Bipolar affective disorder

Bipolar affective disorder, also known as bipolar disorder, used to be called manic depression. Bipolar affective disorder is a chronic disorder, which is strongly hereditary. The disorder is characterised by unusual mood swings. Depression, mania and a combination of both alternate in the life of a bipolar person - sometimes the disorder appears asymptomatic or the symptoms remain very mild.

Individuals suffering from bipolar affective disorder are very likely to suffer from alcoholism or other substance abuse problems, as well. Heavy drinking may intensify both the manic and the depressive episodes. 

During manic episodes, the person’s mood becomes excessively elevated or excited 

Manic episodes are easier to recognise than depressive episodes as the behaviour of the person becomes strikingly active. During a manic episode, persons suffering from bipolar disorder can feel extremely and unrealistically good for weeks, sometimes even months.

Manic episodes are often characterised by lack of good judgement. They may do things that could result in difficulties for themselves and their families and friends. For example, they may mess up their finances or take unnecessary risks in their sex life. This can lead to problems with family, work and the police.

Manic behaviour is not necessarily happy. Manic behaviour does not equal happiness; young people in particular may behave in an aggressive manner during mania. Usually manic individuals do not perceive anything being wrong and they refuse to accept help. Read a case example.

During depressive episodes, the person will often experience feelings of guilt and worthlessness

People suffering from bipolar affective disorder often do not seek treatment when the first symptoms appear. They usually seek treatment after a long and severe depressive episode.

The depressive episodes involved in bipolar affective disorder are more common than manic episodes. The depressive episodes are very similar to those experienced by persons suffering from severe depression. During a depressive episode, persons suffering from bipolar affective disorder feel exhausted and cannot concentrate; they usually have trouble sleeping, as well.

They may feel worthless and guilty, as well as have thoughts concerning death. As a result of their manic episodes, they may have problems with their finances and personal relationships, making the feelings of guilt even worse. 

Combined episodes include both depression and mania

The disorder may also involve combined episodes, during which depression and mania will occur simultaneously. A combined episode can be extremely distressing as the mind is extremely agitated whereas thoughts are depressed. A person suffering from bipolar affective disorder may have hallucinations or delusions; however, these hallucinations and delusions are not as vivid and clear as with someone suffering from schizophrenia

The manic episodes in bipolar II disorder are milder

The manic episodes in the bipolar II disorder are more even, i.e. they are so-called hypomanic episodes. A hypomanic episode is not serious enough to cause significant troubles at work or in social relationships. People suffering from bipolar II disorder often do no seek treatment until they are facing a depressive episode; therefore the disorder may go completely undiagnosed. 

It is important to comply with the medication and identify the symptoms

Bipolar affective disorder can be treated, for example, with mood stabiliser medications, i.e. so-called second-generation antipsychotics, with medication to alleviate anxiety and insomnia, as well as with antidepressants during depressive episodes. Read more about medication in the treatment of mental disorders.

It may take time to find the right medication for bipolar affective disorder but, at its best, the medication effectively prevents or alleviates depressive or manic episodes. The medication and dosage may have to be revised many times before the right medication is found. Sometimes the best medication is a combination of several drugs.

In order for the treatment to be successful, it is imperative to take the medication according to the instructions. A considerable number of people suffering from bipolar affective disorder do not take their medication according to the instructions. This may be because of, for example, not having a sense of illness during a manic episode, reluctance to accept that the disorder is real, side effects caused by the medication, or lack of information about the medication as something alleviating the disorder and preventing the symptoms.

The medication used in the treatment of bipolar affective disorder may last several years as so-called maintenance treatment. Continuous medication will not be necessary only when the symptoms are very mild or the patient is able to control the symptoms well. Using prophylaxis treatment is another alternative, if the patient has learned how to identify the signs of upcoming manic episodes.

In addition, people suffering from bipolar affective disorder should learn how to identify the symptoms that precede the different episodes. Thus the sense of control is increased and the disorder will affect the lives of the individuals suffering from it as little as possible. Excessive stress and sleep deprivation should be avoided in order to prevent the episodes from developing.