Bipolar Disorder
Bipolar Disorder (formally known as manic depression) is a diagnosable mental illness. People who have this condition experience dramatic fluctuations in energy and mood from very intense highs to very deep lows – the ‘manic’ state and the ‘depressive’ state. Unlike normal mood swings, these extreme emotional states can last for days, weeks and sometimes many months. The period between each episode can also vary greatly – from hours to years. They can directly impact the individual’s daily life, relationships, health and general quality of life.
The nature of the illness makes it hard for the person to experience normal moods (although they may experience periods of lesser extremes). Both the manic and depressive states can be overwhelming to the point where they limit the person’s ability to think or function effectively. It often also causes them to behave in ways not in keeping with their normal character.
Causes of bipolar disorder
There is no known cause of bipolar disorder, however there are a number of factors that are known to contribute to it. These include a mix of social, biological and environmental factors.
Genetics – It is generally recognised that a person must have some form of genetic predisposition before bipolar disorder can develop. It does tend to run in families, with roughly 80% of cases having a genetic link.
Studies show that there is a 10% chance of a child developing the condition if one parent is affected. This chance increases to 40% when both parents are affected. However genetics alone does not guarantee that a person will develop the condition. Normally other factors need to trigger its onset.
Stressful experiences – Traumas and life-altering events can trigger the onset of bipolar symptoms. These include events such as divorce, the death of a loved one or physical or emotional trauma.
Also, the long-term impact of overwhelming daily problems such as illness or financial issues can lead to periods of depression and sometimes develop into bipolar disorder.
As with genetics, stress is unlikely to be the sole trigger of the condition.
Chemical imbalances – Studies have proven that an imbalance of the neurotransmitter Serotonin (one of the brain’s chemical messengers) is linked to bipolar disorder and other psychological conditions; however unknown combinations of other neurotransmitters must also come into play.
Pregnancy – Women who have some genetic predisposition for bipolar disorder have an increased chance of developing the condition during the post-natal period.
Medical illness – While this is not an actual cause of bipolar disorder it can occasionally cause symptoms that can be misdiagnosed as mania or hypomania. Some illicit drugs and medications (including anti-depressants) have also been known to cause or trigger manic or hypomanic symptoms. People on such medications need to be aware of the list of potential side-effects and report any unusual behaviours to their prescribing doctor.
Types of bipolar disorder
The term ‘bipolar’ refers to polar opposites – in this case the opposite moods of mania and depression that are the hallmarks of this condition. The moods occur in episodes of varying duration and intensity. In some cases, they can overlap and create a completely different aspect of the disorder.
Mania
During the manic state of bipolar disorder, the person experiences a heightened sense of excitement, confidence, self- esteem, optimism and overall well-being. People in that state may see it as a fantastic and positive experience which they want to prolong. The danger is that the sheer intensity of these emotions will cause them to have impaired judgement and thinking.
Overestimating abilities or underestimating risks can lead to people making poor decisions, being overly aggressive or possibly even placing themselves or others in danger.
In some cases, the sufferer can also develop psychotic symptoms such as paranoia, hearing voices or becoming delusional.
Depression
In the depressive state of this illness, people tend to lose motivation, pleasure in normal activities and interest in interacting with anyone. This phase is usually much worse than the milder forms of depression and can easily last for months. They may also experience psychotic symptoms.
Mixed bipolar episode
At times, those with bipolar disorder may have times where they experience symptoms of both manic and depressive states – switching rapidly from one to the other often within hours. The sheer intensity of their emotions can lead them to become aggressive, hostile or on edge. In extreme cases they may need a form of intervention (such as medication or hospitalisation) to ensure the safety of themselves and others.
Hypomania
Hypomania is a less intense form of mania. Many of the symptoms are similar, however those with hypomania generally do not experience psychotic symptoms. Both forms can be followed by periods of depression.
Bipolar types I and II
Bipolar Disorder I is the more severe form of this illness. Sufferers are more likely to experience longer and more intense episodes of mania, have psychotic symptoms and require hospitalisation.
