About Bipolar Disorder

Bipolar disorder (formerly called manic depression) is a condition experienced by approximately 2% of people that is characterised by episodes of mania. Mania is an emotional state of heightened reality during which the person may feel extraordinarily energetic, optimistic, self-confident and productive. Persons experiencing mania can often go days without sleeping, busily planning grandiose schemes or indulging in exorbitant shopping sprees (sometimes spending millions of dollars.) Many people experiencing bipolar alternate between periods of mania and deep depression. These mood swings can cycle over the course of months or years.

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What is bipolar disorder?

In everyday life we all experience ups and downs. Bipolar disorder, sometimes referred to as manic-depression, is a disorder where there are extreme shifts in mood.

It affects about 1% of the population and typically develops in late adolescence or early adulthood. Bipolar disorder can be very disruptive to the person’s life and is associated with a high suicide rate. Like diabetes or high blood pressure, bipolar disorder is a long-term illness that requires careful ongoing management. Treatment, involving prescribed medication, combined with effective coping skills that focus on symptom management and quality of life, may reduce the incidence of relapses and contribute to the person's wellbeing.

Symptoms

Bipolar disorder causes dramatic shifts in mood from overly happy and/or driven or irritable, to sad, lethargic and hopeless, sometimes with normal moods in between. These changes in mood are accompanied by changes in thinking and behaviour. The periods of highs and lows are called episodes of mania and depression respectively.

Symptoms of a manic episode include (adapted from DSM IV) :

Elevated, expansive or irritable mood, lasting at least a week or being very disruptive to daily functioning. During this period at least 3 of the following symptoms (4 if mood is irritable) are seen:

a) Inflated self-esteem or unrealistic belief in one’s abilities or power

b) Decreased need for sleep

c) More talkative than usual or need to keep talking

d) Jumping from one idea to another or racing thoughts

e) Distractibility, can’t concentrate very well

f) Increased energy

g) Excessive involvement in activities without regard for risks such as buying sprees or sexual indiscretions

Psychotic symptoms such as delusions (false, strongly held beliefs not influenced by logic or a person’s culture) and hallucinations (seeing or hearing things that are not really there) may occur in mania.

Symptoms of a depressive episode include (adapted from DSM IV) :

Depressed (sad/empty/irritable) mood or loss of interest or pleasure and at least four of the following symptoms have been present during the same two weeks:

a) Fatigue or loss of energy

b) Can’t sleep or sleeps too much

c) Marked decrease or increase in appetite; significant weight loss when not dieting, or significant weight gain

d) Feelings of worthlessness or helplessness or excessive guilt

e) Slowed down or lethargic or very restless

f) Can’t concentrate and/or more indecisive than usual

g) Recurrent thoughts about death or suicide

Psychotic symptoms such as delusions and hallucinations may occur in severe depression.

Treatments

With proper treatment most people with bipolar disorder can achieve good stabilisation of their mood swings and related symptoms. Medications known as "mood stabilisers" (e.g. lithium and certain anticonvulsant medications) are usually prescribed as a long-term treatment to help control bipolar disorder in acute episodes and also to prevent relapse. Other medications are added when necessary. Antipsychotic medication can be useful, not only if psychotic symptoms are present ,but also in the treatment of mania, and can help with anxiety, restlessness, or sleep problems linked with the illness. Antidepressants are sometimes prescribed to treat depression in bipolar disorder,but are seldom used alone, as they have been associated with triggering an episode of mania, hypomania or rapid cycling. However, in some cases they may be useful. Electroconvulsive therapy (ECT) is sometimes also used to treat acute severe conditions. While some herbal or natural supplements might potentially be useful in the treatment of bipolar disorder, little is known about their effectiveness as they have not been well studied.

Psychosocial interventions address stressful triggers of bipolar disorder and problems that can occur after episodes. Psychosocial treatments may be individual, group or family based. They can be helpful in providing support and information, and assisting in the development of effective coping skills. They can provide assistance both to people with bipolar disorder and their families. Psychosocial interventions that are commonly used include cognitive
behavioural therapy (CBT), psychoeducation, family therapy and interpersonal and social rhythm therapy.

Causes

Research suggests that there is no single cause of bipolar. Rather bipolar disorder involves a number of factors including:

Genetic factors

In terms of genetic vulnerability, on average, there is an 8% risk of a person's first-degree relatives (parents, children, siblings) having bipolar disorder compared to 1% in the general population. Scientists are trying to find
what genes may contribute to bipolar disorder and when they do, more precise diagnosis and treatments may be available.

Chemical Imbalance

Bipolar disorder is thought to occur when there is a problem with the production and breaking down of certain brain chemicals such as adrenaline, dopamine, acetylcholine, serotonin, and GABA. Research also suggests people with mood disorders (such as bipolar) have problems with the production of certain hormones that influence brain function. Mood stabilisers prescribed for bipolar disorder target these imbalances. Brain imaging studies suggest there may be certain differences in particular areas of the brain when comparing people with and without bipolar disorder. Scientists are still trying to work out how to refine these techniques and what these differences mean.

Stress

People who have a biological vulnerability to bipolar disorder may find that certain stressors set off or trigger symptoms of illness. Such stressors include major life events, disruption to the person's sleep/wake cycle and family conflict. Managing these stressors can be an important part of managing the illness.

SOME TERMS AND DEFINITIONS

Typical mixed episode

A mixed episode involves at least one week when the person experiences some symptoms of both manic and depressive episodes nearly every day. Sometimes the person experiences rapid mood swings (happy, sad, irritable); they can’t sleep, their appetite is affected, they are restless or uptight and may have delusions and suicidal thinking. These symptoms cause significant disruption to daily living. The person may need to be admitted to hospital.

Hypomania

Hypomania is similar to mania, only milder and although this means the person is able to carry out their normal daily activities, the changes in behaviour are obvious enough to be noticed by others. The symptoms must last for at least 4 days to be classifed as hypomania.

Bipolar I

This is a type of bipolar disorder that involves one or more full manic or mixed episode(s). Often the person has had one or more major depressive episodes as well.

Bipolar II

This type of bipolar disorder involves both one or more episodes of hypomania and one or more episodes of major depression.

Cyclothymic disorder

This refers to a pattern involving hypomanic symptoms and mild depressive symptoms that have been happening for two years
or more. Although 'milder' than Bipolar I or II, the symptoms of Cyclothymic Disorder are still severe enough to cause difficulties in work, education, employment and relationships.

Rapid cycling

When a person experiences 4 or more episodes of mood disturbance (mania, hypomania, major depression or mixed episodes)
within a 1-year period, they are said to have a bipolar pattern which is "rapid cycling".

Additional Resources

Australian treatment guide for consumers and carers

Beyond Blue Bipolar fact sheet

Black Dog Institute Bipolar fact sheets

British Psychological Society: Understanding Bipolar