Bipolar Disorder

The Ultimate Guide

Sarah Owen, Amanda Saunders

• Publisher: Oneworld Publications
• Year: 2008
• eBook ISBN: 9781780740072
• Topic: Psychology
• Subtopic: Abnormal Psychology
• Index: Psychology

Written in a highly-accessible question and answer format, this comprehensive and compassionate guide draws on the latest research, a broad range of expert opinion, numerous real-life voices and personal experiences from people with bipolar. With a list of useful resources, it is both the perfect first port of call and a reference bible you can refer to time and time again.From how to recognize the symptoms to how to explain to a child that their parent has been diagnosed, first cousins Amanda and Sarah – who have four close family members diagnosed with the condition – explore and explain absolutely everything that someone with bipolar disorder (and those who live with and love them) needs to know.

CHAPTER ONE

CAUSES, SYMPTOMS AND DIAGNOSIS

Q1. What is bipolar disorder?

Bipolar disorder is a serious mental illness that’s thought to be caused by an imbalance in the way brain cells communicate with each other. This imbalance causes extreme mood swings that go way beyond the normal ‘ups and downs’ of everyday life, wildly exaggerating the mood changes that everyone has. Someone with bipolar can have long or short periods of stability, but then tends to go ‘low’ (into deep depression) or ‘high’ (experiencing mania or psychosis). They can go into a ‘mixed state’ too, where symptoms of depression and mania occur at the same time.

Q2. Why has manic depression been renamed bipolar disorder?

‘Bipolar disorder’ is a relatively new term and has gradually replaced ‘manic depression’ as the official name for this condition. The term ‘manic depression’ was first coined in 1896 by Emil Kraepelin, a German doctor, and was widely used in the psychiatric world throughout the twentieth century, until the American Psychiatric Association renamed it in 1980 as ‘bipolar disorder’ – to reflect what it called the ‘bi-polarity’, or dual nature, of the illness (the highs and lows).

The move towards ‘bipolar’ has been reflected by the UK’s largest charity for bipolar disorder, as Jeremy Bacon, Groups and Self Management Director explains: ‘Our name changed from “The Manic Depression Fellowship” to “MDF The BiPolar Organisation” in October 2004, on our twenty-first anniversary, following consultation with our members – 60% favoured including “bipolar” in our title. The change also reflected the new terminology – people were being diagnosed with “bipolar” rather than “manic depression”.’

Others have willingly embraced the new name too:

‘I prefer the term ‘bipolar’ to ‘manic depression’ as bipolar sounds more medical and less scary. Manic depression seems to carry an undeserved stigma. I was speaking to someone I used to work with when I said my daughter had bipolar – she asked what that meant and I was able to explain. On a separate occasion that same day, I used the term ‘manic depressive’ to see if that was understood, and the reaction I received was of shock.

(Alison)’

However, not everyone is as enthusiastic, including actor and writer Stephen Fry who presented the two BBC documentaries about bipolar disorder in 2006 – The Secret Life of the Manic Depressive – in which he openly talked about his own bipolarity. In the foreword to the book You Don’t Have to be Famous to Have Manic Depression, which was published at the same time, he comments:

‘Bipolar isn’t quite right – the condition isn’t really just about two poles, there are mixed states in between. Besides, why not give it a title that names the effects?’

Another writer with a bipolar diagnosis, Julie A. Fast, also dislikes the term bipolar disorder and suggests an alternative in her book Loving Someone with Bipolar Disorder:

‘Bi-polar disorder is a bit of a misnomer. Yes, people with the illness do go up and down, but doesn’t it seem as if they also go sideways or do little corkscrews as well? Maybe if it were called MULTI-polar disorder, people would understand the illness a little bit more.’

