Living with
Bipolar Disorder

What is bipolar disorder?

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes extreme changes in mood, energy and the ability to function.
Mood swings usually from ecstatic, irritable and/or aggressive (manic) to sad and hopeless (depression). Periods of fairly normal mood can be experienced between cycles.

What are the different types of bipolar disorder?

There are many types of bipolar disorder, but the three main types are discussed below:

• People with bipolar disorder type I have had at least one manic episode and periods of major depression. This was also just called ‘manic depression’ in the past.
• However, people with bipolar disorder II have never had full mania. They experience hypomania (a mild form of mania) and major depressive episodes.
• In cyclothymia there are, for a period of at least two years, several periods or episodes of hypomania and mild depression, which are never severe enough to be classified as full manic or depressive disorders.

How might you recognise bipolar disorder?

Depending on which type of bipolar disorder you have, you may have varying degrees mania and/or hypomania. Mania and hypomania are two distinct types of episodes with similar symptoms, but mania is more severe than hypomania and may cause more noticeable problems at work, school, social activities or in your relationships.

Both a manic and a hypomanic episode must include three or more of the below symptoms:

• Excessively high, euphoric mood (being abnormally happy or upbeat)
• Increased activity, energy, agitation and restlessness (being ‘jumpy’ or ‘wired’)
• An exaggerated sense of wellbeing and self-confidence
• Aversion to sleep
• Unusual sociability, talkativeness and rapid speech
• Racing thoughts (these are consistent, persistent, often intrusive thoughts that come in rapid succession and that are difficult to stop)
• Easily distracted
• Poor decision-making; for example, sexual risk taking or expensive shopping sprees
• Binge eating, drinking and/or drug use
• Denial that anything is wrong.

Mania may also trigger psychosis, a dangerous condition where you lose touch with reality. Psychosis requires immediate medical attention and hospitalisation.

A major depressive episode, on the other hand, includes symptoms that are severe enough to cause noticeable difficulties in you carrying out your daily activities, and must include five or more of the below symptoms:

• Depressed mood, such as feeling sad, empty, hopeless or tearful for most of the day (remember, a depressed mood can appear as irritability in children or teenagers)
• Loss of interest in normal activities or feeling no pleasure in anything at all
• Significant, unexplained weight loss or gain, or a decrease or increase in appetite
• Either insomnia or hypersomnia (too much sleep)
• Either restlessness or slowed behaviour, including speech or emotional reactions
• Fatigue or loss of energy, tiredness, listlessness and irritability
• Feelings of worthlessness, shame or guilt
• Decreased ability to concentrate, including indecisiveness
• Suicidal thoughts or behaviour.

What causes bipolar disorder?

According to the South African Depression and Anxiety Group (SADAG), an estimated 3-4 % of South Africans have bipolar disorder.

While the exact cause of bipolar disorder is unknown, it may be a combination of biochemical, genetic and psychological factors.
Approximately 50 % of patients with bipolar disorder have at least one parent with a mood disorder, hinting at a genetic contribution, meaning that if you have a family member, especially a parent or sibling, with bipolar disorder then you are probably at greater risk of developing the condition yourself.

Men and women are affected equally by bipolar disorder and it usually first develops between ages 15-25 years.

The following may trigger a manic episode:

• Life changes such as childbirth
• Recreational drug use or alcohol abuse
• Trauma or periods of high stress
• Periods of sleeplessness
• Medications such as antidepressants or steroids.

How is bipolar disorder diagnosed?

If you are worried about extreme mood changes in yourself or a loved one, and these mood shifts disrupt daily life and normal functioning, then contact your doctor or healthcare provider for help.
The earlier you get help, the easier bipolar disorder is to treat and manage, so be open and honest with your doctor or mental health professional.

Your doctor may diagnose you or your loved one with bipolar disorder through one or more of the following ways:

• Physical examination and history taking: While talking and interacting with a patient, a doctor can also observe their behaviour and general mood and ask questions about their general daily-life experience and family history.
  Your doctor can also look for signs of underlying medical conditions, like thyroid disease, that can cause depressive episodes and changes in mood. They can also take a blood sample to do laboratory tests to check thyroid hormone levels in your body.
  People with bipolar disorder also have an increased chance of having migraine headaches, heart disease, diabetes and other physical illnesses which your doctor can screen for.
• Psychiatric exam: A psychiatrist or psychologist will talk with you about your thoughts, feelings and mood. They may use a questionnaire to help them. They will also determine whether you have any other mental health condition, like an anxiety disorder or substance abuse, that are associated with bipolar disorder. They may also want to talk to your family or people you live with to determine your everyday functioning.
• DSM-5: Your doctor or mental health professional may use the criteria for bipolar disorder listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association (these are the symptoms listed earlier).

