Today I feature a common disorder - BIPOLAR.
Bipolar disorder is an illness that affects the normal function of the brain. It causes extreme mood swings from elation to depression. The condition used to be known as 'manic depression'. Bipolar Disorder is an illness that results from an imbalance of chemicals in the brain, which can cause extreme fluctuations of mood from the heights of mania (elevated mood which may be out of character for the individual) to the depths of depression (persistent low mood). Everyone experiences happiness and sadness, however those that live with Bipolar Disorder feel these mood changes at an exaggerated level. The changes are often referred to as cycles or episodes.
The cause of bipolar disorder is not fully understood but there are likely to be various reasons leading to its development. It has been shown to run in families.
Bipolar affects about one in 200 people during their lifetime and the illness is usually recognised in young adults. Treatment focuses on mood stabilisers and reducing the symptoms of depression and mania.
There are two types of bipolar disorder:
- Bipolar I Disorder - a 'high' (mania) followed by an episode of depression
- Bipolar II Disorder - depression followed by a less extreme 'high' (mania)
For more details on understanding the signs and symptoms of Bipolar Disorder please go to recognising bipolar disorder.
Bipolar Disorder often goes unrecognised and there is good evidence that it can take up to 10 years for an accurate diagnosis of Bipolar Disorder. Earlier recognition of Bipolar Disorder is likely to offer the hope of more appropriate management strategies being initiated. For some examples of management and coping strategies which have been useful to other people, please visit out Managing recovery section.
If you think this sounds like you or someone you care about then your doctor can help. If you go to the mood disorder questionnaire fill it in and take to your doctor, it may help determine whether further actions or referrals are required as there are many avenues for help starting with your general practitioner.
Bipolar Disorder used to be called Manic Depression.
In the 1960's, it became apparent that there were major differences between people that experienced mania and those that experienced depression, particularly in course and family history. The overlap has always been recognised, but in order to indicate the separation, 2 new terms were adopted: unipolar depression and bipolar disorder.
Bipolar Disorder is a complex illness and symptoms may vary widely amongst individuals. The DSM-IV criteria are a commonly used framework to help clinicians reach a diagnosis.
Bipolar Disorder is characterised by mood swings from extreme highs (mania) to extreme lows (depression). While everyone feels happy and sad at times, people with Bipolar Disorder feel these far more extremely and changes in mood can be sudden. These mood swings are known as episodes or cycles.
Below are some of the symptoms that may characterise Bipolar Disorder:
Three or more of these symptoms are present and have lasted for more than a week:
- Self-esteem is often inflated, can include grandiose ideas
- Decreased need for sleep (e.g. feels rested after 3 hours of sleep)
- More talkative than usual
- Ideas are prolific or a belief that thoughts are racing
- Easily distracted
- Increased goal-directed activity (this can lead to reckless behaviour - socially, at work or sexually)
- Excessive involvement in pleasurable activities that are often high risk and have a high potential for painful consequences (e.g. spending sprees, sexual indiscretions, high risk business investments)
Hypomania is mania that lasts for shorter periods. The distinction between mania and hypomania may be difficult, however usually the level of impaired functioning is greater for mania than hypomania. There is usually no hospitalisation required for hypomania and an absence of psychotic features.
Five or more of these symptoms have been present during the same 2-week period (depressed mood or loss of interest or pleasure must be one of the symptoms):
- Depressed mood (feeling sad or empty or appears tearful)
- Noticeable loss of interest or pleasure in usual activities
- Significant change in body weight or appetite (more or less)
- Insomnia or excessive sleep
- Mental or physical slowing or restlessness
- Low energy
- Feelings of worthlessness or inappropriate guilt
- Reduced ability to concentrate
- Recurrent thoughts of death, thoughts or attempts at suicide
The rapid alternation between mania and depression every day for at least a week.
People with four or more episodes of mania, hypomania, mixed state or depression in the preceding 12 months are described as rapid cycling.
Psychotic symptoms are often found in the very extreme cases of mania with the manifestation usually being in a distortion of reality through hallucinations or delusions, or really bizarre activity.
Treating Bipolar Disorder
As Bipolar Disorder is a biological illness that often has a genetic component, treatment is usually long-term.