We agree that the term ‘multipolar disorder’ describes the condition more accurately because there’s so much more to bipolar than simply being up or down, at one pole or the other. In fact, at the time of writing, the psychiatric world is starting to recognize that the current labels used (such as Bipolar I and II) don’t always reflect the wide range of bipolar symptoms. Yet the answer lies not in dispensing with the labels, says Nick Craddock, Professor of Psychiatry at Cardiff University, but using them as a starting point to decide how people are treated: ‘We might move towards talking, for example, about “bipolar spectrum disorder” or a “continuum of bipolarity”. That way, instead of lumping all people with bipolar disorder together, we will look very closely at each individual’s unique experience of the illness and the underlying biological and psychological changes that are involved. Then we can get a full understanding of what’s required to treat each individual effectively.’

In other words, experts will be less likely to focus on a concrete diagnosis in the future (‘let’s forget what the illness is called’) and concentrate more on an individual’s unique set of symptoms.

Q3. What is the difference between Bipolar I, II and III?

There are ‘types’ of bipolarity, known as Bipolar I, Bipolar II and Bipolar III.

To be diagnosed with Bipolar I, a person will have experienced at least one full manic episode in their lifetime, along with at least one major episode of depression. Around 1% of the general population is thought to develop Bipolar I at some point during their lives.

Bipolar II is diagnosed when someone’s mood swings between major episodes of depression and periods of hypomania rather than manic episodes. The incidence of Bipolar II is estimated to be about 4–5% of the general population.

Bipolar III is not in the official rulebook, but is used by some mood experts in the United States to refer to hypomania that emerges only when a patient has been given an antidepressant.

In the US, Bipolar II and III are sometimes referred to as ‘soft’ bipolar.

Q4. What is cyclothymia?

If a person’s depressive and manic symptoms last for two years but are not severe enough to qualify as bipolar disorder, they may instead be diagnosed with ‘cyclothymia’ which is a milder form of bipolar. According to MDF The BiPolar Organisation, ‘cyclothymic disorder is characterized by frequent short periods of hypomania and depressive symptoms separated by periods of stability’. There is evidence that for some people with cyclothymia, the mood swings will worsen over time until they develop Bipolar II or Bipolar I. Confusingly, cyclothymia is also sometimes referred to as Bipolar III.

In terms of diagnosis, this is a tricky area because where do you draw the line between moody behaviour that’s considered ‘normal’ and the kind of ups and downs that warrant a diagnosis of cyclothymia? Even the world’s leading experts on mental health can’t agree and probably never will. After all, what is normality?

Q5. Is there an age or gender profile for people with bipolar disorder?

According to Equilibrium – The Bipolar Foundation, bipolar disorder affects up to 254 million worldwide, 12 million in the US and 2.4 million people in the UK.

Gender

Unlike unipolar depression that affects more women than men, bipolar disorder affects equal numbers of men and women overall, although research carried out at the Institute of Psychiatry at King’s College in London does show gender differences in the way bipolar tends to run its course:

• The researchers found that in early adult life (defined as 16–25), there were higher rates of bipolar disorder in men than in women.

• Throughout the rest of adult life (26 years and over), the rate of bipolar disorder was higher in women than men.

• Women are thought to have a higher chance than men of developing rapid-cycling bipolar disorder (in which changes in mood occur more rapidly), and mixed state (mania in which a low mood is predominant).

Age

In the mid-1990s, the average age of people being diagnosed with bipolar was 32, but since then has dropped to under 19. The reason for this drop is not known but is probably due to a number of factors, including an increased awareness of the disorder among the public and mental health practitioners, increased drug abuse, changing sources of life stresses and a huge jump in the number of children diagnosed with bipolar disorder in the USA.

Q6. What are the symptoms of bipolar disorder?

People with bipolar often swing between depression and mania. But there’s no ‘typical’ pattern of symptoms. Every bipolar person is different, and the length of time they spend at either extreme of mood (high or low) is very variable – it can be days, weeks or months. And a person with bipolar can have any number of episodes of highs and lows throughout their life. There can be periods of normal mood in between the two extremes, but some people can swing between depression and mania quite quickly without a period of stability in the middle. More than four mood swings in one year is known as ‘rapid cycling’, and some people who rapid cycle can have monthly, weekly or even daily mood swings (sometimes called ‘ultra rapid cycling’).

