Bipolar disorder, also known as manic depression, is marked by extreme mood swings from high to low, and from low to high – or from mania to depression and back again. Some patients feel elated and depressed at the same time. Fundamentally, the illness is characterised by shifts in mood, accompanied by changes in energy, activity levels and ability to carry out daily activities.
“It’s a spectrum disorder, which means that some people who suffer with this illness have mild symptoms with relatively little impact on their functioning, while those with severe symptoms experience extensive disruption of their life,” says Dr Denzel Mitchell, a psychiatrist at Akeso Clinic, Umhlanga.
The illness is usually classified as follows:
- Bipolar 1 disorder: Periods of manic episodes lasting about a week, followed by depression lasting about two weeks.
- Bipolar 2 disorder: Periods of hypomanic episodes lasting about four days, followed by depression lasting about two weeks.
- Cyclothymia: Longer, less intense periods of mania and depression over a two-year period (shorter in adolescents and children).
- Other related bipolar spectrum disorders: Those that do not fit into any of the above.
Prevalence in South Africa
Research indicates that approximately 1, 2% of the population suffers from Bipolar 1 and 2 disorder. However, says Mitchell, most available studies have used different methods, making it difficult to estimate international prevalence.
“In South Africa, the first large population-based mental health epidemiological survey, the South African Stress and Health Study, published in 2009, showed that risk of any mental disorder was higher than international figures. It’s unclear whether the prevalence is increasing, but awareness has grown, and clinicians are diagnosing the condition more often. Whether this is due to people seeking help more readily, the reduction in stigma related to seeking help, or the illness becoming more widespread is difficult to determine.”
Signs and symptoms
Bipolar disorder presents differently, depending on the individual, and it differs in pattern, severity and frequency.
Mitchell describes four types of mood episodes:
- Mania: Characterised by heightened energy, creativity and elated or irritable moods. The person’s speech and thoughts are rapid, and sleep is disrupted. They may be impulsive or reckless. They may feel powerful and invincible, experiencing ‘conversations with God’, or having ‘special abilities’.
- Hypomania: Less intense, this does not usually disrupt functioning, but is characterised by a few days of feeling really energised, irritable or elated.
- Depression: This is a period of low mood, tearfulness and lacking in energy. Individuals may become worried during these periods and they do not enjoy their lives. They may feel hopeless and suicidal at times, and anxiety can prominent.
- Mixed: This is characterised by both depressive and manic/hypomanic symptoms being experienced at the same time.
Common causes of bipolar disorder
According to Mitchell, the causes of the disorder are unknown. “We do know that it sometimes runs it families. This means that there must be a gene or combination of genes that predisposes certain people to bipolar disorder. If a member of your family has this illness, it is possible that you may have it – but not that you will have it. It usually presents for the first time in the teenage years, which makes diagnosis difficult as adolescence is characterised by tumultuous emotions anyway. It can affect anyone, but women tend to experience it more than men.”
Stressful situations and substances, including medications or illegal drugs, can trigger the first episode or even subsequent episodes; often these patients end up using substances to cope with their emotions or impulsivity.
The risks to patients and their families
Bipolar disorder can have far-reaching consequences. Manic phases can lead to poor daily functioning, inability to sleep, disrupted work and reckless behaviours, such as sexual disinhibition.
“The patient’s work and personal lives are affected, as is their health,” says Mitchell. “Severe mania can result in extreme exhaustion, irritability, argumentativeness and aggressive outbursts. Without proper treatment, it can result in damaged relationships, disrupted work, financial problems, drug and alcohol problems and suicide or suicide attempts,” Mitchell adds.
The depressive phases are equally disruptive to both the patient and their families. Patients become withdrawn, negative and hopeless, have little enjoyment, energy or motivation, and they lack the ability to concentrate. “Patients may lose their confidence and become suicidal, leading them to use drugs and alcohol to cope with anxiety or out of reckless impulses,” says Mitchell. “This leads to further complications at home and at work. Usually, as people get older, the depressive phases become more prominent.”
How is bipolar disorder treated?
There is no cure. A long-term, problem oriented, holistic approach is required to manage the symptoms, which may decrease over time. However, even after many symptom-free years, a relapse can occur. Developing self-awareness, as well as the ability to manage and monitor symptoms and relapse signals, is therefore important for the patient and their family.
“An early, comprehensive diagnosis can greatly improve day-to-day functioning,” Mitchell notes. There is growing evidence that, if left untreated, repeated episodes can affect the patient’s long-term cognitive functioning when they are older. On the other hand, in some situations, the condition may disappear completely as a result of proper treatment.” Managing bipolar disorder requires medication and therapy. The aim of treatment is always to maintain a non-depressed, reasonably positive mood. Medications include mood stabilisers and antidepressants. In severe situations, patients may need to be hospitalised.
“Dealing with a bipolar illness isn’t easy, but it doesn’t have to control your life,” says Mitchell. “The aim of treatment is to equip the patient to manage the illness and to cope with symptoms, so that they can have a more regular and less disrupted lifestyle.
Mitchell suggests some tips for managing bipolar disorder and maintaining balance:
- Learn as much as you can about the illness.
- Exercising regularly to lift your mood.
- Keep regular routines.
- Aim to keep your stress levels in check.
- Keep track of your mood and factors affecting how you feel. Try to address issues before there is a change in your mood.
- Make sure you have people you can turn to for support, help and encouragement.
- Stay close to family and friends so you can talk to them about what you are experiencing.
When to seek help
If you are concerned about your mood, and how it is affecting you and those around you, speak to a professional like your doctor or therapist. It’s also worth asking your friends and family if they have noticed any changes in your behaviour. “We all have ups and downs in life, but when the impact on your life becomes unmanageable, you need to seek help,” Mitchell advises. “This is an illness that can lead to substance abuse and suicide, so please talk to someone.”
Much like any other chronic condition, such as diabetes or hypertension, effective management of bipolar disorder can help you to maximise your quality of life. Making healthy choices will help you keep your symptoms under control, minimise mood episodes, and take control of your life.
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