Bipolar affective disorder (manic depression) is a mood disorder that is characterized by:

• Episodes of depression, in which someone's mood is abnormally low.
• Episodes of mania or hypomania when the mood is abnormally elevated with heightened mental and often physical activity.
• Periods of normal mood.

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

What is the depression like?

Feeling depressed or down is a normal reaction to events in our lives. In depressive illness that occurs as part of bipolar disorder, the depressive feelings will be worse, they will go on for longer and they will make it harder to deal with day-to-day problems. Some of these other symptoms may also occur:

• Feelings of unhappiness that do not go away.
• Losing interest in things.
• Being unable to enjoy things.
• Finding it hard to make even simple decisions.
• Change of appetite.
• Weight loss or gain.
• Difficulty sleeping or sleeping too much.
• Going off sex.
• Being fidgety or restless.
• Tiredness and loss of energy.
• Excessive feelings of worthlessness or guilt.
• Being unable to see a positive future.
• Having trouble thinking or concentrating.
• Finding it harder to be with people.
• Having thoughts that one would be better off dead or thoughts about hurting oneself.
• Difficulty in performing normal activities such as work, taking care of things at home or getting along with people.

What is the mania like?

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 judgment and behave in embarrassing, harmful or even dangerous ways. This may be accompanied by:

• Feeling unusually confident.
• Needing less sleep than usual.
• Being more talkative than usual.
• Having racing thoughts.
• Being easily distracted.
• Being unusually active or restless.
• Having problems at home, work or school because of these symptoms.
• Depressive symptoms sometimes occur within the manic episode.

Who gets it?

Anybody can suffer from bipolar disorder; men suffer as often as women and people of higher social class as often as people of lower social class. It is estimated that one per cent of the population will suffer from bipolar disorder at some point in their lives.

What causes it?

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 illness.

What is the outlook?

Some people will have only one or two short episodes and then never be unwell again, whereas a very small proportion persistently experiences the symptoms of depression or mania or flit quickly from one extreme to the other. The average is nine episodes of mood disturbance over a lifetime.

What about treatment?

The aim of treatment is to prevent the episodes of mood disturbance and to treat them if they occur. Sometimes this treatment is best carried out in hospital.

Drug treatment

• 'Mood stabilisers' such as lithium (priadel or camcolit), sodium valproate (epilim), carbamazepine (tegretol) and lamotrigine (lamictal) are used to prevent the episodes of mania and depression and to treat them when they occur.
• Antidepressant drugs, for example fluoxetine (Prozac) or venlafaxine (Efexor), are sometimes used to treat the depressive episodes.
• Neuroleptics, for example sulpiride or olanzapine (Zyprexa) are usually used to treat the manic episodes.

Other treatment

• Support from family, friends, doctors, nurses or from voluntary organizations such as the Manic Depression Fellowship.
• Some specific psychological therapies such as cognitive therapy (CBT) can also be useful.
• It can be helpful to recognize the early signs of illness such as sleep disturbance and to seek treatment quickly as this point to try to nip any relapse in the bud.

If I have bipolar disorder will I pass it on to my children?

Bipolar disorder can run in families but it can occur in people who have no psychiatric problems in their family. The risk of any child going on to develop bipolar disorder is 1 in 100. This risk is increased in the children of someone with bipolar disorder, but is still only about 8 in 100.

Someone close to me has bipolar disorder - what should I do?

• Be understanding.
• Offer practical help.
• Encourage them to seek help if they appear to be becoming unwell.
• Contact a doctor or nurse involved in their care yourself if they are becoming more unwell.
• Take care of yourself.

Seek help immediately if:

• Your relative or friend is not able to look after him or herself properly.
• If you find that they are seriously neglecting themselves by not eating or drinking.
• If they talk of harming or killing themselves.
• If they are starting to become manic and you notice that they are happier, more irritable, talking faster than usual, sleeping less than normal and especially if they are behaving in an unusually risky way.

Your loved one's mania or depression can be distressing, exhausting and can leave you feeling completely powerless to help. You should seek help and support yourself and do what you can to make sure that you have enough rest, exercise and time just for yourself to allow you to recharge your batteries and so be able to continue to help.

I think that I have bipolar disorder. What should I do?

Visit your GP. He or she will talk to you to help decide if your fears are correct and will then be able to organize appropriate care.