Bipolar disorder

Raman, an IT professional shared this story: “My colleague behaves strangely sometimes. He becomes ecstatic for a moment, speaks continuously on random topics, or sometimes boasts of highly ambitious plans like owning a company and making millions of dollars. But after a few days, he becomes extremely quiet, does not interact with anyone or complete his work on time.

Once, when we were out for a team lunch, he threw the plate at the waiter because his order was not brought on time. We were shocked at his behavior. Over time, his behavior became unpredictable and it affected his work and relationship with colleagues. Eventually, he was asked to leave the organization.

I was really curious to know why he was behaving in such a manner and after speaking to my family doctor, I understood that my colleague was suffering from bipolar disorder.”

This fictional narrative has been constructed to aid the understanding of this disorder by placing it in a real life situation.

A person with severe bipolar disorder may also have psychotic symptoms such as hallucinations or delusions and may even have thoughts of self-harm or suicide. Bipolar disorder can inhibit the person's ability to function normally in daily life, and can result in damaged relationships, both professional and personal.

Depression also is not bipolar disorder although some symptoms of both conditions are similar. The main difference is that in bipolar disorder, there are episodes of both mania and depression, as well as extreme mood swings.

Manic phase: During periods of mania, the person behaves impulsively, makes decisions without proper judgment, and takes unusual risks. Also, the person ignores or is unaware of any negative consequences of their unpredictable actions.

• A feeling of absolute happiness that nothing (not even bad news or tragic events) can change things

• Sudden rage or extreme irritability

• May have highly ambitious delusions or strong beliefs that do not have a logical reasoning. The person may claim that he or she has a special connection with God, celebrities, or historical characters.

• Unrealistic beliefs in one's abilities. For example, the person may think that nothing can prevent them from accomplishing a difficult task.

• Inability to control impulsive actions and risky behavior like splurging on unwanted things, foolish business investments, reckless driving, or extreme sexual behavior.

• Uncontrollable thoughts running continuously in the mind

• Inability to sleep which may cause restlessness and hyperactivity

• Difficulty in concentration, being unable to do normal activities

• Feeling of frustration and being irritable during most times of the day

• Rapid speech, jumping from one idea to the another, lack of coherence in thought

• Losing sense of reality, which can lead to psychosis (hallucinations – seeing or hearing things that are not there)

• Overly high self-esteem and unrealistic beliefs in one's capabilities

• Obsessive compulsive behavior – cleaning or organizing things, listening to the same music for days together, trying to dominate or take control over people

Depressed phase: During the depressive phase, the person may experience the following:

• Intense sadness or despair

• Feeling of hopelessness

• Lack of interest in activities they once enjoyed

• Loss of energy, tendency to feel easily tired and lethargic

• Difficulty in sleeping; sleeping too much or not sleeping at all

• Change in appetite, unable to eat well, significant weight loss without dieting

• Difficulty in concentrating, remembering, or making decisions

• Thoughts of self-harm, death or suicide

Possible risk factors could be hormonal imbalance, genetics, extreme trauma due to tragic incident, drugs or substance abuse. Bipolar disorder can co-exist with other illnesses such as acute depression with psychosis or schizophrenia.

1. Bipolar I Disorder: Manic or mixed episodes that persist for at least seven days, or severe manic symptoms that requires the person to be hospitalized immediately. Also, depressive episodes occur that may persist for at least two weeks.

2. Bipolar II Disorder: A combination of depressive episodes and hypomanic episodes, but no predominant manic or mixed episodes.

3. Bipolar Disorder Not Otherwise Specified (BP-NOS): Diagnosed when symptoms of the illness exist but do not meet diagnostic criteria for either bipolar I or II. However, the symptoms are clearly out of the person’s normal range of behavior.

4. Cyclothymic Disorder or Cyclothymia: A mild form of bipolar disorder where episodes of hypomania and mild depression may persist for at least two years.

Coexisting conditions with bipolar disorder

In some cases, bipolar disorder can co-exist with other disorders such as schizophrenia or severe depression. Also, a person with bipolar disorder may be at a higher risk of thyroid, diabetes, or some other physiological illness.

