Bipolar Affective Disorder

What is bipolar affective disorder?

Bipolar affective disorder, usually just called bipolar disorder, is a mental health condition that causes extreme shifts in your mood, energy and activity levels. You swing between periods of mania or hypomania (highs) and depression (lows), each lasting far longer than an everyday mood change, often weeks at a time, and significantly affecting your day-to-day life.

Symptoms of bipolar affective disorder

Support is available if you or someone you know is having a mental health crisis, whatever you're going through. Symptoms depend on which type of episode you're experiencing, and you'll usually have stable periods in between, lasting weeks, months or even years, with few or no symptoms.

High mood: mania and hypomania

• Feeling unusually happy, excited or 'high', or unusually irritable and aggressive
• Having lots of energy, feeling restless, or needing far less sleep than usual
• Racing thoughts, jumping quickly from one idea to the next, or struggling to concentrate
• Talking quickly, so people around you may struggle to follow
• Feeling overly confident, and making impulsive or out-of-character decisions, such as overspending
• Saying or doing things that are risky, out of character, or not usual for you.

Mania is the more intense form and can affect your judgement enough to disrupt work and relationships. Hypomania involves similar but milder symptoms that don't disrupt your daily life to the same extent. In severe manic or depressive episodes, some people also experience psychotic symptoms, such as hearing or seeing things that aren't there, or holding beliefs that don't match reality.

Low mood: depression

• Feeling sad, empty or hopeless, or more irritable than usual
• Losing interest in things you'd usually enjoy
• Low energy, or feeling utterly tired
• Sleeping much more or much less than usual, and changes in your appetite
• Low confidence, and difficulty concentrating or making even simple decisions
• Thoughts of suicide or of harming yourself.

It was once thought that people with bipolar disorder returned fully to normal between episodes, but many people continue to notice mild low mood or difficulty thinking clearly even when they seem better.

Causes of bipolar affective disorder and who is at risk

The exact cause isn't known, but research points to a combination of biological, psychological and social factors working together, rather than any single cause.

Biological factors

There's a strong genetic link. You're more likely to develop bipolar disorder if a parent, brother or sister has it, though having a family member with the condition doesn't mean you'll develop it yourself. Imbalances in the brain's chemical messengers, which help regulate mood, are also thought to play a part; medication used to treat bipolar disorder works by adjusting these chemicals.

Psychological and social factors

• Childhood trauma, abuse, or neglect
• A stressful or upsetting life event, such as a relationship breakdown, bereavement, or money problems
• Excessive self-criticism or perfectionism, which can worsen low moods
• A lack of social support, or a difficult family or home environment.

Recreational drugs, particularly cannabis and cocaine, can trigger or worsen episodes, as can some medicines, including certain antidepressants, either while you're taking them or as you come off them. A parasite called toxoplasma gondii, which causes the infection toxoplasmosis, has also been linked to a higher risk.

Are there different types of bipolar affective disorder?

There are two main types, along with a milder, longer-term pattern and other less common presentations:

• Bipolar 1: at least one manic episode lasting a week or more, or severe enough to need hospital treatment. Depressive episodes often follow, but aren't needed for this diagnosis
• Bipolar 2: at least one hypomanic episode lasting four days or more, together with at least one depressive episode lasting two weeks or more, without ever having had a full manic episode. The depressive episodes tend to be the more prominent, longer-lasting feature
• Cyclothymic disorder (cyclothymia): a milder, longer-term pattern of hypomanic and depressive symptoms

Other specified or unspecified bipolar and related disorders: presentations that don't fit neatly into the categories above.

How is bipolar affective disorder diagnosed?

If your GP thinks you may have bipolar disorder, they'll refer you to a psychiatrist. Because symptoms vary so much between people and can resemble other mental health conditions, diagnosis can take time, and a psychiatrist may want to observe your symptoms over more than one appointment before reaching a conclusion.

To help build a picture, they're likely to ask about the symptoms you've experienced, the length, frequency and severity of your episodes, any patterns or triggers, how your symptoms affect your daily life, your family's mental health history, and your general lifestyle and physical health. You can bring someone you trust to appointments for support.

Getting a firm diagnosis can take a while. Research by the charity Bipolar UK suggests it takes an average of around nine and a half years from first mentioning symptoms to a confirmed diagnosis, with an average of three or four misdiagnoses along the way, so try not to be discouraged if it takes time to get a clear answer.

How is bipolar affective disorder treated?

Bipolar disorder can't be cured, but the right combination of treatment and support helps most people manage their symptoms and live full, productive lives. A psychiatrist will work with you to build a treatment plan, usually combining medication with talking therapy.

Medication

Mood stabilisers are usually central to treatment, helping to even out the highs and lows and reduce how often episodes happen. Lithium is often used as a first-choice, long-term option, and is well established for reducing the risk of relapse, as well as the risk of self-harm and suicide. Other medicines may be used during an acute manic or depressive episode.

Because everyone responds differently, finding the right medication and dose can take some trial and error, guided by your psychiatrist. Never stop taking a prescribed medicine without medical advice, even if you're feeling better, since this can trigger a relapse. If you're pregnant or planning a pregnancy, tell your doctor, as some bipolar medicines aren't safe to take at this time.

Talking therapies

Psychological therapies are usually offered alongside medication, particularly to help prevent relapse and manage depressive episodes. Options include cognitive behavioural therapy (CBT), which helps you identify and change unhelpful thought patterns, interpersonal therapy, and group psychoeducation, which helps you and sometimes your family understand and manage the condition.

Other support

Because bipolar disorder and some of its treatments can affect your physical health, regular health check-ups are recommended, including your weight, blood pressure and blood tests. A stable daily routine also helps: try to keep regular sleep patterns, eat well, exercise, and manage stress, while avoiding recreational drugs, excess alcohol, smoking, shift work, lots of caffeine, and flying across time zones where you can, since all of these can trigger episodes.

If your symptoms are severe, particularly if there's a risk of harm to yourself or others, you may need a period of hospital care or support from a crisis team at home. In rare cases, where episodes are severe, prolonged, and haven't responded to other treatments, electroconvulsive therapy (ECT) may be considered.

When should I see a doctor?

If you or someone else is having a mental health crisis or emergency, including thoughts of suicide or self-harm, get urgent help straight away. This could mean contacting your GP, your care co-ordinator, a local mental health crisis team, or NHS 111.

Outside of a crisis, see a GP if you have extreme mood changes that last a long time or are affecting your everyday life, or if you've already been diagnosed with bipolar disorder and your current treatment doesn't seem to be helping. If you're worried about a friend or family member, gently encourage them to speak to their GP.