Swinging from one mood pole to another
Bipolar Disorder is a biological illness that causes unusual shifts in your mood, energy levels and ability to function in different aspects of your life (for example, work, going to school, taking care of yourself and maintaining relationships).
This illness used to be called Manic Depression because it was thought that people with this illness would fluctuate only between episodes of highly elated, euphoric moods and episodes of major depression. However, the illness is not quite that black and white – there are many moods that actually occur on a spectrum as shown below:
The mood shifts that occur are very different from the normal ups and downs that everyone experiences at times. For some people, the mood changes brought about by bipolar disorder can be dramatic. They can go very quickly from feeling euphoric or ‘high’, to feeling extremely irritated to feeling sad and hopeless.
For others, however, the changes are not so severe or are easily identified and can involve mild to moderate levels of mania, known as Hypomania. For still others, both depression and mania can occur at the same time, leading to a tumultuous, chaotic experience of feeling extremely energetic but sad and hopeless at the same time, with much anxiety. This is known as a “mixed” episode.
Usually, people experience periods of ‘normal’ mood between these episodes (known as euthymia), when they are neither manic or depressed. While many people return to a fully functional level during these periods, many also continue to experience some symptoms, such as low mood (which is known as dysthmia if it lasts for more than two years), anxiety or problems sleeping. This can continue to have an impact on relationships, and functioning on areas such as jobs, marriage or social life or studies.
About 5% of the general population suffer from this disorder, irrespective of age, gender, race or social status. The genetic heredity is close to 80% and like diabetes, heart conditions and many physical illnesses, bipolar disorder is a lifelong illness that requires careful and constant management with medications and psycho-social modalities, treatment with much support and commitment.
Identifying the signs
Unlike other specialties, there is no blood test, cereboscope or x-ray at our disposal. There are checklists or questionnaires for guidance. However, detailed history from several sources including the patient, an intuitive assessment of mental status and behaviour over several sessions, is essential in coming to a conclusive diagnosis while medical treatment is ongoing. In some cases, admission is necessary.
Bipolar disorder and Major Depressive Disorder are both mood disorders. In some ways, bipolar disorders may look a lot like depression. These two disorders are frequently confused, even though they are not the same. What makes bipolar disorder different is that in addition to depression, a person may experience the ‘highs’ of a manic phrase.
The manic phrase
You might notice some of the following:
- Having a lot of energy and feeling restless
- A decreased need for sleep
- Extreme, even frantic activities
- Talking excessively, quickly, and/or loudly
- Experience ‘racing’ thoughts
- Bring easily distracted and unable to focus or concentrate
- Doing reckless things without caring about possible bad consequences such as speeding, sexuak prosmicuity
- Exercising poor judgement
Some people going through bipolar mania also occasionally feel like their minds are playing tricks on them and they see or hear things, they think people are out to get them, or they believe they have special powers. Alcohol or substance abuse like marijuana can worsen these symptoms.
The depressed phrase
During the bipolar depressed phrase, you typically feel extremely sad or empty for days, weeks or longer. Normal activities are just not fun or interesting any more. You might also notice:
- Changes in appetite or weight
- Trouble sleeping or waking up
- Difficulty concentrating and making decisions
- Being agitated or tired and listless/lazy
- Feel worthless, hopeless or guilty
- Thoughts of dying or suicide
If not treated, the symptoms of the depressive phrase can get worse over time – the ‘low’ feelings get lower and last longer. Risk of contemplating suicide is high among bipolar sufferers.
Treatment
The treatment for bipolar disorder is generally made up of several components.
Medications – Some medications are used to provide instant relief from a acute episode of mania or depression, while some help symptoms under control. There are also medications that are used on a long-term basis to prevent recurrences of future episodes (relapse). Commonly prescribed medications are:
Mood stabilisers
- For instant relief of acute episodes
- For prevention of future episodes
- Examples include Lithium, Sodium Valproate, Lamotrigin Carbamazepine
Antipsychotics
- For treating symptoms of mania
- Usually used together with a mood stabiliser
- Examples include Quetiafine, Olanzapine, Risperedone, Sopheus
Antidepressants
- For treating symptoms of depression
- Must be used together with a mood stabiliser
- Examples include Fluphenazine, Sentraline, Esaitabopuam
Psychosocial treatment work hand in hand with medications to help increase your mood stability and improve your day-to-day functioning.
- Psychoeducation – helps you recognise your condition and its treatment.
- Interpersonal and social therapy – helps you improve your relationships in the family and others and develop daily routines.
- Cognitive behavioural therapy – teaches you ways to change negative thoughts patterns or behaviours.
- Family therapy – teaches strategies to reduce stress levels within your family
- Occupational therapy – provides training in a skill area to allow you to rejoin society and improve self-confidence.
- Support group – helps you expand social network. The Malaysian Mental Health Association conducts support group meetings that you can join.
What needs to be done to maintain health
- Take your medications regularly and keep your doctor appointments. Non-compliance is often the main cause of relapses.
- Maintain a stable sleep pattern, at least 7 hours every night.
- Maintain regular patterns of activity, without over-exerting yourself.
- Check your mood regularly with a mood chart.
- Do not abuse alcohol, tobacco or caffeine.
- Enlist the support of family members or friends.
- Try to reduce stress at work or stress due to interpersonal conflicts.
- Learn to recognise early warning signs of an episode.
Bipolar disorder continues to present a challenge to both its sufferers and the mental health community. When it is treated effectively, you can lead a healthy, productive life.
