Up to 29 years old, I was operating at the top of my abilities. A healthy love relationship, several friends on whom I could count on, a promising career as an occupational therapist in mental health, and a master's degree in rehabilitation on the verge of being completed. I was pampered, privileged.

 

But upon reaching 30 years old, bipolar disorder settled into my life like a thunderstorm in a cloudless blue sky. My life was turned upside down. I found myself for the first time in a psychiatric emergency ward. I was terribly sleep deprived, I had delusions that only I understood, and I felt paranoid. According to the doctor on duty, I was having a psychotic mania.

 

During the following year, I had a major depression that robbed me of all my zest for life. I was only the shadow of my former self.

 

Days and weeks passed, I stopped my medication, and I gradually regained my vital momentum. I went back to my work as occupational therapist, and I was enthusiastic about the new challenges I had to face. But rapidly, my condition deteriorated. I found myself stopping to work again and back in the hospital.

 

At the emergency, I experienced seclusion and restraint, that largely humiliated and traumatized me. When I arrived on the inpatient unit, I was really distressed, and I did not feel that the staff welcomed this suffering that I had inside. I, then, turned to the other patients to get comfort.

 

It took a few episodes for my bipolar disorder to stabilize. My latest psychotic manias left me with a particularly bitter taste. When I came back to reality, I realized that I lost what was most precious to me, what constituted my identity: my alertness. As a result, I had to deal with problems of memory and concentration.

 

Here is what bipolar disorder can look like. But it is a complex illness and there are as many different stories as there are bipolar patients.

 

 

Biological mechanisms

 

On the biological level, the scientists observed that for people at risk of developing bipolar disorder or those that have bipolar disorder, there is a disorder in the neuron activity between the parietal lobe and the limbic system. The limbic system enables to go from an alert state to a calm state. In fact, the circuit of the limbic system in the parietal lobe has the tendency to be overactive in bipolar subjects.

 

Some statistics

 

The bipolar disorder affects 1 person out of 100. It affects as many men as women, whatever their ethnocultural origins or their socioeconomic level.

 

 

How does bipolar disorder look like ?  

 

It is a condition where the people who are bipolar have changes in their energy, perceptions and mood. These changes are not adaptive, they can cause serious harm to the person affected as well as their loved ones. The typical age of onset of the illness is between 20 and 25 years old, it can be before or later. The diagnosis is given during a conversation with the psychiatrist and there is no blood test to confirm the diagnosis.

 

There are two types of bipolar disorder: bipolar disorder type 1 and bipolar disorder type 2.

 

 

Bipolar disorder type 1

 

In bipolar disorder type 1, there is a long period of mania (high mood and energy, distractibility, impulsivity and other symptoms). The manic episode is extreme, easily noticed by the others but the person does not necessarily notice it. The manic episode lasts 7 days and more. The person affected has at least three of the following symptoms:

 

• Distractibility: going from one thing to another, much like attention deficit hyperactivity disorder (ADHD) but in a more extreme way.

 

• High impulsivity: making big purchases for example.

 

• Ideas of greatness: the person says that he wants to become president of a country for example, or that he has been chosen by the universe.

 

• Leakage of ideas: the person talks about something and after changes subject randomly and without following a logical order.

 

• Restlessness: difficulty in staying seated and staying calm.

 

• Minimal sleep or no sleep: the person does a lot of things and is not bothered if he doesn't sleep.

 

• Quick talk: there is no place for real conversation.

 

The type 1 bipolar disorder person can have a depressive episode but this is not always the case.

 

 

Depressive episode

 

The principal symptom of depression is a feeling of despondency and hopelessness that: 1) manifests most of the week and lasts most of the day; 2) lasts more than 2 weeks; 3) interferes with work, academic performance or social relations. Other symptoms of depression may be:

 

• Impaired appetite and weight changes;
• Trouble sleeping;
• Loss of interest in work, leisure activities, surroundings and sexual relationships;
• Isolation from family and friends;
• Feelings of incompetence, hopelessness, excessive guilt, pessimism or lack of self-esteem;
• Restlessness or feeling of idling;
• Irritability;
• Fatigue ;
• Memory problems and difficulty in concentration and taking decisions;
• Tendency to cry easily or constant urge to cry;
• Suicide thoughts;
• Loss of sense of reality (e.g. hallucinations, delusions).

