2024 - Manic-depressive disorder (bipolar)

What is it about ?

Bipolar disorder is also known as manic depression. It is a psychiatric condition in which periods of severe depression alternate with periods of mania or hypomania. The affection is responsible for a great psychic suffering. At least 1 in 2 people with bipolar disorder attempt suicide. It is therefore very important to recognize and treat the disease, as well as to avoid relapses.

The condition comes in two forms:

Type 1 disorder: alternation of manic, depressive and mixed periods;
Type 2 disorder: alternation of hypomanic and depressive periods.

Most often, depressive periods take over. But it is fundamental to distinguish between ‘depression’ as an illness and manic-depressive disorder, because the treatment is different.

What is its frequency?

Your risk of having one episode of this disease in your lifetime is approximately 1 in 100. This risk increases if family members have or have had bipolar disorder (family history).

How to recognize it?

The disease involves enormous changes in mood, according to a specific pattern. There may be episodes of depression, hypomania, and mania.

Depression

As in severe depression, this phase is marked by depressed mood, loss of interest, sleep problems, change in appetite, weight loss, less energy, increased or decreased activity. physical or mental, trouble concentrating, feelings of guilt, suicidal thoughts.

Hypomania

This phase is characterized by an improvement in mood, but which does not correspond to the normal state of the person. This phase can last between a few days and several weeks. During this period, at least 3 of the following symptoms are present: physical restlessness, talking a lot, difficulty concentrating and distraction, need for less sleep, increased libido, bouts of irresponsible behavior (for example, throwing money away by windows), more social contacts.

Mania

It is a more severe form of hypomania, which causes the person to function less well. People in this phase can put themselves at risk, but also their families and others. These dangers may be related, for example, to their “hyperactivity” and their lack of judgment.

The characteristics of manic and depressive episodes are sometimes present at the same time or the mood changes very quickly from depression to mania, and vice versa (this is called a “rapid cycle”). The risk of suicide is high during this mixed phase.

How is the diagnosis made?

The doctor will try to get an idea of your mental functioning, when he sees you, but also during the previous weeks.
To find out if you are in a manic phase, he will check if the following characteristics are present:

You move a lot (increased activity and physical restlessness);
You talk a lot (logorrhea);
You have difficulty concentrating, you are distracted;
You have reckless behaviors, such as spending a lot of money irresponsibly;
You have less need to sleep;
You have more desire and sexual activities;
You build relationships more easily, you are very familiar with people;
You have very good self-esteem, or delusions of grandeur;
You have the impression of “thinking faster”, of having “leakage of ideas” …

They will also examine whether you are suffering from delusions or hallucinations by looking for certain thoughts (delusions) or sensory perceptions (hallucinations) that do not correspond to reality, such as hearing, smelling or seeing something that is not there.
Some people with bipolar disorder may have delusions or hallucinations during the manic phase. We then speak of a “psychotic mania”.

Often, people behave relatively well during the consultation, and it may be necessary to speak to those close to them to assess the situation properly.

Because of the importance of distinguishing bipolar disorder from depressive disorder, your doctor will always ask you, when you have depressive symptoms, if you have ever experienced periods of euphoria (or mania) in the past. If these two diseases look the same at first glance, their treatment is totally different.

The doctor will also try to distinguish between problematic alcohol, medication or drug use.

Finally, certain brain conditions can also lead to a manic episode. The doctor will certainly consider this possibility if you have a first manic episode when you are already a certain age (over 50).

What can you do ?

When you have bipolar disorder, you often feel a period of euphoria coming. You begin to feel more and more energized, you need fewer hours of sleep, and the general feeling of arousal increases. This phase, called “presymptomatic”, announces the manic phase.

Take your medication well and discuss side effects with your doctor. Do not stop your treatment on your own or adjust your dose without your doctor’s advice. Stopping treatment suddenly can trigger a manic or depressive episode. Conversely, an overdose of lithium, for example, may require immediate hospitalization.

Avoid sources of stress as much as possible and get enough sleep. Indeed, it is proven that these factors can trigger a new episode.

What can your doctor do?

Emergency hospitalization is usually necessary during the “acute” phase, that is, when the disease literally takes control of the person. This phase is in principle treated by psychiatrists.

The treatment (medicines) differs depending on what stage of the disease you are in and how the disease is progressing.

If the disease returns, a background treatment is also necessary to prevent relapses. In this case, this treatment often has to be taken for life.

When the disease has stabilized and you understand your disease well enough, the basic treatment can be followed by the general practitioner.

The treatment of mania often involves the combination of at least 2 drugs: a mood stabilizer and an antipsychotic.

Taking certain medications requires regular blood checks (at least every 6 months). This is the case, for example, with lithium, the blood concentration of which must be checked to avoid doses that are too strong or too weak. Thyroid hormones and kidneys should also be checked at least once a year with a blood test.

In the treatment of bipolar disorder, it is very important to use the right medications. Antidepressants that are prescribed for depression (without manic episodes) can thus trigger a (hypo) manic phase in people with bipolar disorder.

Mood stabilizers and / or antipsychotics should in all cases be added to the treatment if the doctor considers it useful to prescribe antidepressants.

In addition to essential drugs, multidisciplinary supervision is necessary. You will therefore benefit from the supervision of a team made up of a doctor, a psychiatric nurse, a social worker and a psychologist. This support can make a big difference to your independence and reduce the number of hospitalizations.

Psychotherapy and education (to you who have bipolar disorder, those around you and your family) can be very helpful in learning how to cope with the disease and reducing the risk of relapse.

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