BIPOLAR THE ESSENTIAL GUIDE
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BIPOLAR THE ESSENTIAL GUIDE
FO R E WO R D CO NTENT S
What is Bipolar Disorder? 03
As Medical Advisor to Bipolar Scotland
I am delighted to introduce this new How can I be sure I have Bipolar? 04
and updated version of ‘Bipolar –
The Essential Guide’. This is a vital What are the causes? 05
document for individuals and families
affected by bipolar disorder, especially
those with a recent diagnosis. It What are the treatments? 06
provides important information on
diagnosis and treatment, guidance I’m a carer – where can I get help? 08
on lifestyle and self-management
strategies, and advice on work, Who can give me support? 09
driving, pregnancy, welfare benefits
and legal aspects of care. There is also What about my family and friends? 11
an excellent glossary of key terms
and a list of additional sources of Can i work with bipolar illness? 12
information and support.
Staying well 13
Bipolar disorder is relatively common
(affecting about 1 in 50 individuals at Am I entitled to welfare benefits? 17
some point in their lifetime) but it can
affect people in many different ways. It
usually requires a coordinated approach
Can I get help with studying? 19
to long-term management, with input
from a range of health professionals and Can I still drive? 20
support organisations.
It is important to stress that most What will happen to my insurance
people with bipolar disorder live full premiums? 20
and satisfying lives, both personally and
professionally. It has been my privilege to What about holidays? 21
be involved with clinical and research work
in the field of bipolar disorder for the last
20 years and I look forward to many more Sex, Relationships and Pregnancy 22
years of working closely with colleagues
at Bipolar Scotland to provide ongoing What will happen if I go into hospital? 23
support and education to individuals and
families across Scotland and beyond. Mood Scale 25
I hope you find this guide useful and I wish Mood chart 26
you well for the future.
Mental Health Organisations 27
Professor Daniel Smith
Chair of Psychiatry and Head of Division Glossary 29
of Psychiatry The University of Edinburgh
Bipolar Scotland Medical Advisor
BIPOLAR SCOTLAND 02
WHAT IS BIPOLAR DISORDER? Sometimes symptoms become so severe
that psychosis develops. Symptoms may
then include hallucinations (hearing,
reasoning or explained by a person’s usual
cultural concepts). In mania this may mean
believing that you are on a special mission
Bipolar disorder, or bipolar illness, is a those affected by bipolar 2. With bipolar 1,
the person will experience the full range of seeing and otherwise sensing things which or that you have special powers and
mood disorder which affects 2-3% of the are not there) and delusions (strongly abilities.
population at any given time. It affects symptoms of mania and depression. With
bipolar 2, the more extreme symptoms held beliefs not influenced by logical
genders equally. It is characterised by
extreme mood swings ranging from of mania are absent although the less
severe symptoms known as hypomania will During a depressive episode people experience a range of symptoms:
depression to mania, often with prolonged
periods of stability in between. occur, as will the full range of depressive Feelings of sadness, hopelessness Irritability
symptoms. and emptiness
Onset is often in adolescence or early Appetite and weight changes
adulthood, although diagnosis later in life Moods are best viewed as a spectrum with Reduced energy and constantly
is also common. Bipolar illness is often split severe depression at one end and extreme feeling tired Difficulty making even simple
into two diagnoses: bipolar 1 and bipolar 2. elation at the other. Within that spectrum, decisions
It can take on average 10 years to be most people will find themselves within the Sleep disturbances including
diagnosed from onset of symptoms for middle range at any given time. sleeping too much or waking early Loss of motivation
losing interest and enjoyment in Avoiding social contact
Mania Equilibrium Severe Depression things
poor concentration
Restlessness and agitation
Thoughts of suicide
WHAT ARE THE SYMPTOMS?
Feeling guilty, inadequate and
worthless paranoia
During a manic phase (high) of the illness people experience a range of symptoms Including:
Loss of confidence and self
Extremely happy and Fast, pressurised speech esteem
excited / elated
Depression can give rise to psychosis more episodes in a year. In a mixed state,
Racing thoughts
also. During depression this may mean elements of both depression and mania or
Increased activity believing that you are uniquely guilty, that hypomania will be present at the same time.
Poor concentration and easily you are worse than anybody else or even Between episodes the mood may return
Excessive energy distracted that you don’t exist. Variations on bipolar to normal or some residual symptoms may
illness include rapid cycling and mixed remain.
Reduced need for sleep/unable Increased libido states. Rapid cycling is defined as 4 or
to sleep
Lack of insight
Reduced appetite HOW CAN I BE SURE I HAVE BIPOLAR?
Grandiose and unrealistic plans There is no brain scan or any other test (sometimes called borderline personality
Euphoric feelings and a sense of that can diagnose bipolar illness. Diagnosis disorder) can have mood swings but they
extreme wellbeing Overspending is made by history and examination by a tend to be much more sudden and can
psychiatrist. swing within hours or days.
Extreme irritability and more Loss of inhibitions
critical of others Some conditions can resemble bipolar If you are in doubt, talk to your specialist.
illness, so the diagnosis may not be easy You can ask for a second opinion. But don’t
and may take time. Schizophrenia and be too worried if your specialist is not sure
Poor judgement with impulsive, of the diagnosis. Sometimes it is better to
unusual decisions bipolar can be hard to tell apart, especially
in the early stages. Certain personality wait and see what happens over time than
disorders can resemble bipolar illness. to embark on treatment for an illness you
Numerous plans and ideas don’t have.
In particular, people with emotionally
unstable personality disorder, BIPOLAR SCOTLAND 04
WHAT ARE THE CAUSES? WHAT ARE
The causes of bipolar illness are not
known for certain. Research suggests
that bipolar disorder has a strong
genetic component and that many
THE TREATMENTS?
This section deals with treatment of acute episodes of illness.
hundreds of genes may be involved.
For treatments aimed at preventing relapse, see our section on staying well.
