Bursts of energy and goal-driven activity with very little need for sleep sounds like a recipe for go-getter success. But when it’s accompanied by inflated self-esteem and irrational decisions and, after a few weeks, a mood swing to the other end of the spectrum, it’s time to get help.
‘These extremes of a manic or hypomanic high followed by a depressive low represent the two poles of bipolar mood disorder, formerly called manic depression,’ says Dr Theshenthree Govender, a specialist psychiatrist based at Life Entabeni Hospital and Life St Joseph’s in Durban. It is a mental illness, not a character flaw, she emphasises. ‘The brain is an organ and, like any other organ in the body, it can malfunction.’
Who gets bipolar mood disorder?
Bipolar mood disorder can affect anyone, inhibiting their ability to function. In particular, for those with a genetic predisposition, psychological and environmental stressors – even something positive such as the birth of a child – could precipitate the onset of symptoms. Although it can’t be cured, the disorder can be managed.
There are 3 types of the disorder
The type of disorder depends on the symptoms.
- Bipolar I: manic highs and depressive lows. From being euphoric, feeling invincible and energetic, a patient sinks into despair, feeling useless and unable to manage life. The manic phase can lead to psychosis.
- Bipolar II: hypomania, and usually more depressive episodes. Hypomania is more subtle than mania and doesn’t lead to psychosis.
- Cyclothymia: hypomanic and depressive cycles occur over a two-year period, but the symptoms are not full-blown.
A clinical diagnosis is made by a psychiatrist, based on symptoms, history and genetic predisposition. Dr Govender says it’s essential to rule out that symptoms are caused by a medical condition such as a brain tumour or stroke, medication prescribed for other illnesses or drug abuse.
Dr Rani Samuel, a clinical psychologist who consults at Life St Joseph’s, says when the symptoms are tracked back, it’s usually clear that there’s been ‘a persistent emotional unravelling’ for at least a few weeks. ‘Anyone can have mild mood fluctuations, but in bipolar disorder the mood changes are quite marked,’ she says.
How is bipolar disorder treated?
The type of bipolar disorder and the phase a patient is in dictate the appropriate treatment. ‘If a patient is in a manic episode, there’s a risk of suicide, so we need to stabilise them. If they’re psychotic, sedation might be necessary,’ says Dr Govender.
If a patient is in a depressive phase, a picture of behaviour over time is key because if depression is diagnosed and antidepressants are prescribed, these could precipitate a manic episode.
Long term, a mood stabiliser is the mainstay for managing and controlling the disorder. ‘The medications are optimised according to clinical response, so monitoring, patient compliance and follow-up are essential,’ says Dr Govender. ‘If a patient defaults on prescribed medication and relapses, they are more likely to have an extended episode with increasing episode frequency that becomes progressively destructive,’ she adds. Dr Samuel says that alongside medication, psychotherapy for bipolar mood disorder is fundamental to managing the condition.
Nurse Grace Maleka, Clinic Manager at Life Carstenview, advises that family members of those affected seek out help too. ‘It helps everyone understand and cope with the illness, and the family learns how they can best support their loved one,’ she says.
What is electroconvulsive therapy?
While electroconvulsive therapy (ECT) is controversial due to perceptions based on the old-fashioned technique, it is now safe, effective and done in a theatre with an anaesthetist, says Dr Govender. Small electrical currents are passed through the brain, triggering a brief seizure, which changes the brain chemistry and controls symptoms. A possible side effect is short-term memory loss.
ECT may be used for patients who can’t take medication (such as pregnant women), if the standard treatment isn’t working, or if a patient is manic and highly suicidal or severely depressed and catatonic, says Dr Govender.
WORDS BY GILLIAN WARREN-BROWN
The information is shared on condition that readers will make their own determination, including seeking advice from a healthcare professional. E&OE.
- Adapted from Life Healthcare magazine (2018). Taking charge of bipolar disorder by Warren-Brown, G. p.24. Adapted with permission.