bipolar son | Autism PDD

Bipolar affective disorder is sometimes called manic depression or bipolar illness. In this condition you have periods where your mood ('affect') is in one extreme or another.

• One extreme is called depression where you feel 'low' and have other symptoms.
• The other extreme is called mania (or hypomania if symptoms are less severe) where you feel 'high' or elated along with other symptoms.

The length of time you spend in each extreme can vary. It is usually for several weeks at a time or longer. Bipolar affective disorder is very different from the mood swings that moody people have which last minutes or hours.

You can have any number of episodes of highs and lows throughout your life. In between episodes of highs or lows there may be gaps of weeks, months or years when your mood is normal. However, some people swing from highs to lows quite quickly without a period of normal mood in between. This is called 'rapid cycling'. (If you have the rapid cycling form of the illness you have at least four mood swings per year.)

Who gets bipolar affective disorder?

About 1 in 100 people develop this condition at some stage in life. It can occur at any age, but most commonly first develops between the ages of 18 and 24. It occurs in the same number of men as women. The rapid cycling form of the illness occurs in about 1 in 6 cases.

(Note: mania or hypomania occur in only a small number of people who develop depression. It is much more common to just have depression without episodes of mania or hypomania.)

What causes bipolar affective disorder?

The cause is not known. Your genetic makeup seems to play a part as your chance of developing this condition is higher than average if other members of your family are affected. Stressful situations may trigger an episode of mania or depression in people prone to this condition. However, stress is not the underlying cause.

What are the symptoms of mania and hypomania?

Mania causes an abnormally 'high' or irritable mood which lasts at least one week - but usually lasts much longer than this. It can develop quite quickly - over a few days or so. When you are 'high' you will usually have at least 3 or 4 of the following:

• Grand ideas about yourself and your own self importance.
• Increased energy. You also tend to move quickly and need less sleep than usual.
• Be more talkative than usual. You tend to talk quickly.
• 'Flight of ideas'. You tend to quickly change from one idea to another. You may feel as if your thoughts are racing.
• Easily distracted. Your attention is easily drawn to unimportant or irrelevant things.
• Full of new ideas and plans. Often the plans are grandiose and unrealistic.
• Irritation or agitation, particularly with people who do not seem to understand your 'great' ideas and plans.
• Wanting to do lots of pleasurable things (but these can often lead to painful consequences). For example, you may:
  • spend a lot of money (which you often cannot afford).
  • be less inhibited about your sexual behaviour.
  • make rash decisions, often on the spur of the moment. These can be about jobs, relationships, money, health, etc, and are often disastrous.
  • take part in risky 'exciting' adventures.
  • drink a lot of alcohol, or take illegal drugs.

Severe mania may also cause 'psychotic' symptoms where you lose touch with reality. For example, you may hear voices which are not real (hallucinations), or have false beliefs (delusions). These tend to be delusions of importance (such as believing that you are a famous celebrity).

Usually, you do not realise that you have a problem when you are high. But, as the the illness develops, to others your behaviour can be bizarre. Family and friends tend to be the ones who realise that there is a problem. But, if someone tries to point out that you are behaving oddly, you tend to become irritated as you can feel really good.

If mania is not treated, the bizarre and uninhibited behaviour may cause great damage to your relationships, job, career, and finances. When you recover from an episode of mania you often regret many of the things that you did when you were high.

Hypomania is the term used when you are high, but the symptoms are less severe or extreme as in true mania. You may function quite well if you have hypomania. For example, you may just appear to be full of energy, the 'life and soul' of the party, work too much, but find it difficult to 'switch off' and relax. However, you are still at risk of making rash and dangerous decisions. Family and friends will recognise that you are not your normal self.

What are the symptoms of depression?

The word depressed is a common everyday word. People might say "I'm depressed" when in fact they mean "I'm fed up because I've had a row, or failed an exam, or lost my job" etc. These ups and downs of life are common and normal.

With true depression, you have low mood and other symptoms each day for at least two weeks. Symptoms also become severe enough to interfere with day-to-day functions. The following is a list of common symptoms of depression. You may not have them all, but you usually develop several if you have depression.

• Low mood for most of the day, nearly every day. Things always seem 'black'.
• Loss of enjoyment and interest in life, even for activities that you normally enjoy.
• Abnormal sadness, often with weepiness.
• Feeling guilty, worthless, or useless.
• Poor motivation. Even simple tasks seem difficult.
• Poor concentration. It may be difficult to read, work, etc.
• Sleeping problems.
  • Sometimes difficulty in getting off to sleep.
  • Sometimes waking early and unable to get back to sleep.
  • Sleeping too much sometimes occurs.
• Lacking in energy, always tired.
• Difficulty with affection, including going off sex.
• Poor appetite and weight loss. Sometimes the reverse happens with comfort eating and weight gain.
• Being irritable, agitated, or restless.
• Symptoms often seem worse first thing each day.
• Physical symptoms such as headaches, palpitations, chest pains, and 'aches and pains'.
• Recurrent thoughts of death. This is not usually a fear of death, more a preoccupation with death and dying. Some people get suicidal ideas - "life's not worth living".

What is the usual pattern and outcome of the condition?

Bipolar affective disorder is a lifelong condition. There is no usual pattern. Every case is different. Some general points include the following.

