Bipolar disorder, previously known as manic depression, is a serious mental health condition characterised by extreme mood swings ranging from low mood (depression) to emotional highs (mania or hypomania). Such periods of depression or mania can last several weeks or longer, and dramatically impact relationships, work performance and daily functioning. It’s estimated that 1.5 to 3.5% of the UK population are diagnosed with bipolar disorder (NHS UK, 2017), with the World Health Organisation identifying bipolar disorder as the largest cause of loss of life and health amongst 15 to 44 year olds. Bipolar disorder is a life-long condition, affecting almost every aspect of one’s life and impacting the lives of family and friends.

Due to the nature of its symptoms, bipolar disorder is often misunderstood or misdiagnosed, particularly since the symptoms can also occur in other mental illnesses. It’s not so surprising, therefore, that the condition is also misunderstood by the general public. I’ve very often heard the term bipolar used very casually, as if anyone who’s slightly moody or having an ‘off’ week is branded bipolar. This is quite misleading since the illness is far more than the presence of mood swings and much more severe and debilitating. Several years ago, when I was still studying to become a psychotherapist, someone shared with me a personal story which gave me a deeper understanding of bipolar disorder and how it can impact anyone close to the individual suffering from it. This person shared with me how, throughout her childhood, her father would suddenly disappear for weeks on end. During this time he’d barely sleep or eat, gamble away the family’s savings and on one occasion even gave away the family car. As soon as she completed her O-Levels, Michelle (name changed for anonymity) went out to work to try to support her mother, who finally had to re-mortgage the house so she could support her husband’s reckless gambling and spending. Michelle’s father was eventually diagnosed with bipolar disorder and received the required treatment, but it was too late to reverse the damage caused to his wife and children.

In bipolar disorder, moods can swing from one extreme to another and are often so intense that they interfere with everyday life. Such patterns of mood swings vary widely between one person and another, with some people having only a couple of bipolar episodes in their lifetime, with others experiencing them frequently throughout their entire life. To be diagnosed with bipolar disorder, a person must have experienced at least one episode of mania or hypomania (similar to mania but less severe and without psychotic episodes).

Warning signs of bipolar disorder:

Mania

• Reckless behaviour – increased spending, alcohol and drug consumption, risky sex
• Not sleeping for extended periods
• Rapid thoughts and speech
• Increased use of phone – making contact with many people
• Increased working hours
• Grandiose, unrealistic plans
• Full of energy
• Not eating
• Emotional intensity
• Increased interest in religious/spiritual themes
• Increased sex drive and sexual behaviour
• Paranoid thoughts
• Inability to concentrate

Depression

• Change in sleep patterns
• Increased irritability
• Fatigue
• Withdrawal
• Decreased motivation
• Loss of interest in usual activities
• Suicidal thoughts
• Change in eating habits
• Decreased libido
• Feelings of worthlessness and hopelessness
• Paranoia

During periods of mania or depression, persons with bipolar disorder may experience psychosis, where they’re unable to differentiate between fantasy and reality. Such episodes may include hallucinations, wherein the person may see, hear, touch or smell things which are not real. They may also experience delusions, where they believe something which is not real. During a depressive phase, psychosis may cause the sufferer to believe they’ve committed a crime, are bankrupt, have lost family and friends, have a partner who is being unfaithful, have a terminal illness, have been abducted, and so on. During a ‘high’, the hallucinations and delusions take a different course, where someone suffering from bipolar disorder may believe they’re famous, have special powers, believe someone important is in love with them, have unique talents and other such grandiose beliefs. Some people may even enjoy the high of a manic episode, excited by how creative and productive they are during these periods. Sadly, however, a high is usually followed by a crashing low which counteracts any productiveness or creativity the person may have enjoyed.

So, what causes bipolar disorder?

A combination of different factors contribute to the onset of bipolar disorder, including:

• Genetic factors
• Brain chemistry
• Childhood trauma
• Stressful life events

Someone with a genetic predisposition for bipolar disorder may experience life events which trigger the illness. Such events may include sudden and drastic changes such as loss of a job, moving home, losing a loved one and so on. It may also be triggered in someone who experiences abuse and trauma at a young age. In some cases, substance abuse may bring on a depressive or manic episode. Cocaine, ecstacy and amphetamines can trigger mania, whilst tranquilisers and alcohol can trigger a depressive episode. Sleep deprivation can also trigger an episode, as can seasonal changes.

Diagnosis and Treatment

Bipolar disorder is often difficult to diagnose since its symptoms resemble those of other mental illnesses, such as schizophrenia or borderline personality disorder. Nevertheless, it’s important that anyone suspecting that they or a family member/friend has bipolar disorder, visit a doctor or mental health practitioner to be formally diagnosed and begin treatment. The aims of treatment would be to minimise the frequency of manic and depressive episodes and decrease the severity of symptoms. If left untreated, a manic or depressive episode could last up to a year, having a huge impact on one’s ability to maintain a job, live a healthy lifestyle and maintain stable relationships.

Treatment could include a combination of:

• Medication
• Psychotherapy
• Cognitive Behaviour Therapy
• Hospitalisation

Special care would also need to be taken to maintain a healthy lifestyle (i.e. eating healthily, maintaining a regular sleep pattern and exercising). Even when stable and not experiencing symptoms of bipolar disorder, treatment should be continued to reduce the chances of relapse. This includes taking prescribed medication and seeking support in the form of psychotherapy or counselling.  This would keep symptoms in check and reduce the chances of stressful life events triggering episodes. It would also help maintain stable, nourishing relationships which would go a long way towards providing the support needed to manage the illness.