Bipolar disorder | Mate rangirua

The word bipolar describes the mood fluctuations – from the extremely elated mood (mania) to the very low mood (depression) – that people with this condition experience.

We all have mood swings and times of feeling low or excited. With bipolar disorder, these mood swings are more extreme and affect your ability to carry out normal daily tasks. These mood swings can last days, weeks or months.

Bipolar disorder has been experienced by some of the greatest writers, medical people, musicians, artists and scientists in history, such as Sir Isaac Newton, Florence Nightingale and Mark Twain. 

However, experiencing bipolar disorder can be an overwhelming, frightening and isolating experience. 

If you are in crisis, you may feel that you can't control your extremely negative emotions or grandiose feelings and you may regret actions you carried out while in an elevated mood. It may seem as if your world has fallen apart, that everything is black, that nothing makes sense or that you are in danger. Please get crisis help(external link)(external link) right away if you feel like this.

The cause of bipolar disorder remains unclear. However, factors believed to play a role include genetics, brain chemicals, social and environmental factors, substance abuse and medical illnesses. Sometimes its onset can be linked to a stressful or traumatic life event.

Genetic factors are thought to account for about 60–80% of the cause of the condition. If one parent has bipolar disorder, there is a 10–25% chance that his or her child will develop the illness. If both parents have bipolar disorder, the likelihood of their child developing the illness is about 10–50%.

Bipolar mood changes are called mood episodes. You may have manic or hypomanic (milder mania) episodes, depressive episodes or mixed episodes (which include both manic and depressive symptoms). Elated mood can range from fairly mild through to extremely elated mood, known as mania. 

In a manic episode you may: 

• feel very up or high
• feel jump or wired
• feel extremely energised despite a lack of need for sleep over several days
• have exaggerated self-confidence
• talk really fast about a lot of different things
• be agitated, easily irritable or touchy
• have trouble relaxing or sleeping
• think you can do a lot of things at once and be more active than usual
• do risky things, like spend a lot of money or engage in sexual activities outside of your normal sexual behaviour.

Depression might be identified by extreme tiredness despite sleeping a lot, bouts of uncontrollable crying, loss of interest and motivation, feeling hopeless, helpless or worthless for some time and having thoughts about dying.

In a depressive episode you may:

• feel very down or sad
• feel worried and empty
• have trouble concentrating
• forget things a lot
• lose interest in fun activities and become less active
• feel tired or slowed down
• have trouble sleeping
• think about death or suicide.

These behaviours may develop slowly, so it can be hard to tell whether some are part of your normal character. It can be helpful to ask significant others in your life who know you well whether they have noticed some unusual behaviour. In extreme cases, the symptoms are very intense and you may put yourself or others at risk or feel ashamed after you have recovered. 

You can do a self-test to see if you might have the symptoms of bipolar disorder: Self-test for bipolar disorder(external link)(external link) Black Dog Institute, Australia.

If you think you or someone you care about has these symptoms, see your family doctor (GP). The earlier a diagnosis is made, the better the recovery usually is.

Your doctor may do a physical examination and ask for blood test to rule out any other conditions that may be causing your symptoms. If they think you might have bipolar disorder, they will assess your symptoms to see if they meet the criteria from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5). 

Bipolar disorder includes 2 different conditions – bipolar I and bipolar II.

• Bipolar I disorder is a manic-depressive disorder that can exist both with and without psychotic episodes.
• Bipolar II disorder consists of depressive episodes (which can range from mild to severe) and at least one hypomanic episode that does not inhibit normal everyday functioning. If a full manic episode has been experienced, a diagnosis with Bipolar I Disorder is warranted.

To be diagnosed with bipolar disorder, you must have experienced at least 1 episode of mania or hypomania.

To be considered mania, the elevated, expansive or irritable mood must last for at least 1 week and be present most of the day, nearly every day. To be considered hypomania, the mood must last at least 4 days in a row and be present most of the day, almost every day.

During this period, 3 or more of the following symptoms must be present and represent a significant change from usual behaviour:

• inflated self-esteem or grandiosity
• decreased need for sleep
• increased talkativeness
• racing thoughts
• easily distracted 
• increased goal-directed activity or agitated movement
• engaging in activities that hold the potential for painful consequences, eg, unrestrained buying sprees.

The depressive side of bipolar disorder is characterised by a major depressive episode resulting in depressed mood or loss of interest or pleasure in life. You must experience 5 or more of the following symptoms in 2 weeks to be diagnosed with a major depressive episode:

• depressed mood most of the day, nearly every day
• insomnia or hypersomnia
• loss of interest or pleasure in all, or almost all, activities
• significant weight loss or weight gain, or decrease or increase in appetite
• engaging in purposeless movements, such as pacing the room, or the opposite, minimal physical movement/activity
• fatigue or loss of energy
• feelings of worthlessness or guilt
• diminished ability to think or concentrate, or indecisiveness
• recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt.

In addition, these symptoms must cause significant impairment in everyday functioning and not be caused by substance use, medication, or other mental health problems.

If your doctor thinks you have bipolar disorder, they may refer you to a psychologist or psychiatrist.

With help and support from family and friends, most people learn to manage their bipolar disorder and get on with life. You are likely to have times when you are well and times when you are unwell. The treatment with medication offered by your doctor or psychiatrist is tailored to your needs to help you recover from periods of illness so you get back to your normal moods and behaviours. They then adjust your treatment to help you remain well. 

