Bipolar disorder explained

BIPOLAR disorder. We seem to be hearing more about it. What exactly is it and how is it treated?

Once known as 'manic depression', bipolar disorder is a condition in which moods swing to extremes, from profound depression to an exaggerated high (mania) where a person may experience an unrealistic sense of power, optimism or creativity.

While everyone has mood swings, in bipolar disorder they are so extreme that they interfere with a person's ability to carry out ordinary day-to-day activities – personal and professional – effectively.

According to beyondblue, the national depression initiative, it affects around 1% of Australia's population.

While bipolar disorder often onsets in the late teens and early 20s, it can occur at any age. In many cases, particularly the less severe ones, it can be difficult to diagnose. This is because, when a person is experiencing an 'up' phase, they are less likely to seek medical help. So, while they may be diagnosed with, and treated for, depression, the mood swings that are the defining feature of bipolar disorder may not be apparent to the doctor making the diagnosis.

In addition, in less severe cases, the up-and-down characteristics of bipolar disorder can be more subjectively viewed and open to interpretation, particularly in an adolescent or young adult who is still developing and in whom such changes of mood are often regarded as expected.

Although bipolar episodes may be very frequent, with ups and downs occurring even daily, more commonly they are less frequent and may even occur only every few years. Between episodes, a person with bipolar disorder can generally operate on a more even keel.

The down phase: depression

One of the lesser known features of bipolar disorder is that, although it is actually defined by the presence of 'highs' or mania, the depression involved is likely to be more severe and last longer than in others who may have clinical depression without the bipolar factor.

Some signs and symptoms of depression:

• low mood
• irritability
• change in appetite
• lack of motivation
• low self esteem
• sleep disturbance
• suicidal thoughts
• difficulty managing small tasks or making simple decisions
• hallucinations and/or delusions.

Once there is awareness of the condition and its phases, the onset of a manic episode may be more quickly and readily apparent than a depressive one.

Some signs and symptoms of mania:

• increased energy
• irritability
• overactivity
• increased spending
• increased sex drive
• racing thoughts
• rapid speech
• decreased sleep.

While the story is far from complete, there are a number of known factors that may trigger bipolar disorder. These include a strong genetic link, stressful life events and damage to, or infection of, the brain.

Increasingly, illicit mood-altering drugs are also being implicated. Because their effect is derived by altering brain chemistry, an area which is still largely uncharted, the long term results of use of such drugs is still unknown.

What we do know, however, is that drug induced states and the effects of long term drug use can mimic elements of bipolar and other mood and personality disorders. A further complicating factor is that symptoms of bipolar disorder also often first appear around the age a person begins using these drugs.

Treatment options

While no treatment has yet been found to be 100% effective, and bipolar episodes may still recur, in most cases the harm and distress they cause can be dramatically reduced with help and adherence to a combination of therapies.

Lifestyle management can in some cases help avoid or reduce bipolar episodes, such as:

• eating well and regularly
• exercising regularly
• establishing regular sleep routines
• avoiding or reducing use of alcohol and other drugs.

Medication, including anti-depressants and mood stabilisers, is also appropriate in many cases.

It's not uncommon during manic episodes for a person with bipolar disorder to stop taking their medication in the belief that they are 'cured' or no longer need it, so it's especially important to pay attention to medication compliance around these times.

There's a wide range of medications available and individuals may respond differently to each, so some trial and error may be needed before the right medication mix is found. Once it is found, it's important to keep up with the medication regime as it's prescribed – this offers the best chance for success.

Where to find out more

Call the Lifeline Mental Health Infoline on 1300 131 114 or visit www.lifeline.org.au

Call the Sane Information Line on 1800 688 382.

Visit beyondblue, the national depression initiative at www.beyondblue.org.au

The Black Dog Institute offers very comprehensive information about bipolar disorder and depression. Visit www.blackdoginstitute.org.au

For information and interactive tools to help with mood management, visit www.moodgym.anu.edu.au.