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In 1980, the psychiatric diagnostic term Bipolar Disorder superseded what had previously been referred to as Manic Depressive Illness, or manic depression. No one yet knows for sure what causes Bipolar Disorder but it is thought that genetics, family history and environmental factors play a part.
While everyone experiences ups and downs in the way they feel, the range between the two feelings tends not to be very wide. In contrast, people suffering Bipolar Disorder typically find themselves subjected to significant and sometimes extreme swings in mood and energy.
Bipolar Disorder is not always experienced in the same way. The diagnostic manual DSM-5 subdivides Bipolar Disorder into five categories. Symptoms may vary over time. Some people experience periods of relative mood stability between swings while others do not. It is therefore easy to understand why the treatment of Bipolar Disorder cannot be reduced to a simple, one-size-fits-all approach.
In the manic phase of Bipolar Disorder I, the person experiences periods of intensely heightened mood. This can last just a few days or persist for several months. Thinking, feeling, behaviour and physical states are all affected. Symptoms may include irritability and racing thoughts, as well as unusually intense energy or extreme behaviours, such as spending recklessly on impulse alone. A person may feel elated in an exaggerated way and become very talkative, breach social boundaries or show signs of grandiosity, becoming delusional about the extent of their abilities. The person may find it difficult to sleep or may not even feel the need to. At its most extreme, a manic episode may include symptoms of psychosis such as hearing voices.
Hypomania is a somewhat less intense version of mania so a person’s mood swing would not be as extreme. Hypomanic episodes feature in a diagnosis of Bipolar II Disorder along with alternating episodes of depression. Hypomania can sometimes develop into mania.
Mania may be interspersed with periods of severe depression, featuring symptoms such as low mood, much reduced morale and motivation as well as heavy feelings of hopelessness and physical inertia. It can become difficult to think clearly let alone optimistically. Concentration may be impaired and even simple decisions can become a challenge.
Cyclothymic Disorder is the least severe Bipolar condition and a diagnosis requires that for at least two years the person has frequently experienced symptoms of hypomania and depression. Cyclothymic Disorder tends not to be incapacitating or particularly debilitating. However, it can become more serious if not recognised and responded to. Rapid Cycling refers to the experience of four or more episodes of significant mood swings within a twelve-month period.
The principal aim of treatment is to secure as much stability of mood as possible, as well as in related thoughts, behaviours and sensory sensitivity to enable the person to function as effectively and as safely as possible in daily life. This may be achieved through a combination of health education, lifestyle changes, psychotherapy and prescribed medication. A luxury private treatment centre like Clinic Les Alpes has the resources necessary for such a holistic approach.
To avoid the disruption caused by severe and intense swings from one extreme to the other, medication is generally an essential component of any treatment plan for Bipolar Disorder. Mood stabilisers like Lithium are commonly prescribed, generally to be taken over the long term and sometimes in combination with other medicines. Particular drugs may be prescribed for major symptoms as they occur. Anti-depressants or anti-convulsants are sometimes necessary, as anti-psychotics may be also. Correct dosage and monitoring of potential side effects is especially important. Considerable expertise and highly tuned clinical judgement are prerequisites of the treatment team.
There is a risk to the person stopping medication without consultation. Practical steps to ensure that medication is taken consistently as prescribed is advisable, such as saving a reminder into a mobile phone.
Demystifying and improving understanding of the condition from which a person suffers helps to reduce anxiety and provides a basis from which to take action to restore wellbeing. Psycho-education therefore plays an important role.
A collaborative examination of the way the person lives their life may shed light on things that threaten stability of mood. Help to improve daily routine, sleep and diet may be called for. It may become clear that the person is living a life in which stress takes a significant toll. Learning stress management — the balancing of demands and fitness to cope with them — may prove helpful. Exercise is likely to prove beneficial. Consideration of lifestyle is also where addictions of one kind or another, including Substance Use Disorder, may come into focus. It may become clear that a dual diagnosis is appropriate, something that will be reflected in the treatment plan.
As with many health conditions, isolation and social disconnection are to be avoided. A good support system is vital. Other people sometimes see signs of an impending episode of hypomania, mania or depression before the person themselves. Group therapy can provide a safe place in which to practice reaching out and receiving helpful feedback from peers. Well-informed family and friends can provide a safety net and resources for recovery, which is why, where possible, involving families in the treatment process is so important. Family members also need support in their own right. Couples therapy may be recommended.
Psychotherapy such as Cognitive Behavioural Therapy (CBT) or counselling can help someone recognise and adjust counterproductive patterns of thoughts, feelings and behaviours. It can be particularly useful in identifying the warning signs that their mood is heading one way or the other and develop preventative or coping strategies. Many people find keeping a journal to monitor stress levels and mood swings a practical help.
In most cases a Bipolar Disorder is a condition that will have to be managed throughout life. With the right help, each individual learns how this works best for them and can achieve the aim of living without frequent recurrence of debilitating major symptoms.