Bipolar disorder

First published by ABC Health and Wellbeing Updated: 03/10/2014

We all have mood swings from time to time, but for someone with bipolar disorder these moods become extreme and can have a significant impact on their life.

Everyone has mood swings from time to time, but when a person has bipolar disorder these moods become extreme and can affect their personal and professional life.

People with bipolar disorder experience episodes of extreme highs (mania or hypomania) and lows (depression) in mood, which is why the condition was once known as manic depression.

These shifts in mood are much more severe than the changes in mood that most people experience from day to day.

About 2 per cent of people will develop bipolar disorder at some time in their lives and the Black Dog Institute says it is thought about 80 per cent of bipolar disorder has a genetic basis.

Treatments are effective, allowing most people with bipolar disorder to function well and enjoy a productive lives.

Types

Health professionals categorise bipolar disorder into 3 main types: bipolar 1, bipolar 2 and cyclothymia.

• Bipolar 1 disorder is when people have had at least one episode of mania lasting at least one week, but they may or may not have had any episodes of depression. During a manic episode people can become psychotic (lose touch with reality) which can require hospitalisation.
• Bipolar 2 disorder is when people have had at least one episode of depression and a less severe form of mania called hypomania. Although symptoms aren’t as extreme as bipolar 1, the effect on people’s lives in the long-term can often be just as significant.
• Cyclothymia is when people have troubling moods and numerous episodes of hypomania and depression lasting two years or more but they don’t meet the full criteria for bipolar 1 or bipolar 2.

Symptoms

The pattern of mood swings differs from person to person. Some may have an episode once a decade while others can have daily mood swings. The average person with this condition has an episode lasting 3 to 6 months every few years.

Sometimes the symptoms of both mania and depression can occur at the same time and when this happens it is called a mixed state.

If people have four or more episodes within a year they have rapid-cycling bipolar disorder.

The mania phase of the disorder is characterised by feelings of extreme euphoria and energy as well as having increased activity and being highly productive. Symptoms occur to milder extent in people with hypomania. Symptoms may include:

• having an inflated self-esteem or a sense of being important in some way
• having a reduced need for sleep
• talking more than usual
• having racing thoughts
• being easily distracted
• being more productive than usual such as at school or work
• being involved in potentially harmful activities such as spending sprees, sexual indiscretions, or foolish business investments.

The depression phase of the disorder can appear the same as in unipolar depression. It is characterised by a depressed mood and a loss of interest or pleasure in usual activities. Symptoms may include:

• feeling sad or empty, or being tearful
• reduced interest or pleasure in usual activities
• feelings of worthlessness or guilt
• difficulty concentrating or feeling mentally slow
• fatigue or loss of energy
• decreased appetite and weight loss
• sleep disturbance – insomnia or sleeping too much
• recurrent thoughts of death or suicidal thoughts

Suicide

Some people with bipolar disorder can become suicidal particularly during the depression phase. The suicide rate is about 15 times higher in people with bipolar disorder than in the general population. Suicide attempts mostly occur during the depression phase.

If you or someone you know is thinking about suicide and you are in Australia, call:

• Emergency on 000 (or 112 from a mobile phone)
• Lifeline on 13 11 14
• Kids Helpline on 1800 551 800
• MensLine Australia on 1300 789 978
• Suicide Call Back Service on 1300 659 467

Diagnosis

There’s no single test for bipolar disorder and there may be a 10 to 20 year delay from when symptoms start until someone is diagnosed with the condition.

Diagnosis is usually made by a psychiatrist. They will do a detailed assessment of the history of the illness and severity of the symptoms including looking at things like the pattern of mood swings and how much work and relationships are affected.

They will usually order tests to rule out physical illness and they also assess risk of harm including risk of financial and sexual harm as well as suicide or self-harm.

Treatment

Bipolar disorder often requires lifelong treatment. Treatments are effective so most people with bipolar disorder can manage their illness.

Working with a team of doctors, psychologists and other health professionals to develop a tailored treatment plan and getting support from family and friends can help people successfully manage their illness. The mainstay of treatment for bipolar disorder involves medication and psychological treatments.

Medications are essential for treating bipolar disorder. They include:

• Mood stabilisers: These are used to treat or prevent mania or hypomania. Examples include lithium carbonate, sodium valproate, olanzapine, lamotrigine and quetiapine. Mood stabilisers can be taken with or without antidepressants. They take about a week to start working.
• Anti-depressants are used to treat symptoms of depression. Examples include selective serotonin reuptake inhibitors (SSRIs) or serotonin-noradrenalin reuptake inhibitors (SNRIs). Taking antidepressants alone without a mood stabiliser might trigger a manic or hypomanic episode. They may take two weeks or more to start working.

Psychological treatments are used together with medication and are designed to help people learn to live with a diagnosis of bipolar disorder. Psychological treatments may include cognitive behavioural therapy, family therapy, group therapy, psycho-education and counselling. They can help with strategies like:

• sticking to healthy lifestyle habits including diet and exercise
• developing healthy sleep habits
• quitting alcohol and other drugs
• learning stress management techniques.

Other treatments available:

• Electroconvulsive therapy (ECT): ECT involves using an electric current to stimulate the brain. It is safe and painless and used in people with severe depression who have not responded to medication or other treatments.
• Hospitalisation: This might be necessary in people who are behaving dangerously, at risk of suicide or becoming detached from reality (psychotic). Day treatment and inpatient programs are available.
• Support groups: Attending a support group with other people who have also experienced bipolar disorder has been shown benefit in helping people communicate with their doctor and stick to their treatment plans.

This article was reviewed by Philip Mitchell, Scientia Professor and Head of the School of Psychiatry, University of New South Wales.

By Dr Jocelyn Lowinger