Close relatives of someone with
TREATMENT OF MANIA
bipolar illness, such as children or
siblings, are around 5-10% more likely
to develop bipolar illness. For identical
twins, where one has bipolar disorder,
the other twin has a risk of about 70% The symptoms of mania can be helped
of also having bipolar disorder. by drug treatment and hospital care
is often necessary to keep you safe.
There may be a physical problem Before starting treatment for mania,
with the brain systems that regulate it is important to stop anything that
mood and behavior. This could involve could make mania worse, such as an
neurotransmitters such as serotonin antidepressant drug.
and dopamine, and hormones such
as cortisol. Recent research suggests Antipsychotic drugs such as olanzapine
that bipolar disorder may be caused or quetiapine can help if your mood is
by disruption in the way that daily seriously elated, and especially if you
rhythms of sleep and activity are have psychotic symptoms. They have
regulated by the brain. some side effects such as sedation,
weight gain and “movement disorders”.
They will usually only be prescribed for
a short time. Lithium is more often used
to reduce the risk of further episodes
of illness but it can be effective in Semi-sodium valproate is also effective
mania, either on its own or along with in controlling symptoms of mania. It can
an antipsychotic drug. See the section also cause weight gain and drowsiness. It is
on staying well for more information on related to a drug used for epilepsy. There
lithium. is some evidence that other
anti-epileptic drugs can help in acute
mania. Benzodiazepine drugs such as
diazepam or lorazepam can be effective
for overactivity and insomnia. They cause
dependence so can only be used for short
There is some evidence that a stroke spells. They are often prescribed to be
can trigger an episode of mania. So it is taken only when needed rather than
important to check for evidence of strokes regularly.
in older people who develop mania for the
first time. Finally, if mania is severe and does
not respond to other treatments,
Environment and upbringing may also play a electroconvulsive therapy (ECT) can
part. First and subsequent episodes may be help. See the section on treatment for
triggered by stressful life events or physical depression for more on ECT.
illness. Research is ongoing into the causes
of bipolar illness. BIPOLAR SCOTLAND 06
TREATMENT OF DEPRESSION I’M A CARER – WHERE CAN I GET HELP?
It’s important that your life is not taken
Depression can be harder to treat than At Bipolar Scotland, we work to improve
the lives of everyone affected by bipolar over completely by caring for someone
mania and can be prolonged. There are with bipolar illness. Avoiding burnout is
many treatments available, so even if illness, directly or indirectly, including
carers. Our self help groups are open crucial. Try to keep up your own interests
you find the first one or two treatments outside of your caring relationship.
do not work, don’t lose heart. Most to carers, and carers as well as people
with bipolar illness sit on the Board Make time to relax – it may seem difficult
people find a treatment or combination with all the other demands on your time
of treatments that work for them. of Directors. Usually there are other
carers at self help groups who are able but it’s necessary and healthy. You could
to empathise with your experiences and try some of the advice in the following
Mild depression usually does not need section on general wellbeing.
drug treatment. Diet, exercise, lifestyle share their own.
changes to reduce stress and “talking
treatments” give the best results. There The recommended reading on our
are many talking treatments available. website covers a wide range of relevant
The most used treatment is cognitive literature and includes books written by
behavior therapy. carers about their experiences. Contact
us at bipolarscotland.org.uk
0141 560 2050
Moderate to severe depression occurring Other mental health organisations
as part of bipolar illness does not in general listed throughout and at the back of
respond well to antidepressants on their this booklet can provide information
own plus antidepressants should not be and advice. The following carers
used long-term. Current recommendations organisations may be of interest too:
are that bipolar depressive episodes Carers Scotland 0808 808 7777 &
are treated either with antidepressants Carers Trust carers.org 0300 123 2008.
(such as fluoxetine) in combination with They can inform and advise on subjects
mood stabilisers (such as olanzapine or such as Carers’ Allowance. The website
lithium), or with quetiapine on its own, or mentalhealthcare.org.uk is specifically
lamotrigine on its own. If you are already for people who care for someone
taking lithium, it may be sufficient to with psychosis and has very useful
increase the dose. This should always be information. The Carers Trust also has
done with the advice and support of your websites for young carers matter.carers.
clinician. org for age 16-25 and
babble.carers.org for under 18s.
PREVENTION OF RELAPSE
Lithium is the most effective treatment for FIND OUT MORE
preventing episodes of mania, hypomania Your doctor, nurse or pharmacist can give
and depression in people with bipolar you more information on drug treatments.
disorder. It also reduces suicidal thoughts There are lots of useful websites on drugs,
and behaviours. The most effective non- their uses and side effects. NHS choices
medication treatment for preventing has a useful guide to medicines nhs.uk For
relapse is group psychoeducation. This more information on ECT, try the Scottish Being a carer takes its toll emotionally.
is usually delivered within a Community ECT Audit Network: www.sean.org.uk. Try to find space to discuss your thoughts
Mental Health Team but useful information You will find a lot on the internet about and feelings such as with a counsellor, in a
on psychoeducation for bipolar disorder people’s personal experiences and views. carers group, in a bipolar self help group or
can be found at beatingbipolar.org Others’ experiences are important, but it’s to a trusted friend.
much more important that you find out
what treatment works for you. BIPOLAR SCOTLAND 08
WHO CAN GIVE ME SUPPORT? There may be group therapies available
run by different workers such as art
Social work teams can help with a range
of issues. Specialist social workers called
Mental Health Officers are in post to
therapists. In some areas, peer support
In addition to medication, support is workers are available. They are workers help people with a mental illness who are
available from a number of sources. with lived experience of a mental health detained under the Mental Health Act.
