What is bipolar? Expand Bipolar – sometimes known as manic depression – is a severe mental health illness characterised by significant mood swings including manic highs and depressive lows. The majority of individuals with bipolar experience alternating episodes of mania and depression.Both males and females of any age and from any social or ethnic background can develop the illness. The symptoms can first occur and then reoccur when work, studies, family or emotional pressures are at their greatest. In women it can also be triggered by childbirth or during the menopause.The key to coping with bipolar is an early diagnosis, acceptance of the illness and adapting your lifestyle so you are in control of the symptoms as much as possible. Management of the illness can be achieved through strategies involving medication, health care, therapy and self management.
Bipolar - The Facts Expand 1% to 2% of the population experience a lifetime prevalence of bipolar and recent research suggests as many as 5% of us are on the bipolar spectrum.1, 2 Bipolar also has a huge impact on family and friends. On average it takes 10.5 years to receive a correct diagnosis for bipolar in the UK and before bipolar is diagnosed there is a misdiagnosis an average of 3.5 times.3 Bipolar increases the risk of suicide by 20 times.4 The World Health Organisation identifies bipolar as one of the top causes of lost years of life and health in 15 to 44 year olds.5 Just 21% of people with a long-term mental health condition are in employment.6 Compared to other health problems, treatment of bipolar is still badly affected by misunderstanding and stigma. Bipolar affects every aspect of your life and your relationship. Family and friends can all be put under stress. This is why you need to get a correct diagnosis, accept treatment and start to learn how you can adapt your lifestyle to cope with the ups and downs. 1 Merikangas KR, Peters TL, Update on the Epidemiology of Bipolar Disorder. In Yatham LN, Maj M “Bipolar Disorder Clinical and Neurobiological Foundations”, Chapter 6, page 52-61. Wiley-Blackwell UK, 2010. 2 Lam, D.; Wright, K.; Smith, N. (2004). "Dysfunctional assumptions in bipolar disorder". Journal of Affective Disorders 79. 3 S. Nassir Ghaemi (2001). ‘Bipolar Disorder: How long does it usually take for someone to be diagnosed for bipolar disorder?’. Archived from the original on December 7, 2006. Retrieved February 20, 2007. 4 . 4 NHS Choices (2016). Suicide - Causes. [online] Available at: http://www.nhs.uk/Conditions/Suicide/Pages/Causes.aspx 5 Murray, C. and Lopez, A. ed., (1996). The Global Burden of Disease: A comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. 1st ed. Boston: The Harvard School of Public Health. 6 Office for National Statistics. Social and Vital Statistics Division, Northern Ireland Statistics and Research Agency. Central Survey Unit. (2014). Quarterly Labour Force Survey, October - December, 2006. [data collection]. 5th Edition. UK Data Service. SN: 5609, http://dx.doi.org/10.5255/UKDA-SN-5609-2
How do I know if I have bipolar? Expand Bipolar affects everyone differently and can be difficult to diagnose, but there are some common signs that can help you identify the illness. A mood scale - see our 'Could mood swings mean bipolar?' leaflet - will help you and your doctor understand your mood swings. Take a completed mood scale with you to your next appointment with your doctor and tell them how you have been feeling over a period of time. If you feel comfortable you could complete the mood scale and see your doctor with someone close to you. Sometimes your GP may refer you to a specialist – usually a psychiatrist. Diagnosis should always be undertaken by an appropriately trained medical professional. It is not advisable to self diagnose.
Is there a medical test for bipolar? Expand There is no medical test for bipolar. Instead your GP or psychiatrist will usually complete an assessment focusing on your mood swings. They will ask questions about your family history and background, your sleeping pattern, your diet and your behaviour. They may also take notes about when you first experienced symptoms. All this information is relevant to help make an informed diagnosis.
Is there a cause or cure for 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 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.
If I experience mood swings does that mean I have bipolar? Expand No, everyone has good and not so good days and experiences mood swings. The Bipolar UK mood scale is from 0 to 10 and those not affected by bipolar will experience mood swings between 4 and 6 on the mood scale. If you have bipolar, your mood swings go above stable levels anywhere between a 6 and 10. With bipolar when you experience depression it falls below 4 to as low as suicidal depression of 0. Hypomania (6 to 8 on the mood scale). Someone experiencing hypomania can seem very self confident and euphoric but may react with sudden anger, impatience or irritability for the slightest reason. They may become easily distracted, more talkative or challenging. They may become more reckless than usual, which might mean errors of judgement, sometimes involving spending too much money or taking on more than they can cope with. Mania (8 to 10 on the mood scale) Someone experiencing mania may not recognise it is happening. Incoherent, rapid or disjointed thinking or being easily distracted. Other symptoms may include verbal aggression, paranoia and hallucinations affecting vision or perception. Grandiose delusions or ideas can occur where the sense of identity and self have been distorted by the illness. Sometimes the term psychosis (losing touch with reality) is used to describe these symptoms. Depression (4 to 0 on the mood scale) Most people with bipolar will experience severe depression at some time. Usually this will follow a period of mania or hypomania. For some people depression is more likely to occur during the winter months. Common symptoms experienced during depression include: feelings of emptiness or worthlessness (as opposed to sadness), loss of energy and motivation for everyday activities, pessimism and negativity. Thoughts of death and suicide are also common symptoms.
