Mood swings are the lot of every human being. Under the influence of situational factors (emotional loss, temperature or seasonal variations, financial gain or loss, promotion or demotion, etc.), our mood may vary over the course of the same day, season, or year.
For most people, these mood swings are proportionate to the causal event and they stabilize in no time; however, for someone with bipolar disorder, mood swings are out of all proportion to events. They are of such intensity that he or she is no longer aware that his or her exuberance or anger exceeds all limits, or his or her depression is such that he or she is paralyzed by it and haunted by suicidal thoughts.
This imbalance leads to problems at work, with family and friends, to financial and legal problems. It may lead to suicide, to bankruptcy, hospitalization or imprisonment.
In the process of diagnosing this illness, it is important not only to take into account the clinical state at the time of the consultation, but also to explore the history of earlier states (longitudinal medical history) and the genetic history: research into similar phenomena among siblings (brothers and sisters) and forebears (parents, maternal and paternal uncles and aunts).
Classically, the illness includes a phrase called depressive (low) and a phase called manic (high), hence the terms manic depression or bipolar affective disorder. It should be remembered, however, that there is a “normal” phase when the individual is functioning relatively appropriately. Among certain individuals who are carriers of the illness, phases called mixed can be seen, where the two phases merge.
The depressive phase is characterized by:
- a sad mood
- a slowdown in thinking processes
a slowdown in motor functions
- Sad mood
The individual has a “heavy heart,” he or she loses all taste for enjoying life and is given to crying; he or she blames himself or herself for things in the past, puts himself or herself down, may think he or she has an incurable disease and wants to die. Everything is black.
- Slowdown in thinking
The depressed person has difficulty formulating his or her thoughts. Ability to concentrate and attention span are diminished, responses are often monosyllabic, as if he or she is unable to form a complete sentence.
- Slowdown in motor functions
All activities become painful for a depressed person, he or she has lost all interest in them. He or she might spend days sleeping because he or she is constantly tired. Bathing, brushing teeth, dressing, feeding himself or herself, become chores that he or she tries to avoid. Appetite alters, he or she gains or loses weight, has no energy or pleasure and becomes more and more solitary. He or she often stays in bed, but suffers from insomnia, preoccupied by pessimistic ideas. Suicide may seem like the only solution to this unbearable suffering.
The manic phrase is the opposite of the depressive phase. It is characterized by:
- an exalted mood
- an accelerated thinking process
- Exalted mood
The mood of the manic person is exuberant, exalted. But it’s not like the vitality and optimism seen in entrepreneurs.
He or she is extremely confident of his or her powers and charm, is convinced and convincing, and brooks no criticism, becoming easily irritated and angry. On the emotional plane, he or she has affairs, for the pleasure of seducing and being seduced, to experience something different, without thinking about the possible consequences. Inhibitions and tact are totally absent, which may lead to unfortunate consequences with the family, at work, etc.
- Accelerated thinking process
The thought processes of the manic person are rapid, accelerated. Thoughts tumble over each other so much that the verbal flow cannot keep up the pace and he or she abruptly jumps from one subject to another, talking, talking, talking incessantly, even if the audience is not listening.
Since writing takes even more time than talking, his or her writing can be so incoherent, even he or she cannot understand it.
- Motor hyperactivity
The manic person is always on the move. He or she simultaneously undertakes several projects, getting involved without taking the time to examine the details in order to check their validity. His or her judgment is disturbed; sexual activity increases and goes in all directions. He or she does not know his or her limits, does not take the time to eat, never feels tired, and has too many things to do to think about sleeping. He or she can also overspend and gamble compulsively.
If the people around him or her try to calm or counsel him or her to sleep, he or she becomes irritable and considers that they are the ones who are ill. He or she disturbs them, often during the night due to the insomnia and excessive activity.
The patient in manic phase may become distrustful; think that those around are out to get him or her and want his or her belongings. His or her grandiose projects may be accompanied by suspicion, by paranoid comments: he or she feels persecuted, threatened.
This paranoid aspect may, at any given time, be the principal symptom, which could lead an examiner to make an error and incorrectly diagnose paranoid psychosis or paranoid schizophrenia, and recommend a treatment that is inappropriate.
While the depressive, manic and normal phases usually follow each other in what is called a cycle, sometimes depressive symptoms intertwine with manic symptoms. This is called a mixed phase and is characterized, for example, by:
- a sad affect
- an acceleration in thinking process and a slowdown in motor functions
Generally, a cycle is made up of a manic, a depressive and a euthymic phase, i.e., normal, stable mood.
When someone goes through more than four cycles in one year, he or she is considered to have rapid cycles.
The same individual may have several manic and depressive periods in the same day. Usually periods of depression are spread over an average of ten months, while manic phases, characterized by great excitation, last from three to six months.
It is becoming more and more evident that this illness is not acquired through life experience but is transmitted genetically, which explains the higher incidence of bipolar disorder in the same family. While the disorder affects 1% of adults, the incidence increases to 15% in the same family.
The influence of stress on the brain and the accumulation of stress related to existential problems may also trigger a depressive or a manic episode.
A few years ago, researchers discovered the influence of seasonal factors and sunshine on the outbreak of mood disorders:
- the manic phase is more frequent in the middle of summer and fall
- the depressive phase predominates in winter
Some writers believe that behavioural disorders (hyperactivity, anorexia, bulimia, alcohol and drug addiction, some phobias) are early manifestations of affective bipolar disorder.
Some researchers have advanced the theory that the manic phase could be an antidepressive reaction developed by the individual suffering from bipolar disorder.
Who is at risk?
The first signs of the illness appear before age 35, usually in a person’s 20s.
Prevention and care
The basic treatment for affective bipolar disorder is lithium, a salt that can stabilize mood. Until a few years ago, tricyclic antidepressants (TCA) and monoamine oxydase inhibitors (MAOI) were used to combat the depressive state.
However, it was found that antidepressants administered alone quickly provoked the appearance of a manic phase in individuals with bipolar disorder, while antidepressants combined with lithium treatment contributed to creating rapid cycles or mixed phases.
Currently, depressive phases being treated with lithium are considered to be like hypothyroidisms (real or mild) and weak doses of thyroid extracts (L. thyroxine) are recommended.
Similarly, in the case of rapid cycles and mixed phases created by administering antidepressants, thyroid extracts are recommended in progressively higher dosages.
Neuroleptics (also called major tranquilizers) are also recommended for manic phases. However, people with this disorder are very sensitive to neuroleptics and may present particularly marked side effects. Anticonvulsants are now prescribed more frequently, for example:
- Valproic acid
Interesting trials are being conducted with tryptophan, an amino acid, which could help decrease the dosage of lithium and thus reduce the risks associated with high dosages.
Biological treatment, combined with psychotherapy, enables the patient to embark on a psychological approach.
During a crisis, the psychotherapist uses a behavioural approach, which helps limit inappropriate acts on the part of the patient:
- by offering him or her support and information
- by organizing meetings with his or her family
- by involving him or her in the process of accepting the illness
When the crisis period is over, the patient may undertake the following steps:
- Undertake deeper therapy
- Begin a therapeutic approach that involves loved ones
- Participate, with or without loved ones, in support or mutual aid groups
514.738.4873 or 1.866.REVIVRE
Bipolar Disorders Program, Douglas Mental Health University Institute.
The Bipolar Disorders Program is a superspecialized (third line) service of consultation and treatment for adults aged 18 to 65 suffering from bipolar disorders
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