Bipolar disorder (manic depression) The Royal College of Psychiatrists Our moods are rarely completely stable and the world would be a very boring place if they were, but in bipolar disorder, mood swings aren't like normal highs and lows, they're much more intense.

In this article

Causes

Symptoms

Treatment

Bipolar (also known as manic depression) causes severe mood swings, that usually last several weeks or months and can be:

• Low mood, intense depression and despair.
• High or ‘manic’ feelings of joy, over-activity and loss of inhibitions.
• A 'mixed state' such as a depressed mood with the restlessness and over-activity of a manic episode.

The exact causes of bipolar disorder aren't known, but it’s thought the following play a part in the condition:

• Genes seem to be important; if you have a relative with bipolar disorder, then your chance of developing the condition is higher.
• There may be a physical problem with the brain systems which control mood - so bipolar disorder can often be controlled with medication.
• Stress can trigger mood swings.

There are a number of types of bipolar disorder:

• Bipolar I. There has been at least one high, or manic episode, which lasts for longer than one week. You may have only manic episodes, although most people will also have periods of depression.
• Bipolar II. Where you have more than one episode of severe depression, but only mild manic episodes (called ‘hypomania’).
• Rapid cycling. You have had more than four mood swings happen over a 12 month period. This affects around one in ten people with the condition.
• Cyclothymia . The mood swings are not as bad, but are often longer.

Symptoms include:

Depression

• Feelings of unhappiness that won’t go away
• Agitation and restlessness
• Loss of confidence
• Feeling useless, inadequate or hopeless
• Unable to think positively
• Can't concentrate or make even simple decisions
• Loss of appetite
• Sleeping problems including waking early in the morning
• Lack of interest in sex
• Avoiding other people
• Thoughts of suicide

Mania

• General elation
• Feeling more important than usual
• Full of energy or ideas; moving quickly from one idea to another
• Unable, or don't want to sleep
• More interested than usual in sex
• Making unrealistic plans
• Overactive, talking quickly
• Irritable with other people who can't go along with your mood or ideas
• Spending money recklessly

Psychotic symptoms

If a mood swing becomes very severe, you may have 'psychotic’ symptoms. These include:

• When depressed, you feel guilty, worse than anybody else, or even that you don't exist.
• When manic, you may feel you’re on an important mission or you have special powers or abilities.
• You might also experience hallucinations - when you hear, smell, feel or see something that isn’t there.

There are three groups of mood stabilisers, which can take several months to work properly.

• Lithium is used to treat both manic and depressive episodes. It can be harmful if the dose is too high, so regular blood tests are needed. Side-effects include feeling thirsty, passing lots of urine and weight gain.
• Anticonvulsants - used in epilepsy.
• ‘Atypical’ antipsychotics - used to treat schizophrenia.

Psychological treatments can be particularly helpful in between episodes of mania or depression. They include:

• Psychoeducation – finding out more about bipolar disorder
• Mood monitoring – to help you pick up when your mood is swinging
• Mood strategies – to help you stop your mood swings going into a full-blown manic or depressive episode
• Developing general coping skills
• Cognitive behavioural therapy (CBT) for depression

Self help treatments can help with episodes of bipolar, including:

• Recognising the signs that your mood is swinging out of control so you can get help early.
• Finding out as much as you can about the condition.
• Avoiding particularly stressful situations.
• Having at least one person that you can rely on and confide in. When you’re well, make sure that they understand about bipolar disorder.
• Balancing your life, work, leisure-time and relationships.
• Exercising for 20 minutes or so, three times a week, should improve your mood.
• Doing things you enjoy.

Remember, stopping your medication suddenly can trigger another mood swing. You may also want to write an ‘advance directive’ with your doctor and family to say how you want to be treated if you become unwell again.

Helping someone with Bipolar disorder

When someone is depressed, it can be difficult to know what to say. They may see everything in a negative light and not be able to say what they want you to do. Listen and be patient and understanding.

During mania, the person will appear to be happy, energetic or outgoing, but the excitement of any social situations will tend to push their mood even higher. Try to steer them away from parties or heated discussions, and try to persuade them to get help.

In between mood episodes, find out more about bipolar disorder. Go to appointments with them (if they’re happy for you to do this) and make sure you give yourself space and time to recharge your batteries.

This article was created in December 2008.