In Bipolar Disorder II, sufferers still experience the highs but they don’t get the accompanying psychotic symptoms. While the episodes of type II may be shorter than in type I, overall impairment is believed to be similar.
Who gets bipolar disorder?
1-2 % of Australians will experience bipolar disorder at some stage in their lifetime. It affects roughly the same number of men and women and background is not a factor.
While it can develop at any age onset generally occurs between the ages of 20 – 25 years. It is a leading contributor to the burden of disease and injury of Australians aged 15 – 25 years and is often misdiagnosed in these early years.
Each person’s experience with bipolar disorder will be different due to the variations in mood swing patterns and different forms of the condition.
Patterns of bipolar disorder
Bipolar disorder has a very unpredictable nature. For some it can emerge as regular ups and downs over many years while for others the episodes can occur more frequently with huge extremes.
Rapid cycling refers to a pattern where a person has four or more episodes of manic, depressive, hypomania or mixed episodes a year. The change from highs to lows can occur quite rapidly and often there is no ‘normal’ period between each episode. In many cases the person can remain unaware that they have entered a manic phase and may perceive those who express their concern as negative or unhelpful. These extremes make it very hard for sufferers to stay employed or maintain relationships with family and friends.
Cyclothymic disorder is a less severe pattern of bipolar disorder. It is characterised by short periods of hypomania and mild depression. Sufferers will generally have fewer symptoms and less impact on their everyday life.
Symptoms of bipolar disorder
The main symptoms of bipolar disorder can be grouped according to the type of episode in which they occur. A depressive or manic episode is usually diagnosed if a person experiences three or more of the symptoms below most days over a period of a week or more.
Some symptoms may appear gradually or irregularly at first so the warning signs of bipolar disorder may go unnoticed. If you or someone you know has some of these symptoms it is important to seek help and support as early as possible and begin appropriate treatment.
Common symptoms of a manic episode:
- Talking and thinking rapidly
- Being super active and having lots of energy to burn but with little sleep
- Experiencing a strong ‘buzz’ or ‘high’
- Acting impulsively with little regard for consequences
- Feeling uninhibited
- Having an increased interest in sex
- Having difficulty concentrating and being easily distracted
- Behaving out of character
- Making poor decisions and judgements
- Being very irritable, especially with people who don’t share the same enthusiasm or optimism
- Having extreme social behaviour – being overly critical or familiar with people
- Denying that there is a problem
After a period of mania has ended the person may then feel very embarrassed or ashamed of their manic behaviour causing them to isolate themselves for some time. Sometimes they may not even remember what actually happened. This would depend on the intensity of the manic episode and also on any medications they may have taken.
Symptoms of a depressive episode:
- Talking slowly
- Feeling mentally and physically slow and sluggish
- Having trouble concentrating and remembering
- Having difficulty starting or finishing normal daily tasks
- Experiencing low energy and fatigue
- Oversleeping or having difficulty sleeping
- Loss of appetite, weight loss or weight gain
- Experiencing persistent aches, pains and other symptoms of ill health
- Becoming withdrawn and isolated
- Losing interest in activities that normally create pleasure including sex
- Feeling sad, anxious or disconnected for an extended time
- Being restless and irritable
- Restlessness
- Irritability
- Feeling guilty or worthless
- Having thoughts of death and/or suicide
Following a depressive episode the person may start to believe their symptoms of depression have improved, however they could actually be entering a manic episode.
Psychotic symptoms
In rare cases, sufferers of bipolar disorder may start to develop psychotic symptoms and lose touch with reality. Their extreme episodes may involve delusions (believing in things that appear irrational to others) or hallucinations (imagined sensorial experiences such as hearing voices that are not there).
A person showing psychotic manic behaviour may have extravagant and unrealistic expectations of themselves. Conversely, psychotic depressive behaviour can be characterised by intense feelings of guilt, failure and worthlessness. These can be compounded by hallucinating negative or derogatory voices.
