Bipolar Affective Disorder

Bipolar disorder was previously known as manic depression. The condition affects your moods, exaggerating both the lows (Depression) and the highs (Mania). When you're unwell you are having what is called an episode, each one can last several weeks or more. If your illness is severe it can interfere with your day-to-day life and may even require hospitalisation.

The depressive phase of Bipolar is normally experienced first, with a manic episode being experienced later. Because of this, you may receive a diagnosis of depression initially, that then changes to Bipolar after a high. In some cases the mood swings can occur very quickly with short intervals in between, or indeed with no period of normality - this is called rapid cycling Bipolar.

People experiencing a manic phase may not be aware of it themselves, or deny it because riding the wave can be so exhilarating - unfortunately the wave will come crashing down - and the longer the mania goes on the longer the recovery.

Because of the violent mood swings and roller coaster lives of Bipolar sufferers, maintaining relationships and employment can be difficult - statistically, suicide rates are high.

Symptoms - Depressive Phase

  • feeling sad and hopeless
  • lack of energy
  • finding it difficult to concentrate and remember things
  • loss of interest in everyday activities
  • feelings of emptiness or worthlessness
  • feelings of guilt and despair
  • feeling pessimistic about everything
  • self-doubt
  • difficulty sleeping and waking up early
  • suicidal thoughts

Symptoms - Manic Phase

  • feeling extremely happy, elated or euphoric
  • rapid speech
  • feeling full of energy
  • full of self-importance, inflated ego
  • grandiose ideas and having important plans
  • easily distracted
  • being easily irritated or agitated
  • not sleeping
  • not eating
  • doing lots of pleasurable things which often have disastrous consequences, e.g. spending a lot of money which you cannot afford
  • high sex drive, sexual promiscuity
  • psychosis (hallucinations and delusional thinking)

Diagnosis

If you visit your GP, or self-refer to your local Community Mental Health Team (CMHT), you will be seen by a Psychiatrist if they believe you may be suffering from Bipolar. You will need to answer questions regarding when you first experienced symptoms, and what was happening in your life prior to and during each episode, including whether any thoughts of harming yourself were present. For you to receive the best, most appropriate treatment, you must be truthful and give as much information as you can. You will also be asked whether there is any history of Bipolar in your family, as there is evidence of a possible genetic link.

Treatment with Mood Stabilisers

Mood stablisers are used in the long-term treatment of Bipolar. They help prevent the extreme highs and lows by keeping your mood within normal levels, Lithium Carbonate is one of the most common. If you are prescribed Lithium you must ensure you take the correct dose, the amount of Lithium in your system is measured through regular blood tests - too little will be ineffective, too much can cause side-effects such as diarrhoea and vomiting. When taking Lithium you should avoid Non-Steroidal Anti-Inflammatory drugs such as Ibuprofen (NSAIDs), unless they are prescribed by your GP.

Anticonvulsant medicines used to treat Epilepsy are also used as mood stabilisers for the long-term treatment of Bipolar. They include valproate (in both its sodium and semi-sodium flavours), Carbamazepine and Lamotrigine. Each mood stabiliser can be used singularly or in combination for improved efficacy.

Treatment with Antipsychotics

Modern 'atypical' anti-psychotics such as Olanzapine, Quietiapine and Risperidone are often used to treat the symptoms of mania and hypomania. Older 'typical' antipsychotic drugs such as Haloperidol and Chlopromazine can also be prescribed. These are all powerful sedatives and aid recovery by slowing you down, both mentally and physically (if you have not been eating and sleeping during a manic phase your body will need to rest too). They are used especially when symptoms are severe and disturbed behaviour is presenting. Olanzapine can sometimes be used as a mood stabiliser as well.

A newer drug, also an atypical, is Aripiprazole - more commonly known as Abilify. It is used to treat acute manic and mixed episodes associated with bipolar disorder. It can be less sedating than other antipsychotic medications and is also licensed as a mood stabiliser.

Compulsory Detention (Sectioned under the Mental Health Act)

If your symptoms are severe, you may be detained under the Mental Health Act - if there is deemed to be a danger that you may harm yourself, or others. If this is the case you will have to stay in hospital so that you can receive the intensive treatment you require.

Recognising Triggers

In order to reduce the chances of relapse you should refrain from activities that may have caused you to become ill in the past. Do not take recreational drugs or drink too much alcohol as this may trigger an episode, avoid stressful situations and try to lead a calmer lifestyle.

Learn to recognise the signs that may indicate the onset of illness and take appropriate action. Alerting your doctor when you see early warning signs could result in an adjustment or change of medication that could prevent a hospital admission. Or at the very least, reduce recovery time.

Care Programme Approach - (CPA)

Bipolar Disorder is a serious mental illness and people with the condition may have complex needs that require intensive support. A CPA includes; an assessment of your health and social needs; a care plan to outline how these needs will be met and by whom; the allocation of a key-worker, usually a Community Psychiatric Nurse (CPN) or Social Worker; and regular reviews so that appropriate alterations can be made, due perhaps to a change in circumstances. CPAs are patient, or person-centred - you will be consulted throughout the process.

