Bipolar disorder

Bipolar disorder is a treatable illness.

Bipolar disorder (once called manic depression) is a medical condition which affects the brain, causing extreme mood changes – someone with this disorder may be very ‘high’ and over-excited or very ‘low’ and depressed, often with periods of normal moods in between.

The good news is that Bipolar disorder can usually be successfully treated – most people recover well from episodes of illness and can lead fulfilling lives.

What causes Bipolar disorder?

No one fully understands the causes but most experts agree that it’s a combination of things including heredity and changes to chemical interactions within the brain. Episodes of mania or depression may be triggered by events which a person vulnerable to Bipolar disorder experiences and finds stressful.

How many people are affected?

More people than you may think. It’s quite a common condition that affects as many as one person in 50 at some time in their lives. It happens to people from all ethnic backgrounds. Although it can appear at any age, it’s more likely to develop for the first time in the teens or twenties, and tends to affect more women than men.

What do people experience during an episode?

How long the extreme moods of Bipolar disorder last, and how intense they are, varies a lot from one person to another.

Some people experience mainly ‘highs’, some experience more ‘lows’, while others experience both extremes. Some people may even experience both high and low moods together – they may be extremely energised, for instance, but feel very depressed and hopeless too. This is called a ‘mixed mood state’. For some people there is a ‘rapid cycling’ between the two states.

What are the extreme moods people with Bipolar disorder experience?

There are extreme moods common to Bipolar disorder that include mania, hypomania, depression psychosis.

Mania

Sometimes called ‘a manic episode’, mania means the high end of the mood scale.

Symptoms include:

• Feeling extremely euphoric or very irritable.
• Needing less sleep.
• Being very talkative – talking very fast, or bubbling with ideas, which aren’t followed through.
• Having racing thoughts – people sometimes feel as if they can’t keep up with their own thoughts.
• Risky behavior – being in this manic stage can make people less inhibited, so they may do reckless things like drive too fast, spend too much money, make unwise business investments or gamble. They may be more sexually active than usual, sometimes with people they wouldn’t normally have sex with.
• Inflated sense of confidence or power – acting as if they’re superior or more important than others.

Symptoms like these can cause real problems at work and in relationships. Sometimes people in this manic stage may need treatment in hospital.

Hypomania

This is like a milder, less extreme form of mania – on a mood scale it lies somewhere between a feeling of normal elation and mania.

To someone experiencing this mood, hypomania may seem really good – they may feel as if they’re functioning well and being very productive. However, it often leads to actions the person later regrets and, without treatment, can lead to severe mania or a switch to depression.

The difference between hypomania and mania is that it tends to be shorter (often lasting less than a week), less disruptive to a person’s social or working life, and not require a stay in hospital.

Depression

This is the low end of the bipolar mood scale, but it’s more than normal sadness. People with depression cannot simply ‘snap out of it’. They lose motivation and interest in normal activities or things they used to enjoy.

Symptoms include:

• Feeling depressed, sad, anxious or agitated.
• Feeling slowed-down physically.
• Lethargy and lack of energy.
• Having difficulty concentrating on simple tasks or making decisions – it can be very hard for them to make the effort to do everyday things like cook, make phone calls or appointments, for instance.
• Losing interest in things they usually enjoy and becoming withdrawn.
• Seeing things in a negative way.
• Sleeping too much or having trouble sleeping.
• Eating too much or too little.
• Wanting to cry for no particular reason.
• Thinking about killing themselves, feeling hopeless and that life isn’t worth living.
• Feeling guilty without reason.

Psychosis and Bipolar disorder

When someone is in a very extreme mood state – either very manic or very depressed, they may have symptoms of psychosis (sometimes called a ‘psychotic episode’).

Psychosis – a word that’s often misused – simply refers to a condition affecting the mind, which makes a person lose touch with reality. They may have delusions (believing things that aren’t true), which tend to fit the mood that the person is in. If someone is manic, for instance, they may have delusions about being wealthy or powerful, but if they’re very depressed, they may believe they’ve done something wrong, such as committing a crime.

Occasionally some people with Bipolar disorder also have hallucinations – seeing, hearing, tasting or smelling something that isn’t there.

Psychosis is more likely to develop if the person isn’t taking medication regularly.

Medication is just the start . . .

