( taken from Royal College of Psychiatrists Leaflet on Bipolar disorders)
Bipolar disorder used to be called ‘manic depression’. As the older name suggests, someone with bipolar disorder will have severe mood swings. These usually last several weeks or months and are far beyond what most of us experience. They are:
feelings of intense depression and despair
feelings of extreme happiness and elation for example, depressed mood with the restlessness and overactivity of a manic episode
About 1 in every 100 adults has bipolar disorder at some point in their life. It usually starts between the ages of 15 to 19 - and it rarely starts after the age of 40. Men and women are affected equally.
We don't understand this well, but research suggests that:
This depends on which way your mood has swung.
The feeling of depression is something we all experience from time to time. It can even help us to recognise and deal with problems in our lives. In clinical depression or bipolar disorder, the feeling of depression is much worse. It goes on for longer and makes it difficult or impossible to deal with the normal things of life. If you become depressed, you will notice some of these changes:
You have an intense sense of well-being, energy and optimism. It can be so strong that it affects your thinking and judgement. You may believe strange things about yourself, make bad decisions, and behave in embarrassing, harmful and - occasionally - dangerous ways.
Like depression, it can make it difficult or impossible to deal with day-to-day life. Mania can badly affect both your relationships and your work. When it isn't so extreme, it is called 'hypomania'.
If you become manic, you may notice that you are:
If you are in the middle of a manic episode for the first time, you may not realise that there is anything wrong – although your friends, family or colleagues will. You may even feel annoyed if someone tries to point this out to you. You increasingly lose touch with day-to-day issues – and with other people's feelings.
If an episode of mania or depression becomes very severe, you may develop psychotic symptoms.
As well as these unusual beliefs, you might experience hallucinations - when you hear, smell, feel or see something, but there isn't anything (or anybody) there to account for it.
Some people can get back to normal in between their mood swings. But this is not so for many people with bipolar disorder. You may continue to experience mild depressive symptoms and problems in thinking, even when you seem to be better.
Bipolar disorder may result in you having to stop driving for a while. Visit the DVLA website for further information.
There are some things you can try to control mood swings so that they stop short of becoming full-blown episodes of mania or depression. These are mentioned below, but medication is still often needed to:
There are several mood stabilisers, some of which are also used to treat epilepsy or schizophrenia. Your psychiatrist may need to use more than one medication to control mood swings effectively.
Lithium has been used as a mood stabiliser for 50 years – but how it works is still not clear. It can be used to treat both manic and depressive episodes.
Treatment with Lithium should be started by a psychiatrist. The difficulty is getting the level of Lithium in the body right – too low and it won't work, too high and it becomes toxic. So, you will need regular blood tests in the first few weeks to make sure that you are getting the right dose. Once the dose is stable, your GP can prescribe your Lithium and arrange the regular blood tests.
The amount of Lithium in your blood is very sensitive to how much, or how little, water there is in your body. If you become dehydrated, the level of Lithium in your blood will rise, and you will be more likely to get side-effects, or even toxic effects. So, it’s important to:
It can take three months or longer for Lithium to work properly. It's best to carry on taking the tablets, even if your mood swings continue during this time.
These can start in the first few weeks after starting Lithium treatment. They can be irritating and unpleasant, but often disappear or get better with time.
Less common side-effects are:
These can usually be improved by lowering the dose of Lithium.
The following signs suggest that your Lithium level is too high. Contact your doctor immediately if you notice:
At first you will need blood tests every few weeks to make sure that you have the right level of Lithium in your blood. You will need these tests for as long as you take Lithium, but less often after the first few months.
Long-term use of Lithium can affect the kidneys or the thyroid gland. It is wise to have blood tests every few months to make sure that they are working properly. If there is a problem, you may need to stop Lithium and consider an alternative.
There are other medications, apart from Lithium, that can be used to help.
You need to discuss this with your doctor, but some general principles are:
Much depends on how well you get on with a particular medication. What suits one person may not suit another, but it makes sense to first try the medications for which there is better evidence.
Lithium reduces your chance of relapse by 30–40%, but the more manic episodes you’ve had, the more likely you are to have another one.
|Number of previous manic episodes||Chance of having another episode in the next year|
|Not taking Lithium||Taking Lithium|
|1-2||10% (10 in 100)||6-7% (6-7 in 100)|
|3-4||20% (20 in 100)||12% (12 in 100)|
|5+||40% (40 in 100)||26% (26 in 100)|
As you get older, the risk of getting further episodes stays much the same. Even if you have been well for a long time, you still run the risk of having another episode.
After just one episode, it’s difficult to predict how likely you are to have another. You may not want to start medication at this stage – unless your episode was very severe and disruptive.
If you have a second episode, there is a strong chance of further episodes – so most psychiatrists would usually recommend a mood stabiliser at this point.
For at least two years after one episode of bipolar disorder, and for up to five years if there have been:
If you continue to have troublesome mood swings, you may need to continue medication for longer.
More information about other mood stabilisers can be found in our online leaflet Medications for Bipolar Disorder.
