Bipolar affective disorder (usually known as bipolar or manic depression) is characterised by severe mood swings, from deep depression to extreme 'highs'. It affects about one in 100 adults at some point in their life.

During the high, or manic phase, people can feel full of energy and enormously powerful. They tend to become hyperactive, going without sleep and embarking on unrealistic projects and often becoming irritable. An increased sense of importance and fewer inhibitions are often felt. These feelings can be so intense that a person can lose contact with reality causing them to behave in unusual ways. There can be unfortunate consequences of decisions taken while in a manic phase, for example over-spending or reckless sex.

The depressive phase is similar to other forms of depression and is characterised by lack of energy and interest in life, low self-esteem and feelings of guilt and despair. It can also lead to suicidal thoughts. It is extremely hard to think positively or to see a hopeful future and it can quickly become difficult to do jobs or daily tasks. There may also be physical symptoms such as appetite/weight loss and feeling tired.

Some people will have only manic episodes but most will also have depressive ones too. Some people have more depressive episodes than manic ones. The ways in which bipolar disorder can affect people are classified into different types.

People who have episodes of mania and symptoms of depression are said to have bipolar I disorder. This consists of at least one manic episode that has lasted for over one week. Untreated, manic episodes generally last three to six months while depressive phases can last between six and twelve months.

People with less severe manic episodes (hypomania) and more than one episode of major depression are said to have bipolar II disorder.

People who have more than four episodes in a year are said to have ‘rapid cycling’ bipolar disorder. This affects around one in ten people with bipolar disorder and can happen with types I and II. If the change from mania to depression is quicker (from week to week or even within a single day), then it is called ultra-rapid cycling bipolar disorder.

This is a chronic bipolar disorder consisting of mild depression and periods of mania. Mood swings are not as severe as those in full bipolar disorder, but may continue for longer. Symptoms of either depression or mania rarely subside for more than two months at a time.

There is good evidence for a genetic factor in bipolar illness, but often there is no clear family history. Triggers can include stressful life events, difficult problems or emotional changes.

It can often help to monitor feelings at any time in a cycle of mania and depression. By monitoring mood and thoughts, it is possible to spot changes that come before an episode and make plans for it. A diary can often help to identify anything which is linked to episodes. If possible, stressful situations should be avoided – these can trigger a manic or depressive episode. Finding ways to relax can also help and it is vital to balance work, leisure and socialising. Regularly doing enjoyable things and exercise have been shown to help with mood.

For those people with a full bipolar disorder, mood swings can't be managed by mood monitoring alone and psychiatrists can prescribe different drugs to help deal with the disorder. These include antidepressants, sedatives and mood stabilisers. Make sure that both your psychiatrist and HIV doctor know what drugs you are being prescribed.

Between episodes of mania or depression, psychological treatment can also be helpful. Psychological treatment can include:

• Education – learning about bipolar disorder.
• Mood monitoring – realising when your moods are swinging.
• Mood strategies – doing or avoiding things to help stop episodes.
• Cognitive behavioural therapy (CBT) for depression.

Bipolar disorder can be very distressing for family and friends who may be the first to notice behaviour changes. By agreeing an action plan before episodes occur, it can help to relieve some of the stress. A trusted friend can spot the warning signs of a relapse and take certain pre-agreed steps. These could include agreed rest time, reviewing mood changes on a regular basis or seeing someone from a community mental health team.

MDF The Bipolar Disorder Fellowship: Castle Works, St. George's Road, London SE1 6ES

Tel: 08456 340 540

www.mdf.org.uk

Depression Alliance: 212 Spitfire Studios, 63 - 71 Collier Street, London N1 9BE

email: information@depressionalliance.org

www.depressionalliance.org

The Institute of Psychiatry, South London and Maudsley NHS Trust and charity Rethink have a website www.mentalhealthcare.org.uk with a comprehensive section on bipolar disorder.