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Bipolar disorder

This fact sheet is designed to help MBF members and their families be better prepared for their healthcare experience after a diagnosis of bipolar disorder.

Not all of the information here will be applicable to everyone, so it is important to discuss your individual circumstances with your doctor and other healthcare professionals caring for you. Please, never hesitate to ask 'why' or to have something explained to you until you understand it. If, after you have been given an answer, you still feel as though there are unanswered questions, ask again or ask someone else. You can help the healthcare team to help you if you feel free to communicate your needs to them. Further research and reading (see 'More about living with bipolar disorder') will also help you make more informed decisions about your treatment.

 About bipolar disorder

Bipolar disorder, formerly known as 'manic depression', is an illness characterised by extreme mood swings: periods of deep depression and then euphoric highs (known medically as 'mania'). Around 1% of Australia's population is affected. Often, the first symptoms of bipolar disorder are experienced in the late teens or early 20s, however it can occur at any age.

Mood swings, of course, are quite normal and almost everyone experiences them. However, in bipolar disorder the mood is so extreme that when it occurs (known as an 'episode'), it interferes with the ability to effectively carry out everyday activities, which may affect general health, personal relationships, workplace and professional life, financial decisions and more. A person with bipolar disorder may experience episodes of depression or mania every few months, a couple of times a year, or even just once or twice in a lifetime. In very severe cases, mood swings may be very frequent, with extreme ups and downs occurring even in the course of the same day.

Although the characteristic feature of bipolar disorder is the occurrence of 'highs' or mania, in fact the episodes of depression are likely to be more frequent and last longer than the manic episodes. In addition, the depression experienced by a person who has bipolar disorder is likely to be more severe and longer lasting than depression in a person who does not.

The severity of the depression and the potential for harm it poses makes it particularly important to learn to understand and monitor your own (or your friend's or relative's) moods and actions, so you can take effective steps for treatment and management. Help and support is also required during manic episodes, especially if extreme risk taking behaviours arise.

 Treatment and management options

Bipolar disorder is generally considered a chronic condition. This means that, rather than one single 'cure', treatment is likely to involve ongoing management over time, using a number of different methods. The treatment may also vary according to whether there are symptoms present or whether you are 'between episodes'.

Treatment is likely to start with your GP, who may in turn refer you to a psychiatrist to help confirm the initial diagnosis and recommend treatment, especially relating to medication. Depending on your individual needs, the psychiatrist may take over your ongoing care or you may be cared for by a GP with a special interest in bipolar disorder with occasional visits to the psychiatrist or psychologist.

The type of treatment you have will depend on, among other things:

  • the severity of the condition - how frequent and severe the episodes are;
  • your age and general health - you may have other conditions that affect treatment decisions; and
  • how long you have had bipolar disorder and what, if any, other treatments you have tried.

If you have just been diagnosed, your doctor may wish to take a gradual approach to find out which treatment plan best suits you. One or more of the following may be suggested to you:

  • lifestyle management can, in many cases, make a real difference in reducing the frequency and severity of episodes. It is especially important to have regular exercise, establish a regular sleep routine, to eat well and regularly and avoid or reduce use of alcohol or other drugs;
  • psychological therapy , provided by a mental health professional to help you to learn how to manage both the depressive and the manic phases;
  • hospitalisation may also be recommended by your doctor if your depression or mania is particularly severe;
  • community support options to help with needs such as accommodation and employment, and self help groups; and / or
  • medication , prescribed by your GP or a psychiatrist. This includes both anti-depressants and mood stabilisers (such as lithium) to help control the manic symptoms.

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 Tips on taking medications

Because there are many available medications for bipolar treatment, especially anti-depressants, sometimes a trial and error approach is needed before the right type of drug and dosage is found. It is also very important to understand and remember some basic principles regarding medications used to treat bipolar disorder (especially anti-depressants):

  • you may need to take the medication for some time (often a few weeks) before you may notice an improvement;
  • it may cause side effects. If you are experiencing side effects from your medication, contact your doctor immediately.
  • you may also have to be careful about mixing your prescribed medication with other medications and especially alcohol.
  • it is extremely important to continue taking your medications as prescribed by your health care providers, even if you are feeling well;
  • if you suddenly stop taking the medication without consulting with your doctor, it may result both in serious withdrawal effects and the recurrence or increased severity of bipolar symptoms. This can be a real hazard if you are either very depressed or in a 'manic' phase and feel so well that you don't need medication any more. Both you and those close to you should know that taking your medication regularly and according to instructions is vital, and that special attention needs to be paid to this during episodes of depression or mania; and
  • your medication should be reviewed regularly - every six months or so - by your doctor (either your GP or psychiatrist) to make sure it is still the most appropriate choice for you.

