Bipolar disorder

Bipolar disorder (sometimes referred to as manic depression) is a mental illness that affects normal function of the brain.

Bipolar means two poles or extremes, high mood and low mood. A person with bipolar disorder can experience extreme changes in mood, from high mood (also known as a manic or hypomanic episode) to low mood (also known as a depressive episode). 

The episodes of low or high mood usually last several days, weeks or months but the mood can change very fast. The highs and lows associated with bipolar disorder are different from those everyone gets from time to time. They are more intense, sustained and can lead to distress and interfere significantly with everyday life.

Types of bipolar disorder

There are two main types of bipolar disorder – bipolar I and bipolar II.

People who have bipolar I disorder experience both manic and depressive episodes.

People who have bipolar II disorder experience episodes of less severe mania (hypomania) and usually more severe depressive episodes. 

Causes of bipolar disorder

Many factors are believed to play a role in developing bipolar disorder:

• Bipolar disorder seems to run in families. If one parent has bipolar disorder there is a 10 per cent chance that his or her child will develop the illness. If both parents have bipolar disorder the likelihood of their child developing the illness rises to 40 per cent. However, just because a family member has bipolar disorder does not mean that another family member will develop the illness.
• Environmental factors: the onset of bipolar disorder may be linked to the accumulation of stressful or life-changing events. Stress itself is not the cause of bipolar disorder but may be an important trigger.
• Medications: some medications and certain illicit stimulant drugs can cause manic or hypomanic symptoms.
• Brain chemicals: bipolar disorder may be related, at least in part, to abnormal serotonin levels in the brain. Serotonin is a neurotransmitter that affects a person’s mood.

Signs and symptoms of bipolar disorder

Bipolar disorder involves extreme changes in mood from mania or hypomania to depression. Sometimes people experience a mixture of both depressive and manic symptoms usually occurring as part of a cycle.

Signs of mania include a combination of the following symptoms:

• increased energy
• irritability
• overactivity
• increased spending
• being reckless or taking unnecessary risks (e.g. driving fast or dangerously)
• increased sex drive
• racing thoughts
• rapid speech
• decreased need for sleep
• grandiose ideas (e.g. thinking you are famous, being knowledgeable about everything)
• symptoms of psychosis - seeing, hearing, feeling or smelling things that are not there (hallucinations)  having strong beliefs that others do not share such as paranoid thoughts (delusions).

Signs of hypomania include a combination of the following symptoms:

• inflated self-esteem or grandiosity
• decreased need for sleep (e.g. feel rested after only a few hours of sleep)
• more talkative than usual, or pressure to keep talking
• flight of ideas or the experience that thoughts are racing
• distractibility (e.g. attention too easily drawn to unimportant or irrelevant information)
• increase in goal-directed activity (either socially, at work or school, or sexually)
• excessive involvement in seemingly pleasurable but risky activities that have a potential for harmful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments).

Signs of depression include:

• lowered energy levels
• lowered self-esteem (or self-worth) and guilty thoughts
• difficulties falling asleep, waking up in the night or early in the morning and having difficulties going back to sleep
• changes in appetite or weight
• less ability to control emotions, and feeling pessimistic, angry, guilty, irritable and anxious
• emotions changing throughout the day, for example, feeling worse in the morning and better as the day progresses
• reduced capacity to experience pleasure: you can't enjoy what's happening now, nor look forward to anything that is usually pleasurable. Usual interest in hobbies or other activities drop off
• reduced pain tolerance: you are less able to tolerate aches and pains and may have a host of new ailments
• changed sex drive: absent or reduced
• poor concentration and memory: some people are so impaired that they think that they are developing dementia
• reduced motivation: it doesn't seem worth the effort to do anything, things seem meaningless.

If you suspect you have bipolar disorder

If you think you are experiencing bipolar disorder, visit your GP who can refer you to a mental health professional. Bipolar disorder can be diagnosed and treated hence it is important that you receive appropriate care.  It is possible to live a full and satisfying life with a mental illness. 

Treatment of bipolar disorder

Bipolar disorder can be treated with medications such as mood stabilisers and anti-depressants. Everyone is different, so a medication that may work for one person may not work for another. Your mental health professional will help you find the medication/s that is right for you. Psychological (“talking therapies”) such as counselling and psychotherapy can also be of assistance and are often used in combination with medication use. 

Living with bipolar disorder

The following tips may help you better manage living with bipolar disorder:

• Take the medication that is prescribed for you every day. Missing a dose because you feel better may actually bring on a manic/hypomanic or depressive episode.
• Don’t stop taking your medication suddenly. Discuss any changes with your doctor.
• Make sure you are well informed about the medications you are prescribed and what the possible side effects of these medications may be. Always ask your doctor any questions you may have about your medication.
• Keep a record of your mood through the use of a mood chart (external site), which can help you recognise any change in your mood and what may have triggered it, such as a lack of sleep, change in medication or a stressful situation. Keeping track of your mood can help you feel more in control of your life and help you recognise early warning signs of a manic/hypomanic or depressive episode. Contact your mental health professional early if you feel you may be becoming unwell.
• Involve those around you in the monitoring of your mood. There may be times when you are becoming unwell but you do not recognise it yourself. Those closest to you will be able to help you identify when your mood changes significantly.
• Talk to other people who have bipolar disorder through support groups or online networks (see below for some suggestions). Connecting with other people who have similar experiences to you can help you feel that you are not alone, allows sharing of strategies that have helped others, and can give you hope.
• Consider talking to your employer or supervisor at work, as it can assist them to make changes for you if you become unwell. For example, your employer may allow you to take time off for appointments with your mental health professional, give you a flexible working schedule, or reduce pressure or stress related to your workload. It is of course your decision about whether or not to tell your employer about your illness and you may not feel comfortable.
• Learn as much as you can about your disorder by reading books and searching for online resources. Read only from reputable websites (see below) as some may give you false or misleading information. Knowledge about your illness can provide you with a sense of empowerment and can give you the tools necessary to overcome the difficult periods of your illness.
• Participate in psychological counselling such as cognitive behaviour therapy (“talking therapy”) – see below for suggestions on where to go.
• Try to avoid alcohol and illicit drugs as they can make your symptoms worse and can also interfere with your medications.

Where to get help

• Contact your GP who can give you a referral to a mental health professional.
• Visit the emergency department at your local hospital if you are feeling very unwell or worried about your symptoms
• If you are worried about the mental health of yourself or someone close to you and require assistance contact the Mental Health Emergency Response Line (external site) on: 
  • Perth metro callers: 1300 555 788           
  • Peel area callers: 1800 676 822
• If you feel unsafe, contact 000 (police)

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