Bipolar disorder is a mood disorder characterised by mood swings from mania (exaggerated feeling of energy and well-being) to depression. These mood swings tend to recur and subside spontaneously. The manic episodes may last from several days to months.
The cause is unknown but hereditary (genetically acquired) and psychological factors may play a role. The incidence is higher in relatives of people with bipolar disorder.
There are no blood tests or other investigations that can diagnose bipolar disorder. A psychiatric examination where the person’s thoughts, behaviour and responses to certain circumstances are evaluated will help make a diagnosis.
Symptoms may include:
- Alternating mania (exaggerated feeling of well-being) or depression
- Mood or behaviour can be inappropriate for the situation.
- Anxiety, stress and tension
In the depressive phase:
- Loss of self-esteem
- Feelings of helplessness or worthlessness
- Excessive or inappropriate guilt
- Fatigue lasting for weeks to months
- Feeling sluggish
- Difficulty concentrating
- Loss of appetite
- Weight loss
- Thoughts of death and suicide
- Loss of pleasure and interest in daily activities
- Memory loss
In the manic phase:
- Elated mood
- Increased activities
- Flight of ideas (racing thoughts)
- Inflated self-esteem
- Decreased need for sleep
- More talkative than usual
- Increased purposeless activity (pacing, hand wringing)
- Weight gain
- Poor temper control
- Irresponsible behaviour pattern
- Increased social or sexual activity
- Inability to accept the consequences of their actions
- False beliefs (delusions)
Hospitalisation may be required in the acute phase to control the symptoms. Antidepressant drugs may be given. Sedatives may be used to control mania in the initial phase. Lithium may be used to stabilise the mood. Electroconvulsive Therapy (ECT) may be used to treat persistent depression. ECT causes a seizure by means of an electrical current. It is used to treat severe depression and can be effective in manic disorders. Anti-epileptic medication (medication used to treat seizures) may be used. Psychotherapy may also be needed for emotional support.
The outcome for individual episodes of mood swing is generally good, though recurrence is common. Most people with bipolar disorder will require long term treatment. In some people, Lithium therapy has prevented recurrence of symptoms. In others, poor compliance with treatment or unwanted side effects have made medication less effective.
Bipolar disorder is a troubling condition that affects some 2% of all people (lifetime prevalence = ~ 2%). It is not easy to treat and some patients are actually resistant to treatment, probably because the manic phases can feel quite good sometime (despite being damaging in various ways). But it is clear that treatment is important (e.g. 5-10% of those with Bipolar die from suicide) so understanding this mental health condition is worthwhile.