Therapeutic Focus
Bipolar Disorder
BIPOLAR DISORDER TREATMENT AND REFERRAL GUIDE
The Depression and Anxiety Support Group
1999 / 2000
QUOTES FROM PATIENTS
"The highest, biggest, quickest, can't
keep up with it all, can do it all, from can't possibly fail to
irritation to rage, and finally to the lowest, murky chamber of
hell where the darkest of moods slowly strangles every hope..
and, maybe, in-between all is all right."
"..screeching thoughts race
on the road to oblivion.."
"Depression: I doubt completely my ability to do anything well.
It seems as though my mind has slowed down and burned out to the
point of being virtually useless.. [I am} haunt[ed].. with the
total, the desperate hopelessness of it all.. Others say, "It's
only temporary, it will pass, you will get over it," but of
course they haven't any idea of how I feel, although they are
certain they do. If I can't feel, move, think, or care, then
what on earth is the point?"
"Mania: The fast ideas become too fast and there are far too
many .. overwhelming confusion replaces clarity.. you stop
keeping up with it - memory goes. Infectious humor ceases to
amuse. Your friends become frightened.. everything is now
against the grain.. you are irritable, angry, frightened,
uncontrollable, and trapped"
"Hypomania: At first when I'm high, it's tremendous.. ideas are
fast.. like shooting stars you follow until brighter ones
appear.. all shyness disappears, the right words and gestures
are suddenly there.. uninteresting people, things, become
intensely interesting. Sensuality is pervasive, the desire to
seduce and be seduced is irresistible. Your marrow is infused
with unbelievable feelings of ease, power, well-being,
omnipotence, euphoria..you can do anything..but, somewhere this
changes."
Descriptions offered by patients themselves offer valuable
insights into the various mood states associated with bipolar
disorder.
INTRODUCTION
Manic Depression is more than just a simple mood swing. You
experience a sudden dramatic shift in the extremes of emotions.
These shifts seem to have little to do with external situations.
In the manic, or "high," phase of the illness you aren't just
happy. You are simply ecstatic. Great burst of energy can be
followed by a severe depression, which is the "low" phase of the
disease. Periods of fairly normal moods can be experienced
between cycles. These cycles are different for different people.
They can last for days, weeks, or even months.
Symptoms of the manic phase include behaviour that is out of
proportion to how you would normally act. You feel excessively
good, "on top of the world," and nothing will change your
happiness. You are optimistic to the extreme. You may even have
grandiose delusions. Nothing can stop you from accomplishing
anything you want. Nothing can go possibly go wrong. You spend
money like the proverbial "drunken sailor". Sex is great,
fabulous, you can't get enough. You good judgement and caution
have vanished.
You can be so hyperactive you can literally go for days with
little or no sleep. You mind races. It is full of ideas like a
car without brakes. In conversation you change from topic to
topic in rapid fire fashion. You speak too loudly and rapidly.
Others fail to understand you as your thoughts and speech become
disorganised and incoherent. At times you can become enraged for
not reason or when someone suggests you plans are unreasonable.
If not treated, this phase can last as long as three months. But
typically the depressive phase of the illness sets in. The
symptoms of this phase of the disease are the same as the
"regular" clinical or major depression.
Although manic-depressive illness can be disabling it also
responds well to treatment. Since many other diseases can
masquerade as manic-depression, it is important you or your
loved on receive a competent medical evaluation as soon as
possible.
Now let's talk about how we
can help.
This booklet will help answer that question and others related
to treatment for bipolar disorder. It was created to help you
understand how treatment may make living with bipolar disease
easier:
As you read, you'll discover what you may expect from therapy
and medications, how they work alone and with other treatments,
and when to call your physician and/or mental health
professional. You'll learn about the different types of bipolar
disorder and respective symptoms.
And you will also learn about ways to help yourself. At the back
of this booklet you will find basic guidelines, a chart to help
monitor your moods and a list of resources to help you learn
more about bipolar disorder.
What is and how to Recognise Bipolar?
WHAT IS A BIPOLAR
DISORDER?
Bipolar disorder is a physical illness marked by extreme changes
in mood, energy and behaviour. That's why doctors classify it as
a mood disorder.
Bipolar disorder - which is also known as manic-depressive
illness and will be called by both names throughout this
publication - is a mental illness involving episodes of serious
mania and depression. The person's mood usually swings from
overly "high" and irritable to sad and hopeless, and then back
again, with periods of normal mood in between.
Bipolar disorder typically begins in adolescence or early
adulthood and continues throughout life. It is often not
recognised as an illness, and people who have it may suffer
needlessly for years or even decades.
