Bipolar Mood Disorder

 Written by Dr Barbara Pierce (Adult Psychiatrist)

Bipolar Mood Disorder (BMD), also known as manic depression, is a mental and physical illness characterised by extreme mood swings with changes in energy and behaviour that seriously impedes your ability to function normally.

There are many illnesses in which mood swings can be prevalent, but not everyone with mood swings has BMD. This is why it is so important to see an experienced clinician so that you can be properly assessed and an accurate diagnosis be made.

The mood swings in BMD are characterized by manic and depressive episodes. The duration of such episodes is an important diagnostic factor. Depressive symptoms need to be continually present for at least 2 weeks and manic symptoms for at least 1 week in order for your symptoms to be accurately classified as a true manic or depressive episode. There are some people with BMD who experience so-called ‘mixed episodes’ in which both manic and depressive symptoms can co-exist.

During a depressive episode you typically feel sad, tearful or irritable. You may feel very tired with no energy or feel agitated and anxious. You may lose interest in things you used to enjoy and become demotivated. You may become withdrawn and not want to go out and mix socially with friends and family. You may feel very guilty about certain things in your life and generally find coping with day-to-day life increasingly difficult. You may feel hopeless and helpless and have a bleak view of your future. When depression is severe, you may develop suicidal thoughts or even plan and carry out a suicide attempt. Physically you may have problems sleeping, have appetite changes and gain or lose weight, have problems concentrating and become forgetful, have body aches and pains, and lose interest in sex. Your decision making ability becomes impaired. Hallucinations (e.g. hearing voices, seeing things others can’t see etc) and delusions (fixed, false beliefs) can occur if your depression becomes very severe.

During a manic episode your mood is abnormally elevated, euphoric or irritable. You may feel “on top of the world” and not realise that your feelings are behaviour is not normal. Your thoughts are racing and you speak very quickly, often jumping from one topic to the next, making it difficult for others to understand you. You are full of enthusiasm for everything, have an inflated self-esteem and may take on a number of new projects believing you are invincible and can “conquer the world”. You typically feel little need to sleep or eat as you have boundless energy. The beginning stages of mania can be pleasant, but if left unchecked your mood will become increasingly dysphoric and irritable. Your judgment is often greatly impaired and you may spend recklessly, drive dangerously, take drugs or large amounts of alcohol, be sexually promiscuous and make impulsive, sometimes disastrous, business and personal decisions. When mania is severe you may experience psychotic symptoms.

Hypomania is a less severe form of mania and there are never psychotic experiences. In mania there is a significant disruption in your functioning and interpersonal relationships, and this is less so in hypomania.

BMD is typically classified as BMD type 1 or type 2. BMD 1 is where you have both manic and depressive episodes. BMD 1 can be diagnosed if you only ever have manic episodes. BMD 2 is where you have hypomanic and depressive episodes, with the depressive episodes outnumbering the hypomanic ones. There is also a rapid cycling BMD in which you experience 4 or more episodes of illness in one year.

BMD is common, affecting about 1% of the population. Men and women are just as likely to get the illness, with men tending to have more manic, and women more depressive, episodes. BMD usually first presents in late adolescence/early adulthood, though women can develop the illness somewhat later on than men.

The exact cause of BMD is not known. What we do know is that there is an imbalance in the brain chemistry that occurs that can be corrected using medication. BMD tends to run in families and there is a definite genetic component to this illness. At this stage, no one gene at fault has been identified and it is thought that there are several clusters of genes involved. It is thought that if you alone have BMD, there is a 1 in 7 risk of your children developing the illness.

Episodes are often triggered by stress, but you need to have the biological vulnerability in order to develop the illness. In other words, stress doesn’t cause the illness, but can unmask it. Similarly, illicit drugs and alcohol abuse are triggers. Episodes can be cyclical, triggered by changes in your hormones, sleep pattern and in the seasons.

The most effective treatment plan is one that incorporates both medication and counselling. Although medication is the mainstay of treatment, therapy is important as psychological distress can precipitate and/or prolong an episode of illness and render medication less effective. Talking therapy also plays a vital role in the understanding and acceptance of your illness. Joining a support group in your area can be invaluable for both you and your support network.

Mood stabilisers are the mainstay of drug treatment for BMD. Examples of these are Valproate (Epilim, Convulex), Lithium (Camcolit), Carbamazepine (Tegretol),), Lamotrigine (Lamictin), Gabapentin (Neurontin) and Topiramate (Topamax). Quetiapine (Seroquel), Olanzapine (Zyprexa) and Risperidone (Risperdal) are anti-psychotic drugs that are commonly used as mood stabilisers as well. Such drugs will also be used if you have a severe episode during which you become psychotic. Antidepressants are used cautiously due to the risk of precipitating a manic episode, especially in those with BMD 1. When you are acutely unwell, tranquilisers like Alzam, Valium, Rivotril etc may be used for a short period of time. In the longer term, the aim is for you to be maintained only on one or more mood stabilisers.

It can take time and some changes in medication before the right combination of medication, that maintains stability with few or no side effects, is found. Each person is an individual so it doesn’t mean that what works for your neighbor/friend will work for you, and vice versa. With effective treatment there is little reason why you cannot lead a normal life and fulfill your potential in all aspects of your life. The main difficult really lies in you accepting that you have a chronic illness that will require likely life-long treatment in order to function optimally. Medication cannot cure BMD, it controls the symptoms of your illness and makes it possible for you to lead a normal life.

BMD is a life-long illness, but there is effective treatment available. It is like having any one of the numerous chronic physical illnesses that many of us suffer from, like high blood pressure or diabetes. Consistently taking your medication, having a good understanding of your illness and what can trigger a relapse, eating a healthy diet, having a regular sleep pattern, trying to incorporate regular, moderate exercise into your daily routine, steering clear of alcohol and illicit drugs, minimizing your stress at home and work, are all things that you can do in order to ensure that your mood remains stable and your functioning optimal.

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