Tag: Mood swings in Bipolar Disorder

Each year World Bipolar Day takes place on 30th March and this year members of the public across the globe are being encouraged to use social media to help disseminate information and get the event’s hashtags trending on social media.

World Bipolar Day is designed to raise awareness worldwide of bipolar conditions and to work to eliminate social stigma whilst providing information to educate and help people understand the condition. Hence this post.

1. What is Bipolar

It’s normal to experience a wide range of feelings and moods. At some point we might feel incredibly excited or happy, then another time we feel low, anxious, tearful or downright flipping miserable.

Bipolar disorder (known previously as manic depression) is a mental health condition where people experience extreme highs, called mania, and intense periods of sadness or depression. These phases of mania and depression are called episodes, and can shift rapidly.

Bipolar disorder is a serious mental illness and can affect a person’s thoughts, feelings, mood, energy, behaviour and overall functioning but it can be treated.

There are three types of Bipolar Disorder

• Bipolar I — a person will experience at least one episode of mania lasting longer than a week. They might also have experienced depressive episodes, although not everyone does.
• Bipolar II — a person would experience both episodes of severe depression and symptoms of hypomania.
• Cyclothymia is where a person who has experienced both hypomanic and depressive mood states over the course of two years or more and their symptoms aren’t severe enough to meet the criteria for a diagnosis of Bipolar I or Bipolar II.

2. What is hypomania and mania

• Hypomania is a milder version of mania that lasts for a short period (usually a few days)
• Mania — overactive and excited behaviour — is a more severe form that lasts for a longer period (a week or more)

Someone might have hypomania and/or mania on their own or as part of another mental health problem –including bipolar disorder, postpartum psychosis (after childbirth) seasonal affective disorder (where mood is affected, most commonly in winter), or schizoaffective disorder.

3. Symptoms during manic phases of Bipolar

The symptoms of mania typically include several of the following:

• Racing thoughts — are typically one of the first symptoms during a manic phase. Racing thoughts may be the inability to concentrate and include rapidly changing ideas.
• Feeling overly exhilarated — an overly euphoric or elevated mood is one of the most common bipolar mania symptoms. However, in some cases, instead of an exhilarated mood, individuals experiencing mania might be extremely agitated.
• Higher energy — increases to abnormal levels. For example, someone with mania moves quickly from one activity to the next, not finishing them but have lots of amazing fanciful ideas
• Sleep difficulties — People with mania generally feel that they need less sleep and it wouldn’t be uncommon for someone with mania to stay awake for more than one night, cooking or cleaning, or only sleep a couple hours a night, but report they’ve slept well.
• Pressured speech — the tendency to talk quickly and loudly and often accompanies racing thoughts. They rarely stop to let anyone else talk. The person might want to share their whimsical ideas urgently, without making sense and saying inappropriate things.
• Inflated self-esteem — is more than just being self-assured and overly confident. Rather, it’s an unrealistic and exaggerated sense of being superior or of self-importance. Someone might think that they have supernatural abilities or can achieve impossible things, such as writing Michael Jackson’s hits.
• Engaging in risky behaviors — behaving impulsively, spending money they can’t afford or take part in dangerous or risky behaviours like misusing alcohol or drugs, reckless driving or having unprotected sex.

Some people find their mania entertaining, pleasurable and engage in risky sexual relationships or behaviours. Or they might find them distressing, unpleasant or uncomfortable and some dread the onset, perhaps knowing what’s coming next.

4. Professional experience of Bipolar Disorder

In my job, as Mental Health Nurse and Ward Manager, I only ever met one female patient who didn’t enjoy the mania. At the Day Hospital (DH) we had a group of women who’d all had many episodes of mania over the years. They got together regularly, regaling everyone with their tales of shopping sprees on credit cards they wouldn’t have to pay.

They loved including me in their “Nutter’s Group” because of my previous mental illness and they’d curl up in hysterics with each new adventure; like Sharon who spoke very well and would apply for all sorts of high flying jobs — and get them, when she was manic. Words just flowed effortlessly for her and she’d often be out shopping in Kensington (a posh part of London), collecting store cards along the way, and arrive back at the DH laden with bags of goodies, only to give them all away.

The one lady who dreaded any impending mania was terrified she’d go back and stalk a married man that she’d worked with, but was dismissed because of her behaviours. Whenever she became manic she stalked him; persistently phoning, emailing, and writing to his family, believing that he loved her, not his wife. It was quite a big case in the media some years ago — the last straw was after she’s sent him and his wife a package holding a used sanitary towel as proof of his love for her.

