Virtual Medical Centre

Bipolar Affective Disorder (Manic Depression)

• What is Bipolar Affective Disorder?
• Who gets Bipolar Affective Disorder?
• Predisposing Factors
• Progression
• Probable Outcomes
• How Will Bipolar Affective Disorder Affect Me?
• Clinical Examination
• How is Bipolar Affective Disorder Diagnosed?
• How is Bipolar Affective Disorder treated?
• Bipolar Affective Disorder References
• Drugs/Products Associated with Bipolar Affective Disorder

What is Bipolar Affective Disorder?

Bipolar affective disorder (BPAD) is a psychological illness that involves severe mood swings. These mood swings take the form of depression or mania and may last for several months at a time.

During the time of depression patients often have great sadness, guilt, no appetite, poor sleep and can not enjoy themselves. Mania is the opposite of this with patients experiencing erratic and excited behaviour.

During mania patients often have increased libido, need less sleep, have excessive energy and can sometimes engage in risky behaviour (such as gambling excessively) or can even become violent.

Hypomania is a less extreme form of mania and while the symptoms are similar they are less intense. Some patients may also have a mixed episode that involves the symptoms of both a manic and depressed episode during a short period of time (less then 1 week).

There are 3 recognised types of BPAD:

• Type I: Patients have very high manic periods and depressive episodes.
• Type II: Patients have severe depressions but only mild manic (hypomanic) episodes.
• Type III: Called Cyclothymic disorder, the patient has only mild depression and mild mania.

There is also a type called Rapid Cycling Bipolar Affective Disorder. With Rapid Cycling the patient changes from depression to manic at least 4 times a year and episodes of depression and mania are short.

Who gets Bipolar Affective Disorder?

There is a 2.5% chance of developing BPAD type I & II during your lifetime in Australia. The chance for combined BPAD and Cyclothymic disorder is reported as 5.2%. No racial differences exist. Males are more likely to develop BPAD than females.

Predisposing Factors

The most significant risk factor for BPAD is a family history of either BPAD or depression, with two thirds of patients with BPAD having some family history of mental illness. Genes are thought to account for 80% of cases of BPAD and research is underway to find out more information about how family history and genetics influence the risk of BPAD.

Progression

BPAD is a lifelong condition with episodes of low and high mood. The course of the illness varies greatly between individuals. Symptoms of BPAD (like depression) usually begin before age 20 with the 15 to 19 year old age group being most common. However, these symptoms are often ignored or misdiagnosed until a later age. The main reason is that almost half of all patients with BPAD will first have an episode of depression (only a quarter will first experience manic symptoms such as excited mood, excess energy, etc).

During life the patient will have episodes of low or high mood. Patients with Type I BPAD will have manic (high mood) episodes and depression (low mood) while Type II with have only mild manic episodes (called hypomanic) and more depressive episodes.

Episodes, even if treated, usually last 3-6 months but can last considerably longer. Depressive symptoms (such as low mood, low enjoyment with life, and a lack of energy) can last for years at a time.

How often episodes occur is extremely variable between patients, however the usual time between first and second episode is about four years and then episodes occur about every year. Episodes often become more frequent over time (especially if untreated). Untreated, a typical BPAD Type I patient will experience 10 episodes of mania during their life with a number of depressive episodes.