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Bipolarity analysed: The truth about manic depression

TV actor Shama Sikander and singer Honey Singh opened up about their struggles with bipolar disorder earlier this year, bringing the illness into limelight. But manic-depression still remains largely unknown and misunderstood.

brunch Updated: Oct 08, 2016 22:45 IST
Mental Illness

In March this year, singer Honey Singh revealed his struggle with bipolar disorder

TV actor Shama Sikander and singer Honey Singh opened up about their struggles with bipolar disorder earlier this year, bringing the illness into limelight. But manic-depression still remains largely unknown and misunderstood.

For ten days, Akhileshwar Sahay, then 41, believed he was God. In 2000, the management consultant who had been diagnosed with bipolar disorder two years ago, had a major manic breakdown while attending a friend’s wedding in Kerala. “I had stopped taking my medication prior to that. My connection with reality was totally broken,” he says. “At times I believed I was an incarnation of Vishnu. And sometimes, I thought I was a cross between Mahatma Gandhi and JRD Tata.”

According to the World Health Organisation, bipolar disorder, earlier known as manic depression, affects about 60 million people across the world. It is a mental illness characterised by extremes of moods—episodes of depression and mania/hypomania. Each phase may last from weeks to months.

“For the first time at the age of 37, I had a diagnosis that explained the massive highs and miserable lows I’ve lived with all my life,” British actor-comedian Stephen Fry said in his Emmy-Award winning documentary The Secret Life of a Manic Depressive (2006). Fry spoke about living with bipolar disorder and met other celebrities and ordinary people who were battling the illness. “Since then I’ve discovered just how serious it is to have bipolarity. Four million others in the UK have it. And many of the seriously ill end up killing themselves,” Fry says in the short film.

“During a depressive episode, the person experiences sadness, lethargy, irritability, an inability to feel pleasure, helplessness, hopelessness,” says Dr Rajiv Mehta, consultant psychiatrist, Sir Ganga Ram Hospital, Delhi. “There is alteration in appetite, they sleep too much or too little, there is lack of libido, guilt and a death wish.”

Manic episodes are characterised by high energy, euphoria, increased psychomotor activity, inflated self-esteem, delusions of grandiosity, impulsivity, splurging, loss of social inhibitions, and in some cases, hallucinations. “A bank manager once sanctioned Rs 2 crore instead of Rs 20 lakh during a hypomanic episode. The clients utilised the money and he landed in a lot of trouble,” says Dr Rajesh Rastogi, consultant and head of department, psychiatry, Safdarjung Hospital, Delhi.

At present there are no medical tests – such as blood or imaging tests – to detect bipolar disorder. The diagnosis is made through patient interviews based on detailed questionnaires. Diagnosis, says Sahay, is the tricky part. Sahay was wrongly diagnosed with clinical depression after his first depressive breakdown. It took a second depressive breakdown and a manic high in between the two for his doctors to get the right diagnosis. “My official diagnosis happened in 1998 after the second breakdown,” says Sahay. “The trigger was change, which proved to be disruptive. I had switched careers. From being a government official in railways, I had taken up a private sector job.”

Science does not know the why of the illness yet. Imbalances in brain chemicals called neurotransmitters, such as dopamine, serotonin, gaba, lead to it. Mental health experts point to a combination of biological-psychological-social factors. “If one parent has bipolar disorder, there is a 14 per cent chance that the child will have it too,” says Dr Mehta. “If both parents have it, the risk of the offspring having it shoots up to 34 per cent.”

Then there are certain environmental and social factors, such as childhood abuse and /or sexual abuse, a traumatic life event, bad relationships, a period of great stress, which may cause the illness to develop.

But there is consensus on one issue: the need to get treatment as soon as initial symptoms appear. “If your illness is uncontrolled and unmedicated, it will worsen,” says Sahay. “With support of family, friends, employers, my remission periods have got longer. Even now I have highs and lows, but the peaks have been blunted.”

“The mainstay of the treatment is medication,” says Dr Achal Bhagat, chairperson, Sarthak (a group of mental health organisations), and senior consultant psychiatrist and psychotherapist at Apollo Hospitals. “Mood stabilisers are used sometimes in combination with other drugs which affect the serotonin and dopamine levels in the brain. But largely, mood stabilisers bring the disorder under control.” In the manic phase, tranquilisers may be administered as well.

A still from the 2012 American film Silver Linings Playbook. Actor Bradley Cooper ( right) plays a man with bipolar disorder in the movie

Singer Honey Singh, who described the 18 months that he was battling the illness as “the darkest phase” of his life, said in an interview how seeking medical help brought his condition under control. “But now it is all behind me and I’ve come out of it. I am under a doctor’s supervision,” he said. “I had cut myself off from everyone. I didn’t come out of my room.... I had a beard and I didn’t get a haircut for months. For someone who has performed in front of a crowd of 20,000, I was scared of facing 4-5 people.”

Once the patient stabilises, psychotherapy is provided to help her or him return to a fully functional life. “Psychotherapy becomes relevant when patients recover and can participate in the treatment,” says Dr OC Kashyap, senior psychiatrist and former director VIMHANS. “Then they can be trained to recognise the triggers and warning signs for these phases and learn how to cope better with such situations. Even after the illness is under control, such patients should stay in touch with their psychiatrists as it is a recurring illness.”

An important method of psychological support is Cognitive Behaviour Therapy (CBT). Through it, the person is trained to analyse his or her thoughts and detect unhelpful thought patterns and challenge them. “It helps you accept this illness without it becoming your only identity,” says Dr Bhagat.

