Highs and Lows of Bipolar Disorder
November 2003
By Dr Dayal Mirchandani
Great advances have been made in the treatment of Bipolar Disorder in the last few decades, enabling most people with this disabling illness to lead a normal life
Bipolar Disorder, earlier known as Manic Depressive Disorder, is a common psychological illness that can disrupt one’s life severely, leading to chaotic behavior and even suicide. Affecting nearly one per cent of the population, people suffering from this disease are often highly creative and gifted. They include geniuses like poet Sylvia Plath. While in some cases the disease worsens over time, in others the patient gets well spontaneously.
The disorder is characterized by alternating periods of lows (depression) and highs (mania) during which the person’s behavior and thinking are affected. Symptoms can range from mild to severe. Sometimes the person will suffer an episode or two of depression followed by mania and in other cases the disease may first manifest with mania.
During the depressed phase the patient complains of sadness, fatigue, guilt or hopelessness. In addition, the person may have difficulty concentrating, or suffer from loss of appetite and insomnia. Occasionally the person may feel that life is not worth living and even have thoughts of committing suicide.
During the phase of mania the patient starts feeling euphoric, becomes over-optimistic and develops an inflated idea of self: that he is very rich, creative or powerful. The person may become overactive with racing thoughts, ideas and rapid speech. The person has a tendency to be easily distracted and his interest may jump from one thing to another. He may find it difficult to sleep and may even claim that he does not want to waste time sleeping. During this phase the individual’s judgment is likely to be poor and he may make reckless decisions. Other signs include hyper-sexuality, irritability and violence.
The causes of this disorder are not really known. In some cases it may be genetic and in others, certain chemical changes in the brain might trigger the disorder. Stressful psychological conflicts and trauma often trigger this disorder. Drug abuse, alcohol abuse, even medicines and herbal supplements are other causes.
Great advances have been made in the treatment of Bipolar Disorder in the last few decades, enabling most people with this disabling illness to lead a normal life. The mainstay of treatment is medicine, though in extreme cases electroshock may be necessary. Antidepressant medication relieves depression but may push the person into mania. Anti-mania medication calms and quietness the person but may lead to depression. A salt of lithium and other mood-stabilizing medicines act to stabilize the patient’s mood so that he or she doesn’t turn to depression or hyperactivity.
Alternative treatments generally do not work for this condition and may leave the person vulnerable to further episodes. The only exception to this is high doses of Omega-3 fatty acids found in fish, flaxseed and some nuts (like walnuts) and oil. In high doses it can be as effective as mood-stabilizing medication in treating mild episodes and preventing further attacks.
Newer forms of psychotherapy called IPSRT (Interpersonal and Social Rhythm therapy) have been found to be effective in minimizing the amount of medication required and in reducing relapses. Patients who received this therapy report a much higher quality of life. Unfortunately, most people with this disorder only receive medication and only a few receive any effective form of psychotherapy. This is true not only in our country but in most places across the globe.