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Bipolar Disorder

Bipolar disorder is a chronic condition that is characterised by periods of abnormally elevated and low mood. Over time it also leads to depression.

  1. Bipolar Disorder is often initially diagnosed as clinical depression
  2. Changes of mood accompanied with irritability and hyperactivity
  3. Treated with mood stabilisers or antipsychotics

Bipolar disorder is a serious mental health condition. If you have been diagnosed with bipolar disorder and need to renew your subscription, you can contact one of our UK doctors, who can prescribe medication and talk to you about episodes you may have had.

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Description

What is bipolar disorder?

Bipolar disorder is a chronic mental health condition that was previously referred to as manic depression. It is characterised by episodes of elevated moods, where the person may feel happy yet irritable, and episodes of depressive symptoms. Manic episodes usually last for at least a week, and contain both feelings of an elevated mood and depression.

There are two main types of bipolar disorder. Type I is the manifestation of at least one manic or mixed episode (where both sets of opposing symptoms are experienced at the same time). Type II is defined by the lack of a manic episode, but at least one hypomanic episode (minor symptoms of a manic episode lasting for less than 4 days) and one depressive episode.

What causes bipolar disorder?

What exactly causes bipolar disorder remains unclear, but it is thought to be influenced by the presence of several genes. There are also other factors that may have an effect, such as chemical imbalances in the brain and environmental triggers. You are more likely to develop bipolar disorder if a family member has had the condition, but there is no specific gene that indicates that bipolar disorder will occur. It is more likely the case that a phenotype is expressed from environmental triggers that gives rise to the mood disorder.

Some examples of potential environmental triggers include a severe physical or mental trauma, the death of a family member or another physical condition or problems in life that become overwhelming, and cannot be controlled. Chemical imbalances in the brain can occur in people with bipolar disorder, where there is too much noradrenaline in episodes of mania, and too little in depressive episodes.

Who gets bipolar disorder?

In developed countries, bipolar disorder is the sixth leading cause of disability between the ages of 19 and 45. In the US, it is estimated that the lifetime incidence of the condition is around 1%, and the lifetime cost to the country is around 200 billion. A patient survey from the US also found that over 65% of people with bipolar disorder had been previously misdiagnosed with depression. The first manic episode will usually occur in adolescence and before the age of 30, and the peak age of onset is between the ages of 15-19. In the UK, there is a higher incidence of bipolar disorder in black and minority ethnic groups than in the white population. 

The two most significant complications of bipolar disorder are suicide and disability. If bipolar disorder is untreated, there is a 15% lifetime prevalence of suicide. It is important that doctors recognise the risk of suicide in people with bipolar disorder and develop an intervention plan. During manic periods, people with bipolar disorder are sometimes completely incapable of performing daily activities, and this is where hospitalisation is required.

If you have recently experienced a manic or depressive episode and are unable to talk to an assigned psychiatrist, one of our doctors may be able to help. Our doctors are available to consult with via our online video consultation service. They will also be able to provide a prescription for your bipolar disorder medication.

Page last reviewed:  12/06/2020
Diagnosis and treatment

How does someone know they have bipolar disorder?

Bipolar disorder can manifest in many different ways; it does not only consist of two definitive moods. The episodes may vary dramatically in length and form.

You can't self-diagnose bipolar disorder; a GP will make a referral to a psychiatrist if they suspect that the condition is present.

However, there are symptoms which may point towards bipolar disorder. Depressive episodes are characterised by feeling sad, hopeless, lacking energy, a loss of appetite and generally a reduced interest in things. By contrast, episodes of mania can make a person feel ecstatic, full of ideas, and energy, and too busy to eat or sleep. 

How is bipolar disorder diagnosed?

Bipolar disorder can only be fully diagnosed by a psychiatrist. A doctor will make a referral if they think that a patient may have the condition. 

A clinician will be able to identify symptoms of bipolar disorder having ascertained what someone’s medical history is. If someone has depressive symptoms for a prolonged period (an irritable and hyperactive mood lasting more than four days) bipolar disorder may be suspected.

Furthermore, a doctor might ask questions relating to energy levels, to see if there has been a marked difference, and if it has had an effect on sleeping patterns, which may have led to the person being much more active.

Does bipolar disorder require treatment?

Bipolar disorder will require treatment to prevent the person from becoming severely depressed and becoming a danger to both themselves and others.

It requires both education and good communication between healthcare professionals and the patient, as well as close monitoring during treatment.

What treatments are there for bipolar disorder?

Bipolar disorder is a very complex condition to treat because of its random recurrent nature, where mood episodes differ greatly. The aim of the treatment is to design a routine for the person, whereby the frequency of future episodes can be prevented and acute episodes may be resolved. This may improve functionality.

Managing the condition can be categorised as such: the acute manic episodes, the acute depressive episodes and long-term treatment. 

Initial manic episodes require controlling the patient, who may be violent. Oral medication is required to reduce the manic symptoms quickly. If the person is particularly uncomfortable, they should be admitted to a tranquil environment. The antipsychotic medicine aripiprazole is the first line treatment.

For depressive episodes, a doctor should consider referring the person to a Mental Health Team, where psychiatrists can conduct a risk assessment and decide whether antidepressants are necessary (they aren’t always effective for bipolar disorder). The severity of the depression guides the therapy. If it is mild, medication may not be necessary at all, whereas if it develops quickly after a manic episode, an antipsychotic medicine may be administered. Fluoxetine is the first-line medication for moderate-to-severe depression in bipolar disorder.

Antipsychotic treatments may also be prescribed where necessary. This includes treatments such as Olanzapine or Quetiapine. Another antipsychotic is Risperidone, sold under the brand name Risperdal.

For long-term treatment, the first line-treatment is lithium carbonate. The correct dosage must be taken over an extended period, with monitoring of the thyroid also required, as the treatment can have adverse effects. Therapy should continue for a minimum of two years, and may last for up to five years.

Page last reviewed:  12/06/2020
Questions and Answers

What should I do if I think I might have bipolar disorder?

It is imperative that you contact your local GP if you have developed symptoms of bipolar disorder and have not previously been diagnosed. They will be able to refer you to a psychiatrist if your suspected symptoms become clear indications of bipolar disorder.

Are there side effects of bipolar disorder treatment?

Most of the side effects from treating bipolar disorder are related to lithium carbonate. Lithium carbonate can produce adverse effects over a sustained period of use. Thyroid function should be monitored for long-term treatment as the autoimmune condition, hyperthyroidism, can develop as a consequence of taking lithium. Lithium intoxication can also occur from misuse of the medication. For example, from an increased dosage or deliberate overdose. 

Can I consult a doctor about bipolar disorder online?

You can consult one of our UK doctors about bipolar disorder by using the private video consultation service.

After booking an appointment, you will be able to speak to one of our doctors, who are available at a time convenient for you. They can renew your prescription and refer you to a psychiatrist if you are undiagnosed.

Page last reviewed:  12/06/2020

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