Understanding bipolar disorder

Femi has started and lost two businesses due to untreated bipolar disorder. During manic episodes, he would start ambitious new ventures, work long hours, make deals without proper vetting, and believe he is destined for greatness. When his depressive episodes start, he would stay in bed for weeks, contemplate suicide, stop picking up calls or responding to messages and eventually lose the business he had started. This has become a recurring cycle for him. His family members assumed he was simply irresponsible, as he seemed to be talking normally and they didn’t see anything amiss other than his ‘bad behaviour and laziness”.

Halimah, 23-year-old University student, was diagnosed with bipolar disorder in her final year. Before this, she was known as an eccentric person with behavioral fluctuations among her friends and family. She would have periods of high energy and productivity, sometimes with disinhibition associated with financial and sexual recklessness; and then at other times, she became reclusive, cried frequently and was tired and sad all the time, due to crushing depression.

She was so ashamed by her actions during a manic phase that she became severely depressed and attempted suicide. This finally led to her hospitalisation and an eventual diagnosis with bipolar disorder. With medication and therapy, she graduated from university, completed NYSC, and now works in a Fintech company. She takes her medication regularly and sees her psychiatrist every three months. She and her family wished they had known earlier what the problem was, so she could have commenced treatment earlier and had more stability.

Discussion

Bipolar disorder affects approximately one to two per cent of the global population. In Nigeria’s population of 200+ million, that’s about two to four million people. It also has the highest suicide rate of all mental illnesses. March 30th is the international day for the commemoration of bipolar disorder, and it is an important day to create awareness. Bipolar disorder, especially in Nigeria, is often misunderstood and stigmatized, simply as bad, lazy or irresponsible behaviour.

Bipolar Disorder is a chronic mental health condition characterized by extreme mood changes that last for several weeks or months and is distinguished by behaviour and mood changes that alternate from one extreme pole of intense high mood, elation, reckless and disinhibited behaviour (mania/hypomania), and lows of excessive tiredness, zero motivation, sadness etc(depression). The bipolar cycle can be over the course of weeks, months or years. Bipolar disorder can be of different degrees of severity. So, presentations can be very different for different individuals.

Signs of a manic episode

●             Extreme elation

●             Extreme irritability

●             Feeling invincible

●             Unusual confidence and optimism

●             Racing thoughts that jump from topic to topic

●             Difficulty concentrating because thoughts move too fast

●             Poor judgment and decision making

●             Sometimes psychotic symptoms (delusions, hallucinations)

●             Dramatically decreased need for sleep (sleeping 2-3 hours and feeling fully rested)

●             Talking excessively and rapidly

●             Taking about multiple projects simultaneously

●             Impulsive, risky behavior (spending sprees, reckless driving, sexual indiscretions, business decisions without proper planning)

Signs of a depressive episode

●             Profound sadness or hopelessness

●             Loss of interest in everything previously enjoyed

●             Feeling worthless or excessively guilty

●             Thoughts of death or suicide

●             Sleeping too much or insomnia

●             Significant weight loss or gain

●             Fatigue and no energy

●             Physical slowness or agitation

●             Difficulty concentrating or making decisions

●             Lack of motivation

●             Slowed thinking and poor memory

●             Sometimes psychotic symptoms

Challenges of bipolar disorder in Nigeria

●             Misdiagnosis or no diagnosis

●             Spiritual misattribution

●             Shame and stigma

●             Denial and refusal to use medication

●             Family burden and misunderstanding

●             Relationship and marriage destruction

●             Financial devastation

●             Legal, occupational/business as well as safety consequences

Practical strategies for those with bipolar disorder

●             Accept the diagnosis

●             Take medication consistently

●             See your psychiatrist routinely for reviews at least once every 3 months.

●             Learn your warning signs and triggers

●             Build support team

●             Avoid alcohol and drugs

●             Plan for episodes and communicate your crisis plan with your support network

●             Find purpose beyond illness

How to support someone with bipolar disorder

●             Educate yourself

●             Encourage treatment, use of medications and clinic reviews

●             Learn warning signs

●             Don’t take it personally

●             Help with practical matters: Ensure medication compliance during episodes. Provide structure and monitor safety. You can also help manage finances particularly to prevent manic spending.

●             Take care of yourself

●             Know when to get help: Seek immediate help if they have suicidal thoughts or plans, psychotic symptoms, dangerous behaviour, severe mania or complete inability to function.

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Conclusion

Bipolar disorder is serious, lifelong, and can be very challenging. However, with proper treatment, people with bipolar disorder can live full, meaningful, productive lives. People living with bipolar disorder deserve understanding, proper treatment, and dignified lives. As we commemorate World Bipolar Day, let’s commit to understanding, compassion, medical treatment, support and hope.