Bipolar Disorder

Ruchi, my neighbor, was finding it very difficult to cope with her daily life. This difficulty cropped up in her life some 3 years back, when she was pursuing her Masters from a reputed institution in Kolkata. There were days when she was happy and outgoing, but often irritable, while on other days, she would be extremely sad and anxious. There were ‘up’ periods, when Ruchi had a lot of energy and would engage in a lot of activities. These periods would then change to ‘down’ periods which were marked by hopelessness, an inability to even participate in the regular activities, feelings of hopelessness and often, even suicidal thoughts. These symptoms would make it difficult for her to sleep, stay focused and in general, get along with her daily life.

When she came to discuss these problems with me, I explained what the symptoms could imply and that she should get an assessment done at the earliest. As expected, her assessment result revealed that Ruchi is suffering from what is termed as Bipolar Disorder.

Bipolar Disorder is a debilitating mental disorder which is a chronic, but episodic condition, that is, the symptoms are present occasionally and at regular intervals. In the earlier days, this condition was referred to as the ‘Manic-Depressive Disorder’ or ‘Manic Depression’.

Bipolar Disorder generally consists of three states:

  • A phase of Mania;
  • A phase of Depression; and
  • A relatively symptom free state when the person can easily engage in the activities of daily life.
chart

The symptoms of Mania or a manic episode may be presented as follows:

  • A long period of being in an overly happy or outgoing mood, that is, a constant state of feeling ‘high’;
  • Feeling extremely irritated and agitated;
  • Racing thoughts, where the person tends to talk very fast, racing from one idea to the other;
  • The person tends to be easily distracted;
  • The person tends to feel extremely energetic and tends to take on several new projects at the same time;
  • The person is generally restless, with very less need for sleep;
  • The person develops an unrealistically optimistic opinion about his/ her abilities;
  • The person tends to behave impulsively and tends to take part in a lot of pleasurable, high risk behaviours, such as impulsive buying, impulsive sex, impulsive professional engagements, etc.

When the person shifts from the manic state to the depressed, the person tends to exhibit the exact opposite range of symptoms. The symptoms of the depressive episode may be presented as follows:

  • The person tends to experience persistently depressed mood, with long periods of feeling worried and empty;
  • The person loses interests in activities, even the ones that he/ she used to enjoy, including sex;
  • A continuous state of feeling tired and ‘slowed-down’ is experienced by the person;
  • Difficulties with concentrating, remembering and taking decisions become common;
  • Feelings of restlessness and irritability are present in the depressive episode as well. But there are qualitative differences with the ones in the manic episode;
  • There are marked changes in habits, like eating, patterns of sleeping, etc;
  • Thoughts of death, suicide and suicide attempts are common.

In case of Bipolar Disorder, medication is the primary line of treatment. However, along with medications, the person must simultaneously engage in sessions of Psychotherapy. The modes of Psychotherapy that are generally found effective in the treatment of Bipolar Disorder are as follows:

  1. Cognitive behavioral therapy (CBT) helps people with bipolar disorder learn to change harmful or negative thought patterns and behaviors.
  2. Family-focused therapy includes family members. It helps enhance family coping strategies, such as recognizing new episodes early and helping their loved one. This therapy also improves communication and problem-solving.
  3. Interpersonal and social rhythm therapy helps people with bipolar disorder improve their relationships with others and manage their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes.
  4. Psychoeducation teaches people with bipolar disorder about the illness and its treatment. This treatment helps people recognize signs of relapse so they can seek treatment early, before a full-blown episode occur. Usually done in a group, psychoeducation may also be helpful for family members and caregivers.

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