Medical treatment is usually accompanied by psychological support to learn about the triggers and identify the early warning signs of your symptoms, and to teach you effective and healthy coping strategies.

Most people return to their usual level of functioning after times of illness, although about 1 in 5 will have some ongoing difficulties.

Medication

There are several medicines that have been shown to be helpful in relieving depression and others that are useful in stabilising moods. It is quite common for people with bipolar disorder to be taking some medication long term. Your doctor can help you find the ones that suit you best without causing unnecessary side effects.

Treatment for bipolar disorder can be tricky, when compared to treating (unipolar) depression, because taking an antidepressant drug at the wrong time runs the risk of 'flipping' your depression into a manic mood. This means that mood stabiliser drugs and antidepressants are used carefully, and introduced gradually.

You may be referred to a psychiatrist so that your mood problems and the best treatment for you can be worked out early on. Even so, there may be some trial and error until the best combination for you is worked out.

Talking to your doctor will help you understand your moods and regain control of your life. 

Commonly used mood stabilising medications are Lithium, Valproate and Carbamazepine. Sometimes antipsychotic medicines (eg, Olanzapine and Quetiapine) or antidepressants (eg, Fluoxetine, Paroxetine and Citalopram) are also useful.

If you are taking lithium, you will need regular blood tests to check the right amount is being given. The mood benefits may take a few months to really be noticed. If the lithium level in your blood gets too high you may notice shakes and twitches, weakness, slurred speech, sleepiness, stomach cramps, loss of appetite and vomiting. Contact your doctor, psychiatrist or practice nurse right away. Stop the lithium if you can't contact your doctor.

Also talk to your doctor, nurse or psychiatrist if your other medications appear to cause you problems. They can check you have the most appropriate medication at the right dose. Your doctor will be happy to talk about any medication side effects that might be a problem. Depending on the medicine, these can include weight gain, stomach problems, slowed thinking, tremors (shakes, twitches) or nausea.

The use of medications during pregnancy needs consultation with an expert. Taking your medication every day as directed is important for keeping well long term.

Talking therapy

Psychotherapy can help you develop skills and strategies to manage the condition. It also gives you a non-judgmental place to deal with any emotions, such as sadness, guilt, anger or shame.

Electroconvulsive therapy (ECT)

In some circumstances, electroconvulsive therapy (ECT) might be recommended. Read more about ECT(external link)(external link).

There is much you and your family/whānau can do to help you develop skills and strategies for reducing mood swings and staying well. 

• Exercise helps your mental as well as physical wellbeing (the benefits can be substantial).
• Avoid all alcohol and illegal drugs (they cause mood changes).
• Eat a healthy, balanced diet.
• Develop a good sleep routine and get a good sleep every night – a few nights of poor sleep can trigger a manic episode, so if sleep is a problem ask your doctor about ways to help you sleep (which may include medication).
• Learn about your condition and ways different people manage it.
• Try to keep your life balanced and learn how to manage stress.
• Learn your warning signs so you can get help early before your mood becomes too high or low.
• Talk to trusted friends and relatives about bipolar disorder so they can be there for you when you need it.
• Keep a Daily Mood Swing diary(external link)(external link) to rate your moods from 1–10 and record factors affecting your mood and sleep. This helps to detect changes early.
• Find out if there is a self-management programme near you. 

Apps reviewed by Healthify

You may find it useful to look at some Mental health and wellbeing apps.

Stories from people who live with bipolar disorder.

Some of the world's most creative and productive people live with bipolar disorder and achieve feats the rest of us only dream of! This includes some of the greatest writers, medical people, musicians, artists and scientists in history, such as Sir Isaac Newton, Florence Nightingale and Mark Twain. 

There are plenty of ordinary Kiwis also who have found ways to live well with bipolar disorder. Find out some of their stories here from the Mental Health Foundation NZ(external link).

Zoe's story

Zoe has always struggled to live what she calls “a normal life”. Read Zoe's story(external link) (Mental Health Foundation, NZ)

Gina's story

Gina's diagnosis of bipolar disorder is no longer the sole focus in her life – now her energy is on advocacy and mental health promotion. Read Gina's story(external link) (Mental Health Foundation, NZ)

Debbies's story

Debbie's journey with bipolar disorder took her between three countries, finally to overcome stigma and find a meaningful life. Read Debbie's(external link) story(external link) (Mental Health Foundation, NZ)

Loren's story

Reverend Imoa Setefano's story

Reverend Imoa Setefano talks about living with bipolar disorder – he wants the community to learn about people before judging them.

Video: Living with Bipolar Disorder

This video may take a few moments to load.

(AttitudeLive, NZ, 2013)

Video: Rod's story

Rod's story of diagnosis, treatment and learning to live well with bipolar disorder. This video may take a few moments to load.

(NHS, UK, 2009)

Video: My bipolar diagnosis was a gift

Lianca Lyons was diagnosed with Bipolar Disorder in 2013. She shares her story in this video. This video may take a few moments to load.

(TedX Talks, UK, 2010)

Video: Bipolar Disorder and What I Would Tell #MyYoungerSelf | Stephen Fry

Stephen Fry talks about his childhood experience with bipolar disorder. This video may take a few moments to load.

(Child Mind Institute, UK, 2017)