Jennifer Wright, Clinical Psychologist

Bipolar Disorder can be difficult to diagnose. Some sufferers struggle with unpredictable mood swings for years before they receive appropriate treatment. They find everyday situations difficult to confront because of their internal emotional havoc, and they don't understand why life seems so hard. People with Bipolar Disorder can be very high functioning, but their bouts of debilitating depression and occasional manic episodes confound their lives.

People with Bipolar Disorder may not recognise manic episodes. They can feel they are on a successful “high”, even though those around them may feel uncomfortable about some of their behaviours. Recently, psychiatrists have defined several levels of Bipolar Disorder, including Bipolar II (or rather disrespectfully, Bipolar Lite). At a more moderate level, sufferers continue to report the highs and lows of Bipolar Disorder, but do not experience psychotic episodes and are less likely to be admitted to a psychiatric hospital.

About 1.2 million Australians (and this is probably an underestimate) have been diagnosed with Bipolar Disorder, or have been prescribed medication, such as the mood stabiliser Lithium or an anticonvulsant, such as Lamictal.

Some psychiatrists are linking the increase in the diagnosis of Bipolar Disorder with a reduction in the amount of fish we eat, and a subsequent imbalance of Omega 6 and Omega 3. Fish Oil, which has been promoted as a cure for everything from memory problems to depression, may also help with Bipolar Disorder.

An example of someone suffering from bipolar disorder is a client who is a very successful and popular salesman. However, once every three or four years, he is admitted to the psychiatric ward of a hospital, depressed and experiencing frightening suicidal thoughts. The diagnosis of Bipolar itself did not help him. It was after he learnt to recognise the early symptoms of depression or mania that he began to feel that he might be able to have some influence over his debilitating condition.

A beautiful young woman was an asset to every organisation she joined. But she would begin to become depressed after an initial flying start, and then sabotage herself as her mood became desperately low and out of control. Eventually she would resign from the highly desirable job, shut herself away, and stay in bed for most of the day. Her Bipolar Disorder had been undiagnosed for several years, and at times she became suicidal in her despair and disappointment.

A diagnosis of Bipolar Disorder, combined with therapeutic support, education and appropriate medication has helped this young woman to maintain a job, develop a relationship and start a family. She has learnt to recognise the symptoms of a manic episode and a potential period of depression, and knows when to seek help.

Recognising Bipolar Disorder

The distinguishing characteristic of Bipolar Disorder, compared with other mood disorders, is the presence of at least one manic episode.

Bipolar Disorder is a chronic condition because most individuals who have one manic episode have additional episodes in the future. Statistics suggest that four episodes in 10 years is an average, without treatment. People with Bipolar Disorder are at a significantly increased risk of suicide.

Diagnosing Bipolar Disorder

Research suggests a strong genetic influence. Bipolar Disorder typically begins in adolescence or early adulthood and continues throughout life. Diagnosis can be a problem because it is episodic, and people in the manic stage are often in denial that anything is wrong. People in the depressed phase are often wrongly diagnosed with clinical depression. Therefore, people may suffer needlessly for years without treatment.

Not everyone who has Bipolar Disorder experiences every symptom, and the severity of symptoms varies between individuals and over time. Depression is characterised by extreme dips in mood, which can debilitate sufferers for days or months. Mania is more difficult to diagnose. Sufferers report feeling great, and do not believe that their behaviours are uncharacteristic or inappropriate.

Signs of mania can include abnormal or excessive elation, unusual irritability, decreased need for sleep, grandiose notions, increased talking, racing thoughts, increased sexual desire, markedly increased energy, poor judgement and unusual social behaviour.

People can suffer either of the two extremes of mania or severe depression and approximations of each of these extremes. People are more likely to be suffering from Bipolar Disorder rather than depression when they:

  • Experience repeated episodes of major depression.
  • Have their first episode of major depression before age 25.
  • Have a close relative with Bipolar Disorder.
  • Are depressed, oversleep, and change eating patterns.
  • Suffer short episodes of major depression (less than 3 months)
  • Lose contact with reality while depressed.
  • Have experienced post-natal depression.
  • Show signs of mania or hypomania while taking an antidepressant.
  • Find antidepressants stop working after several months.
  • Try at least three different types of antidepressants that don’t work.

Treating Bipolar Disorder

Every individual with Bipolar Disorder has a unique pattern of mood cycles, combining depression and manic episodes, which is predictable once the pattern is identified.

A comprehensive treatment plan for Bipolar Disorder attempts to alleviate symptoms, prevent future mood episodes, and address relationship or work problems caused by the illness. A treatment plan that combines psychotherapy with medication is often the best strategy.

Treatment for Bipolar Disorder must address the acute stage and the maintenance stage. In the acute phase, the treatment goal is to end the manic, depressive, hypomanic, or mixed episode. This is achieved by:

Medication – Mood-stabilising medications are the primary treatment during the acute phase. Sedatives are used for short-term relief of anxiety and insomnia. For acute depression, antidepressants are prescribed in combination with a mood stabiliser. 

Electroconvulsive Therapy (ECT) – ECT can lead to significant improvement and can be a life-saving option for patients at high risk of suicide, or who are experiencing extremely disturbing symptoms.

Hospitalisation – Trained staff in a safe environment can provide valuable help to patients who are in a phase where they might be likely to harm themselves or others. 

Psychotherapy – Therapeutic support is often not helpful during manic episodes, but can be very helpful in the depressive phase.

Once the acute phase is successfully treated, the focus is on maintaining a stable mood and preventing future episodes of mania or depression. Open communication with health professionals about treatment concerns and options can make a significant difference in symptom management. Appropriate adjustments in medication, consistent support from family, friends and health professionals, and ongoing education can help people with Bipolar Disorder better manage their symptoms. Family members benefit from support to help them understand and cope with this debilitating condition.