BIPOLAR
WHAT IS BIPOLAR DISORDER?
Bipolar disorder, formally known as manic depression, is a severe mood disorder (sometimes known as affective disorder). Bipolar causes unusual fluctuations in a person's mood and is characterised by extreme highs (mania) and extreme lows (depression) often with periods of normal mood in between. Of course, we all experience changes in mood, but the symptoms of bipolar disorder are so severe that they impact on areas of life such as relationships, work and school.
There are different types of bipolar disorder:
- Mania with psychotic symptoms
- Depression with Psychotic symptoms
- Bipolar I
- Bipolar II
- Cyclothymic disorder
- Rapid cycling
- Mixed states.
WHAT CAUSES BIPOLAR?
There is currently no single explanation as to what causes bipolar, however the following factors are thought to be involved:
- Genetics
- Chemical imbalances
- Stressful events such as physical, sexual, or emotional abuse. The birth of a child or a illness.
- Personality
THE SYMPTOMS OF BIPOLAR
Going through any of these experiences can be extremely difficult to cope with, so it's worth thinking about how you can look after yourself, and what kind of treatment could help. It's also worth planning ahead for a crisis.
About manic episodes
Mania can last for a week or more and has a severe negative impact on your ability to do your usual day-to-day activities – often disrupting or stopping these completely. Severe mania is very serious and often needs to be treated in hospital.
Here are some things you might experience during a manic episode:
How you might feel
- happy, euphoric or a sense of wellbeing
- uncontrollably excited, like you can’t get your words out fast enough
- irritable and agitated
- increased sexual energy
- easily distracted, like your thoughts are racing, or you can't concentrate
- very confident or adventurous
- like you are untouchable or can't be harmed
- like you can perform physical and mental tasks better than normal
- like you are understand, see or hear things that other people can't
How you might behave
- be more active than usual
- talking a lot, speaking very quickly, or not making sense to other people
- being very friendly
- saying or doing things that are inappropriate and out of character
- sleeping very little or not at all
- being rude or aggressive
- misusing drugs or alcohol
- spending money excessively or in a way that is unusual for you
- losing social inhibitions
- taking serious risks with your safety
About hypomanic episodes
Hypomania is similar to mania, but has a few key differences:
- it can feel more manageable – for example, you might feel able to go to work and socialise without any major problems
- it lasts for a shorter time
- it doesn't include any psychotic symptoms
While hypomania is less severe than mania, it can still have a disruptive effect on your life and people may notice a change in your mood and behaviour.
Here are some things you might experience during a hypomanic episode:
How you might feel
- happy, euphoric or a sense of wellbeing
- very excited, like you can’t get your words out fast enough
- irritable and agitated
- increased sexual energy
- easily distracted, like your thoughts are racing, or you can't concentrate
- confident or adventurous
How you might behave
- more active than usual
- talking a lot or speaking very quickly
- being very friendly
- sleeping very little
- spending money excessively
- losing social inhibitions or taking risks
After a manic or hypomanic episode you might:
- feel very unhappy or ashamed about how you behaved
- have made commitments or taken on responsibilities that now feel unmanageable
- have only a few clear memories of what happened while you were manic, or none at all
- feel very tired and need a lot of sleep and rest
About depressive episodes
Here are some things you might experience during a depressive episode:
How you might feel
- down, upset or tearful
- tired or sluggish
- not being interested in or finding enjoyment in things you used to
- low self-esteem and lacking in confidence
- guilty, worthless or hopeless
- agitated and tense
- suicidal
How you might behave
- not doing things you normally enjoy
- having trouble sleeping, or sleeping too much
- eating too little or too much
- misusing drugs or alcohol
- being withdrawn or avoiding people
- being less physically active than usual
- self-harming, or attempting suicide
Many people find that a depressive episode can feel harder to deal with than manic or hypomanic episodes. The contrast between your high and low moods may make your depression seem even deeper.
About mixed episodes
Mixed episodes (also called 'mixed states') are when you experience symptoms of depression and mania or hypomania at the same time or quickly one after the other. This can be particularly difficult to cope with, as:
- it can be harder to work out what you're feeling
- it can be harder to identify what help you need
- it might feel even more challenging and exhausting to manage your emotions
- you may be more likely to act on suicidal thoughts and feelings
- your friends, family or doctor might struggle to know how they can support you best
About psychotic symptoms
Psychotic symptoms can include:
- delusions, such as paranoia
- hallucinations, such as hearing voices
Not everyone with a diagnosis of bipolar disorder experiences psychosis, but some people do. It's more common during manic episodes, but can happen during depressive episodes too. These kinds of experiences can feel very real to you at the time, which may make it hard to understand other people's concerns about you.