As with other chronic (ongoing) conditions - like asthma, for example - the best results usually occur with ongoing treatment, including when symptoms are not present. This type of day-to-day management can help reduce both the number and severity of bipolar episodes. See 'Questions to ask your doctor' to help you prepare for conversations with your doctors regarding your medications.

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 Questions to ask your doctors

Your decisions about the treatment and management of your bipolar disorder will depend very much on your individual case. It can be very helpful to ask a friend or family member to be with you so you can go through the questions with the doctor together.

To the GP/referring Doctor:

  • Why have you chosen to refer me to this psychiatrist or psychologist?
  • Could you please explain to me what medication you have recommended and why? Would you mind explaining this to my family & friends so that they can assist me if I need help?

To the specialist doctor:

  • Can you explain what bipolar disorder is and your reasons for this diagnosis?
  • Are you certain about the diagnosis, or may it change over time?
  • Will you or my GP be handling my ongoing care?
  • Can you explain, in simple terms, what you think is the best treatment option in this case and why?
  • What are the likely outcomes of my treatment?
  • What can I expect in the long term?
  • What other treatment options are there and how effective are they?
  • What are the chances that the outcomes will be good, with this treatment or with the alternative options?
  • Are you associated with a comprehensive mental health team? Are there others that would be part of my care team?
  • What changes can I make in my everyday life to reduce my mood swings?
  • How can my family & friends help?

To the specialist doctor if you are going to hospital:

  • Do you know how long the hospital stay is likely to be? Under what conditions will discharge occur?
  • What sort of monitoring and follow-up treatment should I expect once my initial treatment is over? Is there a community care organisation that could help me and/or my family with ongoing support? Or other groups that may be able to help?

Questions about medication

Always share a list of the drugs you are currently taking with your healthcare team, including your pharmacist, when discussing your medication options. To prepare, write a complete list of all the current drugs you are taking, including the name of the drug and the dosage (typically stated in mg) and how often you take it. Remember to include drugs prescribed by doctors, as well medications, vitamins and supplements you buy over-the-counter without a doctor's prescription, even if you taken them occasionally.

  • Do I need to take medication?
  • What changes in my lifestyle (exercise more, better nutrition) could I adopt in order to better manage my mood swings?
  • What are my medication options?
  • Why are you prescribing this particular medication? How does it compare with other available types?

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 What does MBF pay toward my treatment?

Understanding how the healthcare system works can be confusing. This brief summary outlines what you can expect in terms of your health cover, hospital and medical costs. Always check with MBF before you go to hospital.

 Your hospital costs

All levels of MBF hospital cover help pay for in-patient treatments relating to bipolar disorder provided that:

  • they are provided to you while you have been formally admitted to a hospital;
  • they are treatments for which Medicare pays a benefit;
  • they are not an Excluded Service on your level of cover; and
  • you've met all the standard conditions of your membership (like serving the relevant waiting periods).

Your MBF hospital cover will help pay for the following treatments and services so long as you are formally admitted to the hospital:

  • shared accommodation (or private room if available),
  • drugs supplied as part of your inpatient hospital treatment, and
  • allied health therapies such as psychology, occupational therapy, dietetics, and social work as part of your inpatient hospital treatment.

The cost of participating in clinical trials and experimental drugs are not covered by private health insurance.

Remember, if you are not in an MBF Network Hospital and/or public hospital, you may incur substantial out-of-pocket expenses for your hospital charges.

Please note that doctors' charges will be part of your medical costs.

 Your medical (doctors') costs

If your doctor thinks you may need to go to hospital for care, ask your doctor to explain the costs of your inpatient care including their own fees, any fees that other doctors might charge, and any other expenses involved. If there are any gaps for you to pay, ask for a written cost estimate. This is known as 'informed financial consent'. Obtaining this information is extremely important before any planned hospital admission.