Without treatment:

• The average length for an episode of mania is four months. But for some people it can last much longer.
• The average length for an episode of depression is 6-9 months. but again, it can be longer.
• You cannot predict how often episodes of mania and depression will occur.
  • After recovering from an episode of mania, a further episode of mania or depression occurs within 1 year in about half of cases, and within 5 years in about 7 in 10 cases.
  • Some people only ever have one episode of mania for a few weeks or months.
  • The rapid cycling form of the illness occurs in about 1 in 6 cases.
• Some people have 'mixed states' where symptoms of both mania and depression occur at the same time. For example, a low mood, but with racing thoughts.

So, some people have more frequent and severe episodes than others. Because of the nature of the condition, your chance of holding down a job is less than average. Relationships can be strained. Also, you have an increased risk of suicide if depression becomes severe, and an increased risk of death from risky adventures during an episode of mania. The outlook is worse if you take street drugs or drink a lot of alcohol.

With treatment:

The course, pattern and outlook of the condition can be improved. However, there is no once and for all 'cure'.

What is the treatment for bipolar affective disorder?

Treatments include:

• Medicines that aim to prevent episodes of mania, hypomania and depression. These are called 'mood stabilisers'. You take these every day, long-term.
• Treating episodes of mania, hypomania and depression when they occur.

One problem with lithium is that the dose for an individual has to be 'just right'. Too low a dose has little effect. Too high a dose, and side-effects can be a problem. So, if you take lithium, you need to have blood tests from time to time to check the dose is just right for you.

Another leaflet called 'Lithium for Bipolar Affective Disorder' gives more details.

Anticonvulsant medicines
Sodium valproate, carbamazepine, and lamotrigine are also used to treat episodes of mania. They are also used long-term as 'mood stabilisers'. (Anticonvulsant medicines are commonly used to treat epilepsy but have been found to be work in bipolar affective disorder too. However, it is not clear how they work in this condition.) Sometimes one of these medicines is used alone. Some people take an anticonvulsant in addition to lithium if lithium alone does not work so well.

Antipsychotic medicines
One of these may be used to treat an episode of mania or hypomania. Another name for these is 'major tranquillisers'. They include chlorpromazine, haloperidol, risperidone and sulpiride - but there are others. Some are more 'sedating' than others. Once one of these medicines is started, the symptoms of mania often settle within a week or so. These medicines are usually stopped once the symptoms have gone. They are not usually used as long-term 'mood stabilisers'.

Treating episodes of depression
The treatment of depression in people with bipolar affective disorder is similar to that for people who develop depression without episodes of mania.

• Antidepressant medicines are commonly prescribed for all types of depression.
  • Antidepressants work well to relieve symptoms in about 7 in 10 cases.
  • They do not usually work straight away. It takes 2-4 weeks before their effect builds up fully. A common problem is that some people stop the medicine after a week or so as they feel that it is doing no good. So, do persevere if you are prescribed an antidepressant medicine.
  • A normal course of antidepressants is for 6 months or more after the symptoms of depression have eased. If you stop them too soon the depression may quickly return.
  • There are several types of antidepressants, each with various 'pros and cons'. For example, they differ in their possible side-effects. (The leaflet that comes in the medicine packet provides a full list of possible side-effects.)
  • One uncommon problem with antidepressants is that they can 'trigger' an episode of hypomania in some people.
• Lithium is used to treat depression as well as being a mood stabiliser. A combination of lithium and an antidepressant may be used to treat episodes of depression.
• Cognitive therapy (if available in your area) is another option which can work well to treat depression. It is a 'talking' treatment.
• Regular exercise may also help to ease symptoms of depression.

Compulsory treatment
When you have an episode of mania or hypomania, usually you do not realise that you are ill. It is sometimes necessary to give treatment against your will if you have symptoms which are putting you, or other people, at risk of harm. A short admission to hospital is sometimes needed.

Other treatments and new developments
Research continues to try and find better 'mood stabiliser' medicines. New non-drug treatments such as transcranial magnetic stimulation and vagal nerve stimulation are being studied. Also, there is a large trial currently underway to find out which is the best mood stabiliser - lithium or the anticonvulsant sodium valproate. See www.psychiatry.ox.ac.uk/balance/ for details.

What can I do to help?

• Try to avoid stressful situations which may trigger an episode of mania or depression. This is often easier said than done. But, a change in lifestyle may be appropriate for some people. You may find another leaflet useful called 'Stress and Tips on How to Avoid It'.
• Try not to drink much alcohol or take any street drugs. These may trigger an episode of mania.
• If you are prescribed a mood stabiliser medicine, take it regularly. Sometimes, suddenly stopping a mood stabiliser can trigger an episode of mania. So, if you get any side-effects, tell a doctor. The dose of type of medication can often be changed, but do this with the advice of a doctor.
• Consider being quite open to family and friends about your illness. If they understand the condition, they may be able to tell if you are becoming ill, even if you do not realise it yourself. Particularly if you are developing an episode of mania. Rather than thinking of you as 'bizarre' they may think of you as ill and may encourage you to get help.
• Learn about your illness. It has been shown that if you are taught to recognise the early stages of mania, you are more likely to seek help and treatment which may prevent a major episode developing. Your doctor or psychiatrist may help to teach you about recognising when to seek help. Also...
• Consider joining a self-help or patient group. Details are at the end of this leaflet. They are a great source of advice, information, support and help.
• When you are well, consider putting some safeguards on your money so that you cannot overspend if you become high. For example, if you are married, consider putting your bank account solely in the name of your spouse.
• If you are the main or only carer of children (for example, if you are a single parent), it is important that someone else who knows you well is aware that you may become ill quite quickly and not be able to care for your children properly.