Understanding Bipolar Disorder

Some of the most popular figures in modern history – Winston Churchill, Edgar Allen Poe, Beethoven, Van Gogh and Isaac Newton – have been suspected to have BIPOLAR DISORDER, a mental illness that causes unusual shifts in a person’s mood, and energy. Yet, it is perhaps one of the most under-recognized of all mental illnesses.

Bipolar Disorder is different from the normal ups and downs that everyone goes through. The symptoms of the disorder are severe – the person can swing from manic highs to depressive lows. It is often not recognized as an illness, and people may suffer for years before it is properly diagnosed and treated.

What is Bipolar Disorder?

According to the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM), Bipolar disorder is a serious mental health condition marked by radically opposite states of mood. These moods may occur in phases, also called episodes.

The manic episode is typically marked by feelings of grandiosity or heightened self-esteem. People experiencing this phase may seem to be in a “high”. They may be unusually energetic, have little need for sleep, may talk excitedly, get easily distracted, and often recklessly pursue pleasurable activities. In contrast, the depression episode is marked by intense sadness, dejection, lack of energy, apathy and lack of interest in pleasurable activities. Typically, between both episodes, there may not be any symptoms.

A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person and may be associated with good functioning and enhanced productivity. So even when family and friends learn to recognize the mood swings as a possible mental disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can convert to a manic episode or major depression.

Because bipolar disorder tends to run in families, researchers have been searching for specific genes that could be linked to the disorder. Recent research shows that the MLC1 gene could be associated with schizophrenia and bipolar disorder in southern India. (Verma, Mukerji et al, 2005). External environmental triggers could also set off the disorder or worsen existing symptoms. Stressful life events, substance abuse, seasonal changes, sleep deprivation are all potential triggers for either mania or depression.

Seeking Help

Shabeer (name changed to protect identity) was under psychiatric treatment for Bipolar disorder when he came in for therapy. He displayed the cycles of Mania and depression very clearly. During the “down phase” he left regular work and lived on charity meted out by relatives. He refused to take any treatment. During the manic swing he was overly cheerful, had late night parties and wanted to attend therapy thrice a week. But mostly he was aware of his mental illness and would spend hours researching it on the internet. He once asked me, “You think I could be one of those textbook cases of Bipolar?” Shabeer certainly was a “textbook” case. His symptoms were typical and so was his therapy pattern – erratic, complicated and slow in progress.

Although persons diagnosed with bipolar are open to therapy, their illness itself debilitates their progress and creates complications. Diagnosing the problem as early as possible and getting into treatment can help prevent these complications.

Medication: Research has shown that people with bipolar disorder are at risk of developing rapid cycling between mania and depression, if they are treated only with antidepressant medication. Therefore, “mood-stabilizing” medications generally are required to protect them from this switch. Lithium and valproate are the most commonly used mood-stabilizing drugs today.

Psycho-Therapy: Cognitive Behavioral Therapy (CBT) combined with family therapy is useful to prevent relapse and alleviate symptoms for longer periods of time. Research also shows that many people with Bipolar Disorder have suffered traumatic life experiences. Therapies such as Eye Movement Desensitization and Reprocessing (EMDR) to work on these past traumatic memories helps the person with Bipolar to lead a more productive life.

Self help: Most Bipolar patients are advised to avoid high-stress situations, maintain a healthy work-life balance, and try mindfulness based meditation and yoga. Healthy eating and regular exercise are also encouraged to stabilize mood. Keeping a regular sleep schedule is particularly important.

As a therapist, I usually encourage patent with bipolar and their families to learn as much as they can about the disorder. Also, keeping track of the symptoms and watching for signs that the moods are swinging out of control are essential to stop the problem before it starts. For those who may be reluctant to seek treatment because they like the “ups” of the manic swing, remember that the energy and euphoria come with a price. Mania and hypomania often turn destructive, hurting the victim and people around. So get the right help and soon.

This post originally appeared in the Bipolar India.