What is bipolar disorder?
Once referred to as manic depression, bipolar disorder is a chronic mental health problem largely characterised by marked changes in mood, ranging from extreme highs (mania) to extreme lows (depression). Bipolar disorder is caused by a chemical imbalance in the brain that prevents the body from regulating moods correctly.
The majority of people living with bipolar disorder experience alternating episodes of mania and depression sometimes over weeks or months. In between these highs and lows, a person with bipolar disorder may feel very stable in their mood and be able to live and work normally. Indeed, the pattern of mood changes in bipolar disorder varies widely from person to person and can even change over the course of a lifetime. Some people with bipolar disorder may have just a few episodes of mania and depression and feel totally stable in between, while other people can have many episodes, sometimes lasting weeks or months before the cycle begins again.
It’s thought that between 1% and 2% of the UK adult population live with bipolar disorder. Recent research suggests that as many as 5% of UK adults are on the bipolar spectrum. Bipolar disorder can emerge at any age, although it often develops between the ages of 15 and 19, and rarely develops after the age of 40.
What causes some people to develop bipolar disorder?
Although the exact causes of bipolar disorder are unknown, it’s believed that there are a few factors which may play a role. It’s likely that genes and the environment work together in the development of bipolar disorder.
Bipolar disorder tends to run in families. People with a first-degree relative such as a parent or sibling with the disorder may also have a higher chance of developing it than those without affected family members. Interestingly, research tell us that identical twins don’t have the same risk of developing the illness although it’s not yet known why this might be. Granted, someone can have a genetic predisposition for developing bipolar disorder, but they may never experience any symptoms.
Sometimes a major life event such as a traumatic event or a significant bereavement can trigger the onset of bipolar disorder. Where there is a genetic predisposition, such an event can bring about a manic or depressive episode.
Drug abuse or long-term alcohol abuse can also trigger bipolar disorder in some already vulnerable individuals.
Structural differences in the brain
Certain findings on brain scans may be associated with bipolar disorder. More research is needed to see how these findings specifically impact bipolar disorder and what this means for treatment and diagnosis.
There is more than one type of bipolar disorder:
Bipolar I disorder
A diagnosis of bipolar I disorder requires an individual to have had at least one episode of mania that lasts longer than one week. 90% of people with bipolar I disorder will also have periods of depression. Untreated, manic episodes will generally last three to six months, and without medical support, depressive episodes will generally last between six and 12 months. In some cases, the manic phase can trigger psychosis.
Bipolar II disorder
Mania is less prominent in bipolar II disorder with symptoms of depression featured. An individual with bipolar II will have had at least one period of severe depression and at least one period of hypomania (versus mania).
Bipolar I or II disorder with mixed features
Sometimes referred to as ‘mixed bipolar’, people with mixed features experience symptoms of mania and/or hypomania and depression at the same time. This can result in a range of symptoms including, but not limited to, agitation, trouble sleeping, a significant change in weight, and grandiose thoughts.
Bipolar I or II disorder with rapid cycling
About 10% of people with bipolar I or bipolar II disorder will experience rapid cycling. This occurs when an individual has experienced four or more depressive, manic or hypomanic episodes in a 12-month period.
Bipolar I or II disorder with seasonal pattern
Seasonal pattern means that someone’s biolar depression, mania or hypomania is regularly affected in the same way by seasons. For example, an individual might find that they have a bipolar depressive episode during the winter but their manic periods don’t follow any specific pattern.
Someone with cyclothymic disorder will have experienced regular episodes of hypomania and depression for at least two years, with no period of more than two months in which they have felt totally stable. Although individuals diagnosed with cyclothymia are on the bipolar spectrum, they aren’t considered to have a diagnosis of bipolar disorder. Cyclothymia can however develop into bipolar disorder so it’s important that someone living with this type of mood disorder gets support and is monitored regularly.