Are there different types of bipolar? Expand The majority of individuals are diagnosed with bipolar disorder. However some medical professionals may explain your illness in terms of a particular categorisation. Bipolar I Individual’s mood swings move across the mood scale encompassing both manic episodes and depression. Untreated, manic episodes generally last three to six months. Depressive episodes last rather longer – six to 12 months - without treatment. Bipolar II Individuals experience a prevalence of depression. Likely to have more than one episode of severe depression, and 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). Mixed State Symptoms of mania and depression are present at the same time, which may result in agitation, trouble sleeping and significant change in appetite, psychosis and suicidal thoughts. Rapid Cycling This occurs when individual’s mood swings change faster. More than four mood swings happen in a 12-month period. Rapid Cycling affects around one in ten people with bipolar, and can happen with Bipolar I and II. Cyclothymia Individuals experience mood swings but at a much lower level. Symptoms must last for a period of at least two 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, the relative mildness of the mood swings means you are not diagnosed with bipolar. However cyclothymia can develop into bipolar. 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.
What is rapid cycling? Expand Rapid cycling means that someone will experience many episodes of illness each year. How many episodes? Well the cut off is essentially arbitrary, but it is taken to be four or more episodes of mania and depression in any one year period. Some people have very rapid switches and in these cases the terms ultra-rapid (days) and ultra-ultra rapid or ultradian (within a day) cycling have also been used. The diagnosis of rapid cycling is not used by everybody and is not included in all classification systems. For example, although it is included in the American diagnostic system (DSM-IV ) it is not currently part of the international classification system, ICD10. Is it easy to distinguish rapid cycling from other conditions? The diagnosis of rapid cycling bipolar disorder can be difficult. In adolescents it can be mistaken for conditions such as ADHD. In adults, it may be difficult to distinguish very fast cycling patterns from the mood instability found in borderline personality disorder. We know that many people find that it takes far too long before they receive a bipolar disorder diagnosis, something confirmed by Bipolar UK’s recent survey. It is therefore vital that a full assessment is made to ensure that a diagnosis of rapid cycling bipolar disorder is not missed, or indeed, that a label of rapid cycling is not wrongly applied to another condition. ‘There is still a lot we don’t know about rapid cycling — does it represent a separate type of bipolar disorder, or merely reflect bipolar disorder that is not receiving optimal treatment?’ How common is rapid cycling? About 10 to 20 per cent of people with bipolar disorder may have rapid cycling and it is probably more common in people with the form of bipolar disorder sometimes referred to as bipolar II (those that experience less severe highs). It is also the case that rapid cycling is more common in women. Is rapid cycling a subtype of bipolar disorder? There is still a lot we don’t know about rapid cycling – does it represent a separate type of bipolar disorder, or merely reflect bipolar disorder that is not receiving optimal treatment? Although many may no longer experience rapid cycling when they find the combination of medication and self- management that suits them, some people will continue to have many episodes of illness despite adequate treatment. What is clear is that rapid cycling is a transient phenomenon for most people — many people with bipolar disorder will experience periods of rapid cycling at certain times but have other times, when this label would not apply. Why is rapid cycling important? It is important because it may pick out a form of bipolar disorder that responds less well to medication. Studies have suggested that people with rapid cycling have a poor response to treatment. Although the first study to show this was of lithium treatment, it is probably true for other medications too. What makes rapid cycling more likely? It may be that for some people, treatment with antidepressant medication alone can increase the chances of developing rapid cycling. That is one of the reasons why many clinicians will recommend that antidepressants, when used in someone with bipolar disorder, are used in combination with a mood stabilising medication such as lithium. It may also be the case that certain antidepressants, for example the ‘tricyclics’, are more likely to result in rapid cycling than other antidepressants such as the ‘SSRIs’. What is certainly true is that antidepressants, when taken with a mood stabiliser, are much less likely to result in rapid cycling.