Much too bright and far too gloomy.
Text: Béatrice Koch
People with bipolar disorder go from manic highs to periods of depression. Those who learn to recognize the warning signs, however, have a good chance of living a stable life.
From the top of the world to the depths of despair – this is the reality for people with bipolar disorder. “We all have good and bad days,” says Anne Guhn, head psychologist at the Center for Affective, Stress and Sleep Disorders, Basel University Psychiatric Clinics (UPK). “But when someone has bipolar disorder, these mood swings become extreme.”
She mentions a former patient to illustrate just how extreme they can be: “In the manic phase, he felt that he had been chosen for special tasks. In the depressive phase, he found his existence to be absolutely meaningless and planned his suicide.”
They feel good – but have a medical condition.
Bipolar disorder is an affective disorder, which means a person’s emotional state changes noticeably, and repeatedly, over a longer period of time. The disorder takes different forms and occurs at different frequencies: Some people go through several phases of illness throughout the year, while others remain on an even keel for years after an episode.
However, they all fluctuate between depressive periods of sadness and lethargy, and manic phases of euphoria and drive: “In a manic phase, they feel like they could do anything they put their minds to,” says Guhn. “They are confident and fearless, talk a lot more than normal, jump from one idea to the next and require very little sleep.”
Often they do not see their manic periods as a burden; after all, they feel good and are bursting with energy. It is only in hindsight that the dark side of the high point becomes apparent: In their impulsivity, they may alienate their friends or colleagues. Some commit adultery because their libido can be heightened during the manic phase. It is also common to accumulate debt: Guhn tells of people who spent hundreds on taxi rides or luxury items.
Because people with bipolar disorders tend to overestimate themselves during manic phases, they can find themselves in dangerous situations, for example when driving. A euphoric phase will frequently be followed by immediate depression. Guhn explains: “It’s as though the body has to recoup all the energy it used up in the manic phase.”
These examples highlight the seriousness of a manic-depressive disorder. This makes it all the more important to begin treatment as early as possible. However, it takes five to ten years on average to obtain a diagnosis. This is partly because the condition often progresses gradually, and light and dark phases are less pronounced at first and therefore more difficult to identify. Guhn also thinks this is partly because the public is less familiar with bipolar disorder than with depression, and the signs are often wrongly interpreted.
Yet the condition is very common: Around three percent of the population will develop it in their lifetime. Men and women are equally affected.
Stress as a trigger.
Bipolar disorder typically first appears during adolescence or early adulthood. It can have various causes, including genetic influences, environmental factors and personality traits. It is usually triggered by stressful situations such as the end of a relationship, the loss of a job or the death of a loved one. However, it can also be triggered by positive events such as a promotion or wedding.
Treatment aims to mitigate the symptoms of mania and depression, and lengthen the intervals between episodes. As Guhn explains, “when bipolar disorder is diagnosed, we cannot rule out new phases of illness, precisely because they are influenced by multiple factors. So when treating an acute phase, it is all the more important to take steps to prevent another phase from occurring.”
” Treatment comprises a combination of mood-stabilizing medications, psychotherapy and psychoeducation: The better a person knows the illness, the better they can prepare for stressful situations, interpret warning signs at an early stage and get help if needed. The people around them also need to play their part: Relatives will often spot a noticeable change in behavior faster than the person themselves.
“People with bipolar disorder have to look after themselves particularly well,” says Guhn. A healthy lifestyle with plenty of sleep, exercise and regular meals is even more important for them than for people with no psychological conditions.
Living with the condition.
For the treatment to work, it is crucial that patients accept the disorder as part of their lives. This isn’t an easy step to take: “Many people are confronted with a diagnosis in early adulthood, just as they are thinking about their future.”
While their friends are going travelling and starting careers, they have to seriously think about whether they can reconcile their dreams with their condition. But if they can accept it, then they have a good chance of a stable life – even in a severe case, as demonstrated by the patient mentioned at the start of this article: After several inpatient hospital stays within a short period, he now lives in a shared apartment and is pursuing regular work. “He’s open about his condition and knows it’s a part of him,” says Guhn.
More articles in this issue of UNI NOVA (November 2024).