Bipolar depression, manic depression and bipolar affective disorder are all terms used to describe a highly complex and serious mood disorder that is characterised by extreme manic episodes (highs) and severe depressive episodes (lows). It usually begins in young adulthood, although not always, and continues for life.

According to the Royal College of Psychiatrists leaflet on depression, one in ten people suffer from Bipolar disorder. No one really knows what causes it, but genetics is thought to play a major role as it has a tendency to run in families.

Symptoms of a depressive episode

A depressive episode can be diagnosed if five or more of the following symptoms are present for most of the time for a period of at least 2 weeks.

? feeling sad, anxious, or empty mood

? Feelings of hopelessness, pessimism

? Feelings of guilt, worthlessness, helplessness

? Loss of pleasure in activities once enjoyed, including sex

? Decreased energy, a feeling of fatigue or of being "slowed down"

? Difficulty concentrating, remembering, making decisions

? Restlessness or irritability

? Sleeping too much, or can't sleep

? Change in appetite and/or unintended weight loss or gain

? Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury

? Thoughts of death or suicide, or suicide attempts

Symptoms of a manic episode

A manic episode can be diagnosed if at least 3 of the symptoms occur along with an elevated mood for most of the time for at least a week, which is not related to alcohol or substance abuse or a medical condition. If the overall mood is one of irritability then another 4 symptoms must be present.

? Increased energy, activity, and restlessness

? Excessively "high," euphoric mood

? Extreme irritability

? Racing thoughts, talking quickly, jumping from one idea to another

? Distractibility, lack off concentration

? Little sleep needed

? Unrealistic beliefs in one's abilities and powers

? Poor judgment

? Spending sprees

? A lasting period of behaviour that is different from usual

? Increased sexual drive

? Alcohol and drug abuse

? Provocative or aggressive behaviour

? Denial that anything is wrong

Types of Bipolar disorder

The frequency and severity of each episode and the gaps in between them will vary significantly from person to person with no clear pattern that is applicable to all. If we consider that at one end of the scale there is severe depression and at the other end of the scale there is full blown mania, in between there are progressive stages of moderate to mild depression, then normal moods, following on up the scale to hypomania and then mania.

Some people will have many depressive episodes and the odd spell of hypomania; others can experience mania much more often with a depressive episode only happening from time to time. Others may have both together, which is known as mixed state bipolar. Other types of Bipolar include Bipolar 1, Bipolar 2, Rapid Cycling and Cyclothymia.

The symptoms of Bipolar 1 involve recurrent manic and depressive episodes with either stable periods in between or going directly from a depressive episode into a manic phase or vice versa. Periods of depression can last for only a short time or for months. Bipolar 11 usually involves mild manic periods, or even no mania, but more depressive episodes. When an individual experiences many manic or depressive episodes or fluctuations between both within a relatively short space of time it is known as rapid cycling, and Cyclothymia is where the mood swings are not as severe as other types but the episodes can last for much longer.

Each person's experience is unique and because it happens in episodes, there are periods where the individual behaves perfectly normal which can make diagnosis problematic. Some people can have bipolar disorder for years before they seek help and others may not seek help at all. Without treatment, bipolar disorder can have a devastating effect on relationships and work; can result in huge debts being run up, crimes committed, alcohol and substance abuse and even suicide.

Living with Bipolar

Medication will usually be prescribed to deal with the different aspects of the disorder. For example, Lithium is often used to stabilise the mood, as it can effectively control and help prevent both manic and depressive episodes.

Other drugs may be prescribed in conjunction with Lithium to treat symptoms such as insomnia and those of depression. During manic episodes it might be necessary to use antipsychotic medication such as haloperidol or chlorpromazine. In particularly severe episodes, the sufferer may be admitted to hospital for treatment. Various forms of psychotherapy may also be offered in addition to medication.

Bipolar disorder is a lifelong disorder that affects not only the sufferer but their family and friends too so learning about the different mood states, the symptoms that accompany them and the type of event or situation that might trigger an episode can be invaluable in helping to prevent future relapses. It allows the individual to take preventative measures, and to recognise the signs of any impending episode so they can seek appropriate help.