World Bipolar Day: Why is it still so hard to get diagnosed?

Speaking to the Herald ahead of World Bipolar Day on March 30, Ms Laidlaw said: "The narrative around mental health has changed greatly in recent years.

"We can all talk about feeling anxious or depressed or feeling a lack of confidence or low self-esteem.

"That de-stigmatising of general mental health symptoms has been incredibly helpful in a general population but extremely harmful to people who have severe and enduring life-long mental health conditions such as bipolar disorder or schizophrenia, because we're ignoring and neglecting things that really need to come to the top of the agenda.

"If we all talk about having mental health, there's a danger that bipolar is minimised as an illness and not taken seriously."

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An estimated 2-3% of the population are believed to have bipolar disorder - formerly known as manic depression - but it takes an average of nearly 10 years between first presenting to a GP and being correctly diagnosed.

There is no single known cause, but genetics play a role.

People who have a parent or sibling with bipolar are 10% more likely to develop the condition, while identical twins have a 70% risk if their twin is already diagnosed.

Among people known to have bipolar, the suicide rate is up to 20 times higher than the general population, but campaigners including Ms Laidlaw fear that those not yet on treatment will be at even higher risk.

She said: "Last year in Scotland, more than 800 people took their own lives.

"How many of them are people who were living undiagnosed with bipolar who might not have died had they had proper treatment and prescription? That needs to change."

There are different forms of bipolar, but the illness is generally characterised by extreme highs and lows with periods of "equilibrium" in between.

During the hypermanic state sufferers can feel extreme elation, a sense of invincibility, a loss of inhibitions, and be highly productive - sometimes existing on as little as two hours' sleep a night.

It can also coincide with grandiose delusions and erratic or impulsive behaviour.

At the opposite end of the spectrum, sufferers experience a crash of depression, lethargy, paranoia, and at times suicidal thoughts.

Jayne Laidlaw said difficulties seeing a GP face-to-face and 'congested' waiting lists for psychiatry were hindering diagnosis and treatment for people with bipolar (Image: Colin Mearns/Herald&Times)

One of the obstacles to correct diagnosis is that patients tend to approach GPs during a depressive episode, which leads to many wrongly ending up on antidepressants instead of being referred onto a psychiatrist.

Ms Laidlaw said longer appointment times with a GP could help, but that getting seen at all is a growing problem.

She said: "What we've seen since the pandemic is that it has become increasingly hard to be seated in front of a GP.

"We've moved away from GP appointments in a surgery to a phone triaging system, which could lead to a face to face appointment or not. Or it could lead to being seen by a practice nurse.

"So getting seen by a GP is one of the hurdles, and then getting seen by a GP who is curious enough to ask the right questions and recognise that the the person is probably presenting with an illness that is beyond the realms of their expertise.

"Another thing is that the referrals to psychiatry went through the roof during the pandemic. Not just for bipolar, but for other things like autism and ADHD.

"So waiting lists for secondary care are more congested now, but there's still not enough people with bipolar being referred there in the first place.

"People tell us is that once they see a psychiatrist they usually get diagnosed quite quickly, but the important thing is getting referred in the first place.

"There is a backlog, and clearly we need more psychiatrists to deal with that backlog."

The vacancy rate over time for consultants in general psychiatry in NHS Scotland (above) and child and adolescent psychiatry (below) (Image: Turas)

Psychiatry has some of the highest vacancy rates in Scotland, with locums filling around 20% of consultant posts in the NHS.

Meanwhile, in Edinburgh, research recently got underway which could reframe our whole understanding of bipolar.

The study is being led by Professor Daniel Smith, the chair of psychiatry at Edinburgh University's Centre for Clinical Brain Sciences, and expects to report its findings within the next two or three years.

Its underlying hypothesis is that lithium - the drug most commonly prescribed for bipolar - works by making patients more resilient to light and sleep-induced mood disturbance.

Professor Daniel Smith is studying how light and sleep affects bipolar symptoms (Image: UniversityofEdinburgh)

Recruitment began in January with 40 out of a target of 120 bipolar patients signed up within the first month.

Participants sleep in the lab for two consecutive nights.

Prof Smith said: "On the second night we wake them up in the middle of the night and shine bright lights in their eyes for half and hour and then check how that affects their melatonin secretion.

"Then we compare the people on lithium against those who aren't to test whether lithium is protective in terms of rhythms of melatonin in response to light.

"That's quite a new idea and if that's true, it means that lithium is working as a sort of circadian treatment rather than the more traditional idea that it was affecting neurotransmitters.

"We already know that in latitudes such as Scotland, where we don't get much light in winter and too much in summer, that these are high risk periods for patients.

"People with bipolar are more prone to becoming manic in April as we move into Spring, and more prone to depression in November and December.

"There's definitely important seasonal patterns to relapse.

"Obviously it is a mood disorder, but if the primary dysfunction is in circadian systems that changes how we should be thinking about treatments in the future.

"It could be a big deal - but we'll see."