Mental Health Conditions › Bipolar Disorder

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What is Bipolar Disorder?

Bipolar Disorder is a condition that affects your moods which can swing from one extreme to the other. If you have bipolar disorder, you will experience 'episodes' of depression and mania.

Depression and mania

BDS

The depression and mania that are associated with bipolar disorder are characterised as follows:

Both extremes of bipolar disorder have a number of other associated symptoms (see symptoms). Unlike simple mood swings, each extreme episode of bipolar disorder can last for several weeks or longer. The high and low phases of the illness are often so extreme that they interfere with everyday life.

The depression phase of bipolar disorder often comes first. Initially, you may be diagnosed with clinical depression before having a manic episode some time later (sometimes years later), after which your diagnosis might change. During an episode of depression, you may have overwhelming feelings of worthlessness, which often lead to thoughts of suicide.

During a manic phase of bipolar disorder, you may feel very happy and have lots of ambitious plans and ideas. You may spend large amounts of money on things that you cannot afford. Not feeling like eating or sleeping, talking quickly and becoming annoyed easily are also common characteristics of the manic phase of bipolar disorder.

During the manic phase, you may feel very creative and view mania as a positive experience. However, during the manic phase of bipolar disorder.

How common is bipolar disorder?

Bipolar disorder is a relatively common condition with around one person in 100 being diagnosed with the condition.

Bipolar disorder can occur at any age, although it often develops in people who are between 18-24 years of age. Both men and women, and people from all backgrounds, can develop bipolar disorder.

The pattern of mood swings in bipolar disorder varies widely between individuals. For example, some people will only have a couple of bipolar episodes in their lifetime, and will be stable in between, while others may experience many episodes.

Symptoms of Bipolar Disorder

The symptoms of bipolar disorder can be broken down into 3 groups: Depression, Mania & Rapid cycling

Depression

Mania

Rapid cycling

Episodes of depression and mania are sometimes punctuated by periods of ‘normal’ mood. However, some people with bipolar disorder can swing from a high to low phase quickly without having a 'normal' period in between. This is known as rapid cycling.

Causes of Bipolar Disorder

Although the exact cause of bipolar disorder is not fully understood, it can be split up into three factors that are known to cause bipolar disorder symptoms. These are: Chemical imbalances, genetic factors & triggers.

Chemical Imbalances

Bipolar disorder is widely believed to be the result of chemical imbalances in the brain. Neurotransmitters, such as norepinephrine, serotonin and dopamine are the chemicals that are responsible for controlling the functions of the brain.

If there is an imbalance in the levels of one or more neurotransmitters, it may cause the symptoms of bipolar disorder. For example, episodes of mania may occur when levels of norepinephrine are too high, and episodes of depression may be the result of norepinephrine levels becoming too low.

Genetic Factors

As well as being linked to chemical imbalances in the brain, bipolar disorder is also thought to have a significant genetic factor. Bipolar disorder seems to run in families with the family members of a person with the condition having an increased risk of developing it themselves.

However, there is no single gene that is responsible for bipolar disorder. Instead, it is thought that a number of genetic and environmental factors act as triggers for the condition.

Triggers

A stressful circumstance, or situation, is usually required to trigger the onset of the symptoms of bipolar disorder. Examples of stressful triggers include:

These types of life-altering events can cause episodes of depression throughout a person’s life. Sometimes, physical illness can also cause persistent periods of depression.

Bipolar disorder may also be triggered by overwhelming problems in everyday life, such as problems to do with money, work or relationships.

Treatment of Bipolar Disorder

For the majority of people with bipolar, a combination of treatments can be used and they typically include:

Mania Medicines

These medicines are used to control the mood and include the following: Lithium Carbonate, Anti-convulsants (such as Carbamazepine) & Anti-psychotics (such as Quetiapine)

Depression Medicines

These medicines are used to treat the bipolar depression. They include: TCAs (such as Amitryptyline) SSRIs (such as Fluoxetine) & MAOIs (such as Phenelzine)

Trigger Recognition

If you have bipolar disorder, it is possible to learn to recognise the warning signs of an approaching episode of mania or depression. This will not prevent the episode occurring, but it will enable you to get help in time.

This may mean making some changes to your treatment, perhaps adding an anti-depressant or anti-psychotic medicine to the mood stabilising medication you are already taking.

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Lithium Carbonate

In the UK, lithium carbonate (often referred to as just lithium) is the medication that is most commonly used to treat bipolar disorder. Lithium is a long-term method of treatment for episodes of mania, hypomania and depression and it is usually prescribed for a minimum of six months.

If you are prescribed lithium, stick to the prescribed dose and do not stop taking it suddenly (unless directed to by your doctor). For lithium to be effective, it is essential that the dosage is correct. If the dose is incorrect, it may cause side effects, such as diarrhoea and vomiting. If you are taking lithium and you have side effects, tell your doctor immediately.

While taking lithium, you will need to have regular blood tests (at least once every three months) to ensure that your levels of lithium are not too high or too low.

Lithium levels are measured in millmoles per litre of blood or mmol/L

If you are being prescribed lithium for the first time then your treatment team will be aiming to achieve a lithium level of between 0.6 and 0.8 mmol/Ls. Your kidney and thyroid function will also need to be checked every two to three months if the dose of lithium is being adjusted, and every 12 months in all other cases.

Carbamazepine

Carbamazepine is usually only prescribed on the advice of an expert in bipolar disorder. To begin with, the dose will be low, before gradually being increased. If you are taking other forms of medication (including the contraceptive pill) your progress will be carefully monitored.

When you start taking carbamazepine, a number of blood tests will be carried out to check the functioning of your liver and kidneys, and then again after six months. You will also need to have a blood count (at the start and after six months) and you may also have your weight and height monitored.

Quetiapine

Quetiapine is generally branded as Seroquel.

Seroquel works by blocking the effect of a chemical in the brain which is thought to affect thinking, feelings and behaviour. Seroquel can help to treat the symptoms of schizophrenia or episodes of mania or depression that may occur in bipolar disorder.

Amitryptyline

Amitriptyline hydrochloride is used to treat depression. It is thought that Amitriptyline hydrochloride increases the activity and levels of certain chemicals in the brain. This can improve symptoms of depression.

Some people who take Amitriptyline hydrochloride and have depression may find that it intensifies depression and suicidal feelings in the early stages of treatment. These people have an increased risk of self-harm or suicide in the early stages of taking Amitriptyline hydrochloride. As Amitriptyline hydrochloride starts to work these risks decrease.

Fluoextine

Fluoxetine hydrochloride is used to treat a variety of mental health problems. It is thought that Fluoxetine hydrochloride increases the activity and levels of certain chemicals in the brain. This can improve symptoms such as depression and anxiety.

In the early stages of taking Fluoxetine hydrochloride, suicidal thoughts and behaviour may be seen in some people. These people have an increased risk of self-harm or suicide in the early stages of taking Fluoxetine hydrochloride. As Fluoxetine hydrochloride starts to work these risks decrease.

Phenelzine

Phenelzine sulphate is used to treat depression. It is thought that Phenelzine sulphate increases the activity and levels of certain chemicals in the brain. This can improve symptoms of depression.