Remember Dr. Jekyll and Mr. Hyde?

The antagonistic representations of the nature of the same person are NOT fiction. It may happen in reality as well when mood states fluctuate between extremes.

World Bipolar Day is observed on March 30 every year, on the birthday of Dutch painter Vincent van Gogh — one of the most influential artists in the history of Western art. His creativity was paralleled with his mental illness and he was posthumously diagnosed with bipolar disorder.

World Bipolar Day is an initiative by the International Society for Bipolar Disorders (ISBD) partnered with the International Bipolar Foundation (IBPF) and the Asian Network of Bipolar Disorders (ANBD).

Bipolar disorder dramatically affects mood and may result in episodes of depression and elation, which can affect one’s health, productivity, and relationships. World Bipolar Day educates and promotes the spread of information on bipolar disorder through international collaborative efforts.

BIPOLAR DISORDER: WHAT & HOW?

Bipolar disorder, previously known as manic depression, is a severe mental disorder characterized by periods of depression and periods of abnormally elevated mood that each last from days to weeks. If the elevated mood is severe or associated with psychosis, it is called mania; if it is less severe, it is called hypomania. During mania, an individual behaves or feels abnormally energetic, happy, or irritable, and they often make impulsive decisions with little regard for the consequences. There is usually also a reduced need for sleep during manic phases. During periods of depression, the individual may experience crying and have a negative outlook on life and have poor eye contact with others.

Commonly starting between 20-25 years, Bipolar disorder affects nearly 1% of the global population. When it starts earlier in life, it’s associated with worse outcomes. The presence of this disorder in multiple family members, disrupted sleep patterns, alcohol/cannabis addiction, extreme stress, and impaired daily schedule – can all lead to Bipolar disorder, though the exact cause is not yet known. Imbalance in neurotransmitter levels in the brain areas responsible for mood, energy, sleep, and functioning as well as impaired nerve-to-nerve signaling in these areas can all lead to Bipolar Disorder.

Bipolar Disorder can be quite severe and disabling. The frequent swings between a ‘manic’ and ‘depressive’ phase are often undetected and considered to be a normal part of mood fluctuations. Untreated, this illness takes a heavy toll on social life, relationships, and professional domains. With time, mood episodes tend to be more frequent and severe. Irritability and restlessness can increase. During the ‘high’ phase (mania), an individual often does not admit or understand that he/she is ill and refuses treatment. The family needs to identify the signs and initiate treatment. Often, hospitalization may also be necessary to deal with the acute episode. The risk of suicide is high; over a period of 20 years, 6% of those with bipolar disorder died by suicide, while 30–40% engaged in self-harm behaviors. Other mental health issues, such as anxiety disorders and substance use disorders, are commonly associated with bipolar disorder.

TREATMENT

A holistic approach to treatment is necessary.

Several medicines are used to treat bipolar disorder successfully and the treatment depends on the ‘phase’ of the illness (high or low).

Certain medicines called mood stabilizers help the mood to remain stable and prevent the extreme fluctuations that happen in this illness (just like an inverter reduces voltage fluctuations). If there is more than one episode, medicines may need to be continued for a long time, at times throughout life.

Stopping medications without discussion with your doctor and simply for the fear of side effects or stigma – is extremely harmful and carries a huge risk of recurrence of this disorder. Please discuss your concerns, the expected effects/side effects, and the duration of treatment with your treating psychiatrist – well in advance.

Besides, various approaches to psychotherapy (Cognitive Behavior Therapy / Interpersonal Therapy / Social Rhythm Therapy, etc.) are helpful to prevent relapses in Bipolar and maintain mood stability. They are best done by a qualified clinical psychologist in addition to the prescribed medicines. Lifestyle changes are immensely important to keep this disorder at bay, especially regulating your sleep cycle, maintaining proper sleep hygiene, and ensuring adequate night-time sleep. Daily exercises, Yoga, avoiding alcohol and other addictions, proper nutrition, and stress management also help.

SPREADING THE WORD

Perhaps the most important is to identify the early signs of this disorder and seek professional help as early as possible.

There is no stigma or shame in seeking help. The mania or depression episodes do not start in a day. Initially, the signs may be easy irritation, disturbed sleep, increased talking, overspending, change in behavior patterns, reduced social interaction, problems in focusing, feeling or perceiving ‘weird’ sensations, etc. Family members should be on the watch for such symptoms in an individual with Bipolar disorder and seek prompt help in case these appear. This prevents a mood episode from escalating further.

This World Bipolar Disorder Awareness Day – Let’s understand the illness and spread awareness.

Bipolar Disorder can be treated well and disability is prevented in a lot of individuals. Only if we act timely!

About the author– Dr. Debanjan Banerjee, Consultant Neuropsychiatrist, APOLLO Multispecialty Hospitals (AMHL), Kolkata