GPs, psychiatrists and community problem. Their strength is that they Either in hospital or in the community,
psychiatric nurses are the main health will have had many similar experiences if the assistance of a social worker is
professionals you may come in contact to you. Clinical psychologists, necessary, your health workers can make
with. psychotherapists and counsellors are a referral.
specialised workers usually requiring a
Psychiatrists, specialist consultants referral from a GP or psychiatrist and Voluntary organisations can be a valuable
in mental health, will usually discuss availability varies across the country. resource for people with bipolar illness.
with you issues around medication and Bipolar Scotland is a good example
decide on the best types and doses Many areas have a specialist team of this and is the only Scotland wide
for you. Good psychiatrists will work available to people experiencing an organisation solely dedicated to
in partnership with you and take your acute mental health crisis. This may be improving the lives of people with bipolar
feelings and wishes into account when called the Intensive Home Treatment illness and their carers, family and friends.
making these decisions. If you are Team or a similar name. The purpose A network of self help groups, supported
admitted to hospital you will be under of the team is to try to prevent a crisis by Bipolar Scotland, exists to support
the care of a psychiatrist. leading to a hospital admission. The people with bipolar illness, their families,
team may also support people for a friends and carers. To find out if there is
GPs will prescribe the medication you brief period when they come out of one near you contact Bipolar Scotland.
require, as directed by your psychiatrist, hospital to settle back at home and bipolarscotland.org.uk 0141 560 2050
and will look after wider health issues into the community again. The team
including any side effects you may be will visit you frequently to monitor your
experiencing, as additional medication Community psychiatric nurses (CPNs) condition and support you to manage
may be required. As you have bipolar are trained nurses specialising in mental at home. Usually a referral from another
illness, you are entitled to an annual health available to people with bipolar health professional such as your CPN is
health check from your GP. You may illness and other mental illnesses to required to access the service. NHS 24
have to ask for this as not all surgeries provide additional support. There may can be used at any time for advice and
send reminders. be a waiting list before you are allocated assistance with any medical problem
a CPN. Your CPN may visit you in your including mental illness and problems
arising from medication www.nhs24.com Many areas have a local association for
home or you may go to a centre. They will mental health and there is a national
give you an opportunity to talk about organisation called the Scottish
how things are going, provide you with Association for Mental Health (SAMH)
information on what is available and which provides a range of services,
advise you on the management of your information and advice. samh.org.uk
condition. If you have a CPN, he/she is 0141 568 7000
often your first port of call if you have any
problems. Breathing Space and the Samaritans
provide a listening ear and are especially
Other health workers may become useful outwith the usual working hours.
involved in your care as required. An breathingspace.scot 0800 83 85 87
occupational therapist may help you
with managing your condition including samaritans.org 08457 90 90 90
such activities as structuring your day.
Support workers may help with getting A list of other organisations can be found
out to activities and appointments and at the end of this booklet.
often have basic training in Cognitive
Behavioural Therapy (CBT). BIPOLAR SCOTLAND 10
WHAT ABOUT MY FAMILY AND FRIENDS? CAN I WORK WITH BIPOLAR ILLNESS?
This is why a lot of people enjoy attending If you are looking for work or changing
Undoubtedly the greatest sources of
a self help group. Sometimes it is enough Many people ask when they are newly your job, the question often arises
support for people with bipolar illness
to find out that you are not alone. It can be diagnosed “Will I ever get back to work?” “Should I tell prospective employers
at all stages of the illness are family and
a place to ask and answer questions that or “Will I ever work again?” The answer about my bipolar?” There are pros and
friends. It’s easy to take those closest
to us for granted but everything we go
may be difficult to broach in other settings. to both these questions is that, with cons and ultimately it is a personal
Bipolar Scotland can put you in touch with a the right support, most people can work
through, they go through with us. They decision. On the plus side telling
group near you bipolarscotland.org.uk either in a paid or voluntary capacity.
will be experiencing a range of emotions your manager or human resources
0141 560 2050 Work can be a very important component
as you try to come to terms with having department means that you can enjoy
bipolar illness. It can be difficult to accept of recovery. It gives us a reason to get the full benefits of the Disability
FORWARD PLANNING: up and out, a structure to our day, social
the help we need from those we love Equality Duties. Fear of stigma can act
Many people have found that planning ahead contact and an income. At its best it
and sometimes they want to help too as a disincentive but disclosure means
when you are well for the times that you are boosts our confidence and self esteem.
much. How can we strike a balance and not having to keep a secret and helps
unwell can make life easier for everyone. This On the down side, stress and long hours
protect and strengthen those precious to challenge stigma. Some people wait
may include making an advance statement can be detrimental to our mental health.
relationships? until their employer has formed a good
and choosing a named person. These become As well as managing day to day stress,
effective if you are in hospital and are impression of their abilities before
INFORMATION: it is important to look long term at the revealing their diagnosis. Withholding
discussed in detail later in the booklet. Other responsibilities of your job, the hours and
You and your family and friends will all information when asked directly about
practical steps can be agreed between you
have questions about the illness and your duties. your health at the recruitment stage can
and your carers when well and put into effect
what will happen next. You can empower
when unwell. For example, if you are inclined be used as grounds for dismissal and the
yourselves by getting as much good While many people will be able to carry
quality, reliable information as possible.
to overspend when high, simple things like Equality Act may not give full protection
agreeing to give a trusted, close relative your on in their job without any problems, in against this.
Give them this booklet to read and some cases, a diagnosis of bipolar illness
credit and bank cards for safekeeping for a
request any further information you can mean that legally or practically you
while can give peace of mind. You can also Under the 2010 Equality Act employers
need from medical professionals, Bipolar can no longer continue working in your
give someone you trust Power of Attorney are not allowed to ask about an
Scotland bipolarscotland.org.uk 0141 present role. It may be that you need to
to manage your money, property and some applicant’s health, including whether
560 2050 and other organisations. The change or reduce your hours or alter your
aspects of your personal welfare and medical the applicant has a disability, unless the
details for these are at the back of the duties or environment because of your
treatment. This can be helpful if you enquiries are for particular permitted
booklet. mentalhealthcare.org.uk is a illness, for example due to medication.
become ill. purposes. One permitted purpose
website with good information for people In these circumstances you have rights
caring for someone with a severe mental might be to help select disabled people.
under the Equality Act which replaced the Under the DDA a person had to have a
health problem.
