In the high phase (also referred to as hypomania), someone with bipolar disorder may have huge amounts of energy and feel little need for sleep. You may think and talk faster than usual, and your thoughts may jump rapidly from one subject to another, making conversation difficult. You may also have what are called ‘grandiose’ ideas or delusions about your abilities and powers, and a loss of judgement. People in a high phase can get themselves into all sorts of difficulties that they would normally avoid – they may leave their job, spend money they don’t have, or give away all their possessions.
In a low (or depressive) phase, people feel hopeless, despairing and lethargic, become full of self-blame and self-doubt and have difficulty concentrating. This can make it difficult to cope with everyday life. You may want to withdraw from friends and social contacts, and may feel suicidal.
Bipolar disorder affects about one in 100 people. The depressive phase usually comes first and about ten per cent of people thought to have pure depression have a manic episode six to ten years later. About 15% of those who have an episode of mania never experience another.
There are great variations in the pattern of mood swings. Some people have mood swings every few days. Others can have long periods without experiencing problems, and many will hold down demanding jobs. However, a significant minority can be very disabled by the condition and struggle to hold down a job and cope with daily life.
Cyclothymia, also called cyclothymic disorder, is a less intense version of bipolar disorder, with less extreme highs and lows that can still cause difficulties.
It is not clear what causes bipolar disorder, although genetic inheritance may be important – 10 to 15% of the nearest relatives of people with a bipolar disorder have a mood disorder. Biochemical changes in the brain – changes in hormone and neurotransmitter levels – have been found to occur during the manic and depressive phases. Poor parenting and severely stressful life events are also thought to have a role.
The high phase usually comes after two to four depressive episodes. Both phases can include psychotic symptoms, such as delusions (irrational beliefs) and hallucinations (seeing, hearing or smelling things that aren’t apparent to other people). The spontaneous recovery rate in bipolar disorder is very high – about 90%. The relapse rate, however, is also high.
More information from Aware on Bi Polar disorder here
There are a number of things you can do to help manage depressive phases.
- Take control. Some people find it helps if they have some control over what happens to them. This helps to guard against the hopelessness associated with depression.
- Make a fresh start. This has been shown to help people recover from long-lasting depression.
- Set small and manageable goals – this can give you a sense of achievement and make you feel better.
- Keep in touch with your friends. If you are already depressed you may find it very difficult to be sociable, and this can make you feel more depressed.
- Keep active. Exercise can be very helpful in counteracting depression.
- Review your diet. People who are depressed may have low levels of certain essential fatty acids that are found in fish oils.
- Try self-help techniques – for example, meditation and listening to music.
There are also some things you can do that can help stop you going high.
- Take control. Be aware of how you are feeling and when you are heading towards hypomania so that you can plan for and reduce the worst effects.
- Sleeping tablets and tranquillisers may help if taken early on, but be careful not to overdo this.
- Get plenty of rest, even if you don’t really feel like it.
- Cancel most of your plans for the next few weeks. The less you have to think about the better.
- Avoid stimulants, like alcohol, coffee and any kind of recreational drugs.
Depressive episodes, if untreated, last for about six months to one year. On average, someone with bipolar will have five or six episodes over a 20-year period. With treatment, most depressive episodes clear in about three months, but if treatment is stopped before six months of full recovery, the risk of relapse is doubled. The depression may also be treated with anti-depressants and talking treatments, such as cognitive behavioural therapy or counselling. You can find out more about cognitive behavioural therapy (Link to A-Z CBT) and counselling (Link to A-Z counselling) here.
Some people have reported benefits from complementary therapies, such as acupuncture.
The most common treatment during high phases is lithium carbonate, a mood stabilising drug. It is also sometimes prescribed to people with severe depression. High levels of lithium in the blood are dangerous, so anyone taking lithium must have regular blood tests.
Self-management – learning to recognise and self-manage the triggers and warning signs of mood swings can also help you keep your moods more stable. Find out more about self-management (Link to A-Z self-management).