Introduction

Bipolar disorder, formerly known as manic depression, is a condition that affects your moods, which can swing from one extreme to another.

If you have bipolar disorder, you will have periods or episodes of:

  • depression – where you feel very low and lethargic
  • mania – where you feel very high and overactive (less severe mania is known as hypomania)

Symptoms of bipolar disorder depend on which mood you are experiencing. Unlike simple mood swings, each extreme episode of bipolar disorder can last for several weeks (or even longer), and some people may not experience a “normal” mood very often.

Depression

The depression phase of bipolar disorder is often diagnosed first. You may initially be diagnosed with clinical depression before having a future manic episode (sometimes years later), after which you may be diagnosed with bipolar disorder.

During an episode of depression, you may have overwhelming feelings of worthlessness, which can potentially lead to thoughts of suicide.

If you’re feeling suicidal or having severe depressive symptoms, contact your GP, care co-ordinator or local mental health emergency services as soon as possible.

If you want to talk to someone confidentially, call the Samaritans on 08457 90 90 90. You can talk to them 24 hours a day, seven days a week. Alternatively, visit the Samaritans website or emailjo@samaritans.org.

Mania

During a manic phase of bipolar disorder, you may feel very happy and have lots of ambitious plans and ideas. You may spend large amounts of money on things you cannot afford and would not normally want.

Not feeling like eating or sleeping, talking quickly and becoming annoyed easily are also common characteristics of this phase.

You may feel very creative and view the manic phase of bipolar as a positive experience. However, you may also experience symptoms of psychosis (where you see or hear things that are not there or become convinced of things that are not true).

Living with bipolar disorder

The high and low phases of bipolar disorder are often so extreme that they interfere with everyday life.

However, there are several options for treating bipolar disorder that can make a difference. They aim to control the effects of an episode and help someone with bipolar disorder live life as normally as possible.

The following treatment options are available:

  • medication to prevent episodes of mania, hypomania (less severe mania) and depression – these are known as mood stabilisers and are taken every day on a long-term basis
  • medication to treat the main symptoms of depression and mania when they occur
  • learning to recognise the triggers and signs of an episode of depression or mania
  • psychological treatment – such as talking therapy, which can help you deal with depression, and provides advice about how to improve your relationships
  • lifestyle advice – such as doing regular exercise, planning activities you enjoy that give you a sense of achievement, as well as advice on improving your diet and getting more sleep

It’s thought using a combination of different treatment methods is the best way to control bipolar disorder.

Help and advice for people with a long-term condition or their carers is also available from charities, support groups and associations.

This includes self-help and self-management advice, and learning to deal with the practical aspects of a long-term condition.

What causes bipolar disorder?

The exact causes of bipolar disorder are unknown, although it’s believed that several things can trigger an episode. Extreme stress, overwhelming problems and life-changing events are thought to contribute, as well as genetic and chemical factors.

Who is affected?

Bipolar disorder is fairly common and one in every 100 adults will be diagnosed with the condition at some point in their life.

Bipolar disorder can occur at any age, although it often develops between the ages of 18 and 24. Men and women from all backgrounds are equally likely to develop bipolar disorder.

The pattern of mood swings in bipolar disorder varies widely between people. For example, some people will only have a couple of bipolar episodes in their lifetime and will be stable in between, while others will have many episodes.

 

Symptoms of bipolar disorder

Bipolar disorder is characterised by extreme mood swings. These can range from extreme highs (mania) to extreme lows (depression).

Episodes of mania and depression can often last for several weeks or months.

Depression

During a period of depression, your 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

Mania

The manic phase of bipolar disorder 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 often have disastrous consequences, such as spending large sums of money on expensive and sometimes unaffordable items
  • making decisions or saying things that are out of character and that others see as being risky or harmful

Patterns of depression and mania

If you have bipolar disorder, you may have episodes of depression more regularly than episodes of mania, or vice versa.

Between episodes of depression and mania, you may sometimes have periods where you have a “normal” mood.

The patterns are not always the same and some people may experience:

  • rapid cycling – where a person with bipolar disorder repeatedly swings from a high to low phase quickly without having a “normal” period in between
  • mixed state – where a person with bipolar disorder experiences symptoms of depression and mania together; for example, overactivity with a depressed mood

Living with bipolar disorder

Although it is usually a long-term condition, effective treatments for bipolar disorder, combined with self-help techniques, can limit the condition’s impact on your everyday life.

Staying active and eating well

Eating well and keeping fit are important for everyone. Exercise can also help reduce the symptoms of bipolar disorder, particularly the depressive symptoms.

It may also give you something to focus on and provide a routine, which is important for many people.

A healthy diet, combined with exercise, may also help limit weight gain, which is a common side effect of medical treatments for bipolar disorder.

Some treatments also increase the risk of developing diabetes, or worsen the illness in people that already have it. Maintaining a healthy weight and exercising are an important way of limiting that risk.

You should have a check-up at least once a year to monitor your risk of developing cardiovascular disease or diabetes.

This will include recording your weight, checking your blood pressure and having any appropriate blood tests.

