Family and Friends

Further Information

"I've never had a problem taking medication. I have a good relationship with my psychiatrist. When I had horrendous side effects on one medication, and the remedies we tried didn't work, he decided I was allergic to one of the non-essential additives the manufacturers put in. We changed to a similar alternative and that solved the problem. He always starts me on a low dose and works the doses up if necessary, so I never feel like I've been over drugged. I have to admit to not being religious about the time that I take them, though I know some people are, and maybe that works for them. Maybe I should be, and if somebody were to say to me, if you took them dead on the same time every day, you'd see a 10% improvement, then I guess I'd consider it, but for now, it works for me. I only take my meds twice a day, once in the morning and once in the evening, and both my psychiatrist and I agree, that the fewer drugs I'm on, the better. But I think I'm a lot luckier than some others I know as I don't take a huge amount of meds."-Sian

"It helps to know your way around the options you have with BP and get to know your psychiatrist. I always go with Dave and his psychiatrist always asks Dave first how he is and Dave's usual response is "Fine, never been better", so he turns to me and asks "right then Jackie ........ how is he really?" Dave is paranoid and uncomfortable with other officials at the clinic so the psychiatrist has given us his number to his secretary at the hospital and now we just contact him if we feel there are problems. Honestly, we feel lucky to have such a great help. Dave always investigates his meds online or with the pharmacist. the newer anti-psychotics don't suit him at all and he has learnt over a period of time to recognise this, now when he has a med change he knows to say that they dont' suit him and get an older one in place."- Jackie, West Mids

Some members of the services try and block out the family and deal with just the patient, we had a social worker tell us that Jackie didn't matter and should mind her own business as it was me who was ill. I told him if it wasn't for Jackie I'd be dead by now, he left our house red faced, then Jackie reported him to the psychiatrist who had him disciplined over it. Don't ever be afraid to tell the services how you want things doing, remember they call us the clients so really they work for us, they may have the knowledge but we have the experience. -Dave, West Midlands

Bipolar affective disorder is not a curable illness, however the correct treatment and support can help manage the symptoms.  The aim of treatments are to reduce the severity of episodes of mania and depression as they occur and to reduce the frequency of such episodes.  Effective treatment will also help a person to function as effectively as possible and maintain their quality of life between episodes.  There are many different treatments available and it is often a case of 'trial and error' before an effective treatment is found for the person.  The NHS National Institute for Health and Clinical Excellence (NICE) offer guidelines on the clinical management of bipolar affective disorder (NICE guidelines).

Difficulties In Treating Bipolar Affective Disorder

Medications and ECT

Mood Stabilisers

Mood stabilisers are usually the first-line treatment for bipolar affective disorder, people taking mood stabilisers generally take them continually on a long term basis.  The most commonly prescribed mood stabilisers are lithium and sodium/semisodium valproate (Epilim/Depakote).   Sodium valproate belongs to a class of drugs called anticonvulsants and are used to treat epilepsy, other drugs in this class that are also used as mood stabilisers include carbamazepine, lamotrigine and topamax. 

Antipsychotics

Antipsychotic medications (neuroleptics) are sometimes required to help a person recover from an acute manic or depressive episode when psychotic symptoms are present.  Antipsychotic medications are usually used short-term but some people benefit from long-term use, particularly of the newer (atypical) antipsychotics such as olanzapine and quetiapine which also have mood stabilising properties.  People taking antipsychotics may experience side effects such as weight gain, dry mouth, sedation, constipation, sexual dysfunction, tremors, muscle spasms, eye problems and emotional changes.  Not everyone will experience these effects and they will vary in severity from person to person.  Two serious side effects associated with the use pf antipsychotics are tardive dyskensia which can cause uncontrollable movements of the face and body and neuroleptic malignant syndrome (nms).  (Please refer to the factsheet below,  'making sense of antipsychotics')

Antidepressants

Antidepressants are sometimes prescribed in conjunction with mood stabilisers to help people manage the symptoms of depression associated with bipolar affective disorder.  Antidepressants can induce mania in people with bipolar affective disorder and thus should be used with caution.  There are different groups of antidepressants such as SSRIs (selective serotonin re-uptake inhibitors) including fluoxetine, citalopram and sertraline, tricyclics such as amitriptyline and imipramine and monoamine oxidase inhibitors (MAOIs), these include isocarboxazid and tranylcypromine.  Other antidepressants used may include venlafaxine and mirtazapine (related to SSRIs) and tricyclic related antidepressants such as trazadone.