 

 

 

Bipolar disorder type 2

 

Bipolar disorder type 2 is characterized by episodes of short mania (or hypomania) and depression. Hypomania is a milder version of mania. For example, the person could be in a 4 days mania or less or in a hypomanic state.

 

Whether in type 1 or type 2, the manic episode is the principal criterion for diagnosing bipolar disorder. It has been observed that people with type 2 bipolar disorder are more often in a depressive state than manic, making it easy to omit to consider bipolar disorder and diagnose depression instead.

 

 

Causes of bipolar disease

 

The impact of heredity is very high in bipolar disorder. In fact, the affected person inherits a susceptibility in his genes to certain environmental factors that can precipitate the disorder. It's not clear which environmental factors increase this susceptibility but stress or trauma in childhood may be involved. One thing is for sure, it's not like the color of the eyes, there isn't a single gene or group of genes involved in bipolar disorder.

 

 

Treatments

 

 

Lithium

 

Lithium, which is in the periodic table of elements, has a positive effect in reducing symptoms of mania (but not in all the patients). It improves the neuroplasticity of the brain, that is, it attenuates the inflammation in the neuronal tissues of the brain. Lithium has a protective effect on the brain, allowing it to better tolerate stress and prevent neurotoxicity caused by the hyperactivity of the limbic system.      

 

In addition, one of the side effects of lithium is that the level in the blood must be measured carefully. Several blood tests must be performed, especially during the first three months of treatment.

 

 

Epival

 

The epival belongs to the family of medications called anticonvulsants. It is used alone or in combination with other anticonvulsants medicines to manage and control certain types of seizures. It is also indicated for people aged 18 years old and older, who have bipolar disorder in order to treat manic episodes.

 

 

Antipsychotics

 

Atypical antipsychotics (or atypical neuroleptics) may be prescribed to treat manic episodes. Some are also used to prevent recurrence of bipolar disorder. Atypical antipsychotics include abilify, olanzapine, quetiapine, risperdal, xeroquel, zyprexa, etc.

 

 

Antidepressants

 

People with bipolar disorder may be prescribed antidepressants during depressive episodes, but caution should be exercised as they can trigger a manic state or frequent mood swings (rapid cycle).

 

 

Ketamine

 

Ketamine causes a rapid, although temporary, reduction in major depression in people with treatment-resistant bipolar disorder.

 

 

Cognitive-behavioral therapy

 

Cognitive-behavioral therapy is a structured, time-limited psychological intervention. In this intervention, the patient works in collaboration with the therapist in order to recognize the relationships between thoughts, emotions, bodily sensations and behaviors. He identifies thoughts associated with problematic reactions and proceeds to a cognitive reassessment in order to explore alternative viewpoints and modulate mood changes. He uses behavioral strategies in order to deal with mood fluctuations (e.g. planning pleasurable activities when there are depressive episodes and hypostimulation plan during periods of hypomania).

 

 

Family therapy

 

Family therapy requires the participation of family members and is centered on improving family adjustment, communication and problem solving.

 

 

Interpersonal therapy and social rythms

 

Interpersonal and social rythms therapy targets relapse factors including changes in circadian and social rythms, the non-adherence to treatment and stressful events. She teaches how to stabilize the daily routine and the sleep and wake cycle as well as to better manage the psychological problems associated with this pathology (e.g. mourning, role transition, isolation, etc.).

 

 

Electroconvulsive therapy

 

Electroconvulsive therapy (ECT) is effective for the treatment of major depression. Usually used in drug-resistant depression, this method allows the massive secretion of serotonin, dopamine and acetylcholine. ECT does not target the manic aspect of bipolar disorder. It's a treatment of last resort because it requires anesthesia and is associated to memory loss.

