Bipolar Affective Disorder - Fact Sheet

Bipolar affective disorder is also known as manic depression or bipolar depression. It is a mood disorder in which the sufferer experiences marked mood swings which are beyond what most people experience.

These extremes of mood may include the lows of depression as well as the highs of a very elated mood (known as mania). The number and frequency of these periods of depression and mania vary from person to person.

It is estimated that between 1 and 2% per cent of the population suffer from Bipolar Affective Disorder at some point in their lives. Some people will experience just one or two episodes, whereas others will have many episodes of depression or mania.

It is a serious condition but can be helped with the right treatment.

What causes Bipolar Affective Disorder?

The causes of Bipolar Affective Disorder are not well understood.

As with any mental illness, differences in people’s genetic make up can make them more vulnerable to develop Bipolar Affective Disorder. Stressful events, illness or lack of support can trigger individual episodes of mania or depression.

What are the symptoms of mania?

A period of a week or more during which a person feels abnormally good, high, excited, hyper or irritable. This can be so extreme that the sufferer loses contact with reality and starts to believe strange things, have poor judgement and behave in embarrassing, harmful or even dangerous ways. This may be accompanied by:

In severe cases sufferers may develop ‘psychotic’ symptoms of delusions and hallucinations. The content of these is usually in keeping with the euphoric mood and the unrealistic sense of great self-importance.

What are the symptoms of a major depressive episode?

A depressive episode is when you have either a depressed mood or the loss of interest or pleasure in nearly all activities (known as Anhedonia), lasting for at least 2 weeks.

When you are experiencing a depressed mood you might:

For more information, see the Fact Sheet Depression (link will open in a new window) at www.braininjury.org.au.

What are the types of Bipolar Disorder?

Bipolar affective disorder is not one single disorder. Instead, there are four distinct types of Bipolar Disorder.

Bipolar I Disorder

Bipolar I is marked by experiencing one or more manic episodes or mixed episodes and often one or more major depressive episodes. Each depressive episode can last for several weeks or months, alternating with intense symptoms of mania that can last just as long. Between these extremes, there may be no symptoms at all.

Bipolar II Disorder

Bipolar II is marked by experiencing one or more major depressive episodes, along with at least one hypomanic episode. Hypomanic episodes have symptoms similar to manic episodes, but are not as severe. Between episodes, there might be periods of normal functioning.

Cyclothymic Disorder

Cyclothymic Disorder is a chronic fluctuating mood pattern which involves periods of hypomanic symptoms and periods of depressive symptoms. In Cyclothymic Disorder the symptoms do not have to be severe enough to be labelled as mania or depression - it is a milder form of Bipolar Disorder in which the symptoms are less severe, less regular and don’t last as long.

Bipolar Disorder Not Otherwise Specified

When symptoms don't fit any other type, it is called Bipolar Disorder Not Otherwise Specified. Just like the other types of Bipolar Disorder, Bipolar Disorder Not Otherwise Specified is a treatable disorder, but it is not as regular or as clear-cut as the other types and experiences vary more widely from person to person. Symptoms may be as severe as the other types, but not last as long, or may be too far apart to be classified as Cyclothymic Disorder, or there may be recurrent hypomanic episodes without depressive episodes.

All these four types of Bipolar Disorder have the potential to seriously disrupt someone’s work, school, social or personal life. Thankfully, they are also all treatable.

How is Bipolar Affective Disorder treated?

Depressive episodes are treated in the same way as other episodes of depression. This includes psychological therapy and antidepressant medication.

Episodes of mania are usually treated with antipsychotic medication (for example medicines such as chlorpromazine and haloperidol are used).

If the episodes of either mania or depression are severe enough to place the life of the sufferer at risk, or to endanger the lives of others, the sufferer may need to be admitted to hospital in order to be treated.

Often, during acute episodes of illness, mood-stabilising medicines are used. These are also used for longer-term preventive therapy, the aim of which is to prevent relapses. The most widely used and recognised example is lithium. Others include sodium valproate (Epilim), carbamazepine (Tegretol) and olanzapine (Zyprexa). These medications treat the symptoms not the cause and are also used in cases where a brain injury leads to extremes of mood that are not classed as a mental illness.

Lithium treatment needs to be monitored with regular blood tests to make sure that there is enough lithium in the body for it to work, but not too much, which can be harmful.

What can the individual do?

There are many things that people with Bipolar Disorder can do to make the condition more manageable. Some suggestions include:

Prognosis for Bipolar disorder

Like diabetes or heart disease, Bipolar Disorder is a long-term illness that must be carefully managed throughout a person’s life.

Episodes of mania and depression typically recur across the life span. Between episodes, most people with Bipolar Disorder are free of symptoms, but as many as one-third of people have some residual symptoms. A small percentage of people experience chronic unremitting symptoms despite treatment.

Without treatment, however, the natural course of Bipolar Disorder tends to worsen. Over time a person may suffer more frequent (more rapid-cycling) and more severe manic and depressive episodes than those experienced when the illness first appeared. But in most cases, proper treatment can help reduce the frequency and severity of episodes and can help people with Bipolar Disorder maintain good quality of life.

References and further information