1. What is bipolar affective disorder?

From its name, it may be difficult to understand what bipolar disorder is. Another name of this disorder-manic depression may give a clue. As this name suggests, there will be manic and depressive symptoms in someone with manic depression. Depression may be more familiar to most of us. What is mania? When a person becomes manic, he will be extremely elated and his mood state will be the exact opposite of someone who is depressed. When someone has bipolar disorder, his mood will swing between depressive and manic phase. This usually lasts several weeks or months and is far beyond what most of us experience. Sometimes, the patient will have a mixed state, e.g. he may have depressed mood with restlessness and overactivity of a manic episode.

2. Is bipolar disorder common?

About 1 in every 100 adults has bipolar disorder at some point in their life. It usually starts during or after teenage. It is unusual for it to start after the age of 40. Men and women are affected equally.

3. What causes bipolar disorder?

It is found that bipolar disorder is associated with the imbalance of certain chemicals inside the brain, e.g. serotonin. Therefore, medication which can reverse the imbalance can help to control its symptoms. We are not certain of its exact cause. Research suggests that many causes may be responsible which include genetic and environmental factors interacting with each other. Although patient with bipolar disorder may not always have relatives with this disorder, there is genetic component associated with it. Findings that identical twins have higher chance (more than 5 times) of developing bipolar disorder than non-identical twins prove this association. Those carrying the genes may develop the disorder when they encounter certain environmental factors, e.g. physical illness or other life stresses. Some patients who have inherited genes of bipolar disorder may initially present as depression. There may be a swing to the manic phase after they are put on antidepressants. Once started, the disorder will continue its relapsing course without particular triggering factor.

4. What does patient with bipolar affective disorder feel like?

The patient may have depressive or manic symptoms depending on which way his mood has swung. Usually he will be either depressed or manic, but it is possible for him to be in a mixed state. It is difficult to predict which phase he will have in the next episode.

If the patient is in the depressive phase, he will be depressed which goes on for longer than usual and affects his ability to deal with the normal things of life. (For further details, please refer to the pamphlets on depression.)

In the manic phase, he will have an extreme sense of well-being and become optimistic, which is the exact opposite of depression. This feeling can be so intense that it affects his thinking and judgment. He may overestimate his ability, therefore making bad decisions and behave in embarrassing, harmful and even dangerous ways. Similar to depression, it can make him difficult or impossible to deal with life effectively and can affect both relationships and work. Hypomania refers to the phase where the manic symptoms are less severe.

Patient with mania will be very happy and excited. He will be irritable when others don't share his ideas. He is always full of new and exciting ideas. His thoughts will move quickly from one to another. He talks quickly and his speech is difficult to interrupt. He will be full of energy and does not need to sleep. His sex drive will increase. His over friendliness and lack of inhibition may result in sexual relationship with stranger which may be out of his character. He may make other inappropriate decisions, e.g. recklessly spending his money. If an episode of mania becomes very severe, there may even be psychotic symptoms which tend to be grandiose beliefs about himself - that he is on an important mission or that he has special powers and abilities.

5. Treatments of bipolar affective disorder

Drug treatment is very important in the management of bipolar affective disorder. Psychological treatment may be helpful especially in the depressive phase. Certain lifestyle modifications which include having enough sleep can also help to prevent relapse.

Mood stabilizers can be used to treat both manic and depressive episodes and they do not have the risk of triggering a manic swing. Lithium (a naturally occurring salt) and some anti-epileptic agents are example of mood stabilizers.

If the patient has moderate depression, he may be put on a SSRI. SSRI is an antidepressant which increases the level of serotonin (a chemical messenger) inside the brain. It has a lower risk of triggering a manic swing. If there is a recent manic episode or have a rapid-cycling disorder, an antidepressant may push the patient into a manic swing. It is safer to stop the antidepressant and to increase the dose of a mood stabilizer.

During a mania and mixed depressive episode, any antidepressant should be stopped. Mood stabilizers and antipsychotics are most often used instead.

6. Is it ok to stop medications when the symptoms get better?

Like asthmas, bipolar affective disorder runs a relapsing course. Medication treatment can effectively control the symptoms and prevent relapse. Lithium reduces relapse by 30–40%. The more episodes of relapse you have, the more likely you are to have another one. Mood stabilizers and antipsychotics which are commonly used to treat bipolar affective disorder are not addictive. Therefore, it is important to have good compliance to the drugs according to doctor's instructions in order to prevent relapse.

7. How long should the patient take mood stabilizer?

This depends on the severity of the symptoms and the number of previous relapses. Patients need to take mood stabilizer for at least 2 years. For those with frequent relapses and more severe symptoms, they may need to stay on it for a longer period.