Although Bipolar disorder can’t yet be cured, treatment can do a lot to reduce and even eliminate symptoms.

Combining medication with a healthy lifestyle and support from community services and health professionals can help to keep you well.

Taking medication

Being prescribed one or more drugs with different actions at different times can help you balance your moods.

It’s important to take medication as directed, otherwise your symptoms won’t be controlled as effectively. If  you have any side-effects from your medication, tell your doctor – they may be able to reduce or change the dosage, or suggest other ways to manage the problem.

Do I really have to take medication?

Taking medication is one of the most positive things you can do to fight the effects of mental illness – reducing symptoms and the risk of relapse, and improving quality of life. Many symptoms of Bipolar disorder are caused largely by changes in brain chemistry – medication can help restore the usual chemical balance.

Medications for Bipolar disorder

These types of medication are prescribed for Bipolar disorder:

• Mood stabilisers – may be given to treat and reduce the risk of further manic episodes and depression.
• Antidepressants – may be given for a short period if someone feels depressed even though they’re taking mood stabilisers. When you take antidepressants, it’s important to keep taking mood stabilisers – otherwise there’s a risk of developing mania or hypomania.
• Antipsychotic drugs – these can work in a way similar to mood stabilizers, treating both mania and depression, and helping reduce the risk of further episodes. They also prevent or minimize psychotic symptoms such as hallucinations and delusions.

What about side-effects?

It’s important to remember that the same medication can affect people quite differently. In other words, not everyone who takes a particular medication will experience the same unwanted side-effects.

Lithium carbonate

Lithium carbonate is a mood stabiliser that many people find helpful, but can sometimes accumulate in the body and cause unwanted (and potentially harmful) effects.

To prevent this, a blood test is repeated regularly during treatment to monitor the lithium concentration and to confirm that the dose is at the right level. People taking lithium long term should also have thyroid, kidney and central nervous system monitoring to ensure there are no problems.

The signs of lithium toxicity are nausea, vomiting and diarrhoea, usually preceded by increasing tiredness, difficulties in concentrating, unsteadiness and increased thirst. If it appears that someone has a toxic reaction, the treating doctor should be contacted immediately. In most cases of toxicity, the lithium will be eliminated from the body within about two days after stopping the treatment.

Other possible side-effects of lithium (when taken at recommended levels) are a fine tremor, muscular weakness and cognitive difficulties such as memory problems.

Antipsychotic medication

Antipsychotic medication, prescribed for some people with Bipolar disorder, can also have side-effects. As with other medications, these vary from person to person. They may include drowsiness, weight gain, dry mouth, problems with sexual function, absence of periods, and a fall in blood pressure when standing which can cause dizziness.

Always tell your doctor about any of these unwanted effects, so that you can discuss ways to avoid or manage and minimise them.

Getting the most from medication

Here are some tips on how to get the most from your medication:

• Don’t be afraid to ask questions about your medication – understanding what a drug does, and why you need it, makes it easier to keep taking it. Ask how the treatment will help you, how it will affect you and about its advantages and disadvantages.
• Make it simpler – using dosage dispensers available from pharmacies or calendars can help you keep on track and make it easy to remember to take medication.
• Let family and close friends know about your medication – people close to you can provide good support when you’re taking medication long term – it’s good for them to understand how the medication helps and what any side-effects might be.
• Always tell your doctor if your medication is causing problems.
• Look after your physical health – including a healthy diet, regular exercise and checkups. If you take an antipsychotic medication, these may cause weight gain as a side-effect, and this is associated with a number of physical health problems. See How to help yourself for more details on what you and your doctor can do to manage it.

How ‘talking therapies’ can help

Talking to your doctor or another mental health professional can be very worthwhile – besides providing support, it can help you learn ways to cope with problems.

There are different types of ‘talking therapy’, including Cognitive behaviour therapy (CBT) and Interpersonal therapy (IPT).

For further information on the different types of therapies available, see Psychological treatments in the Medication and other Treatments guide.

Can ECT (electroconvulsive therapy) help?

ECT is an established, safe treatment that can be helpful for severe depression, mania and psychosis in cases where medication doesn’t help.

It works by using electrical stimulation to release brain chemicals that help restore normal functioning to the brain.