Living and managing

Coping with bipolar disorder can be challenging. Here are some strategies that may help you or your loved one affected by the condition:

• Stick to your treatment plan: Always take your medications as directed, even if you think your bipolar disorder is better. Do not skip your medications because symptoms are likely to return or worsen.
  Also check with your doctor first before taking other medications, including any over-the-counter medications, vitamins, herbal remedies or other supplements, as these may cause unwanted interactions with your bipolar disorder medication.
  Importantly, do not stop going to therapy sessions either, no matter how difficult they are.
• Avoid alcohol and using recreational drugs: Alcohol and recreational drugs can worsen bipolar disorder symptoms or trigger manic episodes. One of the biggest concerns with bipolar disorder is the negative consequences of risk-taking behaviour, including with drug or alcohol abuse. Get help if you have trouble quitting on your own.
• Maintain healthy relationships: Friends and family members can provide support and help you watch for warning signs of mood shifts.
• Pay attention to warning signs: Addressing bipolar disorder symptoms early can prevent episodes from worsening. You may be able to identify a pattern to your bipolar disorder episodes and what triggers them. Family members and friends can also help you identify you are displaying symptoms and what may have triggered them.
  Have a plan for if you experience an episode, including contacting your doctor or mental health professional.
• Stay generally healthy: It is important that you exercise regularly, eat a healthy diet and get adequate sleep to help manage your mental health condition successfully. But check with your doctor before starting any exercise program.
  If you take lithium, you must talk with your doctor about appropriate fluid and salt intake.
  Additionally, if you have trouble sleeping, talk to your doctor or mental health professional about how you can manage this.
• Consider keeping a mood chart: Keep a record of your daily shifts in mood and how they relate to treatments, sleep, activities and feelings. This can help identify any triggers and when treatment needs to be adjusted.
• Learn about bipolar disorder and join a support group to empower and motivate yourself to stick to your treatment plan. Get more resources to help you cope and to reduce any negative feelings or stigma you may feel about having bipolar disorder.
  Find out more about bipolar disorder on Let’s Talk. You can find resources that you may find useful in helping to manage stress and stay positive. You can also find out about where to get help if you are struggling to cope and need someone to talk to.
• Stay involved in regular activities and hobbies and practise relaxation and stress management techniques: Explore healthy ways to channel your energy, such as hobbies and recreational activities. Do not let bipolar disorder get in the way of you enjoying your normal life and try to continue normal daily activities, like going to see friends or family.
  Additionally, try out stress management techniques such as meditation, visualisation, muscle relaxation, massage, deep breathing, yoga or tai chi, that may help ease stress and anxiety.

What treatment is available for bipolar disorder?

Bipolar disorder requires long-term treatment, since it is a chronic, relapsing illness.
The most effective treatment plan includes a combination of medication, psychotherapy, lifestyle changes and social support.

Psychotherapy used to treat bipolar disorder includes cognitive behavioural therapy (CBT) and family-focused therapy. Psychotherapy may help you gain self-insight, change negative thoughts and feelings, and learn new behaviours and coping strategies. Talking about your emotions with a trained professional can help reduce symptoms.

Diagnosis of this disorder can be tricky, and medication should be monitored closely by a psychiatrist. Medication is used to stabilise the extreme mood swings of mania and depression.

Mood-stabilisers provide relief or prevent acute episodes of depression or mania. Antidepressants, on the other hand, treat the symptoms of depressive episodes. Common mood stabilisers used in the treatment of bipolar disorder include lithium and lamotrigine.

Anti-psychotics, meanwhile, treat psychotic symptoms such as delusions or hallucinations. Long-term maintenance treatment between episodes reduces the severity and frequency of depression and mania.

Bipolar disorder medications are powerful drugs. For this reason, medication should not be stopped without a doctor’s supervision.

When to call a doctor?

Over and above normal consultations, call the doctor when you or your loved one experience the following:

• Suicidal or violent feelings
• Changes in mood, sleep or energy levels
• An increase in bipolar disorder medication side-effects
• An acute medical illness, a need for surgery, or a need for other medications.

What are the potential complications of bipolar disorder?

The vast majority of people with bipolar disorder respond well to treatment. The first step is to discuss your symptoms with an experienced professional, like your family practitioner.

However, if left untreated, bipolar disorder can have serious impacts on an affected person’s quality of life, including, but not limited to:

• Problems related to recreational drug and alcohol abuse
• Suicide or attempted suicide
• Legal or financial problems
• Strained or damaged interpersonal relationships
• Poor work or school performance.