Psychological treatment should include:
Give yourself space and time to recharge your batteries. Make sure that you have some time on your own, or with trusted friends who will give you the support you need. If your relative or friend has to go into hospital, share the visiting with someone else. You can support your friend or relative better if you are not too tired.
A Lithium level check will need to be done every 3-6 months and a blood test for thyroid and kidney function at least every 15 months.
If you are taking Lithium or any other medication for your bipolar disorder, your GP is now expected to give you an annual physical health check. This will include:
Practical help is very important – and much appreciated. Make sure that your relative or friend is able to look after themselves properly.
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Number of previous manic episodes.
You need to discuss this with your doctor, but some general principles are:
Reasonably intense exercise for 20 minutes or so, three times a week, seems to improve mood. Fun.
Make sure you regularly do things that you enjoy and that give your life meaning. Continue with medication.
As well as these unusual beliefs, you might experience hallucinations - when you hear, smell, feel or see something, but there isn't anything (or anybody) there to account for it.
The feeling of depression is something we all experience from time to time. It can even help us to recognise and deal with problems in our lives but in clinical depression or bipolar disorder, the feeling of depression is worse. It goes on for longer and makes it difficult or impossible to deal with the normal things of life. If you become depressed, you will notice some of these changes: Emotional Thinking Physical Behaviour.
This leaflet was produced by the Royal College of Psychiatrists' Public Education Editorial Board.
A Different Life.
Learn how to recognise the signs that your mood is swinging out of control so you can get help early. You may be able to avoid both full-blown episodes and hospital admissions. Keeping a mood diary can help to identify the things in your life that help you – and those that don't. Knowledge.
Children will find it helpful if the adults around them are sensitive, understanding, and can respond to their difficulties in a calm, consistent and supportive way. Adults can help them to understand why their parent is behaving differently. Questions will need to be answered calmly, factually and in language they can understand. They will feel better if they can keep to their usual daily routine.
At the start of a manic mood swing, the person will appear to be happy, energetic and outward-going - the ‘life and soul’ of any party or heated discussion. However, the excitement of such situations will tend to push their mood even higher. So try to steer them away from such situations. You can try to persuade them to get help, or get them information about the illness and self-help.
In between episodes of mania or depression, psychological treatments can be helpful. Treatment usually involves around 16 one-hour sessions over a period of 6 to 9 months.
It used to be thought that if you had bipolar disorder, you would return to normal in between mood swings. We now know that this is not so for many people with bipolar disorder. You may continue to experience mild depressive symptoms and problems in thinking even when you seem to be better.
Mania is an extreme sense of well-being, energy and optimism. It can be so intense that it affects your thinking and judgement. You may believe strange things about yourself, make bad decisions, and behave in embarrassing, harmful and - occasionally - dangerous ways.
More information about helping children cope with a sick parent is provided in our factsheet 'Parental mental illness - the problems for children'. Bipolar UK.
40% (40 in 100).
In between mood episodes, find out more about bipolar disorder. It may be helpful to go with your friend or loved one to any appointments with the GP or psychiatrist.
For a catalogue of public education materials or copies of our leaflets contact: Leaflets Department, The Royal College of Psychiatrists, 21 Prescot Street, London E1 8BB. ephone: 020 7235 2351 x 2552.
get medical help immediay.
Try to avoid particularly stressful situations - these can trigger off a manic or depressive episode. It's impossible to avoid all stress, so it may be helpful to learn ways of handling it better. You can do relaxation training with CDs or DVDs, join a relaxation group, or seek advice from a clinical psychologist. Relationships Activities.
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If an episode of mania or depression becomes very severe, you may develop psychotic symptoms.
Long-term use of Lithium can affect the kidneys or the thyroid gland. It is wise to have blood tests every few months to make sure that they are working properly. If there is a problem, you may need to stop Lithium and consider an alternative.
Lithium has been used as a mood stabiliser for 50 years – but how it works is still not clear. It can be used to treat both manic and depressive episodes.
Any antidepressant should be stopped. Lithium, Sodium Valproate, Olanzapine, Quetiapine or Risperidone are most often used to treat a manic episode.
Keep the name of a trusted professional (and their ephone number) for any such emergency. A short admission to hospital may sometimes be needed.