Treatment for Bipolar Disorder often includes a combination of medications to manage the symptoms plus psychological therapies to help in dealing with the illness and living a full and meaningful life.
As everyone is different, management for Bipolar Disorder can vary widely. Professional help is needed to maximise the likelihood of long-term success. Treatments for Bipolar Disorder are evolving rapidly and now tend to be very successful.
The management of Bipolar Disorder usually has three parts:
- Treating the current episode of mania or depression
- Preventing the recurrence of mania and depression
- Managing the recovery
As Bipolar Disorder has two distinct conditions to treat, mania and depression, treatment usually involves more than one medication.
As a biological condition with genetic elements, long-term treatment is usually necessary to prevent relapses of mania or depression. Without treatment including medication and psychological counseling, relapse is likely.
The term "mood stabiliser" is used to describe medications that are effective in both acute and maintenance phases of therapy.
Here are some of the more common groups of medications used in Bipolar Disorder:
- Antiepileptic drugs
- Conventional antipsychotics
- Newer antipyschotics
- Anti-anxiety medications
Psychological therapies such as counselling, Cognitive Behavioural Therapy and Interpersonal Therapy have clearly shown results that are greater than when the person receives medication alone.
- Counselling: Counselling is aimed at helping with problem solving - solving any long term problems in the family or at work. This encompasses a broad range of approaches and goals. Crisis Counselling involves solving sudden major problems.
- Cognitive Behavioural Therapy (CBT): aims to show people how thinking affects their mood and to teach them to think in a positive way about life and themselves. CBT is conducted by trained therapists and is likely to include a series of sessions as well as homework between sessions.
- Interpersonal therapy: the goal of interpersonal therapy is to understand how social factors (such as work, relationships and social roles) are operating in a person's life situation. The therapy will generally involve 12-16 sessions with a trained counsellor.
Non-medicine approaches to managing Bipolar Disorder
- Electroconvulsive Therapy (ECT) is used to treat severe mania and severe depression - usually in situations where medication can't be taken, such as due to side-effects, pregnancy, or where a person may resist medication but be a danger to themselves (e.g. starving, dehydrated, chronically abusing substances, banging head on wall, etc.). There has been some negative press about the use of ECT, however this is a safe and painless procedure which can be life-saving for severe depression. It is now administered to very specific areas of the brain so that side effects are limited or of very short duration.
Medicines (not prescribed)
Herbal remedies and other natural supplements have not been well studied and their effects on Bipolar Disorder are not fully understood.
Omega-3 fatty acids (found in fish oil) are currently being studied to find out if they may be useful for long-term treatment of Bipolar Disorder.
St John's Wort (hypericum perforatum) is being studied for possible use treating depression. However there is evidence that it can reduce the effectiveness of some medications and can react with some prescribed antidepressants, plus it may cause a mood swing into mania.
In some circumstances, there maybe a role for hospital care to ensure that people receive the most appropriate treatment. A short hospital stay of days or weeks may help in an emergency.
Did you know?
Treating Bipolar Disorder can be complex - both initially and in the long term. To prevent relapse, treatment usually needs to continue for long periods of time - for many months or years. Frequent discussion with medical professionals is recommended.
For more information on maintaining the management of Bipolar Disorder please go to early signs of relapse.
Tools and Downloads
This has recently been developed by mental health professionals to help assess if someone truly has Bipolar Disorder and, if so, what their particular challenges are. Please complete the questionnaire and take it with you to discuss with your health professional. It may help your medical professionals see what you are feeling.
As Bipolar Disorder is characterised by extreme and sudden moods, this diary can help to monitor changes over time. As people with Bipolar Disorder often resist the idea that they have a mental illness, this mood diary may be particularly useful for self-analysis.
For further reading and resources on Bipolar Disorder can be found at Resource Library.
Bipolar Disorder: www.bipolar.com.au
The Black Dog Institute: www.blackdoginstitute.org.au
Sane Australia: www.sane.org
For general information to help people with mental illness improve physical wellness go to: www.mindbodylife.com.au
Clancy's comment: I hope this post has been helpful. Don't forget. No one with Bipolar asked for it when disorders were being handed out. Also, if you were not born with a disability, you'll probably pick one up along the way ...