Bipolar Affect Disorder

There may be aspects of this article that are difficult. We have put this article together for educational and informational purposes. If you are affected in any way, please feel free to reach out to the Arthur Ellis team on [email protected] or send me a message directly.

Bipolar (formerly known as manic depression) is a very complex condition which manifests differently for different people. The word ‘affective’ is a clinical term for mood and bipolar is a mood disorder. We all experience fluctuations in mood, related to whatever might be happening to us at any given time. We all experience symptoms of depression and anxiety at times but bipolar can best be understood as an ‘extreme’ of these symptoms. As mentioned above bipolar is different for each individual, this article will explain the clinical definition of bipolar before explaining in real terms what this actually means followed by the appropriate treatments and then one mans personal experience of living with bipolar affective disorder and some practical advice for you if you suspect you or someone close might be experiencing this condition.

What are the symptoms of bipolar?

There are two core subsets of symptoms experienced in bipolar, depressive and manic

Mania:

• Feeling unusually ‘high’ and optimistic OR extremely irritable
• Unrealistic, grandiose beliefs about one’s abilities or powers
• Sleeping very little, but feeling very energetic
• Talking so rapidly that others can’t keep up
• Racing thoughts, fleeting from one idea to the next
• Highly distracted, unable to concentrate
• Impaired judgement and impulsiveness
• Acting recklessly without thinking about the consequences
• Increased libido
• Delusions and hallucinations (in severe cases), also referred to as psychosis

In addition to the above there is a less severe form of mania referred to as ‘hypo’ mania (hypo is a clinical term for low) someone experiencing hypomania will encounter the above symptoms to a lower intensity apart from symptoms of psychosis. Typically, there will still be an element of control to a person’s behaviour and it wont necessarily be overtly obvious to others (except perhaps the people who know the individual well) that there is something wrong. It still affects a person’s abilities to make sound judgement and reasoning and there is risk of the persons actions being detrimental to them.

Depression:

• Feeling hopeless, sad or empty
• Irritability
• Inability to experience pleasure
• Fatigue or loss of energy
• Physical and mental sluggishness
• Appetite or weight changes
• Sleep problems (either sleeping too much or insomnia)
• Concentration and memory problems
• Feelings of worthlessness or guilt
• Apathy towards activities usually of interest
• Loss of libido
• Thoughts of death or suicide

In addition to these two distinct subsets of symptoms there is a presentation of the illness which is referred to as a ‘mixed state’. This is to say that the person is experiencing both symptoms of mania and depression at the same time. A mixed state is a medical emergency and requires immediate attention from healthcare professionals. This is because suicide risk is heightened at these times because the person the depressive ideations along with the energy and drive of the manic symptoms.

What are the various ‘types’ of bipolar?

As aforementioned bipolar complex is different for everyone, however there are several identified ‘types’ of bipolar which can describe the overall pattern of symptoms that the individual experiences.

Bipolar type I:

The individual with this condition will experience ‘true’ mania, it will be overtly obvious to anyone who encounters the individual that something is not right. They might appear intoxicated, disinhibited and inappropriate and it is not uncommon for the person to come to the attention of the police. It is highly likely that admission to hospital will be required in order to prevent the risk factors associated with this episode.

Essentially when someone experiences mania, their brain becomes overwhelmed with all the chemicals involved in mood regulation (serotonin and dopamine), they will eventually become exhausted due to a lack of sleep and everything happening a million miles an hour and this may result in the ‘bipolar crash’, this is the brains way of coping with the extremes of what’s been going on, a bipolar depression can often be experienced directly following a manic episode. It can be understood in this context as the brains way of rehabilitating itself.

Not everyone with Bipolar type I experiences depressive episodes and the manic episodes could be recurrent or just happen once in a person’s life time. However, this diagnosis is applied in the event of a ‘true’ mania.

Bipolar type II:

Someone with bipolar type II will never experience a ‘true’ mania, their mania will manifest as ‘hypo’ mania and they will predominantly experience depressive episodes. Hypomania remains a dangerous situation to be in with serious ramifications down the line for any impulsivity and reckless actions that might occur. The person is unlikely to require hospitalisation for hypomania unless the presentation is a mixed state. The most significant impairment experienced with this condition is depression and the depression often will present as severe. In extreme episodes of severe depression, the person might develop symptoms of psychosis, generally this manifests as persecutory delusions.

