While the term ‘manic depression‘ is still widely used in everyday language, in 1980 it was replaced by a bipolar disorder in the formal psychiatric classification. Bipolar disorder is severe and is not always experienced in the same way by those affected.
This is recognised by the DSM-5, which mainly, but not exclusively, divides bipolar disorder into bipolar disorder I, bipolar disorder II, cyclothymic disorder (often referred to as bipolar III) and bipolar disorder, which is not otherwise specified.
Mania is a defining phase in bipolar disorder, in which the person experiences periods with an intensely elevated mood. Bipolar mania can last for several months or just a few days. This may include irritability, raging thoughts, unusually intense energy, or extreme manifestations of various behaviours.
This can be interspersed with periods of depression that show symptoms such as bad mood, greatly reduced morale and motivation, feelings of hopelessness and physical sluggishness.
Hypomania is a slightly less intense version of mania. Hypomanic episodes occur with a diagnosis of bipolar II disorder along with alternating episodes of depression. Hypomania can sometimes turn into mania. Cyclothymic disorder is the least severe bipolar disorder, and diagnosis requires that the person has had frequent symptoms of hypomania and depression for at least two years.
These do not have to be serious enough to be classified as either a hypomanic episode or a depressive episode. Cyclothymic disorder tends not to be unable to act or to be particularly debilitating. However, it can become more serious if it is not recognised and answered. From understanding how the fault works to practical steps to restore stability, understanding the condition you are suffering from helps reduce anxiety and provides a foundation on which to take measures to restore well-being.
Examining the way the person lives their life can reveal things that are jeopardising mood stability. Psychotherapy or counselling can help them identify patterns, particularly warning signs that mood is going in one direction or another, and develop prevention or coping strategies.
Medications are often an integral part of any treatment plan to avoid disruptions caused by dramatic and intense fluctuations from one extreme to the other. Ines Santiago of leading Swiss Health & Wellness facility Clinic Les Alpes explains that, ‘typically, treatment entails a combination of at least one mood-stabilising drug and/or atypical antipsychotic, plus psychotherapy’. The most widely used drugs for the treatment of bipolar disorder include lithium carbonate and valproic acid (also known as Depakote or generically as divalproex).
Practical steps to ensure that medications are taken consistently as prescribed are advisable such as storing a reminder in a mobile phone. The aim of the therapy is to achieve as much stability as possible in the mood as well as in related thoughts, behaviours and sensory sensitivity. This can be achieved through a combination of health education, lifestyle changes, psychotherapy, and prescribed medication.
As with many health problems, isolation and social separation should be avoided. A good support system is crucial. Other people sometimes see signs of an upcoming episode of hypomania, mania, or depression in front of the person himself. Well-informed family and friends can help provide a safety net and recovery resources if this should occur.
Dennis Relojo-Howell is the founder of Psychreg.
