Bi-Polar Disorder (Manic Depression) - Part 1

I have the Bi-Polar Disorder (previously known as Manic Depression). It is regarded as a serious mental illness, although I prefer to think of it purely as a condition. Why make the distinction you may ask? I don't have to, but I feel that if you call it an illness it suggests you're lumbered with this dreadful thing that you can't do anything about, except for taking tablets. To me, if you know you've got Bi-Polar you can set about dealing with it, maintaining your health, avoiding certain things, looking for warning signs of an oncoming episode, reacting to the signs, consulting your medical team, making contingency plans that you implement at the right time etc.

Why am I writing this? I feel I've got to the point where I've had the condition for several years, I have experience of it, and I'm ready to try to help others who may have it, or have already been diagnosed with it.

So, what is Bi-Polar? It's a mood disorder. It means that you may get depressed (at the low end of the polar spectrum), or you might get manic (at the high end). You might not experience anything untoward for some of the time, or you may be in a 'mixed state' with elements of both depression and mania. 

I'm going to talk about mania. Mania is where you are high - you are euphoric, can have grandiose ideas which are unlikely to be fulfilled, you may go on spending sprees and mount up large bills, you may be delusional, be sexually uninhibited. Now, naturally, if you feel those things, you feel good about yourself, much too good about yourself! You feel happy, but in a way that is potentially dangerous. Being manic means that you're on a rollercoaster - you sleep little, you have ideas ... and more ideas and so on. It's like the Hans Christian Andersen fairy story of 'The Red Shoes' that keep dancing, and you can't stop. My most recent manic episodes were in 2009 and 2010.  The Psychiatrist at the time thought that the 2009 one, was the result of a medication reduction that had been made on suspicion of a 'Lithium Tremor' - a concern he had that the mood stabilizer I take was at a toxic level. The 2010 manic episode was probably because I'd injured my back somehow, and was in pain, and my sleep was seriously affected.

In terms of medication I normally take only one drug - Lithium, one of the 'mood stabilizers'.  I take it nightly at a dose thought to be sufficient to maintain the 'Lithium level' in my blood stream. The dose doesn't need to be altered much. Normally on a quarterly basis I have a blood test to check the Lithium level is within a therapeutic range and to check that certain organs are not reacting adversely to the Lithium. Contrary to what I understood at the beginning, the Lithium does not stop episodes (of mania or depression) but is supposed to reduce the frequency of the episodes and the severity of them.

In addition to the Lithium, I need to maintain a healthy lifestyle. In my case swimming has always helped - I was an established swimmer well before I was diagnosed as Bi-Polar, but since then I try to go to the pool 2-3 times a week. In addition I run a short daily distance, walk locally in town and sometimes on the hills not far away. Sounds good doesn't it, but I haven't done much recently! But I should, and it's important to counteract the condition. I drink very little alcohol, and although it's tempting, it doesn't really have any place with the condition and just aggravates it. 'Recreational drugs' are also out.

At this point I'm asking my CPN (Community Psychiatric Nurse) to have a word. His name is Dean Warren :

"I have known Barrie for around a year now and at the beginning of that time Barrie was just coming out of a 'high' phase of his Bi-Polar. Barrie is very easy to work with because he has good insight into his condition, which means he becomes aware of when he is becoming unwell. This allows Barrie to ask advice and seek help early, and small adjustments in his medication or daily routine can help Barrie to manage episodes better, reducing symptoms and helping to stop a pre-manic phase going into a full episode of mania. A lot of the adjustments to his daily routine Barrie makes himself and he is aware of what will over stimulate him, such as continued listening to uplifting music and lack of sleep. Sleep is a good indicator for Barrie of how he is, and is the first real indicator of when he is becoming elevated in mood. However, it is also important for Barrie to remain active so as not to become low in mood at the other end of the spectrum."    

Dr. Melany Liebenberg (Speciality Doctor in Psychiatry) - my Psychiatrist, has kindly contributed as well : "I took over Barrie's care in May 2010. He is on Lithium which is widely used for the treatment of mania and hypomania, recurrent depression and bipolar affective disorder. It is known to reduce both the number and severity of relapses. It should usually be continued for at least 3 years. Barrie has 3 monthly Lithium level and routine bloods done to monitor renal, thyroid and liver functions. Common side effects include fine hand tremor, mild thirst and frequently urinating. It is always a case of weighing up risks vs benefits! Barrie has always displayed good insight, is able to identify early warning signs such as reduced sleep and increased energy in order to intervene and prevent relapse where possible and has a good relationship with Dean from the outreach and recovery team. As Barrie said a healthy lifestyle is also of paramount importance in recovery.

Bipolar affects about 1% of the population, but with adequate treatment and support a normal level of functioning and good quality of life is possible. It can even increase creativity as focus improves."

That's the end of Part 1. I don't know when there will be a Part 2 or other Parts perhaps, but I've been thinking about doing this for a long time, and I'm now keen to make a start, and not have deadlines for anything beyond. Almost certainly Part 2 will cover aspects of depression.