BBC - Health - Conditions - Bipolar disorder

The exact causes of bipolar disorder aren't known, but it appears to run in families. A combination of genetic and environmental factors, such as personal traumas or stress, can influence symptoms. Unresolvable problems or emotional damage in childhood may play a part.

About one per cent of people develop bipolar disorder in their lifetime. The risk is higher if you have relatives with the disorder. About 12 per cent of people with a brother or sister with bipolar disorder develop the condition themselves.

The illness tends to appear first in adulthood but may occur earlier. Men and women are affected equally.

The symptoms of depression include low mood, sleep disturbance, loss of appetite, a sense of pessimism, hopelessness, reduced sexual drive, loss of interest or pleasure in life, reduced ability to concentrate and recurrent thoughts of death and suicide.

People in mania are often described as being like a tornado. They experience elevated moods or euphoria, increased activity, pressured fast speech, self-important ideas or grandiose delusions, hallucinations, reduced sleep, increased appetite for food and sex, overspending on a wild scale and all-night excesses.

In a more severe form of mania, the person becomes psychotic, with delusions (false personal beliefs that are not subject to reason or contradictory evidence, and are not explained by a person's cultural concepts). There's a complete mismatch of perception and reality and there may be delusional beliefs about being persecuted, and hallucinations.

In the worst cases, people in mania become unintelligible and neglect themselves.

The order and frequency with which these sets of symptoms appear can vary. Some people have quite regular cycles, in which symptoms of mania are followed by symptoms of depression in a largely predictable pattern. These swings in mood can occur over a period of anything from days to months.

Other people have mixed symptoms - it's possible for a person to have many of the symptoms of mania and also suffer from severely depressive thoughts, especially if the person experiencing the mania has insight into what's happening to them.

There's no cure for bipolar disorder, but many people find that an understanding of their illness and what triggers episodes can help them live a relatively normal life.

With any condition that goes in a cycle, half the battle of managing it is knowing where you are in the cycle at any time. To cope with bipolar disorder, you can monitor your mood and thoughts and ask someone you trust to help you. Whenever they spot a relapse coming, they can warn you, and you can both take certain pre-agreed steps. For example, you might take a couple of days' rest, reviewing whether you've taken on too much lately and shedding some of it, or seeing a community mental health team member.

However, some people with bipolar disorder have extreme mood swings that can't be managed by monitoring alone. Antidepressants may be used, as may antipsychotic medication, and psychiatrists often recommend the drug lithium, which seems to stabilise mood swings.

It's important that exactly the correct level is maintained in the blood because too much can be poisonous and too little will have no effect. For this reason, people on lithium need to be seen regularly by their mental health team and have their blood levels checked.

New mood stabilisers are in development. Researchers are investigating vagal nerve stimulation and transcranial magnetic stimulation to treat bipolar disorder.

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Bipolar disorder (manic depression)

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