Bipolar disorder, which used to be known as manic depression, is a mental illness in which the person affected experiences extreme mood swings.
One moment they’ll be on a great high and be very energetic (mania or hypomania), only to reach a low point (depression) later on.
Dr Viresh Manilal Chiman, a psychiatrist practising at Akeso Parktown, says if diagnosed early and treated using a holistic approach, bipolar disorder can be managed with life-changing improvements for the individual and their family who would otherwise be “struggling against a tidal wave of adversity”.
According to the South African Depression and Anxiety Group (SADAG), more than 4 million people in South Africa are living with bipolar disorder.
The different forms of bipolar disorder
“The term bipolar disorder in fact refers to a group of brain disorders that take the form of three conditions, namely bipolar I, bipolar II and cyclothymic disorder,” Dr Chiman says.
- Bipolar I – a manic-depressive disorder that can be with or without psychotic features
- Bipolar II – alternating depressed and manic episodes
- Cyclothymic disorder – a cyclic disorder of depressive or hypomanic symptoms present for more than 50% of the time for a minimum of two years.
- Bipolar depression refers to an individual with known bipolar disorder who is going through a depressive episode.
How do I know if I’m bipolar?
Dr Chiman explains there are multiple factors that can lead to a bipolar disorder diagnosis. This includes genetics, structural brain changes, inflammatory markers and neurochemical abnormalities.
If you have a family history of depression or bipolar disorder, you may be more at risk of the mental illness. Major stressful life events can also bring on or perpetuate an episode. If you’re already diagnosed with bipolar and not adhering to medication and treatment, it can cause a relapse.
An accurate diagnosis is vital
Dr Chiman says people may present with symptoms that look like mania but are actually secondary to another medical condition, or alcohol or substance use. He stresses an accurate diagnosis is therefore all-important.
“It’s important to observe an individual’s thinking, mood and behaviour as part of the diagnostic process. You need to assess the phase a patient is in during an episode and whether there may be any associated psychotic symptoms. Individuals may, for example, experience a depressive episode, a manic or hypomanic episode, or a mixed episode,” he says.
What is a depressive episode?
A depressive episode usually consists of low mood, an inability to take pleasure in usually enjoyable activities, a change in sleep patterns and appetite, feelings of guilt, hopelessness and worthlessness, being indecisive and having suicidal thoughts. If these symptoms are present for a period of two or more weeks, it may indicate bipolar disorder.
What is a manic episode?
A manic episode on the other hand includes the following symptoms for a period of one or more weeks:
- Elevated or irritable mood
- Increased activity
- Being more talkative than normal
- Having racing thoughts or flight of ideas
- Socially inappropriate comments or behaviour
- A decreased need for sleep
- Grandiose thoughts
- Being easily distracted
- Impulsive or reckless behaviour and increased or compulsive sexual behaviour
Hypomania is similar to mania but with less intensity, lasting for at least four days.
“In a mixed episode, the individual experiences a rapid alteration of hypomanic or manic symptoms and/or depressive symptoms,” Dr Chiman says.
Living with bipolar disorder
Dr Chiman says bipolar disorder can be well managed with a multidisciplinary, holistic approach. However, he points out it’s an illness that affects every aspect of a person’s life so it is important to watch it constantly and not let it take over.
“It is an ongoing process and there will be highs and lows. Medication does have side effects and it is necessary to consider risks versus benefits of any medication decision. Despite these challenges, people living with bipolar disorder can have fulfilled and fruitful lives.”
Don’t ignore the signs
If you experience noteworthy shifts in your mood and changes in your sleep, appetite and energy, speak to a doctor.
If left untreated, bipolar disorder can result in chronic and eventually permanent changes in the brain with impairments to cognitive and decision-making abilities.
“Without management, the condition can result in personal relationships being destroyed, problems in the workplace, financial issues, reckless risk-taking behaviour, a risk of alcohol and/or substance use disorders, criminal behaviour and potential harm to self as well as others,” Dr Chiman warns.