Bipolar disorder, previously known as manic depressive illness, is a mental disorder that is characterised by periods of depression and periods of abnormally elevated mood.
How common is this disorder?
An estimated 4.4% of U.S. adults experience bipolar disorder at some time in their lives. More than 2 million American adults or 1 percent of the population age 18 or older in any given year have bipolar disorder. India has much lower, around 0.1%. But considering our population, even that becomes a very significant number
How long are these episodes?
A typical manic phase lasts for approximately 4-6 months and depressive phase for 6-9 months. What are the symptoms of mania?The elevated phase is known as mania or hypomania, depending on its severity. During mania, an individual behaves or feels abnormally energetic, happy, or irritable. They are over confident, over groomed, over religious and over spend. Individuals often make poorly thought out decisions with little regard to the consequences. They may be hyper sexual and behave in a disinhibited manner. The need for sleep is usually reduced during manic phase. Patient wakes up much earlier than his usual time and over works himself to exhaustion. The symptoms of psychosis may be present.By psychosis it means that patient may believe he is special and has unusual powers known as delusion of grandeur. He may also report hearing voices praising him, singing or God talking to him.
What happens in depression?Opposite happens during depression when they are gloomy for more than 2 weeks with lethargy, over-sleep and reduced interest in previously pleasurable activities. They report sadness and become slow and quiet. Patients become dejected and find life hopeless. Patient may attempt suicide.
Is there a risk of self harm?
The risk of suicide among those with the illness is high at around 6 percent while attempts at self-harm occurs in 30–40 percent of the patients.
How is the course of the illness?Patient may have the first episode in their third decade. The index episode may be depression or mania. There may be many years gap till the next episode. Subsequent episodes may happen more often and some patients have episodes every year, sometimes around the same time of the year. Over decades depressive episodes may become more prominent though initially manic episodes cause major disruptions.
Are other comorbid conditions also present in bipolar illness?
Other mental health issues such as anxiety including obsessive symptoms like repeated thoughts may be there and substance over use during episodes is also common. Case Study
Jennifer * had never felt depressed like this before in her 43 years of life. Why did her husband leave her? She would not be able to work, felt heavy and had become slow. She would find it difficult to have bath even. How should I die? She would think of Suicide often. Her sister reported that this must be her 10th episode with each lasting 3-4 months. In some episodes she would be an express train. She would wake up at 3 am and overwork. At that time she would talk non-stop and call relatives late in the night. She would go to neighbours house and talk about irrelevant things. She would scold her husband and in laws and all the wrong they have done to her. Then there would be episodes like this in which she would be totally opposite and behave meek and withdrawn. She had tried to take her life in the past during this phase. She would lie down most of the time and not talk. Her major problem was that she refused to take medication regularly especially during the high phase.
Treatment of Bipolar Illness
The aim of treating bipolar illness is to establish stability of mood. Mood stabilisers are the mainstay treatment. Lithium, sodium valproate, carbamazepine, oxcarbamazepine , topiramate, lamotrigene are the various options. Atypical antipsychotics such as quetiapine, olanzapine, risperidone, lurasidone are also prescribed. Antidepressants may be required for brief period during a severe depressive episode.
ECT ( Electro Convulsive Therapy) helps in violent and suicidal patients. It is a safe procedure. Non- medication therapy are given side by side to ensure understanding of illness, drug compliance, regular sleep and routine. Abstaining from alcohol will improve outcome. Treatment is often required life long. Medication may be lowered in remission and have to be hiked during an acute episode. In rare cases medicine may have to be camouflaged and given to patient if he does not agree to take medication. Comorbid drug abuse needs treatment.
Treatment helps. It improves quality of life. It reduces risk of suicide. It improves functionality and productivity. Left untreated, patients eventually become dysfunctional and suicidal in depressed phase and violent and disruptive in manic phase. They may lose their job and get divorced and separated from partner. Accidents, Suicide lead to loss of life.Overall better to treat than not to. We may be helping the patient to remain a productive member of society. Bipolar disorder is a form of mental illness which has an episodic life long course. Treatment consists of mood stabilisers which are required life long. Drug compliance reduces relapse and improves functioning and quality of life.