The treatment is usually only given with the consent of the person involved. An exception is when a psychiatrist believes a person is unable to give informed consent and gives the consent for them (but this should only happen after discussing the issue with the person’s primary carer). In some parts of Australia ECT can’t be given unless two doctors agree that it’s the best approach.

The treatment, done in hospital under general anaesthetic, involves passing an electrical current through the brain.

There are not thought to be any long-term adverse effects, apart from memory problems, which are mostly mild and improve with time. These sometimes persist for weeks or (less commonly) months. A headache after treatment is usually gone after a few hours. Studies show that ECT does not cause any ongoing damage to the brain.

Treatment in hospital

In-patient hospital treatment for mental illness is usually only necessary during periods when someone is very ill.

The chances are that their stay will be as short as possible and in the psychiatric unit of a general hospital, rather than a hospital dealing only with psychiatric illness.

Having treatment without your consent

If a psychiatrist or other health processional recommends someone needs treatment and the person doesn’t agree, they may sometimes be treated without their consent. In some parts of the country, this is known as ‘sectioning’ or ‘scheduling’.

The law covering this varies from one State or Territory to another, but the intention is to make sure people have treatment for the sake of their own health or safety, or that of others.

There may be legal limits on how long someone can be treated without their consent, and they may ask to be discharged by a doctor or a body such as a Mental Health Review Board. These facts should be explained to anyone having treatment without their consent.

Community support

Getting together with other people who have the same diagnosis as you can really help. As well as overcoming isolation, it’s a good way to share useful information and strategies to help you cope.

To find a support group in your area: call the SANE Helpline on 1800 18 SANE (7263) or on SANE Helpline Online.

There may be other useful support services in your area too. These include recreational programs, personal helpers and services that provide support to find accommodation or jobs, for instance. Ask your case manager for details.

Will alternative therapies help?

Some people find alternative therapies such as acupuncture or herbal medicine helpful. If you decide to try an alternative therapy as well as your prescribed treatment, make sure that there will be no harmful side-effects. Some alternative therapies are not recommended for people with a mental illness (herbal remedies can interact with other drugs, for example) so it is important to discuss using them beforehand with your doctor.

Be wary of anyone who suggests they can cure your condition (when something sounds too good to be true, it usually is).

For more information, see Medication and other treatments.

Taking positive action against an illness helps minimise the risk of another episode and reduce the effect of symptoms. It also helps people feel good about themselves because it shows they can start to take control of their lives again.

There are a number of ways in which you can take positive action, for example, relieving stress by going for a walk or meditating.

Learn to manage stress

Everyone needs to find ways to manage stress – but it’s especially important if you have Bipolar disorder because stress can trigger episodes of illness.

Some suggestions:

• Going for a walk, yoga, meditation, aromatherapy, or having a long bath can all help to relieve stress – find what works for you.
• Relaxing with things you enjoy – whether it’s a movie, a book, listening to music, watching TV, meeting people or being with a pet – should be a regular part of your life.
• Think about ways of reducing stress in your life. Don’t try to pack too much into your day, for instance, and try to deal with one thing at a time.
• If you can’t avoid stressful events, give yourself time to relax and recover afterwards. If stress is becoming a problem, ask your doctor or case manager to suggest ways of dealing with it.

Get a good night’s sleep

Having Bipolar disorder can sometimes disrupt sleep patterns. Lack of sleep can increase stress and cause problems with mood.

Some suggestions:

• Try to avoid things that interfere with sleeping patterns, for example – shift work, staying out all night or staying up late to study.
• Get to know what helps you sleep, for example – having a warm (not hot) bath 20 minutes before bedtime, allowing enough time to wind down before bedtime, avoiding caffeinated drinks (cola drinks, as well as coffee or tea) or too much alcohol before bed. (Alcohol can make it easy to fall asleep, but may make you wakeful in the night.)

Avoid recreational drugs

Speed (amphetamines), cannabis, and cocaine can all trigger manic episodes, while heavy use of cannabis can trigger psychosis (heavy use is defined as smoking most days or every day).

Ecstasy’s main ingredient (MDMA) can trigger mania. Another problem with this drug is that its after-effects include depression and sleeplessness – the last things you need when you have a diagnosis of Bipolar disorder.

Benzodiazepines (minor tranquillisers) are also known to trigger episodes of depression or mood swings.