Lived Experience

“I don't shout from the rooftops and announce to the world that I have a mental illness - I'm only telling you now as this is specifically a personal experience story. I have a life and I also have an illness - my illness isn't my life.

I am a Manic Depressive (the old term for Bipolar) and am a veteran of the psychiatric system. I've been detained under Section 3 of the Mental Health Act more times than I can remember and spent in total approximately 18-24 months of my life in hospital. I've taken most of the anti-psychotics, anti-depressants and mood stabilisers available and have received other treatments such as Electro Convulsive Therapy (ECT).

You're probably thinking, 'What a nutter!' - and you would be right, when I am acutely ill. However, people tell me that when I'm not stark raving mad that I come across as your average Joe, and without knowing in advance, they wouldn't have thought I had a mental health problem.

My condition was triggered (not caused) by idiotic drug taking. Habitual cannabis smoking and copious quantities of LSD really messed with my mind. Smoking cannabis, far from being harmless like a lot of people believe, can induce psychosis and cause extreme paranoia. Taking mind-altering substances like acid is absolute lunacy and not the smartest thing I've done in my life.

I was very high and extremely disturbed on my first admission to hospital. I was convinced that I was the Anti-Christ, but on the day of my Mental Health Review Tribunal I had a change of heart and announced to the panel that I was Jesus from the planet Mars - my appeal was unsuccessful...

It was just before my 17th Birthday but I was held in a secure ward for just over 2 weeks - being deemed far too ill for the adolescent unit. I then spent an additional 3 months on a less intensive adult ward. Looking back, the worst thing about the whole experience was not the illness itself but being placed on very high doses of anti-psychotic medication, which back then were particularly unpleasant. Though modern medicines can cause unwanted side-effects, they really have improved considerably.

I was still psychotic after almost 3 months and pumping me full of drugs just wasn't working, so I had Electro Convulsive Therapy (ECT). ECT is more commonly used in treatment-resistant depression, but can also be used to treat mania. It is a very contentious issue, many say it is barbaric - but from my personal experience it helped make me better and ultimately discharged sooner, with less time spent on high dosages of medication. In a situation where someone is extremely depressed, non-communicative and not eating, it can save lives. That said, it isn't an effective treatment for everyone.

My illness appears to have lessened in severity as I've got older and my lifestyle has calmed down. Having the support of my wife has been invaluable and motivated me to stay well - people need to take personal responsibility and not engage in activities that could have a negative impact on their mental wellbeing. Drugs, alcohol, not keeping a regular sleeping pattern and non-compliance with prescribed medications, all increase the chances of relapse.

If you have been diagnosed with Bipolar, or know someone that has - please don't think it's the end of the world. There are ups and downs, some quite extreme. A lot of the time however, can be spent symptom free and may even be appreciated more than someone who has not experienced the difficulties associated with the condition.

If you cannot achieve longer periods of being stable and symptom free, then you should challenge your doctor and/or psychiatrist to find you the medication that works best for you. What works for one person will not necessarily work for another, we're all unique.

Mood stabilisers are effective at preventing relapse. Anti-psychotics are used in the acute phase of Bipolar and in most cases (in my opinion), are not appropriate as a long-term treatment. Would you take Ibuprofen and Paracetamol every 4 hours, ad infinitum, just because you did at one time have a particularly bad case of Flu?

I would like to add that during my time in hospital I have always been treated well and with respect by staff (especially in Dorset), even when I have been hostile and verbally aggressive towards them. Also, the amount of stigma regarding Bipolar is reducing, except among the criminally ignorant. It is even seen as hip nowadays, what with today's rock stars and actors joining the growing list of famous, creative and genius Manics...”

Carer's Perspective

“My husband has Bipolar, but I have never thought of myself as his carer. To me our marriage is like any other - the only difference being that from time to time my husband will become ill.

Of course sometimes it can be frustrating and stressful, but in my experience it's not the illness which causes this - rather the process of getting the help when it is needed. I have always found that getting an urgent hospital admission is much like banging your head against a brick wall, and it's extremely difficult watching someone you love become more and more unwell with each day that passes, knowing that the longer it goes on, the longer it will take them to recover.

I have always found it easy to separate my husband from his illness, so when he becomes psychotic and 'Mr Angry' I know it's not my husband speaking, but rather his illness. In fact, there are times when he's in hospital that I don't visit him, as there is a point in his illness when he becomes so psychotic and paranoid that he sees me as the enemy. Visiting him at this point would serve no purpose for him or me.

I have always worked and whenever my husband has become unwell I have told my manager/employer and found them to be understanding and accommodating, allowing me to choose my work patterns or take annual leave at short notice. At the end of the day, people can only help if you are honest with them and they know your situation.

As I said at the beginning, our life is pretty much like everyone else's, just that the lows are possibly lower and the highs higher - but if you don't have bad times how can you appreciate the good?

Bipolar is a part of our lives and I wouldn't change a thing, because ultimately it makes my husband who and what he is...”