Disability Discrimination Act (DDA) on the substantial impairment but under the
1st October 2010. Employers are no longer Equality Duty discrimination based on
COMMUNICATION:
allowed to discriminate against people perception may be considered unlawful.
Keep family and friends informed. Let
them know of changes such as new with mental health problems and are
medication, lifestyle changes and any required to make reasonable adjustments
symptoms you notice. Listen to their STIGMA: to enable people with mental health
concerns and take them seriously. Don’t Sometimes we will come across negative problems to work. These adjustments are
assume that they know how you feel or attitudes to mental health, sometimes even made on an individual basis depending
you know how they feel – ask them. Be in ourselves and others close to us. Stigma on the person’s needs. SAMH provide
honest about how you feel and what you can make it more difficult to accept that advice and training on making reasonable
can manage. Remember that just because we have bipolar illness. Mental illness is no adjustments and have produced helpful
you have bipolar illness, life is not all different to any other illness but because it “solutions guides” aimed at employers.
about the illness and you are still the same affects our behaviour, people are sometimes These can be downloaded at
person inside. wary. Education is the best way to tackle samh.org.uk or phone 0141 568 7000.
stigma and people are usually very interested Bipolar Scotland has also produced
SELF HELP: to learn. “See me” is a national campaign employee and employers’ guides to bipolar
There is a lot to learn from those that have to tackle stigma around mental health illness available directly on 0141 560 2050
passed this way before. You can benefit seemescotland.org.uk 0131 554 0218 Try or at bipolarscotland.org.uk
from the experience of others with bipolar to associate with people who have a positive
illness and their families and friends. outlook towards you and your bipolar illness. BIPOLAR SCOTLAND 12
STAYING WELL
There are lots of things you can do to fatty acids can affect mental health also. KEEPING FIT
stay well and reduce the risk of further Amanda Geary and Dr Liz Miller have It is recommended that adults should try SLEEP
episodes. You may also need drugs to written extensively on this and their books to achieve 30 minutes moderate exercise A crucial factor in staying well is getting
reduce the risk of further episodes. are listed as recommended reading on 5 times a week. This sounds like a lot but a good night’s sleep. Episodes of mania
bipolarscotland.org.uk In general drinking includes things like housework, gardening and depression usually involve sleep
SELF MANAGEMENT TECHNIQUES six to eight glasses of water a day and and walking to the shops. Exercise has disturbance of some sort. You may find it
As you learn more about your own been shown to improve depression and difficult to get to sleep, wake up frequently
maintaining a balanced diet with plenty of
particular pattern of bipolar illness, is an effective way of burning off excess or early in the morning, sleep too much
oily fish, fresh fruit, vegetables, nuts and
energy during elevated mood. As always, or not sleep at all. Establishing a good
you will become better able to manage seeds is recommended. Never skip breakfast
moderation is the key – too much exercise sleep pattern helps to prevent episodes
aspects of your life to prevent or and keep regular meal times. As a starting
can be problematic too. Joining an exercise of illness and any disturbances act as an
minimise symptoms and improve point, “The Mind guide to food and mood”
class, gym, walking group or similar is a good early warning sign that your mood may be
your overall health. We call this self has a useful booklet at mind.org.uk changing. A critical factor in sleeping well
management of bipolar illness and it is 020 8519 2122 Information can also be found way to meet people. Exercise also helps with
getting a good night’s sleep. is sufficient exposure to morning daylight
practised successfully by many people at foodforthebrain.org 020 8788 3801 (especially in winter) and the avoidance of
across the country. This does not mean too much light in the evenings (eg, from
that you will not require treatment but is computers or smartphones).
practised alongside any treatments you
may be taking. The main components are: Good sleep hygiene is essential and advice
on this is available from sleepcouncil.
INFORMATION AND ACCEPTANCE com. In general, avoid caffeine, alcohol and
In order to manage your condition it eating a heavy meal or exercising before
is vital that you accept that you have sleeping. Create a calm environment in the
it and try to become well informed bedroom, do a relaxing activity before
about it. This booklet is a good place bed and keep the same going to bed and
to start. There is a lot of information getting up times. Mind has produced a
on the internet of varying quality and very good booklet “How to cope with
reliability. Try to stick to websites of sleep problems” mind.org.uk 020 8519
reputable organisations, many of which 2122 If you still find you are having trouble
are listed throughout and at the end of sleeping, see your doctor for more advice.
this booklet. If you have questions that
you are struggling with contact Bipolar ALCOHOL/ STREET DRUGS
Scotland where we may well have the Alcohol and street drugs can cause
answer or know where to get it problems in many ways. Cannabis has
info@bipolarscotland.org.uk been shown to lead to serious mental
0141 560 2050 health problems following long term use.
The effect of many other drugs on mental
health is unknown. Alcohol is a depressant
DIET
and is likely to make things worse during
Eating regular nutritious meals and
a period of low mood. During a high mood,
finding ways of achieving this, even
alcohol and drugs can lead to further
when down or high and it is the last disinhibition and impulsive, risk-taking
thing on your mind. Stabilising blood behaviour. Alcohol and drugs can impair
sugar helps to balance mood and many the effect of medication, exaggerate side
foods themselves have properties which effects and become more potent due to
impact positively on mood. Low levels inter- action with medication. Reducing or
of vitamins, minerals and essential cutting out the use of alcohol and street
drugs will help you manage your illness.
