Diagnosis
The symptoms of depression include the following:
A persistently sad, empty or anxious feeling.
Loss of interest in food, sex, work and other activities.
Tiredness and feeling slowed down, despite rest.
Trouble getting to sleep, wakening too early or over sleeping.
Reduced or increased appetite and weight disturbance.
Poor concentration and indecision.
Feelings of guilt and worthlessness.
Chronic aches and pains without a physical cause.
Thoughts of death or suicide.

Mania or in its less intense form, hypomania, is less readily apparent to the individual sufferer, as it may feel good. Intense manic episodes rarely go undiagnosed for long, as the person is restless, over-talkative, active and sleeps little. However, family and friends will recognise that the person is acting out of character.

However, hypomania where there are fewer symptoms of elation, may be unrecognised for years, as the person will regard this phase as a time when they feel uncharacteristically well.

Often there are recurring depressive episodes, with intervening hypomanic episodes during which the person does not complain. These may not be recognised by the doctor. However, family members, if specifically asked, will have observed these mild highs during which the person's mood is unusually buoyant and optimistic.

Elation and mania
Mania manifests itself in a number of ways, mainly excessive feelings:
feeling ‘high’ or ‘on top of the world’ are common descriptions. Other characteristics of mania are:
Anger or irritability
Great energy and not needing to rest
Overactive, restless and distractible
Racing mind that cannot be switched off or ‘pressure in the head’
Talking rapidly and jumping from one topic to another
Decreased need for sleep
Excessive and unrealistic belief in one’s abilities
Poor judgement.
Increased interest in pleasurable activities; new ventures, sex, alcohol, street drugs, religion, music or art.
Demanding, pushy, insistent. domineering or provocative behaviour. Person unable to see that there is anything wrong.
Delusions (false ideas) and or hallucinations (visions or voices) may occur and they usually relate to grandiose ideas about religion, creativity, sex, politics or business.

What causes bipolar disorder?
Bipolar disorder tends to run in families. Studies have shown that some 15% of the immediate relatives of bipolar disorder patients have a serious mood disorder. Research investigations over the past few decades have shown that on average in 70% of cases, bipolar disorder is genetic and the remaining 30% is due to environmental factors.

Environmental factors that are known to affect mood include stresses such as financial or family difficulties, losses such as bereavements, relationship breakups, and loss of employment. Losses and stresses appear to be particularly important prior to the first episode in that they tend to precipitate the illness, but subsequently mood-swings may occur without the same level of upsetting events occurring in the person's life.

Alcohol, street drugs (ecstasy, cocaine, hashish, amphetamines, magic mushrooms), medication (steroids, certain blood pressure tablets and anti-Parkinson drugs') can all cause depression or elation in people who are predisposed to mood-swings.

Complications of bipolar disorder
Bipolar disorder can have as serious impact on life in general and particularly in relationships with family and friends. The individual’s behaviour can be difficult to cope and can lead to serious family disruption and relationship breakdown. Aggressive and erratic behaviour and rash decision making can also lead to loss of employment, bankruptcy, legal difficulties and social isolation. Alcohol and drug abuse and suicidal behaviour is common.

Treatment
Medications are the main forms of treatment for this illness. Most bipolar mood disorder illnesses can be successfully treated with mood stabilising medication. Almost all will have substantial relief of symptoms with present-day treatments.

Psychotherapy or counselling is helpful in providing support and guidance for both the individual and their family and with coming to terms with the illness. It can also be of great benefit in helping to identify relapses at an early stage and enable early treatment intervention. However, it has no effect on controlling or stabilising bipolar mood disorder.

Lithium is the first-line treatment most commonly prescribed mood stabilising agent. It is prescribed as a treatment to shorten the duration of a manic episode and then for longer term use. It works effectively for some 75% of bipolar disorder patients. When lithium fails to prevent recurring mood swings, other treatments, alone or in combination with lithium, such as carbamazepine, valproate, antidepressant and anti-elation medication are used.

Effective antidepressant medications are available to defeat intense depressive episodes. However, they are used sparingly in bipolar depressions, as they tend to precipitate mania or destabilise mood patterns.

While lithium is prescribed to cut short a manic episode, it takes three or more weeks to take effect. While awaiting the anti-manic effect of lithium to occur, some quick acting drugs known as the neuroleptics, such as chlorpromazine or haloperidol are prescribed to contain the mood disturbance.

Only about 30% of rapid cycling mood disorders are successfully treated with lithium. Carbamazepine, alone or with lithium is more successful.

Mood stabilising treatments, such as lithium, are not cures – they control moods. Where lithium has stabilised bipolar mood swings, 80% will experience a relapse of their symptoms if the lithium is discontinued.

Staying well
Learn what you can about bipolar disorder from books, lectures and support groups. It is useful to talk to other sufferers who have achieved mood stability. Their words of wisdom can often be a great source of comfort when trying to come to terms with the illness.

Comply with the treatment recommendations your doctor has set out for you. If you have side effects with the medication, have worries about its long-term effects or feel that you are not making the progress you would have wished, discuss this with your doctor rather than going your own way. The most common reason for treatment failure in bipolar disorder is that the treatment is not being taken as prescribed

Encourage your family to get involved in helping you deal with the illness. They are concerned about you and there is a lot that they can do to assist. They can benefit a lot from getting a factual understanding of the illness, just as you have. It is helpful to choose a close relative or friend to help you spot a relapse.

Families can also derive great benefit from meeting relatives of other sufferers and support group meetings provide them with the ideal opportunity to discuss their concerns and difficulties with other carers.

It takes time to come to terms with a diagnosis such as bipolar disorder, particularly if it implies the need for long-term medication. The support of family, friends, your doctor and other sufferers can be of enormous value. Many people find attendance at support groups such as those run by Aware, where they can share their experiences in an open and uncritical forum, to be the key to gaining an understanding of their illness and how to come to terms with it.

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