Bipolar disorder
Answers to frequently asked questions about bipolar illness or manic depression. For service users, families, friends or anyone with concerns.
What is it?
Bipolar disorder is the medical name for manic depression, and literally means an illness with 'directly opposite' states of mind. People with bipolar illness have mood swings, sometimes feeling 'high' or manic, and at other times feeling 'low' or depressed. Although the 'highs' can be enjoyable, these extreme emotions are often distressing and can be very disruptive to peoples' lives.
If you have bipolar illness you will have times when you are:
manic, this means you may
- have lots of energy
- be extremely active and talkative
- feel extremely happy or sometimes extremely angry
- feel restless and irritable
- have racing thoughts (if these thoughts are strange or unfounded they are called delusions)
- be unable to sleep much
- sometimes hear voices or see things that aren't there (called hallucinations)
You may be described as hypomanic if you
- show signs of mania but do not have delusions or hallucinations. In a hypomanic state, you may be able to continue with your life as normal
depressed - this means you
- feel sad, unhappy
- don't feel like doing things you normally enjoy
- have problems sleeping or sleep too much
- have little energy
- experience memory problems or difficulty concentrating
somewhere in the middle of either of the two states and a healthy frame of mind.
neither manic or depressed
Bipolar illness cannot be cured but a combination of medication (drugs) and talking therapies can help to control the symptoms. With the help of medication, you may be able to carry on your life as usual.
Want to know more?
see also
What causes it?
Scientists don't know what causes bipolar illness. They have found differences in chemicals in the brain of people with bipolar compared with people without bipolar; this suggests there may be a biological basis for the condition.
Bipolar illness affects about 1% of the UK population, although the rate may vary in different countries. Studies suggest that it runs in families - if a close relative has bipolar illness, your risk of developing it is between five and ten times higher than the general population. This is still a relatively small risk (only 5%).
Stressful life experiences and physical illness can lead to bipolar illness. People sometimes find that certain events or situations which are particularly stressful for them can be 'triggers' for an episode of the illness.
Some researchers believe that if someone had problems as a child - for example, attention deficit hyperactivity disorder (ADHD) or depression - they may be more at risk of developing bipolar illness when they grow older.
Want to know more?
see Biology of bipolar disorder
Where do I go for help?
If you think you might have bipolar illness, the first step is to see your family doctor (General Practitioner or GP). If you are worried about a friend or relative, encourage them to see their GP, or offer to go with them.
It can be hard to diagnose bipolar illness and you may be told it is something else, depending on your state of mind when you visit your GP. The symptoms of bipolar illness can be very similar to depression - see Depression
You may find you need a short stay in hospital when your symptoms are particularly bad. Or you may receive care from your mental health team (see 'Who are the people involved in treatment?').
It's important to get help and treatment for bipolar illness. People with severe bipolar illness have a high risk of suicide compared with the general population. There are a number of support groups for people with manic depression, their carers and friends (link to organisations).
Want to know more?
about symptoms and characteristics? see Biology of bipolar disorder
What is the treatment for bipolar illness?
Medication is given to control the symptoms and talking therapies can help people live with bipolar illness.
Medication
Mood stabilizers are the usual treatment for bipolar illness. They are given to prevent extreme mood swings. You may need to continue taking this medication long term (called 'maintenance treatment') even when you feel well.
Mood stabilizers include:
- Lithium - this is the most common treatment and it works for about 60% of people. Your Lithium should be monitored carefully. Side effects can include problems thinking clearly, weight gain and kidney problems (which appear as excessive thirst, and the need to urinate more often than normal).
- Anticonvulsants (such as Carbamazepine, Divalproex) - these are given when lithium doesn't work or when lithium is unsuitable.
Antipsychotics are sometimes prescribed with lithium in early stages of severe manic episodes. These drugs are commonly used for the treatment of schizophrenia. See Treatment of schizophrenia.
Antidepressants may be given to improve depression in bipolar illness. But doctors find that antidepressants alone are often not enough to treat it effectively.
For more information, see Treatment of depression.
