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Bipolar affective disorder (manic depression)

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Bipolar affective disorder (manic depression)

Reviewed by Dr John Powell, MRC psych specialist registrar

What is bipolar affective disorder (manic depression)?

Bipolar affective disorder is also known as manic depression or bipolar depression. It is a mood disorder. The sufferer experiences marked mood swings which are beyond what most people experience. These extremes of mood may include the lows of depression as well as the highs of a very elated mood (known as mania). The number and frequency of these periods of depression and mania vary from person to person.

It is estimated that about 1 per cent of the population suffer from bipolar affective disorder at some point in their lives. Some people will experience just one or two episodes, whereas others will have many episodes of depression or mania.

It is a serious condition but can be helped with the right treatment.

What causes bipolar affective disorder?

Differences in people's genetic make up can make them more vulnerable to develop bipolar affective disorder. Stressful events, illness or lack of support can trigger individual episodes of illness.

What symptoms are involved?

What are the symptoms of depression? Feeling depressed or down is a normal reaction to events in our lives. In depressive illness that occurs as part of bipolar disorder, the depressive feelings will be worse, they will go on for longer and they will make it harder to deal with day-to-day problems.

Some of these other symptoms may also occur:

Feelings of unhappiness that do not go away.

Losing interest in things.

Being unable to enjoy things.

Finding it hard to make even simple decisions.

Change of appetite.

Weight loss or gain.

Difficulty sleeping or sleeping too much.

Going off sex.

Being fidgety or restless.

Tiredness and loss of energy.

Excessive feelings of worthlessness or guilt.

Being unable to see a positive future.

Having trouble thinking or concentrating.

Finding it harder to be with people.

Having thoughts that one would be better off dead or thoughts about hurting oneself.

Difficulty in performing normal activities such as work, taking care of things at home or getting along with people.

What are the symptoms of mania?

A period of a week or more during which a person feels abnormally good, high, excited, hyper or irritable. This can be so extreme that the sufferer loses contact with reality and starts to believe strange things, have poor judgement and behave in embarrassing, harmful or even dangerous ways. This may be accompanied by:

An elevated mood, out of keeping with the individual's circumstances. Often the person will appear euphoric with an overwhelming sense of well-being and self-importance.

Increased energy and overactivity.

Increased speech, often rapid and louder than usual, which may be difficult for others to follow.

A reduced need for sleep.

Loss of inhibitions, which may lead to inappropriate and impulsive behaviour.

Very grand, over-optimistic ideas and plans may be expressed.

In severe cases sufferers may develop 'psychotic' symptoms of delusions and hallucinations. The content of these is usually in keeping with the euphoric mood and the unrealistic sense of great self-importance.

What can be done to help?

If you or someone you know is suffering from the symptoms of this disorder, then it is important to seek medical help.

If you have been diagnosed as having bipolar affective disorder (manic depression) it is important to try to avoid relapses in future. This means recognising events that may trigger a period of illness, and trying to avoid these, or seeking help when these occur. It also means seeking help when the early symptoms of illness arise, and taking prescribed medication that will help to prevent relapses.

How is the diagnosis made?

The diagnosis will be made on the basis of present symptoms and on the history of any previous episodes.

How is bipolar affective disorder (manic depression) treated?

Depressive episodes are treated in the same way as other episodes of depression. This includes psychological therapy and antidepressant medication.

Episodes of mania are usually treated with antipsychotic medication (for example medicines such as chlorpromazine and haloperidol are used). These can cause side effects including stiffness, shakiness, dry mouth and constipation. Other medicines can be given to help with some side effects if they occur.

Sometimes sufferers need to be admitted to hospital in order to be treated.

Often, during acute episodes of illness, mood-stabilising medicines are used. These are also used for longer-term preventive therapy, the aim of which is to prevent relapses. The most widely used example is lithium. Others include sodium valproate, carbamazepine and olanzapine (Zyprexa).

Lithium treatment needs to be monitored with regular blood tests to make sure that there is enough lithium in the body for it to work, but not too much, which can be harmful.

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