When extreme mood swings call for immediate medication

From extreme happiness to utter despair, from complete confidence to hopeless insecurity. Bipolar Disorder, also known as Manic Depression, is a psychological illness associated with extreme mood changes - manic behaviour is one extreme of this disorder and depression, is the other.

The disorder typically begins in adolescence or early adulthood and continues throughout life. Depending on the degree of the illness, it is often not recognised as a psychological problem, because it is episodic. Consequently, those who have it may suffer needlessly for years without treatment.

Sometimes Clinical Depression can lead to Bipolar Disorder, says Dr. Raveen Hanwella, Senior Lecturer & Consultant in Psychiatry at the Faculty of Medicine, University of Colombo. The distinguishing characteristic of Bipolar Disorder, as compared to other mood disorders, is the presence of at least one manic episode along with depressive episodes.

No specific cause may be related to Bipolar Disorder, although heredity seems to be a factor, says Dr. Hanwella.

The illness results from a chemical imbalance in the brain which can be triggered by a combination of biological, genetic and environmental factors. Sometimes stressful life events such as the loss of a loved one, or even positive life changes, can trigger Bipolar Disorder. It is generally preceded by Clinical or Major Depression, but can also occur by itself.

A manic episode is an abnormally elevated, unrestrained or irritable mood, not related to substance abuse or a medical condition. It lasts for at least a week, and includes a number of disturbances in behaviour and thinking that results in significant life adjustment problems. Delusions and hallucinations may also occur.

Some people report feeling very good during the beginning of a manic episode, which is the result of a serious judgment problem. Taking uncalculated risks, grandiose thinking, irritability, feeling full of energy and restlessness, rapid talking and an exaggerated belief in one's abilities, are typical during a manic episode. Such people may get into illogical arguments. Others may experience severe anxiety and panic. Their behaviour may result in considerable painful consequences such as the loss of a job, broken relationships, or running up excessive debts due to their inability to think rationally.

At the other extreme, patients go through a severe depressive phase. During this time they experience persistent feelings of sadness, anxiety, guilt and hopelessness. Disturbances in sleep and appetite as well as fatigue are common. They lose interest in daily activities, are unable to concentrate, and may even think of suicide.

Often, says Dr. Hanwella, the depressive behaviour is easier to recognise than a manic episode.

Medication is essential to cure Manic Depression, explains Dr. Hanwella. Even those with the most severe forms of bipolar disease can obtain stabilisation of their moods with drugs.

There are many effective drugs available, with which those suffering from this disorder can continue to live normal and productive lives, he says, adding that in most cases the medication must be continued throughout life to ensure that there are no chances of a relapse. In rare cases, especially if there is a threat to one's own life or the lives of others, hospitalisation may be required for some time, he says. Electroconvulsive therapy (ECT) is also a form of treatment used if the illness is very severe, says Dr. Hanwella, adding that this is a safe and effective method.

He stresses that many people suffering from Manic Depression do not recognise themselves as ill or needing treatment. It is imperative that family members or close friends coerce them to seek help.

Patients also need psychotherapy or counselling in addition to medication says Sameeha Jalaldeen, psychologist at Asiri Surgical Hospital.

This is usually more beneficial after the medication has taken effect to bring them out of a manic phase, since they tend to be more confused and agitated during that time.

The psychologist needs to first identify the main causal factors of the illness - family members or close friends can also help by relating recent incidents in the patient's life and subsequent behavioural patterns. She adds that it is also important to educate family members on the disorder, since family support is crucial in overcoming it.

While patients usually have several questions as well as fears about recurrence of manic episodes, psychotherapy can help them understand their condition as well as learn coping skills. Relaxation therapy is used to ease their tension and agitation. The main focus of the psychotherapy, says Ms. Jalaldeen, is for them to become self-reliant in handling their illness.

With the right treatment regimen, those who have been diagnosed with Bipolar Disorder can continue normal lives, states Dr. Hanwella, adding that many professionals have had successful careers and fulfilling lives despite having this illness.