Cyclothymia:

This is essentially a lower form of Bipolar type II; symptoms of hypomania and depression will be experienced to a lesser degree and the level of impairment might not intrude on a person’s level of ability to go about their lives because the intensity of symptoms experienced are more manageable. That is not to say that someone with this form of the illness will not experience the associated distress of the condition, it is an enduring illness.

Rapid cycling:

All of the above ‘presentations’ of the illness may manifest for the individual as ‘rapid cycling’. Specifically, if a person has four or more episodes of either mania, hypomania or bipolar depression within a space of 12 months their illness is rapid cycling.

What are the basics of treatment for bipolar?

Bipolar disorders require long term treatment because it is a severe and enduring illness. Treatment is not necessarily about a ‘cure’, the illness is life long but cyclical and so focus is upon control. It is different for everybody, but very common for individuals to present to their doctor only when experiencing the depressive symptoms of the illness. Therefore, is it common for people to be diagnosed with depression initially, this might develop into the diagnosis of recurrent depression over time. Why is this the case? Because someone who is feeling euphoric (in the context of mania) is unlikely to consider that they have a problem – their feeling pretty good so why would they go to the doctor?

Where things become complicated if the underlying problem is Bipolar, is that the first line of treatment for depression involves anti-depressant medications. These group of medications impact of the brain chemistry mentioned above (serotonin and dopamine), this is highly dangerous for bipolar because it can induce manic episodes. It is vital if you suspect you or a loved one has bipolar that this is communicated to your doctor because the group of medications used for the effective treatment of bipolar are referred to as ‘mood stabilisers’.

Effective treatment requires a combination of medication along with psychotherapy. The medications control the episodes and psychotherapy is tailored towards the development of insight into the condition and ways in which to cope with any residual symptoms that may be experienced.

The key to self-help if you or a loved one is diagnosed with Bipolar:

It is completely possible for people with this illness to lead normal and productive lives. In order to achieve this there are a few steps to take into consideration;

• Get educated! It is of paramount importance that you become an expert in understanding how your bipolar affects you as an individual. Ensure you work with your psychiatrist, psychologist and anyone else involved in your care and learn from their professional experience.
• Let those around you (parents, partners, friends etc.) in on your situation and how it affects you, not only will this prevent isolation it will allow others to be mindful of how your illness affects you so that any potential behaviours you may exhibit will be understood in the context of your illness, but they can be your eyes and ears at times things flare up if you loose insight that your becoming unwell. Early intervention will allow you to better control your situation before things escalate further.
• Network with others who struggle with Bipolar. This will help you in your understanding that you are not alone and is helpful in having a forum where you can be yourself and express freely what you’re living with. Most towns/cities have support groups, BipolarUK provide this service and are a valuable resource.
• Embrace it! It doesn’t define you or who you are, its an obstacle you encounter periodically. Its an illness not a choice, acceptance and commitment to the things that help keep you stable will be the thing that allows you lead a productive life and achieve your aspirations.
• Develop your own personal routines and stick to them. Exercise, diet, maintaining the same sleep patterns and effectively managing stress are the things that will contribute towards maintaining stability.
• DO NOT discontinue your treatment during times of stability, it is your treatment that is keeping you well, take the advice of professionals regards your medications and understand that this is something that you must live with. If you had diabetes you would take the second or two to pop the tablet to control it in your mouth or administer the insulin injection so you could keep well, adopt this attitude towards your bipolar.

Support Available

If you would relate or have been affected in any way by this article, please feel free to pop me a message or reach out to the Arthur Ellis Team on [email protected]

If you would like to do a bit more research, please use credible sources, a few that may help are listed below.

Samaritans

Phone: 116 123 (24 hours, 7 days a week)

www.samaritans.org

SaneLine

Phone: 0300 304 7000 (Local call rates, 6pm-11pm. 7 days a week)

www.sane.org.uk

Mind Infoline

Phone: 0300 123 3393 (Local call rates, 9am-6pm, Mon-Fri)

Text: 86463

BipolarUK

https://www.bipolaruk.org/

To arrange a call back, leave a message on 0333 323 3880 or email [email protected]

Find your nearest Support Group - https://www.bipolaruk.org/find-a-support-group