Symptoms of a mixed bipolar episode
Those experiencing a mixed bipolar episode will have symptoms of both mania and depression. Their mood will fluctuate wildly from one extreme to the other and they will often feel agitated, irritated or anxious with their thoughts racing out of control. In this state, sufferers are more likely to experience thoughts of death and suicide.
How is bipolar disorder diagnosed?
Often, those with bipolar disorder are initially unaware they have the condition. It is more likely to be the people around them – family, friends and workmates – who notice uncharacteristic behaviour and extreme highs and lows. If someone tells you that they are concerned about your behaviour it is advisable to listen to them and make an appointment with your GP as soon as you can. When bipolar disorder is left untreated it can worsen and lead to problematic issues with your relationships, health and career.
Unfortunately, bipolar disorder is frequently misdiagnosed. The main reason is that people seek help for what they believe to be depression as these symptoms are very well known. However they may not be aware of the significance of their behaviour in between periods of depression. The symptoms of mania are not generally as well known or recognised so they may go undetected. They may also not have surfaced at the time of the appointment.
In order to make a correct diagnosis, your GP will discuss your behaviour with you and check for likely symptoms such as those listed above. They may also use diagnostic questionnaires centred on your behaviour up to and during a manic or depressive episode. They will often ask about your family history to look for possible genetic factors. If your doctor does suspect that you have bipolar disorder they will most likely give you a referral to a mental health professional (such as a clinical psychologist) who will confirm your diagnosis and recommend a course of physical (medical) and psychological treatment tailored to suit your needs. Their aim is to give you all the support and resources that you need in order to get your life back in order and maintain control over your symptoms.
In Australia, depending on the nature of your illness GP’s can initiate a Medicare funded Mental Health Care Plan. This allows the GP, mental health professional and the sufferer to work as a team to develop an ongoing treatment plan.
Treatment for bipolar disorder
As bipolar disorder is a chronic condition just like diabetes it needs to be managed with care and determination to avoid relapses and worsening of symptoms. A customised combination of mood stabilisers and anti-depressants are issued for the mania and depression respectively. The dose and type of medication should be regularly reviewed with your mental health professional. Most people with the condition will need to remain on long-term medication in conjunction with psychotherapy, lifestyle changes and social support in order to achieve the best possible outcome.
Counselling for bipolar disorder
An experienced mental health care professional or therapist can help someone with bipolar disorder to fully understand the nature of their condition and provide them with a range of coping skills.
One of the most popular and effective treatments is Cognitive Behavioural Therapy (CBT). Using this approach, the therapist will help the sufferer reflect on their manic and depressive episodes and to identify all potential triggers of that behaviour including any contributing thought patterns. The therapist will then guide the person to come up with new alternative thoughts and behaviours to implement.
Family Therapy is also often used as part of the treatment process as it acknowledges the impact the condition has on the sufferer’s relationships. Working together, the family are encouraged to find new and stronger ways to communicate effectively and support each other.
What should I look for in a mental health service provider?
There are a wide variety of people who offer mental health services. The generic terms ‘Counsellor’ or ‘Therapist’ are used to describe various professionals such as psychologists, psychiatrists, social workers or occupational counsellors. They all generally discuss your particular issues and work with you to find ways to address and overcome them. Most have undertaken years of study or additional professional development in their chosen fields however anybody can call themselves a ‘counsellor’. Also, some highly qualified counsellors may not necessarily have training in specific mental health conditions such as bipolar disorder.
You may want to ask your counsellor about their type and level of qualifications or see if they are registered in Australia with a professional society or state body. Only certain kinds of practitioners can be registered with Medicare and process Medicare rebates, however most private health insurance companies in Australia have some provision for mental health care cover as part of their ‘extras’ packages.
Where can I find help near me?
Our directory lists hundreds of psychotherapists, psychologists, counsellors and other therapists from around Australia. These mental health experts offer counselling over the phone and online in addition to one-on-one consultations. Many also offer workshops and seminars.
Enter your postcode or suburb into our search box to see a comprehensive list of the health care professionals near you.
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