BIPOLAR SCOTLAND 14
IDENTIFYING TRIGGERS
able to try new things at work and discuss many episodes you have had, how often COMPLEMENTARY THERAPIES
with your manager ways to deal with the they were, how severe they were and While there is no conclusive evidence to
It is possible to identify the kind of things
pressure. At the same time you might take how well you are able to tolerate the show how complementary therapies may
that trigger off symptoms and episodes
up meditation or relaxation exercises. You drugs that may reduce the risk of more help bipolar illness, some people find them
and by doing this we can avoid them
can’t eliminate the cause but you are being episodes. You need to have a discussion beneficial. Complementary therapies will
or minimise their effect. Examples of
proactive to reduce its effects. with a specialist to make this decision. not cure bipolar illness but may help your
common triggers are: sleep disturbances;
work or study stress; relationship wellbeing generally. If you decide to try a
problems; physical ill health; holidays; Lithium is the drug most often used to complementary therapy, things to consider
childbirth; financial worries; being very reduce the risk of further illness. It is are: what does the treatment involve, what
busy; loneliness. Everyone has their own usually taken once a day. It is important does it cost and is the therapist qualified.
personal triggers, and some we can’t to keep a steady blood level and you will Check with your doctor that the therapy
avoid, such as bereavement. need regular blood tests. Once you are you have chosen is suitable in conjunction
established on lithium, you will only need with any medication you are taking.
What can we do? One way that many a blood test once every three months. Depending on what the therapy consists
people have found useful of identifying Many people find it prevents episodes of, you may have to tell the therapist what
triggers and their effects is by keeping of illness, but you must take it regularly. medication you are taking.
a mood chart or diary. An example of a Feeling thirsty, drinking more and having
mood chart is enclosed with this booklet. to pass urine more often are common side
If you keep a note of things that are effects. You might also find a slight hand
happening as well as recording your mood, tremor and may put on weight.
you can quickly see the effect of different
situations on your mood. You may not be Lithium can interact with some other
able to eradicate a trigger but you may drugs, so always check with your doctor
be able to plan to manage it better. For or pharmacist before taking any other
example, if going on holiday is a trigger medication. If the blood level goes
MANAGING STRESS too high, you may have sickness and
you may want to find out what it is about
Stress is so common in our everyday lives diarrhoea, a severe tremor, loss of balance
holidays that trigger symptoms and adapt
that we are resigned to living with it. It and confusion. If this happens, you must
your plans. Allowing a few days relaxation
is true that stress is unavoidable and get medical attention straight away.
before and after may help too.
some stress is necessary, but excessive Valproate and anti-epileptic drugs can
stress is detrimental to our mental health. also help prevent illness for some people,
EARLY WARNING SIGNS
How do you know that there is too much although valproate should not be used by
Early warning signs are your individual
stress in your life? As well as physical women of child-bearing potential because
changes in behaviour or mild symptoms
symptoms, other signs include: anger, of risks to the child. Also, if you have only
which indicate a changing mood state.
depression, anxiety, changes in behaviour, mostly manic episodes then antipsychotic
Only you can determine which are
food cravings, lack of appetite, frequent drugs can be helpful in prevention.
relevant to you. Examples could be an
crying, difficulty sleeping, feeling tired Likewise, if you have mostly depressive
increase in alcohol consumption; poorer
and difficulty concentrating. It can be episodes then you might find long-term
sleep than usual; increased or decreased
difficult to tell which symptoms are stress antidepressant medication helpful.
sociability; increased irritability. As you
related and which are bipolar related.
become aware of early warning signs you
Again identifying the cause of the stress is None of these treatments are addictive.
should also discuss them with your health
the first step in tackling it. Diet, exercise, But you can become unwell if you
professionals. Your early warning signs
relaxation, deep breathing, sleep and suddenly stop any of these drugs. If you
present an opportunity for you to act. You
stopping smoking can all alleviate the want to come off medication, take time
may have identified a trigger or there may
effects of stress. to think about the risks and discuss your
not be a trigger. The important thing is
to develop strategies to respond to your decision with specialists.
MEDICATION
early warning signs. An example may be
Even with best self-management
that you have identified that increased
techniques, there is a risk of further
pressure at work has led to you having
episodes of mania or depression.
difficulty sleeping and becoming more
The decision on whether or not to use
irritable. Picking up on your early warning
drugs to reduce the risk of further
signs you have realised the cause and are
episodes is complex. It depends on how
BIPOLAR SCOTLAND 16
AM I ENTITLED TO WELFARE BENEFITS? Young Carer Grant – an annual payment
of more than £326.65 for people 16, 17 or
The roll-out of Universal Credit for new
claims was completed in December 2018.
18 who care for people who get a disability The Department for Work and Pensions
If you are in work and your employer has no benefit from the DWP for an average of 16 has stated that they aim to have everyone
sick pay scheme, you can claim Statutory hours a week or more. currently receiving one or more of the
Sick Pay for periods when you are unable to older benefits listed above switched to
work due to illness. Child Winter Heating Assistance - Universal Credit by the end of 2024.
a £214.10 payment to help families of a
If you need to travel for medical child on the highest rate care component of
Disability Living Allowance for Children to
appointments related to your mental health,
heat their homes.
you can apply for a concessionary travel pass
through your local council. If you receive Scottish Child Payment - a new, unique to
disability benefits you may be entitled to a Scotland, benefit that will give qualifying
companion card which allows someone with parents and carers £80 every four weeks to
you a concessionary travel rate. help towards the costs of looking after each
child under 6. It is planned to be fully rolled
In addition to Council Tax and Housing out to children under the age of 16 by the
Benefit, assistance is available in some end of 2022.
circumstances with mortgage interest
payments while you are out of work. Local Child Disability Payment - a payment
money advice centres and Citizens Advice providing extra money to help with the costs
Bureaux can assist with applying for benefits. of caring for a child with a disability or ill-
Best Start Grant Early Learning Payment health condition. It replaces Disability Living
– one off payment of £267.65 when a Allowance for children in Scotland that was
Social Security Scotland is the new benefits child is between two and three years and previously delivered by the Department for
agency delivering certain benefits which six months for families who get certain Work and Pensions.
have been devolved to Scottish Government. benefits.
