Bipolar Disorder (Manic Depression)

What is Bipolar Disorder?

Bipolar Disorder (BD) is a condition in which a young person has extreme changes of mood – periods of being unusually happy (known as ‘mania’ or ‘hypomania’), and periods of being unusually sad (‘depression’).

Everyone has times in their life when they feel very happy (such as when you are about to go on holiday) or very sad (such as when your pet dies). But it only becomes a disorder when the mood changes are unusual or extreme. This can range from being unusually happy (known as mania or hypomania), to being unusually sad (depression) for no apparent cause. The mood-swings are way beyond what would be considered normal for a particular individual, and are out of keeping with their personality.

How common is it?

Bipolar disorder is extremely rare in young children, but there are quite a few studies that suggest that it may start in teenage years and in early adult life. It affects about one in 100 adults. Although the causes are not fully understood, bipolar disorder tends to run in families. In people who have bipolar disorder, episodes may happen at times of stress or disrupted sleep.

How can Bipolar Disorder be treated?

Talking treatments (also known as ‘psychological therapies’)
These may include different types of therapies like:

  • Cognitive-behavioural therapy (CBT) – The young person, sometimes with their family, learns to understand the links between their feelings and thoughts and how this affects their behaviour (see our factsheet on CBT).
  • Family-focused treatment (family therapy) – The whole family can be helped to reduce stress, solve problems and communicate better.

Medication

Medication plays an important role in the treatment of bipolar disorder, especially if episodes are severe. In the initial stages of the illness, medication helps to reduce the symptoms.

The choice of medication can depend upon the type of episode (manic or depressed). Everyone is different, and so the type of medication that is recommended will also be different.

The three main types of medication that are helpful are:

  1. Antipsychotic medication: risperidone, olanzapine and aripiprazole are types of antipsychotics usually used for high/manic episodes.
  2. Mood stabilizers: Lithium is a type of mood stabilizer to help stabilise mood between and during episodes.
  3. Antidepressants:  fluoxetine is a type of antidepressant used for the low/depressive episodes.

Medications can have mild or even severe side-effects. Your psychiatrist will be able to advise about what they are and about what can be done to help. The risk of side-effects needs to be balanced against the risk of the damaging effects of the illness on a person’s life.

It is important that medications are not taken only when the problems are serious. If you have had more than one severe episode of illness, staying on medication is important to reduce the risk of further episodes. Medication may be needed for months or even years. Some people may, under medical supervision, be able to stop their medication when they have recovered and have felt well for a while.

Information for young people

In bipolar disorder, you may find that you feel that you have (1) manic/hypomanic episodes, (2) depressive episodes or (3) mixed episodes.

Your mood changes can sometimes happen very rapidly within hours or days (sometimes called rapid cycling). For some people, the mood symptoms are less severe (sometimes called ‘cyclothymia’).

In between the highs and lows, there are usually ‘normal’ periods that can last for weeks or months. However, if you have had the disorder for some time, these periods of ‘normalcy’ can be shorter or difficult to see.

Below is a list of the symptoms that can occur in each type of episode. You need to have at least one manic or hypomanic episode to be diagnosed with bipolar disorder.

You need to have several symptoms at the same time for at least several days. If there is just one symptom, then it is unlikely you have bipolar disorder.

Symptoms that can occur during a ‘high’ or manic episode

  • feeling incredibly happy or ‘high’ in mood, or very excited
  • feeling irritable
  • talking too much -increased talkativeness
  • racing thoughts
  • increased activity and restlessness
  • difficulty in concentrating, constant changes in plans
  • over confidence and inflated ideas about yourself or your abilities
  • decreased need for sleep
  • not looking after yourself
  • increased sociability or over-familiarity
  • increased sexual energy
  • overspending of money or other types of reckless or extreme behaviour.

Hypomania is a milder form of mania (less severe and for shorter periods). During these periods people you can feel very productive and creative and so see these experiences as positive and valuable.

However, hypomania, if left untreated, can become more severe, and may be followed by an episode of depression. At the extreme end, some people may develop something called ‘psychosis’.

Symptoms that can occur during a depressive episode

  • feeling very sad most of the time
  • decreased energy and activity
  • not being able to enjoy things you normally like doing
  • lack of appetite
  • disturbed sleep
  • thoughts of self-harm or suicide.

On the milder end, you may just feel sad and gloomy all the time. Here too, at the extreme end, some people can develop psychosis.

What effects can Bipolar Disorder have on you?

The exaggerated thoughts, feelings and behaviours can impact on many aspects of your life, for example:

  • loss of confidence
  • loss of sense of control you feel over your life
  • poor concentration with studies
  • problems with relationships with your family and friends
  • behaviour that places a your health or life at risk.

What can you do?

It is important to recognise that you are not alone and to keep up hope. Some people only have one or two episodes. For others the highs and lows can occur through their adult life. When this happens, it is important that you learn to live with it and manage it.

  • The first step is recognising that something is different or a problem. Other people are likely to have noticed that you seem different from your usual self, particularly those who live with you.
  • Speak to people who know you well, such as family and friends.
  • Seeking medical advice early on is very important. If the bipolar illness can be identified and treated quickly, this reduces its harmful effects.
  • If you already have a diagnosis, understand your illness and problems. This can help you to take control and get help before it gets more difficult. This can mean steps like planning for a crisis and making choices about your career.
  • Do things which help you to have a good health, like having a balanced healthy diet, doing some exercise, and getting a good night’s sleep.
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