What is bipolar disorder?
Bipolar disorder (or bipolar affective disorder; previously referred to as manic depression), is a mood disorder characterised by prolonged periods of mood elevation (mania) and depressive episodes. Many patients worry about whether their ‘mood swings’ constitute bipolar disorder, but there are a number of core symptoms that help us to differentiate between normal variations in mood and bipolar disorder.
What are the symptoms of bipolar disorder?
Typical symptoms of mania or hypomania (less pronounced but clinically significant mood elevations) include:
- Mood elevation lasting for at least four consecutive days
- A decreased need for sleep
- Grandiose thoughts
- Changes in speech (usually fast and difficult to interrupt)
- Increased risk-taking and recklessness
The depressive symptoms in bipolar disorder are the same as those seen in unipolar depression – e.g. decreased mood, an inability to enjoy previously pleasurable activities, fatigue, decreased appetite and poor concentration.
In severe cases, psychotic symptoms can emerge, such as auditory hallucinations (hearing voices) and delusional beliefs.
What causes bipolar disorder?
There is a strong genetic predisposition towards developing bipolar disorder, i.e. it occurs more commonly when a first-degree relative has the diagnosis, in a similar way that long-term physical health conditions like diabetes and hypertension tend to run in some families. The onset of bipolar disorder is usually in the 20s of the affected individual. Further episodes can be triggered by a lack of sleep, long-distance travel, stopping medication and other causes of significant stress. Antidepressants can unwittingly cause manic or hypomanic episodes.
How is bipolar disorder treated?
The evidence base strongly supports the use of medication as the mainstay of treatment. Some of the terminology in the drug treatment is confusing as drugs used to treat a range of other conditions, including anti-epileptic drugs and antipsychotic drugs, are effective in the treatment of bipolar disorder.
It is perhaps more useful to think about drugs used in the maintenance phases. Drug treatment in the acute phase can include use of antipsychotics, sedative and other hypnotic agents to treat insomnia and “take the edge off” manic symptoms. Longer-term, maintenance treatment usually involves the prescription of drugs with mood-stabilising properties such as lithium, quetiapine, carbamazepine or sodium valproate.
Various factors determine which drug is used; this is best discussed with the treating specialist. Some drugs are avoided in women of child-bearing age. Psychological treatments can be effective but usually only when manic or hypomanic symptoms have been stabilised.