These benefits are: Adult Disability Payment - a payment
Best Start Grant School Age Payment – providing extra money to help people who
Best Start Grant Pregnancy and Baby one off payment of £267.65 when a child have a long-term illness or a disability Scottish choices
Payment – one off payment of up to £642.35 would normally start primary one for that affects their everyday life. It replaces The Universal Credit Scottish choices give
from 24 weeks in pregnancy up until a baby families who get certain benefits. Personal Independence Payment people people living in Scotland the option of:
turns 6 months for families who get certain in Scotland previously delivered by the
benefits. Department for Work and Pensions. being paid Universal Credit twice a
Best Start Foods – a pre-paid card from
Adult Disability Payment has opened for month rather than monthly
pregnancy up to when a child turns three
applications in the pilot areas of Dundee,
for families on certain benefits to help buy Perth & Kinross, the Western Isles, Angus,
healthy food. having their Universal Credit housing
North Lanarkshire and South Lanarkshire. element being paid directly to their
This will be followed by a gradual national landlords
Carer’s Allowance Supplement – an rollout beginning on 29 August 2022.
automatic payment made twice a year to
people who get Carer’s Allowance through The Universal Credit Scottish choices
Universal Credit
the DWP on certain dates each year. have been available to people making
Universal Credit is a UK-wide benefit
new claims in full service Universal
reserved to the UK Government. It is a
Funeral Support Payment – money single monthly payment that’s replacing the Credit areas since 4 October 2017, and
towards the costs of a funeral at a difficult following six benefits: were extended to everyone receiving
time like this for people on certain Universal Credit from 31 January 2018.
benefits who are responsible for paying income-related Employment and Support The Department for Work and Pensions
for a funeral. Allowance (ESA) deliver the Universal Credit Scottish
income-based Jobseeker’s Allowance (JSA) choices on behalf of Scottish Government.
Job Start Payment – £267.65 for 16 to Housing Benefit
24 year olds who have been on certain Working Tax Credit For more information about the Universal
benefits for six months or more to help Child Tax Credit Credit Scotland Choices please use this
with the costs of starting a job. Income Support link. www.gov.scot
BIPOLAR SCOTLAND 18CAN I GET HELP WITH STUDYING? CAN I STILL DRIVE?
If you are planning to attend college Traffic Act does not
The DVLA require notification of
or university the Equality Act 2010 differentiate between
medical conditions. They will decide
requires education providers to make illegal and prescribed
whether or not you can continue to
reasonable adjustments to ensure drugs. Driving while
drive based on the details you give on
disabled students can participate your ability is impaired by
an M1 form and on information from
equally in student life. By contacting prescribed medication could lead to an
your GP or consultant.
your college or university as early as accident and/or a conviction.
possible, where possible before you You can download the form from
start, they can work with you to put You should discuss driving with your
gov.uk You may be able to keep your
adjustments and support in place so doctor. During episodes of mania or major
licence or it may be issued for a period
that you can have the best possible depression, you should not drive. It might
of 1, 2 or 3 years or at worst it may be
experience of student life. be best to give your car keys to someone
revoked. A D100 information booklet
you trust so that you are not tempted to
is available from the Post Office with
SAMH provide advice on making drive.
more information. You should also
reasonable adjustments and a inform your insurance company. If
“solutions guide” on this aimed at After you have recovered from an acute
you do not, you may find you are not
education providers which can be episode of mania or depression, you
insured if you have an accident related
downloaded at samh.org.uk 0141 568 should be able to drive again. How soon
to a medical condition you did not
7000 Support will be available from you can drive depends on the advice from
declare.
Student Services and the Students’ your doctor, based on guidelines from the
Association. They can advise you DVLA. You can find their latest advice on
If your driving is affected by your
about eligibility for Disabled Students the DVLA website gov.uk
medication DO NOT DRIVE. The Road
Allowance and how to apply.
WHAT WILL HAPPEN TO MY INSURANCE PREMIUMS?
Many people have found that life
assurance, and travel and car insurance
are more expensive, have exclusions or
are denied because of having bipolar
illness.
Different companies have different
You may be able to access a Student policies and practices and there are
Health Service or Counselling Service, some who will give comprehensive
or there may be links with local health cover at a competitive price. It very
services and counselling providers. much depends on your own individual
Service structures vary between circumstances but the experience
institutions, but you can find out what of Bipolar Scotland is that it pays to
is available where you are by visiting go to a specialised insurer. Some are
the Students’ Association. Support and better for bipolar illness than others
information is also available from the and it very much depends on your own
National Union of Students (NUS). NUS individual circumstances. Contact
Scotland hosts the “Think Positive” Bipolar Scotland for more information
programme, which consists of a number bipolarscotland.org.uk 0141 560 2050
of mental health projects. Find out more
at nus.org.uk 0131 556 6598 BIPOLAR SCOTLAND 20WHAT ABOUT HOLIDAYS? SEX, RELATIONSHIPS AND PREGNANCY
A recognised symptom of bipolar
If you have a European Health illness is the effect of a high or a low
Insurance Card which entitles you on your sex drive. People may become
to reciprocal state health care in EU highly sexed during a high, taking
and some additional countries this is risks with multiple partners or simply
still valid post-Brexit. From 1 January wanting a great deal more sex than
2021, the European Health Insurance usual. Conversely, during a depression
Card (EHIC) is being replaced with people may lose interest in sex or any
the UK Global Health Insurance Card physical contact altogether. This can
(GHIC) for all EU countries. Both are put a strain on intimate relationships.
valid if you are visiting an EU country. It may be difficult to do but talking to
your partner while you are well about
This can be easily obtained by applying how you feel at these times can help.
online at nhs.uk or phone 0845 605 You can put in place mechanisms to
0707. This is not a substitute for cope and your partner may be more
comprehensive travel insurance. It is receptive and understanding when
important to tell your insurers about given the chance to talk.
your diagnosis or you may find when
you make a claim that you are not Having bipolar illness should not be
covered. a barrier to having children. At the
earliest opportunity, before you start
Holidays are often stressful as well as trying for a baby, you should talk things
enjoyable. Try to use good judgement over with your doctor, psychiatrist and
to decide before you go whether Community Psychiatric Nurse if you
you are well enough to travel. Plan have one. If you are taking medication,
ahead, making sure you have enough adjustments may have to be made or These changes may raise your risk of a
medication to cover the whole trip. Use the medication withdrawn altogether. relapse either during pregnancy or after
self-management techniques to keep giving birth. You will need to observe
well while you are away. Some people closely for any early warning signs and
with bipolar find that big time zone take action quickly to prevent relapse.
shifts can bring on an episode of mania The support of family and friends will
or depression. This won’t necessarily be crucial during this time. For more
happen, but you should be aware of the information please read the Bipolar
possibility. Also, if you are on lithium Scotland booklet entitled Bipolar
and you travel to a hot country, make Illness and Pregnancy or ask your health
sure you keep drinking plenty of water professionals.
and keep up a reasonable salt intake.