12% (12 in 100) 5+
Morriss, R. (2004). The early warning symptom intervention for patients with bipolar affective disorder. Advances in Psychiatric Treatment, 10: 18 - 26.
6-7% (6-7 in 100) 3-4.
If you have a second episode, there is a strong chance of further episodes – so most psychiatrists would usually recommend a mood stabiliser at this point.
It can take three months or longer for Lithium to work properly. It's best to carry on taking the tablets, even if your mood swings continue during this time. Side-effects.
Make sure that you have enough time to relax and unwind. If you are unemployed, think about taking a course, or doing some volunteer work that has nothing to do with mental illness. Exercise.
There are some things you can try to control mood swings so that they stop short of becoming full-blown episodes of mania or depression. These are mentioned below, but medication is still often needed to:
NICE Guideline 38 : Bipolar Disorder: the management of bipolar disorder in adults, children and adolescents, in primary and secondary care (2006) National Collaborating Centre for Mental Health: London.
If you become manic or depressed, you may temporarily not be able to look after your children properly. Your partner, or another family member, will need to organise the children's care while you are unwell. It can be helpful to make plans for this in advance when you are well.
0845 123 23 20;. Information, support and understanding for people who suffer with depression, and for relatives who want to help. Self-help groups, information, and raising awareness for depression.
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(More information about CBT can be found in our online leaflet Cognitive Behavioural Therapy. ).
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Try to balance your life and work, leisure, and relationships with your family and friends. If you get too busy you may bring on a manic episode.
Welsh organisation which supports people affected by depression. Samaritans.
20% (20 in 100).
Chance of having another episode in the next year Not taking Lithium Taking Lithium 1-2.
User and carer input : Members of the Royal College of Psychiatrists’ Service User Recovery Forum, Bipolar UK and Bipolar Scotland.
Career timeline for psychiatry.
Find out as much as you can about your illness - and what help there is. There are sources of further information at the end of this leaflet. See support groups and caring organisations. Stress.
You should discuss any pregnancy plans with your psychiatrist. Together, you can arrange how to manage your mood during the pregnancy and for the first few months after the baby arrives.
About 1 in every 100 adults has bipolar disorder at some point in their life. It usually starts during or after the teenage years. It is unusual for it to start after the age of 40. Men and women are affected equally. Bipolar I Bipolar II Rapid cycling Cyclothymia.
If you find that they are:
Goodwin, G.M. (2003) Evidence-based guidelines for treating Bipolar Disorder: recommendations from The British Association for Psychopharmacology. Journal of Psychopharmacology, 17; 149-173.
It can be difficult to know what to say to someone who is very depressed. They see everything in a negative light and may not be able to say what they want you to do. They can be withdrawn and irritable, but at the same time need your help and support. They may be worried, but unwilling or unable to accept advice. Try to be as patient and understanding as possible.
10% (10 in 100).
If you continue to have troublesome mood swings, you may need to continue medication for longer.
There are several mood stabilisers, most of which are also used to treat epilepsy. However, Lithium (a naturally occurring salt) was the first effective mood stabiliser.
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More information about other mood stabilisers can be found in our online leaflet Medications for Mania.
You may find that your child may feel anxious and confused when you are not well. If they cannot express their distress in words, toddlers can become difficult or clingy, and older children will show it in other ways.
If you are in the middle of a manic episode for the first time, you may not realise that there is anything wrong – although your friends, family or colleagues will. You may even feel offended if someone tries to point this out to you. You increasingly lose touch with day-to-day issues – and with other people's feelings.
These can start in the first few weeks after starting Lithium treatment. They can be irritating and unpleasant, but often disappear or get better with time. They include:
Much depends on how well you get on with a particular medication. What suits one person may not suit another, but it makes sense to first try the medications for which there is better evidence.
After just one episode, it’s difficult to predict how likely you are to have another. You may not want to start medication at this stage – unless your episode was very severe and disruptive.
You may want to stop your medication before your doctor thinks it is safe – unfortunay this often leads to another mood swing. Talk it over with your doctor and your family when you are well.
Like depression, it can make it difficult or impossible to deal with life in an effective way. A period of mania can affect both relationships and work. When it isn't so extreme, it is called 'hypomania'.
These can usually be improved by lowering the dose of Lithium.
If you become manic, you may notice that you are: Emotional Thinking Physical Behaviour.