Bipolar illness has different forms and everyone responds to treatment differently. There are many different drugs available - if one doesn't work for you, there may be another one that does. You may need to try a couple of medications before you find one that suits you.
If you are having problems with your medication, or you get unpleasant or worrying side-effects, speak to your doctor, nurse or key worker - see Who are the people involved in treatment? They can advise you on the implications of continuing or stopping your medication, and may be able to find a drug that suits you better.
Drugs for bipolar illness can take up to 3 months to work. If you do not feel any better after 3 months, ask your GP or your psychiatrist if you can try another medication.
Talking therapies
Talking therapies, such as counselling, can support and help people with bipolar illness to live with their condition. This may involve helping you reduce stress and recognise situations which might trigger off your illness. Talking therapies can also help with relationships problems and other difficulties arising from the illness.
It is still unclear whether or not talking therapies like cognitive behavioural therapy work for people with bipolar illness, but some research suggests that these therapies can be helpful alongside medication.
Talking therapies may be available on the NHS in your area, but they are in short supply, and what is available varies across the country. If you are interested in these therapies, ask your GP, psychiatrist or nurse.
Want to know more?
see Treatment of bipolar disorder
Who are the people involved in treatment?
If you have a diagnosis of bipolar illness in the UK, you may receive care from your community mental health team. This team may include some or all of the following, depending on your needs:
- Consultant psychiatrist
- Psychologist
- Community psychiatric nurse (CPN)
- Occupational therapist (OT) and/or physiotherapist (if you are elderly)
- Senior registrar (this is another doctor, more junior than the consultant)
- Nutritionist
- Nurse from the ward (if you've been recently discharged)
- Social worker
- GP (they are invited to meetings to review your treatment)
- A member of your family
You will be given a key worker who is the member of this team (often a social worker or CPN, but could be another professional); they will have most contact with you. If you're worried about your treatment, how your feel, or if you have any questions, your key worker is the best person to contact. The mental health team will meet with you about every three to six months to discuss how you are, and to decide on any changes in your treatment and care.
The key worker is also a useful person for the family. They can help the family to recognize early on if their relative may be getting ill again, and can help them with the job of caring for someone with bipolar illness.
Read Gail's story about her relationship with her mental health team
What can I do to help myself?
There are steps you can take to look after your mental health.
- Identify which situations or events make you feel unwell or stressed (such as overworking or arguments with your partner), and try to avoid these 'triggers'. Reduce levels of stress or worry in your life, generally.
- Try to recognise early signs that you are becoming unwell - if you get help you may be able to avoid a bout of illness. Be aware that your friends or family may notice the signs first, even if you feel better than ever.
- Try to talk about your feelings (good and bad) and to communicate with people around you. Good family support can help people with bipolar illness to stay well.
- Find a member of the mental health team you can talk to. (link to who are the people involved in treatment). They should be able to help if you have any worries about your health or treatment. They may also notice any signs of illness before symptoms develop.
- Avoid illegal drugs and drink alcohol in moderation. You may feel better in the short term, but they can make symptoms worse and can affect your medication.
- Take care of your physical health - eat well, exercise regularly, and try to get enough sleep.
- Take up new activities. Art, creative writing, drama or music can have a positive effect on mental health. Some people find that they are extremely creative in a manic episode.
- If you are cannot work, find out which benefits you and your carer, if you have one, are entitled to. In the UK, visit your benefits office for information or visit the DSS website www.dss.gov.uk/
- Take your medication according to the instructions from your doctor
Want to know more?
Support/Groups
Links of support organizations, user/carer groups and websites
Pendulum Resources - excellent bipolar information page with links to other mental health topics. Personal articles by people with the condition. Intended for public.
Information in other languages:
Leaflets in punjabi
Other pieces on emental-health.com
History - insight into history of approaches to bipolar illness.
Biology - referenced guide to diagnosis, biological techniques and findings
Treatment - referenced guide to approaches to treatment and the way they work.
Fastfacts - a quick guide to who gets it, how it's treated, and hot topics.
Links - to other resources
Personal accounts
Read others' experiences of bipolar illness
Gail's story
Please email us with other questions you would like to see featured.
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