Navigating the highs & the lows of Bipolar Disorder

Bipolar Disorder is a mental health condition that is characterised by extreme mood swings, impacting millions worldwide. According to the SA Depression and Anxiety Group (SADAG), over 4-million South Africans alone suffer from the disorder. Understanding more about this condition is crucial, as it can affect individuals, families, and communities deeply.

A complex condition

Bipolar disorder is a complex mental health condition that affects approximately 1-2% of the population worldwide. It is a chronic illness that requires lifelong management and treatment.

The disorder is characterised by episodes of mania or hypomania, where individuals experience elevated or irritable moods, increased energy levels, and sometimes reckless behaviour. These episodes are followed by periods of depression, where individuals feel despairing and hopeless, and may have difficulty sleeping or concentrating or functioning in everyday life.

In his paper, Understanding Bipolarity: Do we have a new pandemic of Bipolar Mood Disorders?, local Psychiatrist Dr Kobus Roux, explains that there are differential grades of severity in the spectrum of bipolar disorders, namely:

Bipolar type I disorder is a serious mental illness, with major depressive and/or manic episodes. Manic episodes are serious and last at least for one week with symptoms so severe that hospitalisation is needed to protect patients from hurting themselves or others.

Manic episodes are commonly manic psychoses and many patients end up in involuntary care to stabilise the psychotic symptoms. The incidence is 1,5% – 2% of the population – this number has remained constant for many years.

Bipolar Type II disorder is also a serious mental illness, but many patients receive voluntary treatment or can be treated as outpatients, provided the suicide risk is monitored. The reason for the increase in incidence is because about 40 – 50% of patients who present with major depression (also a disorder) have now  been identified to suffer from a bipolar illness.

The different mood sets

Bipolar moods are defined by two distinct mood states: one characterised by manic behaviour and the other by a prolonged period of depression. These mood swings can significantly affect the patient’s social, financial, academic, and/or economic life. The cycling between these states can occur over weeks or months, or even within the same day.

Manic episodes: These are characterised by an abnormally elevated or irritable mood, along with increased energy, activity, and a reduced need for sleep. During a manic episode, individuals may experience a heightened sense of self-esteem or grandiosity, engage in risky or impulsive behaviours such as excessive spending, reckless driving, or substance abuse, and have racing thoughts or rapid speech. These episodes can vary in severity and may last for a week or longer.

Depressive episodes: Depressive episodes in bipolar disorder are characterised by feelings of sadness, despair, hopelessness, or emptiness. Individuals may lose interest in activities they once enjoyed, experience changes in appetite or weight, have difficulty sleeping or oversleeping, and feel fatigued or lacking in energy. Other symptoms may include feelings of worthlessness or guilt, difficulty concentrating or making decisions, and thoughts of death or suicide. Depressive episodes in bipolar disorder can be severe and may last for two weeks or more.

Causes of Bipolar Disorder

The exact cause of bipolar disorder is unknown, but it is believed to be a combination of genetic, biological, and environmental factors. People with a family history of Bipolar Disorder are more likely to develop the condition. Imbalances in neurotransmitters, such as Serotonin and Dopamine, may also play a role in the development of bipolar disorder.

Recreational drug use may also trigger an episode or psychotic episode. Additionally, stressful life events, such as trauma or loss, can trigger episodes of mania or depression in individuals with a genetic predisposition.

Check out Maintaining your mental health

Treatment of Bipolar Disorder

Treatment for Bipolar Disorder is not a one-size-fits-all approach, and usually requires a blend of medication, therapy, and lifestyle adjustments. Determining the optimal medication or treatment combination may require several attempts before you get it right. The primary objective of any treatment plan is to stabilise mood, lessen the frequency and intensity of episodes, and enhance overall quality of life.

Medication: Mood stabilisers, antipsychotics, antianxiety medications, and antidepressants are commonly used to manage symptoms of bipolar disorder. Individuals with bipolar disorder must work closely with a psychiatrist to find the exact right medication regimen.

It is important to note that some of these medications can increase the chance of birth defects if taken while pregnant. They can also lower the effectiveness of birth control drugs, and they may not be safe to take while breastfeeding.

Therapy: Psychotherapy, such as cognitive-behavioural therapy (CBT) or interpersonal therapy, can be beneficial in helping individuals manage the symptoms of bipolar disorder. Therapy can help individuals identify triggers, develop coping strategies, and improve communication skills. Children of parents with Bipolar Disorder can also benefit greatly from CBT to better understand their parent’s behaviour and learn tools for how to deal with them when a manic episode occurs.

Lifestyle changes: Maintaining a regular sleep schedule, eating a balanced diet, exercising regularly, and avoiding drugs and alcohol can help tremendously. Medications with codeine, recreational drugs and excess intake of caffeine should also be avoided as they can act as mood destabilisers.

Holistic remedies: Holistic approaches like mindfulness practices, bright light therapy, acupuncture, regular exercise, and herbal remedies can complement traditional treatments for bipolar disorder. Omega-3 fatty acids, St. John’s Wort, 5-HTP, and Saffron extract are believed to have mood-stabilising and antidepressant qualities.

Visit: A mom battling with Borderline Personality Disorder

Newly discovered treatments 

Researchers are constantly exploring new treatments for bipolar disorder. Here are some promising treatments offering hope for individuals who do not respond to traditional antidepressant medications: 

• Botulinum Toxin Therapy: Injecting botulinum toxin into the brow muscles of bipolar patients in one study led to remission in bipolar depression in two-thirds of participants, and reduced symptoms of depression in the remaining participants.The “cure” only lasts as long as the toxin, and treatment needs to be ongoing.
• Ketamine: Better known for its use as an anaesthetic medication in both humans and in veterinary medicine, ketamine was recently discovered to have antidepressant effects in lower doses by antagonising the NMDA receptor.
• Interpersonal and Social Rhythm Therapy (IPSRT): This is a type of psychotherapy designed to treat bipolar disorder. It focuses on stabilising daily routines and managing interpersonal relationships to regulate biological rhythms, such as sleep and meal times. IPSRT aims to reduce stress and stabilise mood by improving social interactions and maintaining a regular daily routine.
• Psychadelics: Research is currently being conducted into the benefits of micro-dosing of mushrooms and other hallucinogenic drugs in the treatment of some psychiatric disorders.

*Please consult a healthcare provider before starting any holistic remedy to avoid interactions or adverse effects.

Also read: My bipolar journey