What is a bipolar disorder?

A bipolar disorder is a condition that affects a person's mood. While everyone has mood swings from time to time, someone with a bipolar disorder can have very extreme mood swings that range from feeling high or overexcited, to feeling low and depressed. It is estimated that around 1% of Australians will develop a bipolar disorder at some point in their lives. [1]

1. Mitchell P.B. (2013) Bipolar disorder. Australian Family Physician 42:616-619.

Causes and risk factors

It is not known exactly what causes a bipolar disorder. As with other conditions that affect mood, such as depression, it is thought that people with a bipolar disorder have an imbalance of certain mood-affecting brain chemicals, such as serotonin and norepinephrine.

Research has shown that there is a genetic link to a bipolar disorder, meaning that you have an increased risk of developing the condition if you have a close family member who has it.

Genetic

Related to genes, the body's units of inheritance or origin.

Serotonin

A chemical messenger within the brain that is thought to play a role in mood and behaviour. Many antidepressant medications act by increasing the amount of serotonin in the brain.

Norepinephrine

A chemical secreted by the adrenal gland and also by some nerve endings. Its actions include increasing blood pressure, dilating the pupils and opening the airways. Also known as noradrenaline.

1. Mitchell P.B. (2013) Bipolar disorder. Australian Family Physician 42:616-619.

Types

There are two main subtypes of a bipolar disorder: bipolar 1 disorder and bipolar 2 disorder. These differ on the severity of symptoms, especially with feeling high, which can be severe (known as mania) or much milder (known as hypomania).

Bipolar 1 disorder is usually diagnosed if a person experiences one or more episodes of mania and depression in their life. If these episodes are very severe, hospitalisation may be required. Bipolar 2 disorder is diagnosed if a person experiences episodes of hypomania and milder forms of depression.

1. Mitchell P.B. (2013) Bipolar disorder. Australian Family Physician 42:616-619.

Signs and symptoms

People with a bipolar disorder have extreme mood swings that range from feeling extremely high, overexcited and energetic, to feeling very depressed and helpless.

During an episode of hypomania or mania, a person may experience:

  • Difficulty sleeping;
  • Very fast speech;
  • Trouble concentrating, and;
  • Reckless and impulsive behaviour, such as quitting a job or overspending of money.

Some episodes of mania may be so severe that a person may experience symptoms of psychosis, meaning that they can no longer tell what is real and what is not.

During a bipolar depression, a person may experience:

  • Feeling sad and/or hopeless, sometimes even feeling suicidal;
  • Reduced appetite;
  • Extreme tiredness, and;
  • Difficulty sleeping, or sleeping too much.

Stress can be a trigger for bipolar episodes. The pattern of mood swings can be different for each person with the disorder. Some people may experience mainly highs, while others may experience more depressive moods. These moods may last for days, weeks or months at a time. If a person experiences more than four episodes within a year, their condition is called rapid-cycling bipolar disorder.

Young woman's face, half of the face has a happy expression and the other half has a sad expression.A bipolar disorder causes extreme mood swings that range from overly excited to severely depressed. 

1. Mitchell P.B. (2013) Bipolar disorder. Australian Family Physician 42:616-619.

Methods for diagnosis

Diagnosing a bipolar disorder can be difficult, as there is no precise medical test that can confirm whether you have the condition. A diagnosis is usually made by a specialist (psychiatrist). To work out if you have a bipolar disorder, they will consider details about your symptoms and medical history.

You may also be required to have certain medical tests to rule out any other medical conditions that could be causing your symptoms.

1. Mitchell P.B. (2013) Bipolar disorder. Australian Family Physician 42:616-619.

Types of treatment

There is no cure for a bipolar disorder. It is a long-term condition that usually requires lifelong treatment, which generally involves medication, psychotherapy and support from family and friends.

Medication

Mood stabilisers

Mood stabilisers are medications that are used to prevent or treat mania. Mood stabilisers can be taken with or without antidepressants and may take up to a week before they start working. Common mood stabilisers used to treat a bipolar disorder include:

  • Lithium carbonate;
  • Sodium valproate;
  • Carbamazepine, and;
  • Olanzapine.

