Sunday March 30, 2008
Ups and downs
By Dr SHUNITRA DEVI CHANDRA SEGRAN
Is your life an emotional roller coaster? If its a constant ride, there is a possibility that it’s bipolar disorder.
LIFE is full of up’s and down’s. Some days are “bluer than blue” and some days are a walk in the park.
Scientifically, regulation of moods is, among others, a complex function of the human brain. Just like all other diseases of the human body, loss of this regulatory function leads to an individual with a mood disorder known as bipolar disorder.
In the manic phase, the person may go on a spending spree, only to totally regret it when they shift to the depressed state. What is it?
Bipolar disorder (BPD) is a medical condition characterised by extremes of mood. A person with BPD may experience swinging between the two poles of mood – from episodes of extreme elevated mood (mania) to episodes of extreme low mood (depression), with or without periods of normal mood in between.
Each mood swing is called an episode and may last for days, weeks or even months.
Unlike ordinary mood swings, these episodes are more intense and disruptive to everyday functioning, affecting energy, activity levels, judgment and behaviour.
BPD is a serious illness as psychosis and suicide are of grave concern for those diagnosed with this disorder. BPD was previously known as manic-depressive disorder.
BPD is estimated to exist in about 2% to 2.5% of any given population. However, the prevalence is most often under-reported due to several reasons – misdiagnosed as other mood disorders (manic phases may be diagnosed as pure schizophrenia), limited public awareness, and the social stigma of mental disorders, especially among Asians.
BPD affects both men and women, although the depressed phase is twice as often in women compared to men.
BPD first appears in late adolescence or early adulthood. It is rather unusual to present for the first time after the age of 45 years. More recently, even children and teenagers have been reported with BPD.
What causes BPD is still a puzzle to many scientists. Most believe it is a combination of biochemical, genetic and environmental factors that are to blame.
Imbalances in certain brain chemicals called neurotransmitters such as serotonin have been implicated in the dysfunction of the brain’s mood regulation system.
The existence of the disease among close family members has suggested a genetic link, but gene identification is still under investigation.
Stresses such as death in the family, divorce and other mentally traumatic occurrences could also trigger the first episode of mania or depression.
Signs and symptoms
Although BPD is treatable, many people don’t recognise the signs, and as a result, deny themselves any treatment.
Since BPD actually worsens without treatment, it is important to recognise the signs and symptoms of this disorder, not only in one’s own self, but those around you as well.
Mania feels good at first, but it has a tendency to get out of control easily. For example, people tend to be reckless in their spending and impulsive in their actions.
Hypomania is a milder form of mania where one is able to carry on with their day-to-day life and is much less disruptive.
The depressive phase is somewhat an exaggerated opposite of mania. Often there is a sense of disengagement from reality and low energy. Severe episodes have been associated with suicide as a major risk factor, especially in those with a family history of suicide, early onset of the disease or a history of drug and alcohol abuse.
Seeking help
Living with untreated BPD can cause problems in almost every aspect of life, from your career to your relationships to your outlook on life.
Bipolar sufferers get into trouble with debts, unwanted pregnancies, drug and alcohol addictions and of course, are at a much higher risk of suicide compared to the general population.
Depression too affects the nerve cells in the brain, predisposing to dementia and a weaker immune system in old age.
It is important to recognise that BPD is a very treatable condition, but it is also a very recurrent disorder. The three key factors that determine the success of keeping this disorder under control are controlling the symptoms, returning to normal function and preventing recurrence.
Controlling symptoms
The mainstay of initial treatment remains controlling the acute episode of mania or depressive state medically with pharmacological agents.
Given in the right dose and the right duration, this acute episode is usually successfully reversed with medication. However, these agents require time to penetrate the brain cells to further stabilise the condition. Dosing correctly and giving the right dose for the right duration of time is equally important when prescribing mood stabilisers.
Returning to normal function
Normalisation of functions is attempted as the next step in therapy and this usually requires lifestyle modification efforts in addition to medication. Strong counselling, advice on managing sleep and even some time off work to recover is often helpful.
Preventing recurrence
BPD is notorious for its recurrence. Chances of recurrence are higher when the first onset occurred before the age of 20 or in the very old.
As such, prevention of the next episode is as important as treating a current episode.
A good treatment plan involves:
1. Medication
An episode of bipolar depression is treated with antidepressants while an episode of mania requires anti-manic agents.
More importantly, this should be combined with a mood stabiliser agent at the same time. This is to prevent the chances of pushing a depressed patient into the manic phase during the treatment with antidepressants and vice versa.
Mood stabilisers that are established in this role include sodium valproate and lithium.
2. Psychosocial therapy – counselling and motivation.
3. Leading a healthy lifestyle
4. Alcohol and drug avoidance – rehab therapy when necessary
5. Sufficient sleep
6. Good family and social support
Conclusion
BPD is a common disorder and unfortunately often ignored or neglected by both the patient and the physician.
It is important to realise that a diagnosis of BPD is not an indictment on your character. Just like any other illness, it merely reflects a dysfunction in one of the areas of the brain.
While living with BPD can be unhealthy for both the patient and all around, getting it treated makes a drastic difference to one’s life.
Related Stories:
Sign and symptoms of bipolar disorder
Warning signs of suicide
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