 

 

Transcranial stimulation

 

Transcranial stimulation is a method that is less invasive that reduces depressive episodes et and intensity of manic episodes. However, it must be considered that this is a new technique and that few clinics or laboratories practice it.

 

 

Lifestyle interventions

 

Lifestyle interventions can also support bipolar people, like getting a good night sleep, doing exercises, have a balanced diet, having quality social interactions, taking advantage of light during the day or better still taking omega-3 supplements. All these actions support the nervous system in a positive way but cannot nevertheless replace the effectiveness of medication.

 

 

The suffering of the affected person

 

Being a person having bipolar disorder, I say without a doubt that this disease causes a lot of suffering, which sometimes feels like surviving rather than living life to the fullest. Moreover, it is not trivial to note that the risk of suicide is 20 to 30 times higher than that of the general population. This statistic is tragic, that is why the loved ones and health professionals should be particularly sensitive to the suffering of the affected person.

 

One of the main reasons that explains this suffering is the fact of being confronted to multiple griefs at the same time. Symptoms of mania or depression, associated to cognitive difficulties (in certain cases), limit the fulfillment of social roles (e.g. career, parenting). The bipolar person is incapable to do what society expects from him, he compares himself to others, which reinforces his depressive feelings.

 

 

 

Stigma and self-stigma

 

Another major cause of psychological suffering is stigma. It's the reaction of a group towards a person having a mental health problem and assigning them a label that categorizes them as deviant. When we are stigmatized, we experience feelings of embarassment, abandonment and exlusion. Stigma can even be caused by loved ones, health care professionals, and can be found in various settings including the workplace.

 

 

 

Stigma can lead to self-stigma, meaning that the person begins to believe these negative opinions about themselves and begins to think that they deserve to be blocked from accessing possibilities. Self-stigma often leads to low self-esteem. I myself have experienced a lot of self-stigma, I continue to live with self-stigma, but with less intensity than at the beginning of my illness.

 

When bipolar disorder came into my life, I was in shock. I was prejudiced against people with mental health problems (even though I worked in this field !). I perceived myself very negatively and I experienced a deep sense of inferiority. It is in this context that I stopped answering calls from some of my friends. I was to ashamed about what was happening to me and I didn't want them to see me as I was. I self-stigmatized. Result: I withdrew into myself and it was the start of the crumbling of my social network.

 

 

How to recover ?

 

When we live with bipolar disorder, we would like to move towards a satisfying and fulfilling life, despite the mental disorder and the presence of residual symptoms. For my part, my job at Groupe Innova enables me to have an active life, to contribute to life in society and to maintain a stable routine that takes into account my capabilities.

 

In addition, even if I sometimes have residual depressive symptoms, I make efforts to enlargen and consolidate my social network. It is important to me that my social environment appreciates me, respects me and hears what I have to say. My entourage is composed at the same time of people living a situation similar to mine and people without mental disorder.

 

Recovery is a process that includes progress and steps backwards. Sometimes it's hard to stay hopeful. However, living with a bipolar disorder does not mean the end of our projects, to the contrary. It is important to keep in mind one of our projects and to take first steps towards it.

 

 

 

A word on bipolar disorder and creativity

 

According to literature, hypomania or a brief period of mania is associated with an increase of creativity. Indeed, during my hypomanic phases, I had the tendency to make more connections than usual. On the other hand, when associations of ideas become too pervasive, mania takes over the creativity.

 

 

Conclusion

 

The health impact of bipolar disorder type 1 and even of bipolar disorder type 2 is important. This disorder undeniably slows down the life trajectories of those who suffer from it. The ups and downs can also be real challenges for the patients and their loved ones.

 

In addition, there is, thankfully, a wide variety of treatments, including pharmacological and psychological interventions. Recovery also involves leading an active lifestyle, having a good social network and cultivating projects that motivate us.

 

With regards to stigma, the best way to fight it is to adequately learn about mental illness and educate others afterwards. More the level of understanding is higher, the less likely people will stay away from someone with a mental health problem.