Arjun, a college fresher was taken to be the happiest boy on earth by his friends during the first week of college. He dressed well, cracked jokes and during every off period he strummed his guitar making his own lyrics. Many girls fell for him right away and he found that very flattering. Some of his friends were however quite surprised when he said that he was thinking of contacting Sting and was sure that he would win the Grammy Award in near future.

Two weeks later Arjun won the second prize in the music competition of his college. On hearing the results he smashed his guitar and tore all the lyrics he had made. He started calling the judges bad names and said that they had lobbied the results or he would have surely secured the first position. He started to come to college unshaven, his hair would be in a mess and he smoked whenever he could. When he was asked by a professor to leave the class due to inattentiveness, he tried to throw himself of the balcony.

Luckily Arjun was saved. He was taken to the psychiatrist and is now undergoing treatment for bipolar disorder.

Bipolar Disorder, also known as manic depressive psychosis is a serious mental disorder characterized by cyclic mood swings, the patient oscillates between extreme sadness and happiness. During a manic phase there is hyper-excitability, extreme elation, excessive motor activity, boundless energy, rapid flight of ideas, inflated self esteem, lack of need of sleep, engaging in hazardous activities, talkativeness, increased sexual drive, pursuing goal directed objectives. During a depressive phase a person feels deep despair, retardation of ideas, hopelessness, lack of self confidence, uncalled for guilt, decreased sex drive, under activity, unresponsiveness, poor professional / academic performance, fatigue, difficulty in concentrating and decision making, restlessness, irritability, over sleeping, loss of interest in pleasurable activities, change in appetite (sudden weight loss or weight gain) and sometimes suicidal impulses. Statistics show that one out of five people suffering from bipolar disorder take their lives. 

A manic episode is diagnosed if elevated mood occurs with three or more symptoms daily, almost every day, for one week or longer. A depressive phase is diagnosed if at least five symptoms last most of the day, nearly every day, for a two week phase or longer. When the mania is mild or moderate it may be termed as hypomania.

It is a popular misconception that the manic phases are less harmful than the depressive phases. Though manic phases may be characterized by elation; it is often accompanied by irritability, over spending, poor judgement, substance abuse, unrealistic belief in one’s abilities, provocative and obnoxious behavior. When a person is on a manic high he may just deny that there is a problem with him and wish that the euphoric stage persists. Interestingly many bipolar patients have had to be hospitalized during manic phases. Psychiatrist, Dr. Satyajit Ash says,” Though a person may feel happy, hopeful and look towards a brighter future during a manic high, the condition definitely needs medical attention as they behave irrationally and lose their sense of judgement. If their wishes are opposed during a manic phase they often tend to get violent.” 

The diagnosis of Bipolar Disorder may often may often be confused with schizophrenia because bipolar patients often suffer from typical psychotic features of schizophrenia like paranoid ideation, delusions and hallucinations. Indeed, neuro-imaging studies suggest neuro-developmental similarities between schizophrenia and bipolar disorder. Anxiety disorders specifically post traumatic stress disorder and obsessive compulsive disorder are very common in bipolar patients. Many of them in fact become alcoholics and drug addicts.

Doctors are yet to find a definite cause for bipolar disorder. It may be caused due to an imbalance in certain chemical messengers in the brain called neurotransmitters. Bipolar disorder is often seen to be running in families proving that it does have a strong genetic component. If one twin is bipolar there is 50 % chance that the other identical twin will suffer from the same ailment. Too much or too little thyroid hormone can lead also to mood swings.

The onset of bipolar disorder is usually during the late teens or early twenties. Some however have symptoms as a child too. By definition, bipolar disorder is recurrent. Research shows that 90 % of people who have a manic episode go on to have future ones. On an average a person has four episodes in ten years. When more than four episodes occur within a year, then the ailment is a rapid cycling one. Bipolar patients have poor peer relationships, marital break ups and often lose their jobs.

Sabita Maiti, Case Coordinator of Paripurnata, a halfway home in Kolkata shares a case of bipolar disorder they treated, ”Teena had her first depressive episode when she was in Class XII. She dressed in dirty rags, wandered aimlessly in the streets, scavenging garbage for food. The people of her community admitted her to Pavlov Mental Hospital and was later brought to Paripurnata. Mood swings were quite recurrent in her. Sometimes she would be cheerful, laughing, telling everyone she had so many qualities and wanting to draw attention. Other times she would be in tears, thinking her life was hopeless, that nobody loved her and thought her to be a victim of circumstances of her bitter past. But she was treated for her illness and is now back at home and well.”

Like every other mental ailment, bipolar disorder is treated through medication and counseling. A patient must approach the doctor early otherwise it may become a life time ailment making suicide a likely consequence. Medications known as mood stabilizers are usually prescribed to control bipolar disorder. For 80 % of bipolar patients, lithium effectively controls symptoms. Anticonvulsant medications may be used along with lithium. Anti-depressants are not always recommendable because though they may alleviate depression they may trigger a manic high in the process. Anti psychotics are often effective during the manic stage. If mood swings are triggered by thyroid problems, thyroid pills are to be taken in addition to the usual medication. 

Cognitive behavioral therapy helps bipolar patients to change harmful thought patterns and behaviors. Family therapy helps to reduce distresses within the family. Interpersonal and social therapy helps to solve relationship problems and better social skills. 

* The names of the mentally ill patients have been changed for sake of privacy.