Living with Bipolar Disorder
28 May 2020
Formerly called “manic-depressive illness" or "manic depression”, bipolar disorder is the fourth most-common mental health problem worldwide, affecting almost 4 million people in the UK, according to the Mental Health Foundation. It predominantly appears between the ages of 15 and 25 and persists for the rest of one's life. In its most typical form, the patient alternates between periods of abnormally elevated moods (manic episodes) and depressed moods (depressive episodes). The World Health Organization ranks it as the 6th most common disorder in the world.
How do we recognise the symptoms of bipolar disorder? What are the characteristics of a manic episode? How is the disorder managed?
What is the difference between "normal" mood changes and bipolar disorder?
According to Dr. David Gourion, a psychiatrist, "normal" mood changes will not have a functional impact on a person's life. The question is therefore to observe whether these mood changes prevent the person from working or caring for his or her family, if they prevent the person from "functioning".
Who can diagnose bipolar disorder?
Bipolar disorder is very difficult to diagnose because there are no biological markers. On average, there is a 10-year gap between the first episode and diagnosis. However, there are "clues": depression that starts very early before the age of 20, depressive periods that begin and end very quickly, a poor response to antidepressants, a very strong seasonality of the disorder, etc. According to Dr. Gourion, this is a really complex problem because we must not under-diagnose people with bipolar disorder by treating them with antidepressants, but we must also not over-diagnose by prescribing mood-regulating treatments to people who do not need them. A general practitioner can obviously make this diagnosis, but patients often turn to a psychiatrist.
Couldn't an episode "help" lead to a diagnosis?
Generally, undiagnosed bipolar patients seek help during depressive states. They are therefore prescribed antidepressants. However, antidepressants can be misleading because they will relieve the depression in the short term but aggravate it in the long term by triggering a manic or euphoric episode. The problem here is that patients generally cope very well with these episodes, so it is rare that they return to see their doctor at this point in time. So it's a vicious circle. It is often family and friends who spot a problem.
What does a manic episode look like?
In Bipolar I patients, there is a feeling of invincibility and detachment from reality. The patient may think he or she is capable of anything, make grandiose plans with an overflowing imagination and hardly sleep at all. All this agitation subsides suddenly, triggering an episode of depression. In Bipolar II patients, the mood episodes are less intense. Patients experience episodes of hypomania, which are of shorter duration and do not completely disconnect the person from reality. Patients may also experience a form of omnipotence; they may want to take control of the situation. He or she is certain that they possess the truth and have flashes of insight and brilliance. These more "discreet" episodes are, however, more difficult to detect and can therefore have a dramatic impact on the patient's life. A person who indulges in a reckless shopping spree or exhibits uninhibited behaviour in the evenings may be "excused" by those around him or her until the point of "one too many times".
What treatments are available?
It is vital that bipolar disorder be treated, as 20% of untreated bipolar patients commit suicide. It is vital that we take care of it because 20% of untreated bipolar patients commit suicide. Lithium remains the standard treatment, with 70% of patients who respond positively to it. The remaining 30% do not respond well or only partially respond and require combination therapy strategies. Today the therapeutic arsenal has been significantly broadened with, in particular, anticonvulsant drugs and atypical antipsychotics. However, finding the right combination can take time. The psycho-education of the patient and his or her family and friends is essential, as are the different types of psychotherapy.
What are the signs that might indicate the onset of an episode?
Sleep problems are a very important marker because they are often the first symptom of an episode, and they can also be a triggering factor. Patients who pull an all-nighter for professional or personal reasons will sometimes trigger an episode. It is therefore essential to establish a regular sleep pattern and a healthy lifestyle. Meditation, breathing exercises or sophrology can help. Alcohol and cannabis, on the other hand, should be avoided.
Is bipolar disorder hereditary?
Very little is known for certain about the heredity of bipolar disorder, but there is usually a history of bipolar or mood disorders in relatives. Suicide attempts are also a marker. For children of a bipolar patient, they have a 5-10% risk of developing bipolar disorder themselves. It is therefore advisable to remain vigilant in order to detect possible signs. However, "these children also have a 90 to 95% chance of not developing bipolar disorder at all," insists Dr. Gourion.
How to find support on Carenity?
Carenity currently has thousands of patients and relatives of patients affected by bipolar disorder. On the platform, you can find support from other members of the community. Join our current discussions below!
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