5. Mood swings in Bipolar Disorder

Mania might sound exciting and moreish but what follows is soul destroying and heartbreaking to watch. Take a look at the chart below and see the midline — that’s classed as normal mood and the short squiggly line shows that, like in most of us, moods go slightly up and down, depending on the circumstances i.e. we get excited when we’re going to a wedding or we feel down if we’re going to a funeral perhaps.

But in Bipolar, the person’s moods swing violently – see how high the squiggle goes — then how low it drops — possibly way down beyond anything most people might experience in their lifetime.

Unfortunately, during my fifteen years, several patients made attempts to die by suicide because they couldn’t bear the devastating drop in mood. The lady who stalked her colleague was always devastated and so embarrassed by her behaviour during the manic phase, she would feel suicidal as her mood dropped.

6. Symptoms during a depressive phase of Bipolar

During the depression phase of bipolar disorder, someone might:

• Feel empty, sad, worried
• Have trouble concentrating or remembering things
• Have a hard time making even minor decisions
• Have little to no energy to do normal things
• Feel like you don’t enjoy anything, even things they used to enjoy
• Eat too little or too much
• Sleep too little or too much
• Have a hard time getting out of bed
• Think about suicide or death

A person could have all of these symptoms or some of them. Someone with bipolar disorder can sometimes feel very sad but also full of energy. The surest sign of a phase of depression is that you feel down for a long time — usually at least for 2 weeks. You might have these episodes rarely or several times a year, Webmd.com.

Most people who have a diagnosis of Bipolar will have been prescribed mood-stabilisers medication and, while it’s important to adhere to their medication regime throughout the various phases, they must also maintain contact with their Mental Health Team who will be able to monitor their moods and adapt their medication as appropriate.

7. Self-help strategies for bipolar disorder

• Monitor your mood — daily, including factors such as medication, sleep and anything that might be impacting on your mood. You may be able to download a chart or and app to help you do this.
• Stick to routine — important in keeping your mood stable. In order to maintain stability, organise a schedule and try to stick to it regardless of your mood.
• Build a good support network — friends, carers and family can be there if you’re struggling or just need someone to listen. They might also be able to offer another perspective on your mood and help you cope day-to-day.
• Limit stress — where possible and try not to take on too many other commitments.
• Sleep hygiene — disturbed sleep can have a negative impact on mood. Try to get into a sleep routine.
• Take your time in making decisions — or ask a trusted friend to help you make decisions if you’re feeling impulsive and want to go on a shopping spree
• Join a support group — it might be reassuring to hear from people who are experiencing similar symptoms or circumstances. Support groups can offer great advice and comfort.
• Exercise. Regular exercise is helpful as a way to help manage mood and mental state.
• Relaxation is effective in reducing stress.
• Avoid or reduce alcohol and drug intake — which can make our mood worse. If you’re on medication, alcohol and drugs can be particularly dangerous. Talk to your psychiatrist, your Mental Health Team or GP.
• Only take prescribed medication — and don’t make changes to medication without talking to your Doctor or psychiatrist.
• Make a wellbeing plan — Perhaps you’ve made one of these with your care team and given a copy to close family or friends? You can record your plans for how you’ll manage your routine, how to manage any highs or lows, and contact details if you need help.
• Ensure you have a suicide safety plan. Prepare how to manage low moods and suicidal thoughts. Keep your contact details list close to hand for emergencies.

If you or someone you know is experiencing the above symptoms, please contact your GP, Doctor, your local Mental Health Team immediately. You might like to read the useful Mental Health Contacts List here for various UK agencies and organisations who are able to offer advice and support.

In the meantime, look after yourselves and each other. As always, I’d be delighted to answer any questions and read your comments or suggestions. I certainly need something to keep my mind off the dreaded V word ‘cos although I know it’s important to keep up to date, I’m finding it all really worrying and quite depressing.

Acknowlegements:

• https://www.mind.org.uk/information-support/types-of-mental-health-problems/bipolar-disorder/types-of-bipolar/
• https://www.bipolaruk.org/faqs/are-there-different-types-of-bipolar
• https://www.medicalnewstoday.com/articles/324578 What are the main symptoms of bipolar?
• https://www.goodtherapy.org/blog/self-help-guide-to-living-with-bipolar-0629154