Dehydration can cause your lithium level If the mother takes certain medications
to rise. during the first three months of
pregnancy, there is an increased risk to
the unborn child. Good family planning
advice and effective contraception are
important. If you think you are pregnant
and are taking medication, especially
lithium or valproate, contact your doctor
as soon as possible.
BIPOLAR SCOTLAND 22WHAT WILL HAPPEN You also have the right to independent As you get better you may be able to leave
advocacy – someone to help you the hospital for periods of time known
understand what is happening with your as passes. These are an opportunity to
IF I GO INTO HOSPITAL? care and to support you to say what you ease yourself gradually back into your life
want and make decisions. This will be outside the hospital.
someone who does not work for services
On the Commission’s website there are such as health or social work. This can be
You may already have had a stay in really valuable during an episode when
hospital or may have one in the future. various leaflets on the Mental Health Act
and the Adults with Incapacity Act, some your symptoms can impair your usual
Most admissions to hospital are abilities. Staff should be able to contact
voluntary and informal. If there are of which are in a variety of languages and
large print. a suitable organisation to provide an
fears that your health has deteriorated independent advocate for you or you
to the extent that you or someone else can contact the Scottish Independent
may be at risk you may be detained You have the right to prepare an advance
statement when you are well which Advocacy Alliance siaa.org.uk
under the Mental Health (Care and 0131 556 6443. While in hospital you will
Treatment) (Scotland) Act 2003, will then be taken into account when
you are unwell. The statement should have a named nurse who will be able to
commonly known as being “sectioned.” keep you informed about your care and
include details about which treatments
work well for you, which don’t and which answer any questions you may have.
Compulsory admission is usually under
a short-term detention certificate. treatments you do not wish to have. You
can also prepare plans for such things as You may not always be seen by your
This can only be granted by a specialist consultant psychiatrist but by other
psychiatrist. Also, a specialist social childcare, pet care and who should be
contacted if you have to go into hospital. psychiatrists who work with your
worker known as a mental health officer consultant. Your consultant though
must agree. It can last for up to 28 days Copies of your advance statement
is ultimately in charge of your care. In
and gives your psychiatrist authority should be held by your GP, psychiatrist,
meetings about your treatment, there
to treat you, but your psychiatrist can CPN and any other relevant health
may be many people present you do not
remove the certificate, or suspend it if professional, as well as your named
recognise e.g., occupational therapists. It
you are getting better. You can appeal person. is your right to ask any questions such as
to the Mental Health Tribunal (call who they are and why they are there. The
them on 01698 390000 to find out meetings are also an opportunity to ask
how) and you are entitled to free legal questions about your condition and care
representation. If there is no time to and to tell the team anything you think
get specialist assessment, you can be they need to know.
admitted urgently and given emergency
treatment. A specialist will assess
you before you receive any regular
treatment. Also, a minority of people
need to be treated further under mental
health legislation, but this must be
approved by the Tribunal. A small number
of people need mental health treatment When you are discharged, there may be
if they have been arrested or convicted A named person is someone you a specialised team of people to help you
of an offence. nominate to receive information about settle back at home, but if there is not,
your care and to have input into the ask what support you will receive during
The Mental Welfare Commission exists decisions made about your care while this transition period. If you have been
to ensure effective operation of the you are in hospital. Choose your named accessing community services these
Mental Health Act and to protect the person wisely. It does not need to be should come back into effect and it is
rights of people using mental health your next of kin but, if you do not specify important that you are seen by a worker
a person, it will automatically be your very soon after you return home.
services. mwcscot.org.uk or Freephone
0800 389 6809. “primary carer” or next of kin.
BIPOLAR SCOTLAND 24MOOD SCALE
TALKING IN NUMBERS
THE BEAM MOOD CHART
The Beam Mood Chart has a second page which allows you to record thoughts, feelings
and events. For more on this see Bipolar Scotland’s Mood Monitoring booklet at
bipolarscotland.org.uk
BIPOLAR SCOTLAND 08 BIPOLAR SCOTLAND 26MENTAL HEALTH
ACKNOWLEDGMENTS
ORGANISATIONS Penumbra
We would like to show our appreciation to everyone who provided
their expertise to produce and update this guide.
