Treatment

Medication is a critical part of bipolar treatment. It is treated primarily with mood stabilizers, of which there are three types. These are Lithium, antipsychotics, and anticonvulsants. Patients can take up to one medication from each category, depending on the severity of the case. Other medication may include anti-anxiety drugs, sleeping pills and antidepressants. The latter present a risk of provoking mania, and are only used during a severe episode of depression, and only in conjunction with mood stabilisers.

Lithium is the oldest mood stabiliser and is one of the most widely used. It works well but also has many side effects, including possible kidney damage, so for less severe cases other drugs may be preferred.

Antipsychotics do what it says on the tin. They prevent hallucinations and other symptoms of mania that stem from psychosis. They help to balance the brain's thinking mood and perception, though scientists are yet to understand why. One of their main disadvantages is that they stimulate appetite, which may lead to weight gain. I myself have struggled with this and have put on more weight than I would like. Doctors tend to downplay this side effect, maybe to avoid patients being reluctant to take the medication, but it is important to be informed in order to be able to make healthy choices.

Anticonvulsants were initially created to treat epilepsy, but were found to treat bipolar as well. There are a high amount of people with both epilepsy and bipolar, and some even believe them to be two sides of the same coin. This may be why ECT (Electro Convulsive Therapy) is so effective in extreme cases. ECT introduces an electrical current to the brain which induces a seizure similar to those in epilepsy. Despite its bad rep in the media (think: One Flew Over The Cukoo's Nest), ECT is non-violent (it is done under general anaesthetic) and is the most effective treatment, but it does have side effects like headaches and memory problems.

Talking of side effects, it is important not to read the list before taking the treatment, as this may provoke the nocebo effect, which means that you will have negative side effects because you think that you're going to have them. With ECT though, doctors are legally obliged to tell you about the possible side effects, so it's a bit of a catch 22 situation.

All this being said, medication only does 40% of the work, so let's move on to non-medicinal treatments. The main ones of these are psychoeducation, CBT, family focused therapy, mindfulness, and then of course there's having a healthy lifestyle. I'll come back to the latter two in later posts.

Psychoeducation is the name for the workshops that I'm currently doing. In fact, all of my posts so far, excepting the poetry, have been themes that we've covered.  Psychoeducation involves educating and providing information to patients with mental illnesses and to their family members. Patients are given information about the causes, symptoms, prognosis, and treatments for their condition. Learners find out not only what to expect, but also what they can do or avoid to improve their condition. 

CBT stands for Cognitive Behavioural Therapy. This is a type of therapy that I've experienced myself to treat depression. It involves learning to challenge and transform negative thinking and behaviour and often involves writing down negative thoughts, then writing down alternative, more positive ones. For example, if a friend who systematically wishes you Happy Birthday doesn't do so one year, instead of thinking 'They must not care about me anymore' the patient learns to think 'Maybe they have a lot going on at the moment. I should get in touch and see how they are.'

Family-focused therapy was  developed especially to treat bipolar disorder. It was designed based on the theory that a person's relationship with their family is vital to the success treatingof managing their  illness. In FFTs family members are included in therapy sessions  in  order to improve family relationships, which has been found in several studies to help stabilise the person with bipolar and prevent relapses. FFT mainly focuses on educating the family about bipolar disorder, building better communication skills in order to deal with stress, and solving problems together as a family.

Treatment of bipolar disorder is varied and a symbiosis of medical and non-medical treatment is necessary in order to best treat the illness and help the person with bipolar to achieve stability and avoid relapses.

Euthymia

I am currently euthymic. What does that mean? It means that I'm stable; neither depressed nor manic. However it is important to note that euthymia is a phase of bipolar disorder, and the illness is still there even when the person is stable. One does not get cured of BD but one can be stabalised and live normally for decades. However, if the treatment is stopped the patient will relapse, with a 50% chance of relapse within the three following months.

During euthymia it's still possible to suffer from symptoms such as anxiety, hypersensitivity, feeling depressed, having trouble sleeping, and cognitive difficulties (problems with memory, concentration and organisation). However in general the person feels well during euthymic phases. And it's precisely during these phases that there is the most work to do to put into place a healthy lifestyle. Medication only stabalises the person at 40%, the rest is therapy and lifestyle. This includes Cognitive Behavioral Therapy, eating well, sleeping well, and exercising. That is not to say that doing all these things will prevent a relapse, as life events can provoke one, but doing these along with taking medication can greatly reduce the chances of relapse and the severity. It's important to note however that these need to be put in place while the person is stable, as no-one who is experiencing a depressed phase is going to be able to start going jogging, and equally no-one experiencing a manic episode is going to be able to start getting a good night's sleep.

So euthymia's all good, right? Well, not for everyone. After the bright rainbow highs of (hypo)mania, euthymia can feel dull and grey. Some people feel nostalgic about hypomania and may actively seek it out. Stephen Fry has talked about this, as per the illness he is at his most creative and productive when hypomanic. Seeking it out often means stopping medication however, and this is dangerous. People may also stop taking medication because they feel well, but this inevitably leads to relapse, and the more a person relapses, the more likely they are to relapse again, and the more severe those relapses will be. There is also the fact that medication will be less effective after starting it up again after having stopped it.

So basically euthymia is a desirable state, but achieving it doesn't mean that you are cured and it certainly doesn't mean that you can come off of your medication. It can be maintained through medication, but that alone isn't enough and therapy and a healthy lifestyle are also necessary. It's all about balance. 

Mania and me

Mania is both scary and exciting. When I'm manic I am bubbly, more so than usual, until the pressure in the bottle rises and the bubbles fizz up, out of control, leaving the bottle suddenly empty. It's hard to explain to someone who hasn't experienced it, but the closest I can get is being drunk, and getting drunker and drunker until you completely lose control and then waking up with the worst hangover ever, that lasts for weeks, if not days.

There are two types of mania, hypomania and mania. During hypomania the symptoms are less intense, the person is aware that they are behaving differently from normal, and they are able to continue functioning in a somewhat normal manner i.e. going to work. During hypomania the person is more sociable, talks faster than normal, is more productive but needs little sleep, concentrates better, is more creative and is more productive at work among other symptoms. Sounds great, right? Well the problem is that hypomania mostly leads to mania, which is when things start really going out of control. The person becomes euphoric, believes themselves to be very important, spends a lot of money, speaks without stopping, has wild mood swings and becomes unaware of danger. They can even become psychotic and start hallucinating. Basically all the positives are classed under hypomania, while the negatives are pure mania. And mania is always followed by a period of depression, making it doubly negative. 

Looking back I can now see that I was at least somewhat experiencing hypomania during my month long CELTA course when I was training to be an English language teacher. Over a five day period I slept for 15 hours, and yet felt full of energy and was extremely productive, even going so far as to start going running and swimming in the little time that wasn't spent at college or prepping lessons.

I have experienced true mania twice, and was hospitalised both times, but more on that another time.