08457 90 90 90 (ROI 1850 60 90 90);. Confidential, non-judgmental support 24 hours a day by ephone and for anyone who is worried, upset, or suicidal.
If you are pregnant, it's best to discuss with your psychiatrist whether or not to stop Lithium. Although Lithium is safer in pregnancy than the other mood stabilisers, the risk to the baby needs to be weighed against the risk of you becoming depressed or manic. The risk is greatest during the first three months of pregnancy. Lithium is safe after the 26th week of pregnancy, although you should not breastfeed your baby if you are taking Lithium.
The following signs suggest that your Lithium level is too high. Contact your doctor immediay if you notice: Blood tests.
During pregnancy, everyone involved - the obstetrician, midwives, health visitors, GP, psychiatrist, and community psychiatric nurse – need to stay in touch with each other.
Provides support, advice and information for people with bipolar disorder, their friends and carers. Bipolar Fellowship Scotland.
We don't understand this well, but research suggests that:
Geddes, J. (2003) Bipolar disorder. Evidence Based Mental Health, 6 (4): 101-2.
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Treatment with Lithium should be started by a psychiatrist. The difficulty is getting the level of Lithium in the body right – too low and it won't work, too high and it becomes toxic. So, you will need regular blood tests in the first few weeks to make sure that you are getting the right dose. Once the dose is stable, your GP can prescribe your Lithium and arrange the regular blood tests.
26% (26 in 100).
Lithium reduces your chance of relapse by 30–40%, but the more manic episodes you’ve had, the more likely you are to have another one.
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For at least two years after one episode of bipolar disorder, and for up to five years if there have been:
Go to Expert Advice ______________________________________________________________________________
This leaflet reflects the best available evidence available at the time of writing.
The College has produced a comprehensive set of guides covering a whole range of mental health issues.
Bipolar disorder may result in you having to stop driving for a while. Visit the DVLA website for further information.
This video describes the training pathway involved in becoming a consultant psychiatrist. View video Job Board.
Review: Dr Martin Briscoe, Deborah Hart.
As you get older, the risk of getting further episodes stays much the same. Even if you have been well for a long time, you still run the risk of having another episode.
0141 560 2050. Provides information, support and advice for people affected by bipolar disorder and all who care for them. Promotes self-help throughout Scotland, and informs and educates about the illness and the organisation. Depression Alliance.
Less common side-effects are:
Mania or depression can be distressing – and exhausting - for family and friends.
It is possible that Sodium Valproate, an anti-convulsant, works just as well Lithium, but we don’t yet have enough evidence to be sure. It should not be prescribed to women of child-bearing age.
This leaflet is for anyone who wants to know more about bipolar disorder (sometimes called bipolar affective disorder or manic depression). It is especially helpful for anyone who has bipolar disorder, their friends and relatives. Many patients prefer the term ‘bipolar’ rather than ‘bipolar disorder’ as they have an illness not a disorder. This leaflet describes:
There are other medications, apart from Lithium, that can be used to help.
Olanzapine, an antipsychotic medication.
Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.
Carbamazepine and Lamotrigine are also effective for some people.
The College publishes several journals and a wide range of books on mental health. See Publications Leaflets.
At first you will need blood tests every few weeks to make sure that you have the right level of Lithium in your blood. You will need these tests for as long as you take Lithium, but less often after the first few months.
The amount of Lithium in your blood is very sensitive to how much, or how little, water there is in your body. If you become dehydrated, the level of Lithium in your blood will rise, and you will be more likely to get side-effects, or even toxic effects. So, it’s important to:
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Older children may worry that they have caused the illness – that it is their fault. They need to be reassured that they are not to blame, but also to be shown what they can do to help. When an older child takes responsibility for caring for a sick parent, they will need particular understanding and practical support.
If you have been admitted to hospital for bipolar disorder, you may want to write an ‘advance directive’ with your doctor and family to say how you want to be treated if you become ill again.
This depends on which way your mood has swung.
Bipolar disorder used to be called ‘manic depression’. As the older name suggests, someone with bipolar disorder will have severe mood swings. These usually last several weeks or months and are far beyond what most of us experience. They are:
Once the treatment has started, symptoms usually improve within a few days, but it may take several weeks for a full recovery. You should check with your doctor if you want to drive while taking this sort of medication. Self-monitoring.
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