Across the country there are many local
associations for mental health and other T: 0131 475 2380
W: www.penumbra.org.uk
small mental health projects. They can
E: enquires@penumbra.org.uk Professor Daniel Smith - Chair of Psychiatry and Head of Division of
be a great source of support and advice. Psychiatry The University of Edinburgh
National organisations such as Bipolar
Scotland, Scottish Association for Mental
Health, Support in Mind Scotland, Action on Helplines
Dr Donald Lyons
Depression and Penumbra have information,
Helplines can be very useful in times of crisis
training and other services that can be
when everything seems overwhelming. Don’t
Aileen Leitch
accessed. Self-help groups for people with
bipolar illness are also available. Contact hesitate to phone one of these numbers – Louise Devlin
Bipolar Scotland or visit their website to it’s always best to talk about how you are
find one in your area. feeling than to bottle things up. Karen Martin
Breathing Space: 0800 838587 Edited by Jamie Stewart
Bipolar Scotland
T: 0141 560 2050
W: www.bipolarscotland.org.uk Samaritans: 08459 09090
E: info@bipolarscotland.org.uk
Saneline: 08457 678000
Scottish Association for Mental Health
T: 0141 530 1000 SHOUT: Textline 85258
W: www.samh.org.uk
E: enquire@samh.org.uk
Support in Mind Scotland
T: 0131 662 4359
W: www.supportinmindscotland.org.uk
E: info@supportinmindscotland.org.uk
Produced in partnership with
NHS Greater Glasgow and Clyde BIPOLAR SCOTLAND 28GLOSSARY
Complementary therapies: treatments tongue. If the drug is stopped, this may delusions (fixed, false beliefs out of keeping
which claim to ease a range of mental get worse for a while but should eventually with their culture) or hallucinations (usually
and physical ailments which are outside improve. Your care team will watch carefully hearing voices that are not real). Unusually
Terms in italics are explained here. of conventional medicine. They include for this problem if you are on long-term high or low mood can also occur, making
acupuncture, reflexology and Reiki. antipsychotic drug treatment. it sometimes difficult to tell apart from
Adults with Incapacity Act: this Act
bipolar illness.
provides ways to manage the money, welfare
Equality Act 2010: this act makes it Named Person: you can nominate someone
and property for individuals who lack the
unlawful to discriminate on the basis of to be your named person under the Mental Self help groups: support groups where
capacity to do it themselves. When well,
“protected characteristics”, including age, Health Act. This person has the right to people with a common interest such as
you can make a statement setting out what
gender and disability. You can find out more be involved and consulted about your bipolar come together to discuss relevant
treatment you would and would not like to
here: equalityhumanrights.com treatment. In some cases, your named issues and help each other through
have in future. If you become ill and can’t
person can appeal against compulsory listening and sharing, open to people with
make decisions, anyone treating you must
treatment. the diagnosis as well as their loved ones.
take your advance statement into account.
See the Scottish Government’s short guide
Permitted Work: if you are getting Self management: self help techniques
to advance statements at scotland.gov.uk
Employment and Support Allowance and which use forward planning and lifestyle
or see Bipolar Scotland’s guide to Advance
other benefits because of an illness or changes to allow people to better manage
Statements.
disability you may be able to do some types their illness.
of work within certain limits. This is called
Borderline personality disorder: see
‘permitted work’. The idea of permitted Sleep hygiene: habits and good practice
emotionally unstable personality disorder
work is that it allows you to test your own which can improve sleep such as not having
Emotionally unstable personality disorder: capacity for doing some work and perhaps TV in the bedroom, cool temperature for
Clinical psychologists: health professionals
a condition where the individual feels gain new skills. To help make this possible the bedroom and not eating or exercising
who have specialist training in psychological
emotion more deeply and intensely than earnings under permitted work are ignored too close to bedtime.
therapies in ways that help reduce distress
others. This can lead to rapid swings of in the benefit calculation, up to a limit set
and enhance psychological and physical
mood and, in some cases, self-harm. It can annually.
wellbeing. They work with people who have
be mistaken for bipolar disorder (and vice-
experienced a wide variety of mental health
versa). Personality disorders: your personality
problems.
forms during your childhood and
Mental Health Act: full name is the Mental adolescence. Some people enter adulthood
Cognitive Behavioural Therapy (CBT): a
Health (Care and Treatment) (Scotland) Act with patterns of thinking and behaviour that
form of “talking treatment” that helps by
2003. This is an important Act. Under this cause difficulties for themselves and others.
changing the way the individual thinks. By
Act, you can be detained in hospital and/or For example, some people are excessively
helping the individual identify automatic
given compulsory treatment. But the Act paranoid or obsessional. These traits tend to
negative thinking and finding more positive
also gives you certain rights, e.g. advocacy, be present all the time, unlike bipolar illness
ways to think, it has been shown to treat
advance statements and right of appeal. which occurs in episodes.
mild to moderate depression.
For more information, see the Scottish
Government’s short guide at Power of Attorney: this is someone you
Community psychiatric nurse (CPN):
scotland.gov.uk appoint to manage your money, property Voluntary organisations: independent
psychiatric nurse based in the community
and welfare if you become unable to do this organisations which work on a not for
rather than a psychiatric hospital. They form
Mental Health Officers: these are social yourself. There is useful information here: profit basis, many of which are charities
an integral part of community mental health
workers who have special training and publicguardian-scotland.gov.uk such as Bipolar Scotland.
teams. They are often patients’ key workers
experience in mental health and learning
within the NHS mental health system and
disability. The have a number of duties Psychiatrist: A doctor who works in After reading through this booklet, you
are often the first port of call for further
under mental health and incapacity law. psychiatry is called a psychiatrist. Unlike may still have questions you want to ask. It
referrals to psychiatrists, psychologists
other mental health professionals, such as is not possible to cover every situation in a
or other mental health professionals.
Movement disorders: some people who psychologists and counsellors, psychiatrists booklet. At Bipolar Scotland we welcome
Community psychiatric nurses mainly visit
take antipsychotic drugs find difficulty with must be medically qualified doctors who questions via our website or telephone. We
people in their own homes but they also
movement.You might find your movements have chosen to specialise in psychiatry. This will do our best to answer those questions
see people in other settings such as GP
are slow with muscle stiffness and tremor. means they can make a diagnosis, prescribe and if necessary will signpost to other
surgeries or the community mental health
You can also find yourself restless. These medication as well as recommend other services. If you have bipolar illness or you
team base. Community psychiatric nurses
side effects can be helped by reducing the forms of treatment. care for someone who does, make us your
are fully trained psychiatric nurses who have
dose or by giving other medication as an first stop bipolarscotland.org.uk
experience working in a psychiatric hospital
antidote. In the long term, a small number Schizophrenia: a mental illness where or 0141 560 2050.
or ward.
of people develop movements they can’t thinking and perception are worst affected.
control, usually around the mouth and People with schizophrenia may have BIPOLAR SCOTLAND 30You can also read
