What causes bipolar? Find out what we know about the causes of bipolar Expand Although much progress has been made in understanding bipolar and how it can be managed, research has still not led to either a consensus on the cause or a cure. Some research suggests that there is, if not a known genetic link, then certainly an inherited predisposition to developing bipolar. It is also known that stressful life events may often precede or trigger an episode of mania, hypomania or depression. As our understanding of the function of the brain increases, more insights and more effective medication can be developed. This is why Bipolar UK works in partnership with research organisations.You may also like to see this:
Introduction to bipolar An introduction to bipolar disorder and the services offered by Bipolar UK Expand An introduction to bipolar disorder and the services offered by Bipolar UK Bipolar, sometimes known as manic depression, is a severe mental illness characterised by significant mood swings including manic highs and depressive lows. Download this leaflet as a PDF
Are there different types of bipolar? Some doctors use different classifications to describe bipolar symptoms - bipolar 1 and bipolar 2. Read this overview to find out more. Expand Bipolar disorder, also known as bipolar affective disorder, is a mood disorder. Depending on your age, you may also be aware that it used to be called manic depression (and some people still prefer to use that term for their diagnosis). Bipolar is a chemical imbalance in the brain that prevents the body from regulating moods correctly. Which causes very extreme responses to stress: Emotional Physical External stimuli – noise, light, smell Resulting in intense mood and energy swings (depression & mania). It is estimated. That around 2% of the population are living with bipolar.* The majority of individuals who receive a diagnosis will be diagnosed with bipolar disorder, however some medical professionals may explain your illness in terms of a particular categorisation. Bipolar 1 Individual’s mood swings move across the mood scale encompassing both manic episodes and depression. A diagnosis of bipolar I disorder means you will have had at least 1 episode of mania that lasts longer than 1 week. 90% of people will also have periods of depression. Untreated, manic episodes will generally last 3-6 months. Depressive episodes will generally last 6-12 months without treatment. Bipolar 2 A diagnosis of bipolar II disorder means it is common to have symptoms of depression. You will have had at least 1 period of severe depression. And at least 1 period of hypomania instead of mania. The majority of individuals with bipolar II will experience hypomania (6 to 8 on the mood scale) rather than extreme manic episode (8 to 10 on the mood scale). Bipolar 1 or 2 disorder with mixed features You may hear this being called ‘mixed bipolar state’. You will experience symptoms of mania or hypomania and depression at the same time, which may result in agitation, trouble sleeping and significant change in appetite, psychosis and suicidal thoughts. Bipolar 1 or 2 disorder with rapid cycling Rapid cycling means you have had four or more depressive, manic, hypomanic episodes in a 12-month period. Rapid cycling affects around one in ten people with bipolar, and can happen with bipolar I and II. see also a separate FAQ: What is rapid cycling? Bipolar 1 or 2 with seasonal pattern Seasonal pattern means that either your depression, mania or hypomania is regularly affected in the same way by seasons. For example, you may find that each winter you have a depressive episode but your mania does not regularly follow a pattern. Cyclothymia A diagnosis of cyclothymic disorder means you will have experienced regular episodes of hypomania and depression for at least 2 years, with no period longer than two months in which there has been a stable state and no mixed episodes. Although individuals diagnosed with cyclothymia are on the bipolar spectrum, they will not have a bipolar disorder diagnosis. Cyclothymia can however develop into bipolar disorder. Psychosis Sometimes severe mania (8 to 10 on the mood scale) or depression (2 to 0 on the mood scale) is accompanied by periods of psychosis. Psychotic symptoms include hallucinations and delusions, sometimes referred to as messianic mania. You can use our mood scale to help you describe your mood. The mood scale can also be used with our mood diary to help keep track of your moods. * Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2014 You may also like to see:
You have been diagnosed with bipolar A leaflet designed for people who have received a diagnosis of bipolar. Expand A leaflet designed for people who have received a diagnosis of bipolar. This leaflet is for people who have been diagnosed with bipolar and gives you information and advice about managing the illness. How can you manage your bipolar? This leaflet has been given to you as you’ve been diagnosed with bipolar. Bipolar disorder is an enduring, severe mental health condition characterised by extreme mood swings - manic highs to depressive lows. You are not alone. Over 1 million people in the UK have bipolar, and many of these individuals lead productive, happy andfulfilling lives. The key to coping with bipolar is early diagnosis, acceptance and adapting your lifestyle so you can control the condition as much as possible. You can also manage bipolar through medication, the right healthcare, therapy and self-management. The earlier you receive treatment, the better. Even the mildest symptoms of bipolar can become very serious. Bipolar affects everyaspect of our lives and can put individuals and their loved ones under immense stress. What happens now? Treating bipolar There’s no cure for bipolar but you can take medication to help manage the condition. Bipolar affects everyone differently and it can take time to find the right medication or combination of medications for you. Please see our leaflet on medication for more information. Your doctor may also refer you to specialist local NHS mental health services. Many people with bipolar are offered treatment from community mental health teams. These may include psychiatrists, psychologists, social workers, occupational therapists, and community psychiatric nurses. Understanding bipolar As well as receiving the right medical support, you need to understand bipolar and how it can affect you and your loved ones. There are many