In between episodes of mania or depression, psychological treatments can be helpful. Treatment usually involves around 16 one-hour sessions over a period of 6 to 9 months.
Psychological treatment should include:
(More information about CBT can be found in our leaflet Cognitive Behavioural Therapy.)
You should discuss any pregnancy plans with your psychiatrist. Together, you can arrange how to manage your mood during the pregnancy and for the first few months after the baby arrives.
If you are pregnant, it's best to discuss with your psychiatrist whether or not to stop Lithium. Although Lithium is safer in pregnancy than the other mood stabilisers, the risk to the baby needs to be weighed against the risk of you becoming depressed or manic. The risk is greatest during the first three months of pregnancy. Lithium is safe after the 26th week of pregnancy, although you should not breastfeed your baby if you are taking Lithium.
During pregnancy, everyone involved - the obstetrician, midwives, health visitors, GP, psychiatrist, and community psychiatric nurse – need to stay in close touch with each other.
Any antidepressant should be stopped. Lithium, Sodium Valproate, Olanzapine, Quetiapine or Risperidone are most often used to treat a manic episode.
Once the treatment has started, symptoms usually improve within a few days, but it may take several weeks for a full recovery. You should check with your doctor if you want to drive while taking this sort of medication.
Other help: If you run into trouble from, say, spending too much when you are high, your mental health team will help you to negotiate with your bank or people you owe money to. If this has happened, it may be worth thinking about giving power of attorney over your affairs to a carer or relative whom you trust.
Learn how to recognise the signs that your mood is swinging out of control so you can get help early. You may be able to avoid both full-blown episodes and hospital admissions. Keeping a mood diary can help to identify the things in your life that help you – and those that don't.
Find out as much as you can about your illness - and what help there is. There are sources of further information at the end of this leaflet. See support groups and caring organisations.
Try to avoid particularly stressful situations - these can trigger off a manic or depressive episode. It's impossible to avoid all stress, so it may be helpful to learn ways of handling it better. You can do relaxation training with CDs or DVDs, join a relaxation group, or seek advice from a clinical psychologist.
Try to balance your life and work, leisure, and relationships with your family and friends. If you get too busy you may bring on a manic episode.
Make sure that you have enough time to relax and unwind. If you are unemployed, think about taking a course, or doing some volunteer work that has nothing to do with mental illness.
Reasonably intense exercise for 20 minutes or so, three times a week, seems to improve mood.
Make sure you regularly do things that you enjoy and that give your life meaning.
You may want to stop your medication before your doctor thinks it is safe – unfortunately this often leads to another mood swing. Talk it over with your doctor and your family when you are well.
If you have been admitted to hospital for bipolar disorder, you may want to write an ‘advance directive’ with your doctor and family to say how you want to be treated if you become ill again.
If you are taking Lithium or any other medication for your bipolar disorder, your GP is now expected to give you an annual physical health check. This will check your:
If you are taking Lithium, you will need a Lithium level check every 3-6 months, and a blood test for thyroid and kidney function at least every 15 months.
Mania or depression can be distressing – and exhausting - for family and friends.
It can be difficult to know what to say to someone who is very depressed. They see everything in a negative light and may not be able to say what they want you to do. They can be withdrawn and irritable, but at the same time need your help and support. They may be worried, but unwilling or unable to accept advice. Try to be as patient and understanding as possible.
At the start of a manic mood swing, the person will appear to be happy, energetic and outward-going - the ‘life and soul’ of any party or heated discussion. However, the excitement of such situations will tend to push their mood even higher. So try to steer them away from such situations. You can try to persuade them to get help, or get them information about the illness and self-help.
Practical help is very important – and much appreciated. Make sure that your relative or friend is able to look after themselves properly.
In between mood episodes, find out more about bipolar disorder. It may be helpful to go with your friend or loved one to any appointments with the GP or psychiatrist.
Give yourself space and time to recharge your batteries. Make sure that you have some time on your own, or with trusted friends who will give you the support you need. If your relative or friend has to go into hospital, share the visiting with someone else. You can support your friend or relative better if you are not too tired.
Keep the name of a trusted professional (and their telephone number) for any such emergency. A short admission to hospital may sometimes be needed.
If you become manic or depressed, you may temporarily not be able to look after your children properly. Your partner, or another family member, will need to organise the children's care while you are unwell. It can be helpful to make plans for this in advance when you are well.
You may find that your child may feel anxious and confused when you are not well. If they cannot express their distress in words, toddlers can become difficult or clingy, and older children will show it in other ways.
Children will find it helpful if the adults around them are sensitive, understanding, and can respond to their difficulties in a calm, consistent and supportive way. Adults can help them to understand why their parent is behaving differently. Questions will need to be answered calmly, factually and in language they can understand. They will feel better if they can keep to their usual daily routine.
Older children may worry that they have caused the illness – that it is their fault. They need to be reassured that they are not to blame, but also to be shown what they can do to help. When an older child takes responsibility for caring for a sick parent, they will need particular understanding and practical support.
( taken from Royal College of Psychiatrists Leaflet on Bipolar disorders)