Bipolar Disorder

What is Bipolar Disorder?
Bipolar disorder (also know as manic depression) is a metal disorder that involves severe mood swings accompanied by changes in emotions, thoughts, behaviours, physical health and functioning. The mood swings are more extreme and more prolonged that the everyday ups-and-downs that we all experience. Emotions may vary from depression and hopelessness through to feeling overly elated ('high') or irritable. People usually go through periods of normal mood in between times.

The extent of the problem
About 1% of the population has a bipolar disorder. Men and women are equally likely to be affected. Typically, the first episode of depression or mania occurs in late adolescence or early childhood. Bipolar disorder is highly likely to recur, and 80% of people with a bipolar disorder will experience at least one further episode of mania or depression.

Causes & Consequences
There is no one reason why a person develops a bipolar disorder. There is evidence that bipolar disorders can run in families. The current thinking is that genes are probably a more important vulnerability factor for the development of bipolar disorder than upbringing and childhood experiences. A wide range of factors may be important in bringing an episode of bipolar disorder varying from stressful life events, excess alcohol consumption, lack of sleep to physical health.

Although the causes of bipolar disorder are not yet known, the effects of repeated episodes of the disorder are well described. An untreated manic episode can have particularly negative consequences for the person with bipolar disorder and for their family. Disinhibition, excessive spending or other inappropriate behaviours can lead to a variety of social and psychological problems. Alternatively, when a person experiences a severe depressive episode they can feel so hopeless that they no longer feel life is worth living and many try to harm themselves. Lastly, people with bipolar disorder may use alcohol or drugs in an attempt to control their mood swings.

Treatment
The aims of treatment are to reduce the symptoms of depression or mania, to prevent the frequency of future episodes, and to help the individual come to terms with having a bipolar disorder.

Most people will require medication at some stage, but supportive counselling and/or specific psychological treatments, such as cognitive behavioural therapy, can plan an important role.

If a person experiences and episode of mania or severe depression they may need to be admitted to hospital to allow more intensive treatment and support to be offered, or to help avoid actions that are dangerous or regrettable. People with less severe depressive or hypomanic episodes can usually be offered additional treatment and support in the community.

Medication
Longer-term treatment: Individuals with a bipolar disorder will virtually always be offered a prescription for a 'mood stabilizer' to try to reduce the severity or frequency of mood swings. Disadvantages of mood stabilizers are that they need to be taken for many years to show any effect, a regular blood test is required, and there can be side effects. On balance, research shows that the benefits outweigh the disadvantages.

Shorter-term treatment: It is usual to offer additional medication (called major tranquillizers) to people experiencing an acute manic episode. This medication is prescribed to try to reduce physical and mental agitation and to improve sleep. These drugs are usually withdrawn once the mood stabilizing medication starts to help.

Antidepressant medication may be used if an individual experiences an acute depressive episode. These drugs are rarely used alone in a person with a bipolar disorder.

Psychological Therapies
Most individuals with bipolar disorder and their families welcome the opportunity to talk about the impact of the disorder on their lives and to get help in coming to terms with the problems they experience. Counselling can be useful in offering support and helping people to adjust to what has happened. There is now some research that shows that cognitive behaviour therapy and some other psychological treatments (such as family therapy) can be particularly beneficial. Cognitive behaviour therapy provides a framework for understanding bipolar disorder and the impact is has had on the individual. They can explore new ways of dealing with problems and coping with stress and depression. Other possible interventions are briefly noted below:

Becoming an Expert on Bipolar Disorders: It is important for the sufferer to become as knowledgeable as possible about bipolar disorders, including understanding the signs and symptoms; the treatments available and the side effects of different prescribed medications. This information will allow greater collaboration with mental health professionals and opportunities to influence treatment.

Developing Regular Patterns of Activity: Disrupted sleep patterns can trigger further episodes of mania or depression. It has been found that maintaining fairly regular patterns of eating, sleeping and activity can reduce the frequency and the severity of mood shifts. Keeping a record of moods, activities, and sleep patterns and then planning a balanced schedule that avoids 'overdoing it' has proved beneficial for many individuals.

Reducing Stress and Avoiding Stimulants: It is important to understand what types of events and experiences have proved stressful to an individual in the past. It may be possible to avoid some stressors (eg. life events such as moving house or job). Learning strategies to cope with mood shifts so as to avoid overuse of alcohol, caffeine and other drugs is particularly important.

Recognising and Managing Early Warning Signs: It is usually possible to identify about three symptoms of depression and three of mania that warn an individual with bipolar disorder that they may be about to experience a further episode. It may be possible to develop and plan to prevent a full blown manic or depressive swing by taking action when the first symptoms of relapse occur. This plan may include several key people such as the sufferer, mental health professionals and family members.

Information about bipolar disorders is also available from the Manic Depression Fellowship, 8-10 High Street, Kingston-Upon-Thames, Surrey KT1 1EY.

Behavioural and Cognitive Psychotherapists are usually health professionals such as nurses, psychologists, doctors, social workers, counselors, etc. Whilst all behavioural and cognitive psychotherapists share the above principles, individual therapists may call themselves Cognitive Psychotherapists, Behavioural Psychotherapists, Cognitive Behavioural Psychotherapists or Rational Emotive Behavioural Therapists. These different titles often reflect the preference and training of the individual therapists for specific techniques which addresses problematic thoughts, assumptions and beliefs directly (Cognitive Psychotherapists), address behaviour directly (Behavioural Psychotherapists) or a combination of techniques aimed at addressing thought and behaviour (Cognitive Behavioural Psychotherapists, Rational Emotive Behavioural Therapists). However, whatever techniques they prefer to use, all therapists aim to help clients achieve desired change in the way they think, feel and behave.