organisations that can help you, including Bipolar UK. Our helpful services are there to support you, your family, and loved ones, and can also help support you in the workplace. You can also manage bipolar by adapting your lifestyle and watching what you eat. Ideally, you should eat a healthy, balanced diet, cut down on caffeine and alcohol, exercise regularly, try to sleep for seven to eight hours each night, avoid stress, and make sure you find healthy ways to relax. Your family, friends and loved ones Bipolar affects every aspect of your life and your family, friends and colleagues can be put under stress. To understand and manage bipolar, you will need support. If you can, speak to family members, your partner or close friends. You could ask them to go with you to see your doctor or to other appointments. Loved ones may also have useful insight into your behaviour, which can be helpful for health professionals. Family members and loved ones should be involved in planning your treatment and care and, unless you don’t want them to be, should be consulted by mental health professionals. Mental health teams should also give your family members clear information about your diagnosis and how they can also help you. Helpful services Your local NHS mental health team will also run some hospital-based services. If your mood swings become extreme, you may have what is called a manic or severe depressive episode. When this happens, you may need to spend some time in hospital or to receive support from community crisis teams at home. The community crisis team offers you treatment at home to avoid, if possible, you having to go to hospital. They may come to your house or offer treatment in a residential service or day centre, depending on what’s available in your local area. Psychiatric hospitals offer a safe space to receive treatment, but when you’re experiencing a manic episode, you might not always be able to recognize when you need this type of treatment, and refuse the treatment that you need to get well. If this happens, you might be sectioned, or admitted to hospital, under the Mental Health Act. This will only happen against your wishes if it’s in your best interests or to protect others. How you can help yourself You can work with your doctor and other mental health professionals who are there to support you. You should make sure you involve your family and loved ones and find out as much as you can about the illness. It’s also helpful to talk with other people who are also affected by bipolar. You can understand how bipolar affects you as an individual by monitoring your moods and learn what can trigger your mood swings too. You should also learn how to manage your mood and mental health through adapting your lifestyle. Bipolar UK also provides a range of services to support anybody affected by bipolar.These include:• Our Support Line• Our eCommunity, a free online forum• Support Groups• Work and Learning Support Download this leaflet as a PDF
Introduction to medical treatment A leaflet introducing the range of medications available to treat bipolar Expand Always seek a doctor's advice when making decisions about medication Medications are the cornerstone of treating bipolar disorder, though there are many other aspects to keeping well. We’ve compiled this short resource guide for information only. There is a range of different medications used to treat bipolar. Many different medications are used to treat bipolar. Which medications are used will depend on the nature and degree of your symptoms and the phase of the illness you are in. For example, when bipolar is associated with other problems such as sleep disturbance additional medication may be needed. Medications commonly used fall into these categories: Mood stabilisation or mood maintenance For use when high (hypomania/mania) For bipolar depression For associated conditions, such as sleep difficulties and anxiety Scientific evidence shows that how effective an individual or a combination of medications is can vary significantly. People can respond differently to the same medication and an individual’s response to a medication can change over time. There are a variety of side effects and different people will experience these in different ways. There are also new medications being developed for bipolar all the time. 1. Medications for mood stabilisation or mood maintenance Your doctor may prescribe one of these for your condition. Each of these medications acts in a different way in the brain to prevent your mood becoming unstable. They may also act to improve your mood if depressed or calm you down if high. Lithium Divalproex Carbamazepine Valproic acid Olanzapine Quetiapine How do they work? Their exact mechanism is not known and they probably work in different ways. They may have a common action to change the level of mood changing chemicals and boost levels of a “brain fertiliser hormone” called Brain Derived Neurotrophic Factor (BDNF). This is boosted particularly in critical areas of the brain responsible for mood regulation, or an area known as the limbic system and prefrontal cortex. Blood monitoring Many of the mood stabilisers require some kind of regular blood monitoring to check the medication’s plasma level. Lithium can affect organs such as the kidney, thyroid and liver. Regular blood tests can monitor this and are vital in preventing damage.. Physical health When you start on a mood stabiliser or antipsychotic you may have tests before and then at regular intervals afterwards. Olanzapine and quetiapine can cause changes in your metabolism leading to weight gain, diabetes or raised cholesterol. Initially your weight gain, blood pressure and blood will be tested every three months for the first year and then each year thereafter. It is important that these tests are done to detect changes early and treat them. 2. Medications used when high (hypomania/mania) Antipsychotics Antipsychotics are the most commonly used type of medication to treat a manic episode. They are divided into groups based on their potential side effects. No medication has a more tolerable side effect, but rather they have different side effects. Newer medications are equally effective in treating bipolar but all have different side effects that are not necessarily less troublesome than older ones. Psychiatrists use the wider range of antipsychotics available to suit individual patients. Antipsychotics have been shown to act as mood stabilisers in some cases. Some of the mood stabilisers are effective in treating a manic episode if given at higher doses. The following is a list of common antipsychotics that your psychiatrist may use: Aripiprazole Haloperidol Olanzapine Quetiapine Risperidone Clozapine Other anti-manic medications that are not antipsychotics include clonazepam, lorazepam, lithium and valproate. Other medications Other medications may also be used to prevent or treat mania, but there is less evidence for their effectiveness. These include topiramate, lamotrigine, levetiracetam, oxcarbazepine, ritanserin, ziprasidone and gabapentin. How does bipolar medication work? The exact mechanism is not known. They have a sedative effect on the brain and alter the balance of a brain chemical called dopamine which is known to be abnormal in mania and psychosis. 