SELF HELP FOR BIPOLAR
While your GP may prescribe medications and talking therapies, there are additional steps a person can take to improve their condition.
This can include:
- Try to avoid stressful situations which may trigger episodes of mania or depression.
- Try to establish a daily routine, and schedule daily activities so that you have things to occupy your time.
- Ensure that you eat regularly and healthily and get plenty of sleep as good physical health can support good mental health.
- Avoid working excessively long hours as tiredness can trigger episodes of mania or depression.
- Try to do some regular relaxing activities as these will help to avoid depression and mania.
- Try to become more aware of how you are thinking, feeling and behaving. Keeping a diary of your moods, thoughts and reactions can be helpful.
- Try not to drink much alcohol or take recreational drugs as these may trigger an episode of mania.
- Take your medication as it is prescribed-Sometimes, suddenly dropping a mood stabiliser can trigger an episode of mania.
- Consider being open to family and friends about your condition. If they understand the condition, they might be able to recognise if the individual is becoming ill.
- Learn about bipolar- get an understanding of symptoms, and signs can allow you to recognise and hopefully prevent a major episode developing.
- Consider joining a self help group-these are a great source of advice, information, support and help.
- Consider putting some safeguards on the finances to prevent overspending during the mania episodes.
TREATMENTS FOR BIPOLAR
This will usually depend on what kind of episode you're experiencing.
During depressive episodes
- You're likely to be offered medication – this might be new medication or adjusting your current medication.
- You might also be offered a structured psychological treatment that's proven to help with depression, such as cognitive behavioural therapy (CBT).
During manic or hypomanic episodes
- You're likely to be offered medication – this might be new medication or adjusting your current medication.
- You're unlikely to be offered a talking treatment if you are currently experiencing a manic or hypomanic episode.
What can I do in the longer term?
The aim of treatment should be to help you maintain stable moods and manage your symptoms well. As you start to feel more stable, the majority of your support could come from a community mental health team (CMHT) or your GP, although your GP should arrange for you to still be in touch with a mental health specialist.
Your health professionals should work with you to help you identify:
- Clear emotional and social recovery goals for you to work towards and regularly reflect on and revise with your doctor.
- A crisis plan, so you know what to do if you experience any of your early warning signs or triggers, or begin to feel very distressed.
- How you feel day-to-day, so you can be aware of how best to manage your mood and notice any changes.
- A medication plan, including dates where you can review your dose, how well the medication is working and any side effects you experience.
If you are receiving a talking therapy, you might set some of these goals with your therapist. You should share these goals with your GP. You may also want to share them with your family, friends and carer if you have one.
Which talking therapies might I be offered?
There are several talking therapies you might be offered to help you manage your bipolar disorder in the long term. These are a few that have been tested and shown to work well for some people, although other therapies may work too:
- Cognitive behavioural therapy (CBT) – looks at how your feelings, thoughts and behaviour influence each other and how you can change these patterns.
- Interpersonal therapy – focuses on your relationships with other people and how your thoughts, feelings and behaviour are affected by your relationships, and how they affect your relationships in turn.
- Behavioural couples therapy – focuses on recognising and trying to resolve the emotional problems that can happen between partners.
Other types of talking therapies you may be offered are:
- Enhanced relapse prevention/ individual psychoeducation – this is a brief intervention to help you learn coping strategies.
- Group psychoeducation – this involves working in a group of people with shared experiences, led by a trained therapist, to build up knowledge about bipolar disorder and self-management.
- Family-focused therapy – this involves working as a family to look at behavioural traits, identify risks and build communication and problem-solving skills.
Some of these treatments are more widely available than others. What you are offered can also depend on what you and your doctor agree would be most useful for you.
How can talking therapies help in the long term?
Talking therapies can help you:
- Understand or make sense or meaning out of your bipolar disorder, and reflect on the impact it has had throughout your life
- Identify early warning signs and symptoms
- Develop strategies to cope with early symptoms, triggers and episodes
- Make a crisis plan
- Set goals and plans for staying well
What treatment can I get in a crisis?
If you start to feel very unwell, or if an episode of depression or mania is lasting for a long time and your regular treatment isn't working, you may need to access crisis services to help you get through it. This may include:
- Emergency support, such as going to A&E
- Getting support from a crisis resolution and home treatment (CRHT) team
- Hospital admission
