood, while others may develop symptoms later in life. Bipolar disorder is not easy to spot when it starts but with early diagnosis, bipolar disorder can be successfully treated.  

What causes bipolar disorder?

Very little is known about the causes of bipolar disorder. There are a number of possible factors that have been identified.

Family history: bipolar disorder does run in families, suggesting a genetic link. Although many people have no known family history.

Hormones: Disturbances in the endocrine system which controls hormones in the body may also be involved. An overactive thyroid gland (hyperthyroidism) can mimic the symptoms of bipolar disorder, and it is very important that this is excluded by a test of thyroid function (this is a simple blood test).

Stress and stressful life events: the start of a bipolar disorder may be linked to a period of great stress, such as leaving home, starting college, exams, childbirth or a career change or problems in everyday life such as a relationship breakdown or money problems. Stress seems to be the most significant trigger.

Sleep disturbance is an important contributor and can be both a trigger and an early sign of mood changes.

Difficult childhood experiences: severe emotional damage caused in early life by physical, sexual or emotional abuse or early grief, loss, trauma or neglect can all be contributing factors.

The importance of early recognition and treatment

Earlier recognition of Bipolar Disorder is important. Delays in getting the correct diagnosis and treatment can lead to more personal, social, and work-related problems.  Early treatment helps most people to stabilize the mood swings and reduce the frequency and severity of episodes and enables people to get on with their lives. Medication can be very effective in controlling mania and preventing the recurrence of both manic and depressive episodes. Early intervention will also include providing information, support, education, and guidance to the young person and their family to aid understanding and coping.

Useful websites

http://www.bipolaruk.org.uk  Website of Bipolar UK, a UK user-led charity for individuals and families affected by bipolar disorder. Includes information about self help, bipolar disorder , e-forum and a quarterly journal.

http://www.rethink.org/diagnosis-treatment/conditions/bipolar-disorder  Rethink Mental Illness website has a dedicated section providing information on bipolar disorder, including symptoms of bipolar disorder and how it can be treated and managed, including National Institute for Health and Clinical Excellence (NICE)recommendations for treatment

http://www.bbc.co.uk/health/tv_and_radio/secretlife_index.shtml BBC website based around Stephen Fry’s two part documentary ‘The Secret Life of the Manic Depressive’ exploring what life is like with bipolar disorder. Includes a bipolar diary and eight short videos of individuals talking about their bipolar experiences.

http://www.bipolarscotland.org.uk/  Bipolar Fellowship Scotland’s website resource about bipolar disorder including information, recommended reading and support groups in Scotland.

http://www.mentalhealth.org.uk/information/have-your-say/personal-stories/ The website includes a selection of personal stories, including two by people who have had bipolar experiences (Sara and James) and what they have found useful in their recovery journey.

http://bipolarblast.wordpress.com/recovery-stories/ A website advocating alternative approaches to understanding and supporting bipolar disorder. Includes a selection of recovery stories.

moodscope.comA free on line service where each day you can record a right now snapshot of how you are feeling. This builds to a mood graph that helps you identify triggers for mood changes. Users find mood scoring can have a direct positive impact on mood.

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