3. Medications used for bipolar depression The following medications are established treatments for bipolar depression: Lithium Lithium plus antidepressants Lamotrigine Olanzapine plus fluoxetine Quetiapine There are many groups and types of antidepressants, too many to list in completeness here. Those commonly prescribed today are the SSRIs (selective serotonin reuptake inhibitors) and include fluoxetine, paroxetine and citalopram. They work by altering the balance of the brain chemical serotonin in parts of the brain. Antidepressants alone without a mood stabiliser are avoided in bipolar depression as there is a risk of inducing a hypomania or rapid cycling. Other treatments, but with less scientific evidence for effectiveness in bipolar depression, include valproate, carbamazepine, aripiprazole and gabapentin. Treatment resistant bipolar depression This can be disabling and your doctor will have to weigh the risk of inducing a high or rapid cycling in you if using multiple treatments. Your doctor may, by combining medication types, boost their effectiveness. Combinations your doctor may investigate include multiple mood stabilisers, two antidepressants or lithium plus lamotrigine. In severe cases electroconvulsive therapy (ECT) may be necessary. The law governing the use of ECT is very strict in the UK and it is used infrequently. 4. Medications used for associated conditions Sleeping tablets From time to time people with bipolar suffer from sleep difficulties. Managing your sleep by keeping regular patterns and habits will aid good sleep. This is essential in keeping your moods stable. Avoiding stimulants like coffee in the afternoon and evening is a good example. If you are struggling to sleep it may be wise to take a sleeping tablet with your doctor’s agreement as when you have bipolar you can become more sensitive to sleep loss. Don’t take herbal supplements or other sleep aids without first consulting your doctor. Your doctor may be cautious about giving you too many sleeping tablets too often as they can become addictive. When stopping them you may have difficulty sleeping for a night or two and have vivid dreams. The most commonly used prescription sleeping tablets are zolpidem and zopiclone. Anxiety medications Anxiety problems with bipolar are common. Generalised anxiety, panic attacks and social anxiety are all more common in bipolar than in those without the condition. Anxiety problems are more likely just before, during or after a period of instability of mood. Most of the medications used to treat bipolar may help anxiety. However some of the side effects may make it worse or may seem like anxiety. For example some antipsychotics can induce a restlessness called akathisia (Greek for “can’t sit still”). It is important to report your symptoms in detail to your doctor so he/she may provide the right treatment. There are many psychological and other non-medication treatments for anxiety. Commonly used medications include antidepressants, beta-blockers, valproate and gabapentin. How do they work? They have a varied mechanism but benzodiazepines act like a key on large receptors on the surface of brain cells causing the cells to be less likely to activate, therefore mildly sedating them. 5. Women and Sodium valproate Valproate is a medication used to treat bipolar, other mental health conditions and epilepsy. It’s associated with a risk of birth defects and development disorders in children born to women who have taken Valproate during pregnancy. It is vital that women and girls are aware of the risks of this medication. Women should receive a patient booklet and alert card from their doctor or pharmacist. Nobody should stop taking Valproate without discussing it with their doctor or psychiatrist. You can search for Valproate on our website for more information. There are medications that are safer to take during pregnancy than others. We recommend that you speak with your doctor and midwife to ensure that you are getting the safest treatment for you and your pregnancy. For more information, we have produced a booklet with Action on Postpartum Psychosis (APP) which is available upon request. We hope you’ve found this leaflet useful. Medication is the cornerstone of treating bipolar, but there are many other aspects to keeping well including diet, physical exercise and complementary therapies. If you look after yourself, you are better equipped to understand bipolar and monitor variations in your mood swings. Check out our Medication and treatment blog for more stories and information Other links UK Psychiatric Pharmacy Group – This site offers a group of frequently asked questions about medications. The Royal College of Psychiatrists – This site offers a range of detailed information leaflets for a variety of mental health issues. The Institute of Psychiatry, King’s College – This site carries a comprehensive list of medications and their side effects plus helpful videos. Please do not hesitate to contact your doctor or mental health professional for specialist advice. Download this information as a PDF
I feel very isolated and would like to talk with someone who understands Bipolar UK services are often delivered by people affected by bipolar themselves Expand Bipolar UK provides a range of services for individuals affected by bipolar. Whether you have a diagnosis for bipolar, are concerned about the possibility of bipolar, are being affected by a member of your family or a loved one, we are here to assist and support you. Our services include: Local and national online support groups Our Support Line offering information and advice via telephone or email Online eCommunity open 24/7