Bipolar Affective Disorder (BPAD) sometimes referred to as Manic-Depression is a chronic condition characterised by extreme swings in mood. This can include extreme emotional highs known as “mania” or “hypomania” and extreme lows “depression”.

Bipolar symptoms look different for each person. In some cases, episodes can last for weeks and even months and occur every few years. Others may experience shorter but more frequent episodes.

Bipolar affects approximately 2.2% of Australians. Generally, it starts in early adulthood and it is usually a lifelong condition.

 

Signs and symptoms of Bipolar 1

Mania (lasting at least 7 days)

•       feeling high, extremely happy or elated or irritable
•       Inflated self esteem or grandiose ideas
•       Increased energy and creativity
•       Reduced need to sleep
•       Racing thoughts
•       Rapid speech- talking loudly or jumping from topic to topic (flight of ideas)
•       Being easily distractible
•       Impulsive often risky behaviour such as spending or sexual activity
•       Unrealistic plans
•       Delusions or hallucinations

 

Not everybody experiences all of these symptoms, however they are common phenomena in the manic phases of BPAD

•       Depression
•       Low mood
•       Teariness
•       Lack of motivation
•       Lack of interest in usual activities or interests
•       Difficulty concentrating
•       Sleep disturbances including insomnia and excessive sleeping
•       Social withdrawal
•       Feelings of worthlessness guilt
•       Suicidal ideations

 

It is essential  that the depressive episodes are recognised and treated early as most suicide occur during thisphase.

Types of Bipolar Disorder

Bipolar I

This is characterised by extreme highs and lows in mood. It involves 1 or more manic episodes with periods of hypomania or depression often preceding this. It can also include psychosis. Generally, due to the severity of these symptoms, people may require hospitalisation.

Bipolar II

This involves highs that are not as extreme known as “hypomania” and also periods of depression. Hypomanic episodes can last hours or days. There are also periods of normal mood known as “euthymia”. Whilst this disorder is not as severe as Bipolar I, it can be more chronic in nature as the depressive symptoms are often more frequent and longer-lasting.

Cyclothymic Disorder

This disorder results in persistent and unpredictable mood changes, however they are not as severe and generally have shorter duration. They still impact daily functioning.

 

Causes or factors that may contribute to the development of Bipolar Disorder

• Genetics– research shows there are strong genetic links in Bipolar Disorder. Whilst there are no genes that can be identified, it is believed a number of genes are involved. Therefore, having someone in your family that has BPAD can increase your risk of developing the disorder.
• Personal, environmental and social factors – some people that are susceptible to BPAD may be triggered into episodes of mania or depressions eg family conflict, childhood abuse, major life altering events
• Chemical Imbalances in the Brain– chemicals including norepinephrine, serotonin and are linked to mood disorders including BPAD
• Health related factors – certain medical conditions such as traumatic brain injuries may trigger changes in the brain triggering the condition
• Substances – misuse of certain substances ie some recreational drugs can be linked to BPAD ie cocaine and amphetamines. There is also evidence that excessive caffeine may trigger episodes of mania in some cases.

 

Diagnosis

Diagnosis usually involves a thorough physical examination to rule out any physical conditions that may present with similar symptoms. This will usually include various blood test.s

A full and careful mental health assessment including history of life experiences, medications, substance use, family history etc

Mood charting- can assist in tracking the frequency and severity of symptoms

Early diagnosis and engagement in treatment is essential in developing strategies, stabilising moods to avoid harmful situations and improve quality of life.

 

Treatment

Medication

•       antidepressants
•       mood stabilisers such ie lithium
•       anticonvulsants ie valproate, carbamazepine
•       antipsychotics ie olanzapine, aripiprazole

Therapy

Psychological therapies are extremely effective in managing symptoms of BPAD. These can include:

•       Cognitive Behavioural Therapy (CBT)
•       Dialectical Behaviour Therapy (DBT)
•       Mindfulness- based cognitive therapy
•       Interpersonal Therapy (IPT)
•       Acceptance and Commitment Therapy (ACT)

 

Electroconvulsive Therapy (ECT)

ECT can be used in extreme cases where medication is ineffective, usually in extreme situations. Despite concerns people may have regarding ECT, it can be extremely effective and life saving in some situations.

 

How can I manage my Bipolar Disorder so that I have fewer relapses and a better quality of life?

Whilst there are no cures for BPAD, there are some strategies that can assist in maintaining optimal mental health whilst living with the condition. These can include:

•       Avoiding recreational drugs and too much caffeine
•       Ensure adequate sleep
•       Learn to manage stresses more effectively
•       Engage in regular exercise
•       Maintain a healthy diet
•       BE compliant with medications
•       Engage in therapy
•       Join a support group
•       Work with your team to set a crisis management plan
•       Have realistic expectations

 

Complications of Bipolar Disorder

Having BPAD can increase the risk of:

Substance abuse including alcohol,tobacco and other drugs

•       Anxiety
•       Cardiovascular conditions
•       Diabetes
•       Obesity
•       Suicidality

 

Morbidity

BPAD can have significant impacts on quality of life. These can include education and job related difficulties, marital problems, interpersonal difficulties, side effects from medications and suicidality. Regular engagement with your mental health team, having a supportive network and compliance with treatment can significantly reduce the impact of symptoms and manage periods of being unwell.

As well as ongoing daily complications, Bipolar Disorder can have serious and life threatening implications. During manic phases, people can experience physical and financial problems. Due to an increase in risk taking behaviour, people can come to harm through impulsive physical actions, overly sexual behaviours, fatalities involving speed, heights and excessive substance use. People can also engage in excessive spending such as gambling large amounts as well as purchasing cars and even property. During the depressive phase, depression can be so severe that it can lead to suicidality.

Bipolar Disorder is a serious Mental Health condition that with support of your medical/psychiatric team and family can be managed. Whilst episodes of mania/depression are inevitable, managing them and reducing symptoms and complications can be achieved and reduce the morbidity and mortality associated with it.

Reducing the stigma related to BPAD and other mental health conditions is imperative in supporting our community, embracing individual differences and improving quality of life for us as a society.

 

Where can I get help?

Lifeline: 13 11 44   (24 hours a day)

Black Dog: Institute www.blackdoginstitute.org.au

R U OK?: https://www.ruok.org.au

Kids Helpline: 1800 55 1800 (24 hours a day)

13YARN  13 92 76  is the first national crisis support line for mob who are feeling overwhelmed or having difficulty coping. Confidential one-on-one with an Aboriginal or Torres Strait Islander Crisis Supporter.