Bipolar disorder

Bipolar disorder, (previously known as manic depression) is a mental health condition. It involves cycles of extreme low and high mood.

A person with bipolar disorder may cycle between feeling euphoric and extremely energetic (‘manic’), and feeling very low (‘depression’). The cycle of manic and depressive symptoms is different for everyone. Some people may only experience one episode of mania or hypomania, whereas others might have more frequent mood challenges. Treatment with medication may stop the symptoms, or make them shorter or less intense.

The exact cause of bipolar disorder is unknown. Contributing factors may include brain chemicals, environmental factors, physical illness and stress. Research suggests that around 80 per cent of the causes are genetic.

Symptoms of bipolar disorder generally begin in early adulthood. For most people the disorder is a lifelong diagnosis. However, with appropriate treatment and support:

• bipolar disorder symptoms can be well managed
• people with bipolar disorder can maintain a good quality of life.

It is estimated that approximately 2.2% of Australians live with a form of bipolar disorder. One in 50 adult Australians experience bipolar disorder each year.

Types of bipolar disorder

There are a number of different types of bipolar and related disorders.

Bipolar I disorder

People with bipolar I disorder typically experience:

• one or more manic episodes (extreme highs) lasting at least one week, as well as
• depressive episodes

With bipolar I disorder, episodes of mania are severe enough to interfere with day-to-day life.

Depressive episodes are often more frequent and longer-lasting than mania.

Bipolar II disorder

People with bipolar II disorder typically experience both hypomanic and depressive episodes.

A person with hypomania will experience similar symptoms to someone with mania, but less intensely.

Hypomania associated with bipolar II lasts only a few days (rather at least one week of mania, as with bipolar I). Although bipolar II disorder has less severe symptoms than bipolar I disorder, it can be chronic (ongoing).

Depressive episodes are often more frequent and longer-lasting than hypomania.

Cyclothymic disorder

Cyclothymic disorder is characterised by persistent and unpredictable changes in mood. The highs and lows are much less extreme than for bipolar I and II disorder, with a number of symptoms of hypomanic and depressive episodes, but not enough to meet criteria for either.

Mixed episodes

Some people experience 'mixed episodes' – where they can feel some of the signs and symptoms of both depression and mania or hypomania.

Bipolar disorder – mania

Common symptoms of mania associated with bipolar disorder include:

• feeling extremely euphoric ('high') or energetic
• going without sleep
• thinking and speaking quickly
• reckless behaviour, such as overspending
• participating in unsafe sexual activity
• aggression
• irritability
• grandiose, unrealistic plans.

The symptoms of hypomania are the same as those for mania, but less severe and of shorter duration (lasting 4 days or longer).

During manic or hypomanic episodes, symptoms are present for most of the day, nearly every day.

Bipolar disorder – depression

Common symptoms of depression associated with bipolar disorder include:

• withdrawal from people and activities
• feelings of sadness and hopelessness
• lack of appetite and weight loss
• feeling anxious or guilty without reason
• difficulty concentrating
• suicidal thoughts and behaviour.

Bipolar disorder – psychosis

People with bipolar disorder who are experiencing an episode of mania may also have symptoms of psychosis, including delusions and hallucinations.

Causes of bipolar disorder

The exact cause of bipolar disorder is not known. Contributing factors may include:

• genetics
• brain chemicals
• environmental factors
• physical illness
• substance use
• stress.

Research suggests that around 80 per cent of the causes are genetic, and people can have a strong genetic predisposition to bipolar disorder. This means that for those people, because of the coding in their genes, certain triggers may cause symptoms of bipolar disorder to occur. Triggers may include stressors such as abuse, loss, or trauma. Sometimes bipolar disorder develops without a trigger.

One theory is that the illness might be linked to the brain chemicals (neurotransmitters) serotonin and norepinephrine. These chemicals help regulate mood. It is thought that, for a person with a genetic predisposition to bipolar disorder, these chemicals may easily be thrown out of balance.

While the onset of bipolar disorder may be linked to stressful life events, it is unlikely that stress causes bipolar disorder. People who live with bipolar disorder often find that managing and reducing stress in their lives helps to reduce their chance of triggering a relapse.

Treatment for bipolar disorder

Bipolar disorder requires long-term treatment and management. Treatment options may include:

• mood-stabilising medications
• antidepressant medications
• anti-psychotic medications
• psychological therapies
• hospitalisation – for appropriate treatment during acute episodes
• education – to help people understand and manage their condition and be more self-sufficient
• community support programs – to provide rehabilitation, accommodation and employment support
• self-help groups for emotional support and understanding.

Where to get help

• Your GP (doctor)
• Psychiatrist
• SANE Help Centre Tel. 1800 18 7263 Monday to Friday, 10 am – 10 pm
• SANE peer support moderated forums
• Beyond Blue Support Service Tel. 1300 22 4636