Remember, there may be more than one doctor involved in your care. You may not meet them all in person.

Each doctor will charge separately for his or her services and may or may not charge a gap.

Key things for you to know about medical costs and your health cover are:

  • MBF will pay benefits toward your doctors' charges for the service you receive:
    • when formally admitted as an in-patient in hospital or day surgery, and
    • when the service relates to treatment included under your level of cover, and
    • when you are entitled to a Medicare benefit for the treatment.
  • The Medicare Benefits Schedule Fee ('MBS') is the amount determined by the Commonwealth Government for the purpose of paying Medicare Benefits. For eligible in-patient services, Medicare pays for 75% of the MBS; MBF pays the remaining 25%.
  • Many doctors charge above the MBS, creating a 'gap' - an amount the patient has to pay.
  • MBF does not pay any amount charged by your doctor above the MBS unless there is an agreement in place between your doctor and MBF. This agreement is known as the MBF Medical Gap Cover Scheme.
  • MBF has created the MBF Medical Gap Cover Scheme to help reduce gaps paid by members. Doctors who participate in this scheme have agreed to accept the MBF benefit as full payment for your treatment. If a doctor has agreed to treat you under the MBF Medical Gap Cover Scheme there will be no 'gap' to pay for that doctor's charge.
  • It may be that not all doctors involved in your hospital treatment are 'no gap' doctors. So you may have to pay a gap for some doctors' services, but not others.

Remember, doctors are independent of MBF and can decide whether or not to treat you under the MBF Medical Gap Cover Scheme.

Click here for a list of 'no gap' doctors or call MBF.

 Other costs relating to your treatment and recovery

If you have selected MBF extras cover, MBF can also help with the cost of a number of other outpatient or community-based services that may assist with the treatment and management of bipolar disorder. These are not payable during a hospital admission.

Depending on your level of MBF extras cover these benefits may include:

  • occupational therapy, to help you re-establish your usual living or working routine;
  • psychology, such as Cognitive Behavioural Therapy (CBT), group therapy, and counselling for you and family members included on your cover;
  • pharmacy (for drugs not listed on the Pharmaceutical Benefits Scheme);
  • dietetics provided by a Registered Dietitian to help establish good eating habits;
  • MBF Living Well Programs to help pay for things like gym membership fees or yoga classes (restrictions apply); and
  • complementary therapies such as therapeutic massage.

MBF extras benefits are only payable for services provided in Australia by an MBF Recognised Provider. MBF Recognised Providers are health service providers that meet MBF guidelines. Call 131 137 to confirm whether or not your provider is a MBF Recognised Provider.

You can enjoy higher benefits on all preventive and general dental services and selected physiotherapy, optical, pharmacy and gym membership services (restrictions on claiming apply) by using the growing MBF MemberCare network of service providers. With our MBF MemberCare network of providers, you are guaranteed of receiving at least 70%-90% of the charge back on selected services depending on your level of cover, up to the annual limit of your cover. Find an MBF MemberCare service provider.

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 Living with bipolar disorder

If you, or a friend or family member, have bipolar disorder, the subtlety of some of its symptoms at early onset, means that it's especially important for everyone concerned to be very aware of the signs and symptoms of episodes and factors that might trigger an episode, such as lack of sleep, stress, or alcohol or other drug use. It may sometimes be possible to avoid or reduce the impact of these factors in your life. Factors such as exercise and regular sleep can, in some cases, be helpful in reducing symptoms.

Many people with bipolar disorder also find it useful to keep a 'mood diary'. A diary can help you track these factors, gauge the effectiveness of treatment and help identify the triggers for your particular case.

Similarly, your doctor may be greatly helped by a close friend or family member providing insights into your general moods and wellbeing. This can help everyone concerned gain a better understanding of how severe your condition is, how well the treatment is working and how best to manage it over time.

 More about bipolar disorder and its treatment

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 More about going to hospital, MBF Network hospitals, no-gap doctors, and MBF MemberCare providers

As well as calling MBF, you can find plenty of useful information about your health cover and what to expect when you go to hospital right here on this website.

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Last updated: 05-06-07

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