Psychotic bipolar mania or psychotic bipolar depression
In some cases where someone is experiencing an episode of severe mania or severe depression, they may also experience psychosis. Psychotic symptoms can include auditory and visual hallucinations and delusional beliefs.
Other types of bipolar disorder
These include bipolar disorder brought on by certain drugs or alcohol or due to a medical condition, such as Cushing’s disease, multiple sclerosis or a stroke.
Symptoms of bipolar disorder
In between peiods of mania and depression, people with bipolar disorder can feel well and stable but during episodes, the following symptoms are common.
Bipolar mania and hypomania
Mania and hypomania are two separate states but they share the same symptoms. Mania is more severe than hypomania and causes more noticeable problems on a day-to-day basis. At its most extreme, mania can trigger a break from reality (psychosis) and can require hospitalisation.
On the other hand, hypomania (literally meaning ‘under manic’ or ‘less than mania’) is less extreme and therefore less likely to cause damage in the person’s life. However, it still requires the right kind of support and treatment. When manic, some people report feeling at their most creative and productive and may resist offers of support believing that they are as well as can be.
For someone to be considered manic or hypomanic, they must exhibit three or more of these symptoms:
- Unusually upbeat, agitated or jumpy
- Unsually talkative, sometimes speaking in a very disjointed way
- Racing thoughts
- An inability to focus on one thing at a time
- A decreased need for sleep
- Increased sex drive
- An increase in activity and energy levels
- Exaggerated self-confidence (euphoria)
- Grandiose beliefs
- Poor decision-making such as going on shopping sprees despite the financial consequences, having sexual relations with strangers, or making bad investments.
A major depressive episode includes symptoms that are severe enough to cause noticeable difficulty in day-to-day activities. An individual experiencing an episode of bipolar depression will exhibit five or more of the following symptoms:
- Feeling very sad, empty, hopeless or tearful
- A marked loss of interest in almost all activities
- An inability to feel pleasure about anything (also known as anhedonia)
- Significant weight loss even when not dieting or significant weight gain in a short period of time
- Insomnia or sleeping too much
- Consistently negative thoughts
- Restlessness or slowed behaviour
- Low or non-existant sex drive
- Fatigue or loss of energy
- Feelings of worthlessness, or excessive or inappropriate guilt
- A decreased ability to concentrate or make decisions
- A preoccupation with death or dying
- Thinking about, planning, or attempting suicide.
Watch this video from Mind on what it’s like to live with bipolar disorder.
When and where to get support
If you are concerned that you might be living with bipolar disorder or another mood disorder, it’s vital that you seek help from your GP in the first instance. He or she will ask you questions about your moods over the past two years along with questions about your general health and lifestyle. Depending on their findings, you may be referred to a psychiatrist or other mental health professional for specialised support.
You can also visit Bipolar UK, the leading charity for information on all aspects of bipolar diagnosis and treatment.
Treatment for bipolar disorder
There are a range of treatments available to prevent episodes of bipolar depression and bipolar mania and to help people stay well over the long-term. It’s important that people living with bipolar disorder are monitored by a healthcare practitioner such as a GP or psychiatrist.
It’s thought that using a combination of different treatment methods is the best way to control bipolar disorder which may include some or all of the following:
Many people living with bipolar disorder take daily medication to prevent episodes of mania and depression. Known as mood stabilisers, they are taken daily on a long-term basis.
Some people also take medication to treat the main symptoms of depression and mania as and when they occur.
Psychological treatments or talking therapies
Depending on the severity of the symptoms, some people attend talking therapy including cognitive behavioural therapy (CBT). Talking therapies can help people to stay well, manage their symptoms, and learn how to recognise the signs that they are becoming unwell.
Many people living with bipolar disorder find that regular exercise, healthy eating, avoiding stimulants such as alcohol and caffeine, and getting enough sleep can not only help them to stay well but can lessen the symptoms of depression and mania when they do arise.