Effective treatments are available that greatly alleviate the
suffering caused by bipolar disorder. This brochure contains
some frequently asked questions about bipolar disorder.
WHAT CAUSES MANIC
DEPRESSION (OR BIPOLAR DISORDER)?
The exact cause of manic depression is not known, but it is
believed to be a combination of biochemical, genetic and
psychological factors.
Biochemistry
Research has shown that this disorder is associated with a
chemical imbalance in the brain, which can be corrected with
appropriated medication.
Genetics / Herediatry
Bipolar disorder tends to run in families. Researchers have
identified a number of genes that may be linked to the disorder,
suggesting that several different biochemicals problems may
occur in bipolar disorder (just as there are different kinds of
arthiritis). However, if you have bipolar disorder and your
spouse does not, there is only a 1 in 7 chance that your child
will develop it. The chance may be greater if you have a number
of relatives with bipolar disorder or depression.
Biological Clocks
Mania and depression are often cyclical, occurring at particular
times of the year. Changes in biological rhythms, including
sleep and hormone changes, characterise the illness. Changes in
the seasons are often associated triggers.
Psychological Stress
People who are genetically susceptible may have a faulty
"switch-off" point - emotional excitement may keep escalating
into mania: setbacks may worsen into profound depression.
Sometimes a stressful life event such as a loss of a job,
marital difficulties, or a death in the family may trigger an
episode of mania or depression. At other times, episodes occur
for no apparent reason. Research continues to be needed to
identify more clearly the causes, of manic depression and to
find better ways of treating it.
The earlier treatment is started, the more effective it may be
in preventing future episodes.
WHO GETS MANIC DEPRESSION?
Manic depression is common - affecting about 1% of the
population. Men and women are equally affected. While the
disorder has been seen in children, the usual age of onset is
late adolescence and early adulthood. Mania, occasionally
appears for the first time in the elderly, and when it does, it
is often related to another medical disorder. Manic depression
is not restricted to any social or educational class, race, or
nationality. Although an equal number of men and women develop
the illness, men tend to have more manic episodes. Women
experience more depressive episodes. Many people with bipolar
disorder are very well known. Some have won Academy Awards;
others have created literary and fine-art masterpieces, or led
their nations in critical times of history.
Very effective treatments for bipolar disorders are available.
Where to approach for treatment?
IS MANIC DEPRESSION TREATABLE?
Fortunately, the answer to this question is "yes". Treatment in
the form of medication and counselling can be effective for most
people with manic depression.
Bipolar disorder is similar to other lifelong illnesses - such
as high blood pressure and diabetes - in that it cannot be
"cured". It can, however, be managed successfully through proper
treatment, which allows most patients to return to productive
lives.
On the other hand, if not diagnosed and not treated, the impact
of the illness can be devastating to the individual, significant
others, and society in general.
Around 85% of people who have a first episode of manic
depression will have another. Because of this, maintenance
treatment is essential in this illness. Good quality of life is
usually possible with effective treatment.
WHAT ARE THE SYMPTOMS OF BIPOLAR DISORDER?
Over the course of bipolar disorder, four different kinds of mood episodes can occur: 1. Mania (manic episode) During a manic episode, the mood can be abnormally elevated, euphoric, or irritable. Thoughts race and speech is rapid, sometimes non-stop, often jumping from topic to topic in ways that are difficult for other to follow. Energy level is high, self-esteem inflated, sociability increased, and enthusiasm abounds. There may be very little need for sleep ("a waste of time") with limitless activity extending around the clock. During a manic episode, a person may feel "on top of the world" and have little or no awareness that the feelings and behaviours are not normal. Mania comes in degrees of severity and, while a very little amount may be pleasant and productive, even the less severe form known as hypomania can be problematic and cause social and occupational difficulties. A manic episode is more severe than a hypomanic episode with a magnification of symptoms to the extent that there is marked impairment in interpersonal and social interactions and occupational functioning. Hospitalisation is often necessary. Severe mania can be psychotic - the person loses contact with reality and may experience delusions (false beliefs), especially of a grandiose ("I am the President"), religious ("I am God") or sexual nature, and hallucinations (hearing voices or seeing visions). Psychotic mania may be difficult to distinguish from schizophrenia and, indeed, mistaking the former for the latter is not uncommon. During a manic episode, judgement is often greatly impaired as evidenced by excessive spending, reckless behaviours involving driving, abuse of drugs and alcohol and sexual indiscretion, and impulsive, sometimes catastrophic business decisions.
