Understanding bipolar disorder: Here’s how a 32-year-old learnt to live with it

Those suffering from this condition often rationalise their emotional response but the reasons behind them aren’t linear. What they feel may not make sense or appear logical to you. But to them, it feels like you are not “getting them” and they become angrier.

I traced back Jagdish’s symptoms to a couple of months ago and found that he had a manic increase in energy levels, decreased need for sleep (averaging 2-3 hours per night), and a heightened sense of being right, always. He had shown “risky behaviours” like online gambling and reckless driving. He had extreme emotional surges and troughs, classic signs of bipolar disorder, and his parents told me that his performance had declined drastically due to his restlessness and high distractibility. He had been sent home from work quite a few times due to his “intolerance towards colleagues”.

His family reported that he had been engaging in impulsive decision-making, excessive spending in online gambling and uncharacteristically increased social interactions. His speech was rapid and circumstantial, and Jagdish expressed unrealistic plans of becoming an “overnight multimillionaire.” At times he seemed euphoric, at times fidgety.

What were his triggers?

Jagdish had no significant medical conditions. But like most bipolar patients, he had a genetic history of mental health disorders. His mother had once been treated for depression while his maternal uncle had been treated for an unspecified mood disorder. So he had a family history which flared up in his adult years.

Approximately a year before this episode, he had a six-month period of low energy and social withdrawal, which his parents attributed to his “break-up.” But that could very well have been the trauma that triggered his flare-up and behavioural change and caused an imbalance in brain neurotransmitters like dopamine and serotonin.

Which therapy works?

Bipolar Disorder is a lifelong condition but it can be managed with drugs and psychotherapy. We initially put Jagdish on antimanic and mood stabilising drugs. That helped Jagdish realise that he had a problem. Then we started cognitive-behavioural therapy (CBT) or talk therapy to change his thought patterns and help him with coping strategies in the real world.

We also trained Jagdish’s family so that they could monitor his medications and sense potential depressive episodes. Jagdish followed a structured lifestyle routine of diet, exercise and sleep. Though he was an occasional drinker, we advised him to go off alcohol which depresses the patient more than elevating them. After three months, Jagdish had fewer mood swings and could even control them. Then we put him on mindfulness-based stress reduction techniques like meditation. After a few weeks, Jagdish himself enrolled in an online support group and regained his normal rhythms. He could sense warning signs. His attendance and productivity at work improved, too.

However, periodic relapses are always possible, so patients have to be on therapy and medications for an extended period of time, necessitating regular follow-ups and long-term monitoring. But they could do without stigma that only fuels their anxieties and makes them the guilty party.

(Dr Ajinkya is psychiatrist at KDAH, Mumbai)