Ramachander (not his real name) is aged 32. While at the University studying law, he felt stressed and developed severe depression, which responded to medicine and talking therapy.
When on medication initially, he continued to feel low and ordered St John’s Wort from the local health food shop and started taking it.
After two weeks, he went high and felt energetic and excited.
Reckless spending
He started spending money that he did not have, buying things that he did not need. He bought several expensive watches on his credit card and stood on the high street giving them away.
He was admitted and settled down. Since then, he has four episodes of feeling high and two of feeling low. His grandfather and an uncle have had similar experiences.
Feeling low
Bipolar disorder is a psychiatric condition in which mood swings occur between low and high. Being low can be depressive with feelings of sadness and unhappiness. Like symptoms of depression such as sadness, uselessness, helplessness, hopelessness, worthlessness, poor self-esteem, a lack of energy, feeling sad and unhappy, tearful, poor concentration, suicidal ideation and thoughts, inability to make decisions.
These symptoms may be accompanied by changes in appetite (too much or too little weight (gain or loss), poor sleep, waking up early in the morning and avoiding people. Libido may be very poor. Mood changes may be related to the time of the day.
Getting high
When high the individual may feel full of energy, creative ideas, excited and happy, on top of the world without any reason, may feel important with thoughts racing. Their speech cannot keep pace with their thoughts.
They may feel overactive, become extravagant, make unrealistic plans and be unaware of their illness.
In both types of mood changes, the individual may feel irritable. Those with a serious condition may have symptoms of psychosis such as hearing voices or seeing things which do not exist. They would have abnormal experiences, believing that they are on an important mission with immense power.
The causes
Bipolar disorder runs in families. There may be physical reasons and sometimes episodes may be precipitated by stress or life events.
It is important that vulnerable individuals keep an eye on what triggers their mood changes.
Managing the problem
Each episode will be treated with specific anti-depressant or anti-manic medication. Mood stabilisers such as lithium, sodium valproate and carbamazepine can be used. Mood stabilisers do not take away mood swings but make the swings more manageable.
In manic episodes, anti-depressants should be stopped and in depression anti-manic agents may need to be stopped.
Lithium is shown to be effective but regular blood tests to ensure that blood levels are within the therapeutic range are essential.
Therapeutic treatment
Talking treatments can help understand managing the mood swings. Different types of therapies can help. Of these, there is some research evidence that cognitive behavioural therapy and couple therapy can help identify stressors at an early stage and interventions put in place.
It would be helpful if those affected maintain a ‘mood diary’ for about three months to identify which of the two conditions, if any, are more common.
Relatives and friends can help by being supportive, understanding and enable patients to navigate their illness.
Seeing a GP as soon as possible and specialist intervention can help reduce the duration and severity of mood swings.
There may be local organisations which can help and support both the patients and their families.
Dr Dinesh Bhugra is Professor of Mental Health and Cultural Diversity at the Institute of Psychiatry, King’s College London and Honorary Consultant at the Maudsley Hospital, where he runs a sexual and couple therapy clinic. He was earlier President of the Royal College of Psychiatrists and Chair of the Mental Health Foundation. He is a Trustee of Care-if. He will take charge as President of the World Psychiatric Association in September 2014. In early 2012, Queen Elizabeth II honoured him with appointment as a Commander of the Order of the British Empire (CBE).