RISKS OF DENIAL

TV actor Shama Sikander, best known for her role as Pooja from the TV show Yeh Meri Life Hai (2004), said in an interview in March that she was diagnosed with this illness four years ago. Her then boyfriend, who had studied psychology, had pointed out the symptoms and her first reaction was that of denial. “...At first my reaction was, ‘No, I am not going to a doctor. I am perfectly fine and there is nothing wrong with me’.

TV actor Shama Sikander said in an interview in March that she was diagnosed with bipolar disorder in 2012

The stigma associated with any kind of mental illness makes people hide what they are going through and suffer in silence. Doing so can be quite dangerous in case of any mental illness, be it depression or bipolar disorder, because the condition only worsens with neglect. “Treatment keeps the disability at bay, making it possible to have a highly functional and good-quality life,” says Dr Bhagat. “But if you don’t seek help or stop medication, the intensity, duration and frequency will keep on increasing with each episode.”

The possibility of self harm looms large not just during a depressive phase where one could be battling suicidal thoughts, but even more so during a manic episode where delusions combined with high energy could cause the person afflicted to lose touch with reality – and in some cases be incited to violence.

Dr Mehta shares a case where he diagnosed a businessman with bipolar I disorder during a manic phase. “He lacked the insight to realise his condition and even his family did not press him to take medicines. A week later, his father came to me saying his son was in prison for having attacked someone with a hammer when provoked in the manic state.”

“I was lucky that my wife took up the challenge of managing my illness with medical intervention,” says Sahay, who went public with his illness in 2009 and has been fortunate to find considerate employers. “The day I suffered my first mental breakdown, she took me to a psychiatrist. My wife, my children ensure I take my medication. When I travel for work, my colleagues ensure I take my meds on time. All this has helped me manage my professional and personal life.”

In the American TV show Homeland, Claire Danes plays a CIA operative suffering from bipolar disorder (Kent Smith)

THE ROAD AHEAD

Accepting an illness that will stay with you for life is hard enough without having to suffer the social shame attached to it. People living with bipolar disorder tend to hide their condition for the fear of being labeled mad or ruining their professional life. The word bipolar – a disorder that can drive people to suicide – is often used as a jibe or insult.

“We need a peer-support mechanism for those living with this condition,” says Dr Bhagat. “People living with this condition need to come together and share their experiences with each other.”

Celebrities in India may have started using their cultural clout to bring mental health issues into the public discourse, but a lot more needs to be done to make it less painful for people to accept and talk about their mental illnesses.

“Our society has never been very psychologically oriented,” says Dr Kashyap. “People tend to resort to religious shrines and godmen to seek cures. But things are gradually improving. People in big cities at least are becoming psychologically sophisticated.”

TYPES OF BIPOLAR DISORDER

Bipolar I disorder: Depression is accompanied with mania, in which the symptoms are more severe and last for at least a week or more. Mania causes impairment in day-to-day functioning and is marked by delusions of grandiosity and in some cases even hallucinations.

Biopolar II disorder: Phases of severe depression alternate with spells of hypomania, which are experienced for at least four consecutive days.

Rapid cycling bipolar disorder: The gap between episodes is small, which makes it harder to get better and get back to normal.

Ultra rapid cycling: Moods changes occur within the same day

YOU ARE NOT ALONE

A number of celebrities across the world have bipolar disorder:

Catherine Zeta-Jones: The Welsh actor, who won an Academy Award for the 2002 film Chicago, was diagnosed with bipolar II disorder in 2011. She sought help for the condition and has twice stayed at mental health facilities for treatment.

Vivien Leigh: The Gone with the Wind star was hospitalised several times and underwent electric shock therapy, the then prevalent treatment for bipolar disorder. Her illness was not made public until after her death due to the stigma attached to it.

Carrie Fisher: The American actor, best known for playing Princess Leia in the original Star Wars trilogy, was diagnosed with bipolar disorder in her twenties. She has been vocal about her condition and the treatment she has received for it. Fisher also appeared on Fry’s 2006 documentary The Secret Life of a Manic Depressive.

Jean-Claude Van Damme: The Belgian actor and martial artist, who shot to fame with Bloodsport (1988), was diagnosed with rapid cycling bipolar disorder in 1998.

Amy Winehouse: The singer-songwriter who died of alcohol poisoning at age 27, admitted in several interviews that she was manic depressive.

HOW TO CARE FOR SOMEONE WITH BIPOLARITY

Mental health experts advise carers to keep the following things in mind:

* Administer medication regularly. Do not miss follow-up visits to the psychiatrist.

* Behaviour on part of family members that expresses over-concern, hostility and/or criticism increases chances of highs and lows. Avoid expressing such emotions.

* The person should be encouraged to talk about what is bothering him or her. Keeping emotions pent-up increases chances of another episode.

* The person affected should be advised to slow down and not involve themselves in predictable stress.

* It is important that bipolar patients get proper sleep.

* The person affected should not drive during an episode or when heavily medicated.

* Consumption of addicted substances such as alcohol, cannabis should be avoided.

* People with bipolarity are control sensitive. Be suggestive. Don’t argue with them during a manic episode.

* During a period of remission, the patient and family members should decide on how to handle a manic phase and how much cash the person should be allowed to carry during such time. People tend to splurge or give away money during a manic high.

From HT Brunch, October 8, 2016

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