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Bipolar affective disorder

Published by Bupa's health information team, July 2008.

This factsheet is for people with bipolar affective disorder, or who would like information about it.

Bipolar affective disorder is a condition which causes mood swings that touch the extremes of your emotions. Your mood varies from excitement and elation known as mania, to depression and despair.

Bipolar affective disorder is also called manic depression, or sometimes just bipolar disorder.

About bipolar affective disorder

Bipolar affective disorder affects the activity of the brain so it becomes disordered and this is shown in your behaviour. If you have bipolar affective disorder you will experience extremes of emotion, from excessive energy and elation to depression and suicidal thoughts. Your mood will swing between the two.

One in every 100 adults is affected by bipolar affective disorder at some point during their life. It's most likely to occur between your mid teens and mid twenties. Men and women are equally likely to develop bipolar affective disorder.

If you have bipolar affective disorder you may be diagnosed with a certain type.

Symptoms of bipolar affective disorder

The symptoms of bipolar affective disorder vary. They usually appear for a set amount of time (an episode) and include certain patterns of behaviour.

Mania and hypomania (mild mania)

Different people react during an episode of mania in different ways. You may:

Manic episodes can last for long periods, for example a few months, which can lead to physical exhaustion, excessive spending and unwise or inappropriate relationships.

Depression

This can also vary from person to person, but generally you will:

The depressive phase can be so different to the manic phase in that it can produce profound feelings of despair.

Mixed

Some people have feelings of mania and depression which occur at the same time. For example, you may feel sad but also have lots of energy all at once. About four in 10 people with bipolar affective disorder have symptoms which are mixed. People with mania may also experience brief feelings of depression.

Psychosis

You may also have delusions (false beliefs), hallucinations (hearing, seeing, smelling or feeling things that aren't there) and you may find it hard to communicate with people. Symptoms of psychosis may occur at the same time as mania or depression.

Cyclothymia

You may experience transient changes in mood which are relatively mild but are still unpleasant. These are common and not diagnostic of bipolar affective disorder. This is cyclothymia.

Causes of bipolar affective disorder

The exact cause of bipolar affective disorder is not known, but it's probably due to a combination of factors.

There may be another cause of your altered mood such as steroids, substance misuse or stress-related issues.

Diagnosis of bipolar affective disorder

A relative or friend may realise you have bipolar affective disorder before you do as they are more aware of the changes in your behaviour. If you or your friend/relative thinks you have the symptoms of bipolar affective disorder you should visit your GP.

It can be difficult to diagnose bipolar affective disorder because you may only go to your GP when you feel depressed, and not when you feel elated. It can be confused with other conditions such as depression and schizophrenia. You may also suddenly recover from an episode without treatment.

Your GP will ask about your symptoms and talk to you. He or she will ask you about your medical history and how you are feeling. You may be referred to a psychiatrist, a doctor who specialises in mental health, or a community mental health team for further help.

Treatment of bipolar affective disorder

Treatments help keep your mood constant and treat the symptoms of mania or depression.

Self help

You may find it helps to keep track of your moods so you can prevent episodes of mania or depression, and so you can ask for support if you feel you need it. A mood diary can help you see what affects you and how severe your symptoms are.

Learning how to deal with stress can prevent episodes. Maintaining a good work-life balance and doing things that you enjoy can help you relax and feel well. Regular exercise and a healthy diet are also helpful. For more information, see Related topics.

Medicines

Antipsychotics

If you are having a manic episode, your doctor may prescribe an antipsychotic medicine to treat your symptoms short term or before a mood stabilising medicine is given. This may include medicines such as olanzapine and quetiapine. Side-effects include weight gain and dizziness.

Mood stabilisers

To help prevent mood swings, mood stabilising medicines such as lithium may be given. The lithium dose you take will need to be monitored by a doctor who will take blood tests to make sure you are getting the right dose. You may feel better in a few days but it can take three months or so for lithium to start working properly.

Side-effects can include weight gain, tremors and feeling thirsty. If the level of lithium is too high in your body you may be sick, slur your speech and stagger. If you have these symptoms you should contact your doctor immediately. When taking lithium you should eat regularly, drink plenty of unsweetened fluids and not drink caffeinated drinks, as this can affect your medication.

Valproic acid may also be given to treat the manic episodes of bipolar affective disorder. Side-effects can include feeling sick, diarrhoea, tremors and stomach problems. Always continue your medication as advised by your doctor, even if you start to feel well. You shouldn't suddenly stop your medication as it may make your symptoms come back (relapse).

Antidepressants

You may be advised to take this medication short term for an episode of depression. Medicines include the type of antidepressants called selective serotonin reuptake inhibitors (SSRI) such as citalopram and fluoxetine.

There is the risk that you may switch from depressive to manic symptoms when taking these medicines. Some can be taken with mood stabilisers to prevent this occurring. Side-effects can include palpitations, sleep problems and confusion.

For more information, see Related topics.

Psychological treatments

Cognitive behavioural therapy is a talking treatment that helps to change the way you think, feel and behave. This can help treat the depressive symptoms of bipolar affective disorder.

For more information, see Related topics.

Talking and thinking about your bipolar affective disorder with a counsellor or psychologist may help prevent your symptoms returning.

Hospital treatment

If psychotic or manic symptoms are severe, you may need to be admitted to a hospital to have appropriate care, supervised by a psychiatrist.

For people who are unwilling to have treatment, the Mental Health Act gives doctors certain powers to keep them in hospital for treatment. Usually, hospital treatment is only imposed when there is a risk to a person's health or safety, or that of others. This is often because you don't realise you are unwell.

Women and pregnancy

Certain medicines such as carbamazepine can affect the contraceptive pill and you may need to use additional barrier methods of contraception to prevent pregnancy.

Some medicines such as lithium and valproic acid can increase the risk of development problems in unborn babies. Ask your doctor for advice if you are planning to have a child or have become pregnant while taking medicines prescribed for bipolar affective disorder. If you are planning to get pregnant you will need to plan the pregnancy carefully. You may need to change your medication or stop taking it. Medication may need to be restarted straight after labour as this is a risk time for relapse. You should let your midwife know you have bipolar affective disorder.

Help and support

You may decide to give family and friends information about bipolar affective disorder so they know what to expect if you have an episode. Family and friends can help by understanding the condition and how it affects you.

There may be times when you need support or help immediately. This may be if you neglect yourself by not eating or drinking during an episode as this can affect your medication. You may even behave in a way which puts yourself or others at risk of harm. You will usually have contact with a key worker (social worker or community psychiatric nurse). You should consider giving friends or family their contact details for emergency situations or if they are worried about you.

Further information

Related topics

Sources

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: July 2008.