Bipolar disorder, sometimes called manic-depressive illness affects over 2 million adults in this country. It usually emerges in early adulthood but some people experience their first episode in childhood or adolescence. The illness causes a disruption in mood and includes depressive episodes and periods of mania or hypomania. However, it is a very treatable disease and people who receive treatment can live a long productive life.
It is a very disruptive and distressing disease, both for the affected person and his or her family. When depressed, the person may feel hopeless and withdraw from family and friends, even becoming suicidal. During a manic episode they may feel euphoric and behave in a grandiose manner or become irritable or aggressive and engage in reckless behaviors. They may feel highly motivated and start monumental and unrealistic projects or come up with outlandish schemes. Spending sprees and reckless driving can result in financial and legal problems. Sexual escapades and work failure can ruin marriages and careers.
The euphoria experienced during manic episodes can be so hard to resist that people do not want to seek treatment. An increase in goal directed activity can lead to getting a lot done but without sleep the person eventually crashes. A family member may have to coax them into hospitalization or call for emergency treatment. This can be especially difficult if the affected person becomes combative.
Seeing a spouse or parent in this condition can traumatize family members. They may feel angry because they perceive the condition to be a controllable behavior problem. They may feel relieved when the person is out of the home and guilty for their reaction. It is important for family members to realize that the illness is not the person's fault, and at times is beyond their control. It is a brain disorder. Medication is usually the first line of treatment for the disorder and can help calm a person's mood.
Mood stabilizers and some anti-psychotics may be used. It is important to take them as prescribed. Even with medication, moods may change drastically and careful monitoring is critical. A daily mood chart can be helpful when trying to identify social and environmental stressors and triggers that might exacerbate the condition.
Because an affected person may not recognize or feel there is a problem, it can be useful to make a contract with their spouse or parent in advance that spells out what steps will be taken at the first signs of trouble. That may include an immediate appointment with the psychiatrist or hospitalization. A lack of need for sleep, racing thoughts, uncharacteristic irritability or aggression, yelling, and increased sexuality or reckless spending can indicate an emerging episode.
The disorder appears to be genetically transmitted but stress seems to play a role in its emergence. Keeping stress manageable is critical. Family members can help by eliminating behaviors that are over-stimulating and changing patterns that cause conflict. Highly emotional arguments and yelling need to be avoided. Periods of quiet time are important. A good daily routine, including healthy meals and exercise is essential.
During depressive and manic episodes, the individual may experience psychosis. Their thinking may become delusional and they may sense, see or hear things that are not real. Colors, smells, and imagery may become more vivid and intense. Movies, plays and even some church services can be to stimulating and worsen psychotic symptoms. Some forms of meditation and yoga can be too mystical during these episodes and should be avoided until the person is stable. Substance abuse frequently accompanies the disorder and may be an attempt to self-medicate the mood swings. Substance abuse treatment is critical. Mood altering substances, including caffeine, destabilize the brain, disrupt mood and sleep patterns, and interfere with the transmission of medication in the brain.
Psycho-social therapy can help a person identify social and environmental stressors and restructure their routine to reduce stress and increase stability. Cognitive-behavioral therapy helps correct distorted thought patterns and increase behaviors that promote healthy attitudes and more successful relationships.
The earlier the treatment the better. Although it can be a very disruptive disease, treatment is available and constantly improving. A happy healthy life is a very realistic expectation.