While it’s not clear what effect other party drugs like ketamine (sometimes called ‘Special K’) and GHB, may have on Bipolar disorder, the general advice for anyone with a mental health problem is to leave them alone.

Alcohol

While moderate alcohol intake is unlikely to be harmful (‘moderate’ means two drinks or less for women daily and no more than four drinks daily for men, with several alcohol-free days a week), people with Bipolar who drink heavily may not control their illness well.

The combination of alcohol with antidepressants and antipsychotic drugs may also make you very drowsy – talk to your doctor about how much alcohol is safe for you and what the effects may be.

Smoking

If you smoke, then giving up cigarettes is a dramatic way to improve your general health and reduce the risk of serious illness (as well as improve your bank balance). While depression can be a temporary side-effect of quitting for some people, don’t let this put you off.

Talk to your doctor or psychiatrist about the best way to quit successfully and safely, avoiding the risk of associated depression.

For more information on drugs in general, please see the Guide to Drugs.

For more information on how to quit smoking, please see the Guide to a Smoking and Mental Illness.

Looking after your health

For people affected by Bipolar disorder, it’s even more important to do things that are good for you.

Some people affected by mental illness can be at greater risk of physical health problems such as diabetes and heart disease, because of the effects of symptoms and side-effects of medication as well as lifestyle factors.

For this reason it is important to see a GP regularly and have periodic checks of weight, waist measurement and blood tests for cholesterol, blood sugar, and liver function among others.

The doctor can also advise on a healthy lifestyle, including an improved diet, getting regular exercise, quitting smoking, and sleeping well, for example.

For more information on how to live more healthily, please see the Healthy Living.

Keep an eye on your moods

After you’ve experienced a few extreme mood swings, you’ll find it easier to see them coming.

Signs of mania or hypomania may include having increased energy, feeling like taking on more projects, being more impatient and irritable, and feeling more ‘inspired’ than usual.

Signs of depression may be feelings of anxiety, sleeping more, or finding it hard to get out of bed in the morning. But it’s also important to know the difference between episodes and the usual ups and downs that we all experience.

It’s normal to feel down for a day or so sometimes, but if the feeling doesn’t go away, talk to your doctor. The same goes for feeling elated – it’s normal when you’ve had some good news or there’s another real reason for it, but not if you stay high as a persistent mood.

Tackling suicidal thoughts

It’s not uncommon for people to have thoughts about harming or killing themselves when they’re depressed – just remember that these are only thoughts, that they will pass and there’s no need to act on them.

These thoughts are also a real warning that your treatment needs improving, so talk to your doctor about them as soon as possible. Adjusting medication can help deal with the causes of suicidal thoughts, and psychological treatments can help with strategies to cope with the thoughts if they do arise again.

For more information on how to mange and prevent suicidal feelings, please see Staying Alive.

Stay in touch

Depression sometimes means you don’t feel like talking to other people. It’s important to fight this feeling because not mixing with others can make the depression worse. Try to make the effort to stay in touch with family, friends and neighbours – you’ll feel better for it.

Living with, or having a close relationship with, someone who has Bipolar disorder can be demanding if they have extreme moods. If they are feeling depressed, it’s important to remember that problems such as having trouble getting out of bed and lack of motivation aren’t laziness, but symptoms of an illness which can be seriously disabling.

During times of mania or hypomania, the person may feel there’s nothing wrong and become angry if you suggest there’s a problem. When the episode has passed, ask them to suggest what’s the most helpful thing you can do when they are becoming unwell.

Remember, carers need to look after their own health too. When someone you care about has an extreme emotional state, it’s natural for you to be affected by this.

While caring for the person, try to maintain your own life, interests and feelings. Eating good food, getting regular exercise and making time to relax all help you stay in good shape physically and mentally – and that makes it easier to cope. This will help you be a better carer, as well as help your own mental health.

Many people find it helpful to be in touch with a carer support group. Contact the SANE Forums provide a safe, moderated online space where people affected by mental illness, as well as family and others carers, can share information and advice and provide mutual support.

The doctor and any other members of the treatment team should also be able to provide you with support and any relevant information. They sometimes need reminding about this responsibility,

For further information for families or carers of a person with Bipolar disorder, please see Families.

In a crisis

If you or someone you know experiences a mental health crisis, it can be difficult for others to know what to do. See How to help in a crisis for advice on how to help.