28. February 2020
The patient Mrs. G. knows strong mood swings already from childhood. All emotions were present, from high jubilation to deathly sorrow. Nevertheless, she experienced a normal childhood most of the time and was a good student. The training period was turbulent, but in her mid-twenties Ms. G. successfully started her professional life. After a few years on the job, Ms. G. fell ill with a severe depression and, at the urging of her family, went to a clinic.
After a few weeks, she discontinued treatment, considering herself cured, and left the facility in a euphoric mood. She spent all her savings on luxury items and a fancy sports car, as she wanted to start a new life. Her new lifestyle overwhelmed her friends and family; they could hardly get close to Ms. G.. She no longer let them talk to her and thought she was “destined for something bigger”.
But the supposed new life of luxury did not last long. Private insolvency followed, and she relapsed into a severe depression and was hospitalized again. There, after extensive diagnostics, the diagnosis “bipolar disorder” was made.
The example of Mrs. G. shows that in bipolar disorder, the mood alternates between two extremes. This is why the term “bipolar” has become established, because it means two-sided. One extreme is the so-called mania, the other is depression. In the past, people with bipolar disorder were therefore also called manic-depressive. However, this designation is outdated. Bipolar disorders are less common than purely depressive disorders: About 1-2 out of every 100 people have such a disorder.
Moods and mood swings
To understand bipolar disorder, it helps to keep in mind the moods we humans can have. Even in healthy, unremarkable people, moods can have swings up or down. However, these do not last long and rarely reach the extreme. Normally, our mood settles around a healthy base level. This is a good thing, because we are not capable of acting when our mood is either too negative or too high. We need balance in order to be able to lead a satisfied life.
Bipolarity means that affected individuals experience depressive and manic phases as well as symptom-free phases. A cyclic alternation between mood states is characteristic. However, the periods of the cycle are highly individual. Sometimes patients remain in depressive phases for months, are subsequently symptom-free for a few weeks, and then switch to an elevated mood.
Excursus: In very rare cases, the change between mood states occurs at very short intervals of days or even hours. In these affected persons is spoken of “rapid cycling”.
In the manic phase, the mood is greatly elevated. One can no longer speak only of “very good mood”, because the euphoric mood has something delusional. It is difficult for relatives and friends to talk calmly with the affected person. Other symptoms include:
Of course, the manic episode does not always take extreme proportions. If the mood is elevated, but the affected person still acts (mostly) controlled, then it is called a hypomanic phase (hypo in the sense of “under”). If the mood alternates between pronounced mania and depressiveness, the condition is called a bipolar disorder I. If the manic episodes are not pronounced (i.e. hypomanic), we speak of a bipolar disorder II.
In a depressive episode, the mood is depressed, there is dejection and listlessness, just as in a purely depressive disorder. However, the depressiveness can take on extreme proportions, because sufferers often regret their behavior during the mania and, of course, suffer additionally from its consequences, such as money worries, breaking off contact with family and friends, infidelity or accidents caused.
As with all mental disorders, a complex set of causes must be assumed. There is no one reason why one person develops bipolar disorder and another does not. However, there is strong evidence that in bipolar disorder the neurotransmitter balance in the brain is out of balance. Medications can be used to balance these neurotransmitters.
In psychotherapy, sufferers learn about their disorder in detail. They find out warning signs of an upcoming depressive or manic phase and learn to counteract these phases with certain behaviors. These can include stress reduction, relaxation, sports and conversations with trusted people. A “disease management” is established, so to speak, so that a life can be led that is as balanced as possible.
Medications for bipolar disorder
Medication is prescribed after detailed diagnostic testing to determine whether the disorder is purely depressive or bipolar. Purely depressive disorders are treated with antidepressants, while bipolar disorders are treated with mood-stabilizing medications. These are also called phase prophylactics.
Close supervision during medication adjustment
If bipolar patients are initially treated with antidepressants alone, complications may arise in conjunction with a predisposition to mania: The energy for action increases sharply, although the mood is still negative. This increases the risk of suicide, since the necessary drive for this is again present. Although the risk also exists for purely depressive patients, it is higher in bipolar disorders. That is why, especially at the beginning of drug treatment, close-meshed care of those affected is necessary.
Ms. G. is now well medicated and, together with her psychotherapist, has drawn up a concept for how best to cope with her illness. She has recognized that too much stress in her professional and private life promotes a change into a depressive or manic phase. Increased or decreased sleep are also a signal for her to deal with herself more intensively and take precautionary measures. She has reduced her working hours and regularly practices relaxation techniques.
Twice a month, she has an appointment with her psychotherapist and discusses current issues. Her psychiatrist monitors her medication intake at regular intervals. This allows Ms. G. to lead a normal life, with her mood settled in the healthy range.