According to the latest Diagnostic and Statistical Manual of Mental Disorders or DSM IV (the fourth version of a manual published by the American Psychiatric Association, which is used in the UK and US for categorizing and diagnosing mental health problems) the typical symptoms of bipolar disorder are depression, hypomania, mania and psychosis. Other ‘unofficial’ symptoms include anxiety, low self-esteem, libido problems and self-harm.

Q7. What is depression?

How many times do people say they’re depressed about their job, their relationship or even the weather? Yet what does depression really mean?

The definition from DSM IV gives a list of common symptoms as:

• a depressed mood for most of the day

• a loss of interest or pleasure in almost all activities

• changes in weight and appetite

• sleep disturbance

• a decrease in physical activity

• fatigue and loss of energy

• feelings of worthlessness

• excessive feelings of guilt

• poor concentration levels

• suicidal thoughts.

Someone can experience either ‘unipolar’ or ‘bipolar’ depression. There are some differences between the two:

• In bipolar depression, the average duration of symptoms is three to six months, but in unipolar depression it is six to twelve months. The shorter the depression, the more likely it is to be bipolar.

• Compared with unipolar depression, post-natal depression is more common in bipolar disorder.

• The more episodes of depression you have, the more likely you are to be bipolar rather than unipolar. More than 95% of bipolar patients have recurrent episodes, versus unipolar patients, of whom two-thirds have recurrent episodes.

• The earlier the onset of the depression, and the more people in the family with bipolar, the more likely it is to be bipolar disorder (rather than unipolar depression).

And although mania or hypomania are the defining characteristics of bipolar disorder, people with a diagnosis tend to spend much more time depressed than manic during the course of the illness. In fact, it’s been estimated that people with Bipolar I spend three times longer feeling depressed than manic and are depressed around a third of the time. People with Bipolar II have been found to experience an even higher proportion (50%) of time feeling depressed than manic.

Statistics aside, for those who experience depression in all its terrible, crushing reality, this is how it actually feels:

‘I feel very detached and as if nothing is real. I feel like I am a camera and I’m watching every action, and everything is really slow. Then it just turns into this absolute nothingness ... I can’t locate a cause, I just feel incredibly tired all the time, I sleep 22 hours a day, or I don’t sleep at all, but I’m sort of on the edge of sleep. I don’t want to eat, I don’t want to move.

(Tamara)’

‘What happens these days is that my body literally starts to give way ... suddenly walking to the shop becomes like climbing Mount Everest, and it’s just ridiculous and I just can’t do it. It’s literally like somebody has pulled the plug on me. And there’s this sense of impending doom, and my thoughts start to change drastically. I’ll be obsessed with death thoughts. I don’t get suicidal, but my mind is full of anything to do with death or decay or waste, and it’s like, ‘Here it comes ... the winter of my mind’.

(Ashley)’

‘For months on end I spend days and days shut in my room. I don’t want to do anything. I don’t want to see anyone. I hate everyone around me and hate myself more than anyone. I didn’t speak to my dad for four years. It was a nightmare.

(Paul)’

Sarah vividly recalls Rebecca’s deepest depression, during the winter of 1999:

‘For a period of six or seven months, Rebecca cocooned herself in her bedroom under her duvet. Her life became TV and...

Table of contents

• Cover
• Title Page
• Copyright
• Contents
• With thanks ...
• A word from Paul Abbott
• A word from Jo Crocker
• A word from Professor Nick Craddock
• Introduction: Is this book for you?
• Chapter One Causes, Symptoms and Diagnosis
• Chapter Two Treatment
• Chapter Three Support
• Chapter Four Hospital Care
• Chapter Five Lifestyle Choices
• Chapter Six Living with Bipolar
• Extra resources
• Recommended reading
• With more thanks ...
• Glossary
• Index