Bipolar Disorder is manageable if treated correctly
24 May 2013
Sunday 26 May 2013 is marked as National Bipolar Awareness Day. In South Africa, one in 100 adults has bipolar disorder, usually starting during teenage or young adult years. Bipolar disorder used to be called manic depression. As the older name suggests, someone with bipolar disorder will have severe mood swings. These usually last several weeks or months and are far beyond what most of us experience. In 1991, the total economic burden of bipolar disorder in the USA was estimated at $45 billion, the cost of which is attributed to treatment, hospitalisation, misdiagnosis, and consequent productivity loss. Nearly one third of patients admit to attempting to take their life at least once, and between 10% and 20% of patients successfully commit suicide. In the Western Cape province of South Africa, BPD has the same prevalence as in developed countries, and is the most common reason for admission of female patients to Acute Psychiatric Services. Bipolar Disorder Type I is diagnosed after one high or manic episode, which lasts longer than one week. Bipolar Disorder Type II is diagnosed when there has been more than one episode of severe depression, but only mild manic episodes. These are called hypomania. Mania after using drugs is not the same as bipolar disorder. We don’t know the cause of bipolar disorder, but it may run in families, and episodes of mania or depression are sometimes triggered by stress. Mania is an extreme sense of well-being, energy and optimism. It can be so intense that it affects your thinking and judgement. You may believe strange things about yourself, make bad decisions, and behave in embarrassing, harmful and occasionally dangerous ways. A period of mania affects both relationships and work. When it is not so extreme, it is called hypomania. The feeling of depression is something we all experience from time to time. It can even help us to recognise and deal with problems in our lives. But in clinical depression or bipolar disorder, the feeling of depression may continue for at least two weeks, making it difficult or impossible to deal with the normal things of life. If an episode of mania or depression becomes very severe, you may develop psychotic symptoms, usually false beliefs. Between episodes of depression and mania people with bipolar disorder often have problems with anxiety and substance abuse. These need to be recognised and treated, as well as bipolar disorder. You may also continue to experience mild depressive symptoms and problems in thinking, even when you seem to be better. Treatments for Bipolar Disorder: There are some things you can try to control mood swings so that they stop short of becoming full-blown episodes of mania or depression. Medication is still often needed to keep your mood stable and treat a manic or depressive episode. There are several mood stabilisers, most of which are also used to treat epilepsy or psychosis. In between episodes of mania or depression, psychological treatments can be helpful. Psychological treatment includes: psycho education i.e. finding out more about bipolar disorder and recognising the early warning signs of relapses, mood monitoring, mood strategies and cognitive behavioural therapy for depression. Try to avoid particularly stressful situations as they can trigger off a manic or depressive episode. It is impossible to avoid all stress, so it may be helpful to do relaxation training or mindfulness practice. Try to balance your life and work, leisure, and relationships with your family and friends. Many people with bipolar disorder have a good recovery from the first few episodes and return a normal life. Prevent or minimise relapses by spotting early warning signs and helping others recognise these when they occur. Staying in touch with a caring family, bipolar support groups and health professionals will help you.