Bipolar disorder

What would you think if your acquaintance suddenly quit his job as an office clerk, rented a barn for his five new classic cars and from now on wanted to earn his money by restoring old cars? You would probably call him crazy. In a way, you might be right. Because this is exactly the cliché of people who are going through a manic phase.

Mania is one pole of bipolar disorder. The opposite pole is depression. This is a so-called "affective disorder", since it is primarily the emotional sensation that is impaired. The two opposite mood states occur alternately over individually varying periods of time.

Between the manic and depressive episodes, there are phases in which the affected person lives symptom-free. Their mood is then as constant as yours and mine. How long this symptom-free period lasts varies greatly from individual to individual. Anything from a few days to several years is possible. In addition, the rhythm changes in the course of the disease. However, the manic phases are always shorter than the depressive ones. By now, you're probably wondering what these manic and depressive episodes actually look like. For example like this:

I own the world!

About one third of those affected experience a feeling of great euphoria during manic phases. In the remaining two-thirds, the high level of activity is accompanied by irritability. You can recognize manic persons by their great urge to talk, their overflowing ideas and their relatively low need to sleep. They would prefer to do everything at once and immediately. They are extremely active professionally, socially, and sexually. They believe they have special talents or powers. It does not occur to them that certain deeds could have negative consequences. For example, they do not realize that they will not be able to pay off the debt from the purchase of a vintage car.

In addition to the classic mania with full expression of symptoms, there is the so-called "hypomania". In this case, the signs of mania are less pronounced.

I am worth nothing...

Depression is the absolute opposite of mania. The person affected is simply miserable. He is sad, feels useless and possibly wants to take his own life. Nothing gives him pleasure anymore. He doesn't care about things he used to care about. Concentrating or thinking is then extremely exhausting, which is why the affected person is hardly able to make decisions. He can't get himself up for anything and is constantly tired. Nevertheless, he sleeps little. During a depressive episode, the appetite may decrease. However, he can also go completely overboard. Accordingly, weight fluctuations occur. Affected persons also constantly reproach themselves for trivial things, feel guilty and worthless.

People with bipolar disorder sometimes experience "mixed" phases. In this case, manic and depressive symptoms occur together. This can have particularly fatal consequences when a negative self-image coincides with increased activity. The risk of suicide is then particularly high.

If someone you don't know very well were to meet you during his manic phase, you probably wouldn't get the idea of a mental disorder. Someone who is so active and lively can't be sick. In the depressive phase, sufferers withdraw. Therefore, they hardly encounter anyone who might notice their bad mood. Only the family or close friends have a chance to notice the depression.

Bipolar disorder is often confused with other mental illnesses. For example, about two-thirds of those affected tend to abuse alcohol, drugs or medications. This is then often the primary diagnosis when they are taken to a psychiatric ward. The extreme feelings also promote unusual eating behavior. Sometimes sufferers eat a lot, sometimes they refuse almost any food. Anxiety and panic attacks can also occur. All these additional manifestations cloud the view of outsiders on the actual problem of the affective disorder.

The consequences of the unusual behavior during the depressive as well as the manic phases are often serious: The entire life of the affected person can gradually be destroyed. They sometimes destroy even their social and family relationships. For employers, they are usually unbearable in the short or long term. Ultimately, up to half of those affected commit at least one suicide attempt. Up to one third actually kill themselves in the course of their illness.

The exact causes of bipolar disorder have not yet been exhaustively researched. What is certain is that there are familial clusters, which is why a genetic component is assumed. However, the trigger for the first depressive or manic phase is always an extreme life event. This can be severe stress or a traumatic experience. In the subsequent phases, there are then no specific causes. If the disorder remains untreated, it often continues with increasingly rapid successive phases. The symptom-free intermediate phases then become noticeably shorter.

Approximately one to two out of every one hundred people will develop bipolar disorder in the course of their lives. Around 75% of those affected experience their first episode before the age of 25. In retrospect, patients almost always recall first signs of extreme mood swings in their teens. It is very rare for a person over 40 to be newly diagnosed with bipolar disorder. Overall, men and women are affected about equally often.

Dealing with people suffering from bipolar disorder is extremely delicate. For example, they do not feel ill during manic phases - quite the opposite. In depressive phases, they tend to lack any motivation to do anything. They then believe, for example, that they are not worthy of therapy. In the symptom-free intermediate phases, they then actually have no problems. So motivating to therapy can be very difficult. If you suspect a bipolar disorder in a friend, you have to approach him with tact and patience. Ultimately, sufferers are more likely to end up in a psychiatric ward because of their extreme behavior during a manic episode or because of a suicide attempt than because they allow themselves to be persuaded into therapy.

Therapy itself is also complicated. The goal is to prevent further episodes. This is because each episode increases the likelihood of more and more manic and depressive episodes.

Both medication and classic psychotherapy are used in the therapy. Lithium has proven to be effective for phase prophylaxis. However, it quickly hits the kidneys, which is why older patients should only take it with great caution. The therapist also teaches the patient as much as possible about bipolar disorder. They must learn how to assess themselves and recognize new episodes at an early stage. Ideally, relatives also receive information about the illness and how to deal with the person affected. The main aim is to improve sleep with the help of relaxation techniques. The overall success rate is mixed: one year after an inpatient stay, around half of the patients are still fully compliant.

The emotional life of people suffering from bipolar disorder fluctuates between two extremes. During a manic phase, they feel energetic, active and euphoric or irritable. If they go through a depressive episode, they are depressed, listless and feel worthless. There are symptom-free periods between these extreme mood states. The exact time course of the phases varies greatly from individual to individual. For laypersons, the disorder is very difficult to recognize. Many sufferers tend to abuse alcohol, drugs or medication, which appears to outsiders as a dominant disorder. Typically, bipolar disorder manifests between the ages of 20 and 30. The risk of suicide is very high with this mental illness. Nevertheless, those affected accept therapeutic measures very poorly on average. The primary goal of therapy is to prevent further episodes with the help of medication and psychotherapeutic interventions.