Self-care and self-management

Self-care

Self-care is an essential part of daily life. It involves taking responsibility for your own health and wellbeing with support from the people involved in your care.

It includes staying fit and maintaining good physical and mental health, preventing illness or accidents, and caring more effectively for minor ailments and long-term conditions.

People with long-term conditions can benefit enormously from being helped with self-care. They can live longer, have less pain, anxiety, depression and fatigue, have a better quality of life, and be more active and independent.

 

Talking about it

Some people with bipolar disorder find it easy to talk to family and friends about their condition and its effects. Other people find it easier to turn to charities and support groups.

Many organisations run self-help groups that can put you in touch with other people with the condition. This enables people to share helpful ideas and helps them realise they’re not alone in feeling the way they do. These organisations also provide online support in forums and blogs.

Some useful charities, support groups and associations include:

  • Bipolar UK
  • Carers UK
  • Mind
  • Rethink
  • Samaritans
  • SANE

Talking therapies are useful for managing bipolar disorder, particularly during periods of stability.

Services that can help

You may be involved with many different services during treatment for bipolar disorder. Some are accessed through referral from your GP, others through your local authority.

These services may include:

  • community mental health teams (CMHT) – these provide the main part of local specialist mental health services. They offer assessment, treatment and social care to people with bipolar disorder and other mental illnesses.
  • early intervention teams – these provide early identification and treatment for people who have the first symptoms of psychosis. Your GP may be able to refer you directly to an early intervention team.
  • crisis services – these allow people to be treated at home, instead of in hospital, for an acute episode. These are specialist mental health teams that deal with crises that occur outside normal office hours.
  • acute day hospital – these are an alternative to inpatient care in a hospital. You can visit every day or as often as you need.
  • assertive outreach teams – these deliver intensive treatment and rehabilitation in the community for people with severe mental health problems, providing rapid help in a crisis. Staff often visit people at home and liaise with other services, such as your GP or social services. They can also help with practical problems, such as helping to find housing and work, or doing your shopping and cooking.

Avoiding drugs and alcohol

Some people with bipolar disorder use alcohol or illegal drugs to try to take away their pain and distress. Both have well-known harmful physical and social effects and are not a substitute for effective treatment and good healthcare.

Some people with bipolar disorder find they can stop misusing alcohol and drugs once they’re using effective treatment.

Others may have separate but related problems of alcohol and drug abuse, which may need to be treated separately.

Avoiding alcohol and illegal drugs is an important part of recovery from episodes of manic, hypomanic or depressive symptoms, and can help you gain stability.

 

Money and benefits

It’s important to avoid too much stress, including work-related stress. If you’re employed, you may be able to work shorter hours or in a more flexible way, particularly if job pressure triggers your symptoms.

Under the Disability Discrimination Act 1995, all employers must make reasonable adjustments to make the employment of people with disabilities possible. This can include people with a diagnosis of bipolar disorder or other mental illnesses.

A range of benefits is available to people with bipolar disorder who cannot work as a result of their mental illness. These may include:

  • Attendance Allowance
  • Carer’s Allowance
  • Council Tax Benefit
  • Disability Living Allowance
  • Housing Benefit
  • Incapacity Benefit
  • Statutory Sick Pay

Living with or caring for someone with bipolar disorder

People living with or caring for someone with bipolar disorder can have a tough time. During episodes of illness, the personalities of people with bipolar disorder may change, and they may become abusive or even violent.

Sometimes social workers and the police may become involved. Relationships and family life are likely to feel the strain.

If you’re the nearest relative (as defined by the Mental Health Act 1983) of a person with bipolar disorder, you have certain rights that can be used to protect the person’s interests.

These include requesting that the local social services authority asks an approved mental health professional to consider whether the person with bipolar disorder should be detained in hospital (also known as “sectioning”).

You may feel at a loss if you’re caring for someone with bipolar disorder. Finding a support group and talking to other people in a similar situation might help.

If you’re having relationship or marriage difficulties, you can contact specialist relationship counsellors, who can talk things through with you and your partner.

Dealing with suicidal feelings

Having suicidal thoughts is a common depressive symptom of bipolar disorder. Without treatment, these thoughts may get stronger.

Some research has shown the risk of suicide for people with bipolar disorder is 15 to 20 times greater than the general population.

Studies have also shown that as many as 25-50% of people with bipolar disorder attempt suicide at least once.

The risk of suicide seems to be higher earlier in the illness, so early recognition and help may prevent it.

If you’re feeling suicidal or you’re having severe depressive symptoms, contact your GP, care co-ordinator or the local mental health emergency services as soon as possible.

If you can’t or don’t want to contact these people, contact the Samaritans on 08457 90 90 90. You can call them 24 hours a day, seven days a week. Alternatively, visit the Samaritans website or emailjo@samaritans.org.

Self-harm

Self-harm (sometimes called self-injury) is often a symptom of mental health problems such as bipolar disorder.

For some people, self-harm is a way of gaining control over their lives or temporarily distracting themselves from mental distress. It may not be related to suicide or attempted suicide

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