Antidepressants

A bipolar disorder may sometimes be treated with medications called antidepressants. These help to control mood by restoring the balance of chemicals in the brain, such as serotonin and norepinephrine. If antidepressants are taken without mood stabilisers, they may trigger episodes of mania. Some of the common types of antidepressants prescribed to treat a bipolar disorder include:

  • Selective serotonin re-uptake inhibitors (SSRIs);
  • Serotonin and noradrenaline re-uptake inhibitors (SNRIs), and;
  • Monoamine oxidase inhibitors (MAOIs).

These medications generally need to be taken for at least two weeks before any improvement in symptoms can be seen. Medication may also need to be continued for a time, even after the symptoms have gone, to prevent them from returning. When stopping antidepressant medication, the dose usually needs to be reduced gradually over time to avoid any withdrawal responses.

Side effects

Like with most medications, some people may experience some side effects when taking antidepressants. Some common side effects include nausea, dizziness, tiredness and sexual dysfunction. Some antidepressants can have more serious side effects if they are taken with certain other medications or herbal remedies, or when combined with alcohol. Your doctor will work with you to find the medication that is best for you.

Very rarely, some antidepressants may increase suicidal thoughts and the risk of suicide. The risk is highest in the first week after starting antidepressant treatment, or when the dose of antidepressants is changed. If a person experiences suicidal thoughts, it is important to contact a doctor immediately.

Psychotherapy

Psychotherapy is sometimes referred to as 'talking therapy' and describes the process of treating a mental illness by applying different psychology techniques that can improve people's understanding of their condition and the various ways that it can be managed. Psychotherapy treatments for a bipolar disorder may include cognitive behavioural therapy, family-based therapy and group therapy.

A young woman in a session with a therapist.Psychotherapy can assist with managing a bipolar disorder. 

Hospitalisation

Some people with a bipolar disorder may need to be hospitalised during a bipolar episode if they are at risk of harming themselves or others.

Support groups

Having the support of close family and friends or attending a support group with other people who have also experienced a bipolar disorder may help people to understand and manage their condition.  

Electroconvulsive therapy

Electroconvulsive therapy (ECT) is a procedure that is sometimes used to treat severe cases of bipolar depression. This procedure is performed in a hospital, under a general anaesthetic. It involves passing a small amount of electric current through the brain. Depending on the severity of the condition, this procedure may be performed a few times a week for several weeks. It can work quickly to relieve symptoms and improve mood. Some people may experience some short-term memory loss for a few days or weeks after having treatment. 

General anaesthetic

An anaesthetic given to a person to put them to sleep while having an operation or medical procedure. Afterwards, the person regains consciousness and usually has no memory of the procedure. A general anaesthetic is given in hospital by a specialist called an anaesthetist.

Psychotherapy

A therapeutic treatment, also known as talking therapy, used to treat different types of mental health issues ranging from shyness or depression to anxiety attacks.

Serotonin

A chemical messenger within the brain that is thought to play a role in mood and behaviour. Many antidepressant medications act by increasing the amount of serotonin in the brain.

Sexual dysfunction

Any abnormal difficulty that interferes with the sexual response or sexual activity of an individual or a couple.

Norepinephrine

A chemical secreted by the adrenal gland and also by some nerve endings. Its actions include increasing blood pressure, dilating the pupils and opening the airways. Also known as noradrenaline.

1. Mitchell P.B. (2013) Bipolar disorder. Australian Family Physician 42:616-619.

Potential complications

If left untreated, a bipolar disorder can affect many aspects of everyday life. The most serious complications of a bipolar disorder include suicidal thoughts and attempts at suicide or self-harm. This generally occurs during the depressive phase of the condition. If a person experiences suicidal thoughts, it is important to contact a doctor immediately.

1. Mitchell P.B. (2013) Bipolar disorder. Australian Family Physician 42:616-619.

Prognosis

There is currently no cure for a bipolar disorder. It is a long-term condition that usually requires lifelong treatment to effectively manage and improve the symptoms.

1. Mitchell P.B. (2013) Bipolar disorder. Australian Family Physician 42:616-619.

Support services

If you or someone you know needs help, please call or visit:

Lifeline. Website: http://www.lifeline.org.au/ Tel: 13 11 14.
Kids Helpline. Website: http://www.kidshelp.com.au/ Tel: 1800 55 1800.
Beyond Blue. Website: http://www.beyondblue.org.au/ Tel: 1300 22 4636.

1. Mitchell P.B. (2013) Bipolar disorder. Australian Family Physician 42:616-619.