Further Support & Advice

Introduction


This page is for anyone who wants to know more about bipolar disorder (sometimes called bipolar affective disorder or manic depression). It is especially helpful for anyone who has bipolar disorder, their friends and relatives.

This page describes:

  • some of the problems it can create
  • ways of coping

Pregnancy

You should discuss any pregnancy plans with your psychiatrist. Together, you can arrange how to manage your mood during the pregnancy and for the first few months after the baby arrives.

If you are pregnant, it’s best to discuss with your psychiatrist whether or not to stop Lithium. Although Lithium is safer in pregnancy than the other mood stabilisers, the risk to the baby needs to be weighed against the risk of you becoming depressed or manic. The risk is greatest during the first three months of pregnancy. Lithium is safe after the 26th week of pregnancy, although you should not breastfeed your baby if you are taking Lithium.

During pregnancy, everyone involved – the obstetrician, midwives, health visitors, GP, psychiatrist, and community psychiatric nurse – need to stay in touch with each other.

Treating a manic or depressive episode

Depressive episodes

Antidepressant medication will usually need to be added to any mood stabiliser. The most commonly used are the ‘SSRI’ (selective serotonin re-uptake inhibitor) antidepressants. These affect the action of a chemical in the brain called serotonin, and seem to be less likely than other kinds of antidepressant to push someone into a manic episode. The older ‘tricyclic’ antidepressants should be avoided for this reason.

If you have had a recent manic episode or have a rapid-cycling disorder, an antidepressant may push you into a manic swing. It may be safer to increase the dose of the mood stabiliser without an antidepressant.

Antidepressants can take between 2 and 6 weeks to improve your mood, but sleep and appetite often improve first. Antidepressants should be continued for at least 8 weeks after the depression has improved, and then should be reduced slowly.

Even when you feel better, it is safer to carry on taking the tablets as your GP or psychiatrist advises. If you stop them too soon, you are more likely to become depressed again. If you stop them suddenly, you may get withdrawal symptoms.

If you have repeated depressive episodes, but have never switched to mania on antidepressants, you can continue on both a mood stabiliser and an antidepressant to prevent further episodes.

If you have had manic episodes, you should not continue antidepressants long-term.

Mania and mixed depressive episodes

Any antidepressant should be stopped. A mood stabiliser or antipsychotic medication can be used, either alone or together. Antipsychotic medications are used in schizophrenia, but they also help to reduce the overactivity, grandiosity, sleeplessness and agitation of a manic episode.

The older antipsychotics (e.g. Chlorpromazine, Haloperidol) have some unpleasant side-effects such as stiffness, shakiness and muscle spasms.  Some of the newer drugs (e.g. Risperidone, Olanzapine) can improve manic symptoms without these short-term unpleasant side-effects.

Once the treatment has started, symptoms usually improve within a few days, but it may take several weeks for a full recovery. You should check with your GP if you want to drive while taking this sort of medication.

Stopping the mood swings – helping yourself

Self-monitoring

Learn how to recognise the signs that your mood is swinging out of control so you can get help early. You may be able to avoid both full-blown episodes and hospital admissions. Keeping a mood diary can help to identify the things in your life that help you – and those that don’t.

Knowledge

Find out as much as you can about your illness – and what help there is.

Stress

Try to avoid particularly stressful situations – these can trigger off a manic or depressive episode. It’s impossible to avoid all stress, so it may be helpful to learn ways of handling it better. You can do relaxation training with CDs or DVDs, join a relaxation group, or seek advice from a clinical psychologist.

Relationships

Depression or mania can cause great strain on friends and family – you may have to rebuild some relationships after an episode.

It’s helpful if you have at least one person that you can rely on and confide in. When you are well, try explaining the illness to people who are important to you. They need to understand what happens to you – and what they can do for you.

Activities

Try to balance your life and work, leisure, and relationships with your family and friends. If you get too busy you may bring on a manic episode.

Make sure that you have enough time to relax and unwind. If you are unemployed, think about taking a course, or doing some volunteer work that has nothing to do with mental illness.

Exercise

Reasonably intense exercise for 20 minutes or so, three times a week, seems to improve mood.

Fun

Make sure you regularly do things that you enjoy and that give your life meaning.

Continue with medication

You may want to stop your medication before your doctor thinks it is safe – unfortunately this often leads to another mood swing. Talk it over with your doctor and your family when you are well.

Have your say in how you are treated

If you have been admitted to hospital for bipolar disorder, you may want to write an ‘advance directive’ with your doctor and family to say how you want to be treated if you become ill again.

What can I expect from my GP? (England & Wales only)

Treatment
If you are taking Lithium, your GP is now expected to give you:

  • a blood pressure and general health check every year;
  • a Lithium level check every 3-6 months;
  • a blood test for thyroid and kidney function at least every 15 months.

Advice for family and friends

Mania or depression can be distressing – and exhausting – for family and friends.

Dealing with a mood episode:

Depression

It can be difficult to know what to say to someone who is very depressed. They see everything in a negative light and may not be able to say what they want you to do. They can be withdrawn and irritable, but at the same time need your help and support. They may be worried, but unwilling or unable to accept advice. Try to be as patient and understanding as possible.

Mania

At the start of a manic mood swing, the person will appear to be happy, energetic and outward-going – the ‘life and soul’ of any party or heated discussion. However, the excitement of such situations will tend to push their mood even higher. So try to steer them away from such situations. You can try to persuade them to get help, or get them information about the illness and self-help.

Practical help is very important – and much appreciated. Make sure that your relative or friend is able to look after themselves properly.

Helping your loved ones stay well

In between mood episodes, find out more about bipolar disorder. It may be helpful to go with your friend or loved one to any appointments with the doctor or psychiatrist.

Staying well yourself

Give yourself space and time to recharge your batteries. Make sure that you have some time on your own, or with trusted friends who will give you the support you need. If your relative or friend has to go into hospital, share the visiting with someone else. You can support your friend or relative better if you are not tired.

Dealing with an emergency

In severe mania, a person can become hostile, suspicious and verbally or physically explosive.

In severe depression, a person may start to think of suicide.

If you find that they are:

  • seriously neglecting themselves by not eating or drinking
  • behaving in a way that places them, or others, at risk
  • talking of harming or killing themselves.

– get medical help immediately.

Keep the name of a trusted professional (and their telephone number) for any such emergency. A short admission to hospital may sometimes be needed.

Looking after children

If you become manic or depressed, you may temporarily not be able to look after your children properly. Your partner, or another family member, will need to organise the children’s care while you are unwell. It can be helpful to make plans for this in advance when you are well.
Emergency
You may find that your child may feel anxious and confused when you are not well. If they cannot express their distress in words, toddlers can become difficult or clingy, and older children will show it in other ways.

Children will find it helpful if the adults around them are sensitive, understanding, and can respond to their difficulties in a calm, consistent and supportive way. Adults can help them to understand why their parent is behaving differently. Questions will need to be answered calmly, factually and in language they can understand. They will feel better if they can keep to their usual daily routine.

Explaining bipolar disorder to children

Older children may worry that they have caused the illness – that it is their fault. They need to be reassured that they are not to blame, but also to be shown what they can do to help. When an older child takes responsibility for caring for a sick parent, they will need particular understanding and practical support.