The mental health expert conducts several tests and assessments to diagnose the condition correctly, and to rule out other underlying problems which could be causing these symptoms. To assess the severity of the symptoms, the expert may ask the person to maintain a daily record of their mood changes, sleep patterns and details of daily activities that could help in prescribing the appropriate treatment.

A psychologist evaluates the person's thoughts, feelings and emotions. The expert may also speak to the family members to collect more information about the person's condition. A psychological self-assessment may also be conducted to analyze the severity of the disorder.

Getting treatment for bipolar disorder

Bipolar disorder, like diabetes or heart disease, is a long-term condition and needs to be managed through a person's lifetime. Proper diagnosis and treatment can help a person lead a healthy and productive life. Treatment can make an enormous difference by reducing the frequency and severity of episodes. A combination of medication, therapy and counseling (cognitive behavior therapy) can be very effective in treating bipolar disorder. Treatment may vary depending on the age, medical history, severity of the condition, or the person's tolerance to medication.

Not getting treatment, or discontinuing the existing treatment or medication can actually worsen the condition or cause a relapse. In some cases, the symptoms may get triggered unexpectedly and the person may not even be aware of it or be able to control it.

The main purpose of the treatment is to:

• Reduce the frequency and severity of the disorder

• Enable the person to manage daily activities and enjoy his/her life at home and at work

• Prevent self-harm and suicide

Coping with bipolar disorder

Bipolar disorder can impact every aspect of your life. Accepting the fact that you have bipolar disorder and learning as much as possible about it can help you cope with the condition.

You can:

• Follow the mental health expert's prescribed treatment.

• Go for regular checkups and take medication regularly

• Lead a healthy lifestyle by taking care of your nutrition and having a regular sleep routine.

• Be aware of your mental state and identify situations or events that could trigger the symptoms.

• Acknowledge and respect the support of caregivers (family members and friends).

• Join a support group and interact with other people who are facing the same issue. Such interactions will keep you motivated and you will be able to manage the condition better.

Caring for someone with bipolar disorder

If you know someone with bipolar disorder, encourage them to consult a mental health expert and get treatment. The person may not be willing to accept that they have a problem. In such a situation, you may have to meet the doctor first and then take the person along.

You can:

• Try to remain calm and relaxed when communicating with them. Your calmness can influence the person in a positive manner.

• Encourage the person to follow an activity plan and regularize their daily tasks, which will help them control the symptoms.

• A mixed episode in bipolar disorder can be frustrating and risky. Try to observe and assess what stressors could cause a risky behavior and help the person avoid such things. For example, irregular eating or sleeping routine, or easy access to money.

• After a bipolar episode, the person may feel a deep sense of shame and guilt about their inappropriate or risky illness-related behavior. Try to calm them down and explain to them that such behavior is due to the condition and not a voluntary action.

• Reassure the person that with regular treatment, they can get better and live a normal life.

• Be watchful about comments or actions that indicate self-harm or suicide, and immediately report it to the doctor.

Caring for the caregiver

Caregivers also undergo a lot of stress and emotional turmoil. Most often, women caregivers feel a lot more stressed, exhausted, and anxious than their male counterparts and may be at risk of developing depression. Caregivers are so concerned about their loved one's health that they forget to take care of themselves.

As a caregiver, you may need help if you are:

• Not feeling energetic or active when compared to the days before you were a caregiver

• Frequently falling ill due to cold, infection, or flu

• Constantly exhausted, even after sleeping or relaxing for some time

• Neglecting your own needs, either because you’re too busy or you don’t care anymore

• Thinking that your life revolves around caregiving, but it gives you little satisfaction

• Having trouble relaxing, even when help is available

• Being increasingly impatient and irritable with the person you’re caring for, and with others

• Feeling overwhelmed, helpless, and hopeless

Hence, it is very important that you take care of your physical and mental health. It will be beneficial if you can do some of the following:

• Get proper rest and nutrition

• Exercise regularly

• Learn and use stress-reduction techniques

• Take time off for yourself without feeling guilty

• Take up a hobby or any activity that help you relax

• Seek and accept the support of others

• Talk to a trusted counselor or friend and share your thoughts and feelings