It all began in my first job. I was 21 and I experienced my first episode of mania.
I remember some of it vividly and other parts were just a blur. I felt that I was on top of the world, could take on any project and multiple projects.
I couldn’t switch off, and couldn’t sleep. Over the next number of days, my work colleagues noticed that I became very excitable and was speaking really quickly about all sorts of plans and ideas.
My friends outside work contacted my family as they got increasingly worried about me as I became more paranoid. I was hospitalised, treated well and stabilised with medication.
This was followed by a period where I was low for approximately 6 months.
I managed to returned to work. I was diagnosed with bi-polar disorder.
That was over twenty years ago. I am married have two children and work part-time.
Over these years I have had four relapses, mainly associated with me coming off medication as I have felt well.
I like that phase before things go manic, in this phase I am hugely productive, get loads done and feel on top of the world.
I know medications play a big role but would value your thoughts around this?
I am in a stable period on medications.
Dr Eddie replies;
Mary, thanks very much. Let me start with the National Institute of Clinical Excellence (NICE UK) which recommends gold standard treatments for different mental health presentations. For bipolar they recommend a combination of cognitive behaviour therapy (CBT) and medication for treatment.
In my experience some people with bi-polar presentation are tempted to come off their medications during stable periods for differing reasons;
Fed up taking medications due to blunted emotions
Seeking the hypomania phase (that phase before the out of control mania phase)
For creative types (painters, poets, writers) etc coming of this medication can be very alluring!
I need to be very clear here, medications in bi-polar are an essential and critical part of the treatment regime and should never be stopped abruptly.
Medications play a central role in Bi-polar. Four times it appears you have learned this. So I am asking you to commit to staying on your prescribed medications.
Bipolar is a significant condition sometimes called manic depression.
Bipolar while common has different variants and a good quality psychiatric assessment is essential.
The highs are known as manic episodes, where the symptoms put the individual or those around them at risk due to impulsivity, irrationality, aggression or delusions.
During the lows of bipolar are major depressive episodes; prolonged sadness, feeling helpless, hopeless & worthless, pessimism, irritability, worry to name but a few.
So now that I have been totally clear on the importance of medications, psychology can play a significant role too. It can start by with exploring how you view how bipolar has impacted on your life and your relationships. Importantly, understanding what impacts on relapsing and developing your personalised relapse and recovery signature is critical.
Relapse & Recovery
Knowledge of your own relapse signature is too often poorly developed in individuals with bi-polar. I believe you need to tie this down in very clear ways so that you/your family know exactly when to trigger a review and prevent a relapse.
So what’s this? Imagine a traffic light where green is the well zone and what you need to keep doing to maintain this (good sleep, less stress, being assertive etc).
Amber indicating that things were changing and what you could do to manage these changes. This amber phase is important and where you can identify subtle signs that things are sliding, e.g. for depression; less chatty with family, feeling sad, being less productive in work, not returning emails.
Red indicates what you do in an episode and what you could do to manage this, who to contact, linking in with your GP, consultant, community nurse, family members etc.
The more personalised this plan the quicker you can act to ensure you spend as little time as possible in the red zone.
Families and friends need to be brought into this signature planning as often they can be aware of subtle changes in your mood that you might not see.
Planning around managing relapses using a range of psychological strategies, including mood monitoring, and behavioural strategies, depending on whether you are going low or high and good cognitive techniques to manage unhelpful thought processes.
When you notice changes in your mood, you would be able to use these techniques to manage these changes.
In fact, I would encourage anyone with difficulties around mental health issues to look at their traffic light model and do more of what keeps you in the green wellness zone and target early changes that led you towards the red zone.
Manic Phase Symptoms
Increase in physical/mental activity
Exaggerated optimism & self-confidence
Decreased need for sleep
Racing speech & thoughts
Poor judgement, distracted