Electroconvulsive Therapy

Electroconvulsive therapy (ECT) is usually carried out as an inpatient therapy for people who are severely depressed/suicidal and respond poorly to medications.  It is a controversial therapy as it involves inducing a seizure by passing an electrical current through the brain and noone is quite sure how ECT works.  For some people ECT has been an invaluable treatment in helping them recover, for others the side effects of ECT outweigh the benefits.  

Mind (National Association for Mental Health) offer a range of useful factsheets available to download and print or read online. Click on the links to open these factsheets in a new window

Talking Therapies

Cognitive-Behavioural Therapy

Cognitive behavioural therapy (CBT) aims at helping people identify and challenge the unhelpful and negative thoughts they may experience with bipolar affective disorder and replace them with more helpful thoughts (cognitive).  It also aims at reducing the frequency of unhelpful behaviours and increasing helpful behaviours, such as participation in pleasurable activities (behavioural).  CBT is an active therapy that will usually involve the person completing assignments/tasks inbetween sessions.

Counselling/Psychotherapy

Counselling and psychotherapies can provide an opportunity for a person to talk about and overcome the difficulties associated with having a diagnosis of bipolar affective disorder.  It may help you through a crisis or difficult situation and may help you manage areas of conflict in your life such as relationship difficulties.

Group Therapy

Group therapy has many of the benefits of counselling/psychotherapy but it is carried out in a small group of people rather than on a one-to-one basis.  For some people group therapy may prove a daunting experience but others find the experience of listening to,  talking to and sharing with other people with similar problems useful in overcoming difficulties.

Please take some time to read through the following factsheets provided by Mind for a further understanding of talking therapies available.

Hospital Admission

Sometimes hospital care is necessary when a person is so ill that they become a danger to themselves or others. Admission to hospital may be voluntary or involuntary, in the United Kingdom an involuntary admission is carried out under a section of the Mental Health Act 1983 (See Mind rights guide 1: Civil admission to hospital).  Going into hospital is often a frightening and overwhelming experience for any person.  How to cope with hospital admission is an informative useful factsheet produced by Mind which may help relieve some of the uncertainty and anxiety about what to do and expect when a hospital admission is necessary.

Community Help

General Practitioners

A GP is often the first point of contact for a person experiencing difficulty with their mental health, for some people regular appointments with their GP mean they can manage their illness effectively.  GP's can prescribe medication, many offer counselling services and advice on other services available.  If a GP suspects bipolar affective disorder, due the complex nature of it they will normally refer the person to a psychiatrist or community mental health team for more specialised treatment.

Community Mental Health Teams (CMHTs)

CMHTs generally offer community support for people suffering with serious, enduring mental health problems.  Professionals you may encounter when you are in touch with the CMHT include community psychiatric nurses (CPNs), Social Workers and Psychiatrists.  Your care will normally be overseen by a care-coordinator, which is a member of the team responsible for assessing you care needs and helping you receive the support necessary to manage your illness, this is called a care plan.  They may offer advice and support in accessing help with accommodation needs, welfare/benefits, employment, social activities and everyday living tasks.  Your care-coordinator should also be able to refer you to other services, such as a psychiatrist or occupational therapist. Usually a referral to the CMHT is made by a persons GP or other professional such as a psychiatrist, however some CMHTs do offer self referral.

Crisis Resolution Teams

Crisis teams provide home care for people experiencing a mental health crisis as an alternative to hospital admission.  They provide a 24-hour service including home visits and telephone support.  Crisis teams offer intensive support in the management of a mental health crisis

Day Centres/Drop in Centres

Day centres/hospitals and drop in centres offer a range of services for people with mental health problems.  They can be situated within a hospital or within the community. Day services may offer practical help such as counselling services, occupational based help, education and skills such as cooking.  They also provide an opportunity for a person to try new activities such as music and arts and crafts and to engage with other people which can help overcome the isolation often felt by people with a mental health problem.

Please see Mind factsheets for further information on available community care.

Self Help

For a person suffering with bipolar affective disorder it is important to arm yourself with as much information as possible (see Further information for reading list and useful links)  CBT and counselling are useful in helping a person know how to recognise the triggers and signs that something is wrong but it takes commitment and discipline to use these skills in managing your own illness.  Having more control over their mood swings maybe increase a persons self worth and confidence.  Some key points in learning to manage bipolar affective disorder are.

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