Bipolar Disorder


‘Highs’ and ‘lows’ are a part of everyday life. However, sometimes, people experience distinct episodes (lasting a few weeks each) of 'lows' (periods of depression), 'highs' (periods of mania or hypomania) or mixed symptoms, with a return to ‘normalcy’ in between these episodes. Put together, these can cause long-term impairments and can adversely affect the one’s personal, work and social life too. If established, they may constitute symptoms of a Bipolar disorder (synonym: Manic-depression).

What is bipolar disorder?

Patients with Bipolar disorder have distinct depressive or manic or mixed phases (episodes). When depressed, patients may feel low in mood with a pronounced lack of interest and energy, which is persistent through the day, evident in most aspects of life & lasts for a few weeks or more.

When manic (or hypo manic if symptoms are less severe), patients feel persistently ‘high’ (elated) or irritable, with associated increase in energy levels, activity levels, and overly optimistic thoughts and plans. Sometimes, patients can also have mixed episodes with symptoms of highs and lows within the same episode.

The prevalence of Bipolar disorders is about 1-2% in the general population. Both men and women are similarly affected.

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What are the symptoms of Bipolar disorder?

Manic phase: In the Manic phase, patients can have an abnormally high or irritable mood, with associated symptoms which lasts at least one week or longer. Behaviours also include elevated sense of esteem, increased energy and activity levels, restlessness, disturbed sleep, etc.

Depressive phase:  The term ‘depression’ is used to describe a clustering of low mood and associated symptoms which are persistent and pervasive for at least two weeks. They are also sufficiently severe to affect sleep, appetite and day-to-day functions. Symptoms also include low mood, sadness, inability to enjoy things which were enjoyable, guilt, inability to concentrate, no motivation, etc.

Treatment:

Pharmacological treatment: Antipsychotic medications tend to be used as first line treatments for acute manic episodes. Antidepressants are often used under cover of a mood stabilising medication like Lithium, Valproate or a mood stabilising antipsychotic. The duration of treatment will depend upon the number and severity of the affective episodes, but will need to be at least 2 years (after a single episode of illness).

Psychological treatment: Psychological treatments focus on educating the patient and the family about the illness. For Bipolar disorders in particular, Cognitive-behavioural principles are used to identify early warning signs (EWS) and measures that would help to prevent a full blown relapse. CBT may also be used to help with the depressive phase of the illness.

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