By guest blogger Dr Chi-Chi Obuaya Consultant Psychiatrist...
What is bipolar disorder?
Bipolar disorder (previously referred to as manic depression) is a mood disorder that is characterised by prolonged periods of mania and depression. Many patients worry about whether their ‘mood swings’ constitute bipolar disorder, but there are a number of core symptoms that help us to differentiate between bipolar disorder and normal variations in mood.
What are the symptoms?
Typical symptoms of mania or hypomania (less pronounced but clinically significant mood elevations) include:
- Mood elevation lasting for ≥4 consecutive days
- Decreased need for sleep
- Increased risk-taking and recklessness
- Grandiose thoughts
- Changes in speech (usually fast and difficult to interrupt)
The depressive symptoms are the same as those seen in unipolar depression - e.g. decreased mood, an inability to enjoy previously pleasurable activities, fatigue, reduced appetite and lack of concentration.
In severe cases, psychotic symptoms can emerge, such as auditory hallucinations (hearing voices) and delusional beliefs.
What are the causes?
The development of bipolar disorder has a strong genetic predisposition; it occurs more commonly when a first-degree relative has the diagnosis. The onset is usually in the 20s of the affected individual. Further episodes can be triggered by a lack of sleep, long-distance travel, stopping medication and other causes of significant stress. Antidepressants can unwittingly cause manic or hypomanic episodes.
How is it treated?
The evidence base strongly supports the use of medication as the mainstay of treatment. Some of the terminology in drug treatment is confusing as drugs used to treat a range of other conditions, including anti-epileptic drugs and antipsychotic drugs, are effective in the treatment of bipolar disorder.
Drug treatment in the acute phase can include use of antipsychotics, sedative and other hypnotic agents to treat insomnia and “take the edge off” manic symptoms. It is perhaps more useful to think about drugs used in the longer-term maintenance phases. Here the treatment usually involves the prescription of drugs with mood-stabilising properties such as lithium, quetiapine, carbamazepine, lamotrigine or sodium valproate.
There are numerous factors that determine which drug is used - this is best discussed with the treating specialist. Some drugs are avoided in women of child-bearing age. Psychological treatments can be effective, although usually only when manic or hypomanic symptoms have been stabilised.
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