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Mental wellness

March 28, 2016

Bipolar disorder: With help, there’s hope

Bipolar disorder used to be called manic depression. It’s a serious, challenging illness, but a timely, multi-pronged approach to treatment can bring relief.

At 39, Andrea Paquette has gotten a handle on her bipolar disorder. But it’s been a difficult journey.

The founder and executive director of the Bipolar Disorder Society of British Columbia and Bipolar Babes, a charity aimed at boosting awareness and removing the stigma associated with the condition, was diagnosed at 25. “I had a mental health breakdown – I went into a state of mania,” she recalls of that time. “I thought I was going to be the next prime minister of Canada.”

After phases of euphoria alternating with severe depression, as well as two hospitalizations, Paquette began rebuilding her life. She had to adjust to a collection of medications, mixed reactions from friends and having to start over in a variety of jobs. But she persevered, and now manages her symptoms through medication, stress-management therapies, exercise, a strict diet and regular visits with a psychologist, psychiatric nurse, psychiatrist and GP. She also relies on the support of family and friends.

“I feel like I can be more productive,” says Paquette, who now runs programs for kids and teens in B.C. schools to educate them about the disorder. Plus, she refuses to let bipolar define her.

“I realized I was not my illness – I had an illness.”

What is bipolar disorder?

Bipolar disorder often strikes just as a person is emerging from the turbulent phase of adolescence, around the ages of 18 to 24, according to a brochure published by the Mood Disorders Society of Canada. It can also begin in childhood and as late as the 40s and 50s. Formerly called manic depression, it’s thought to be associated with an imbalance of the neurotransmitters in the brain, but its exact cause isn’t yet understood. People with a family history are at higher risk of developing bipolar, but family and work stressors, injuries, illnesses and hormonal imbalances may also play a part in its onset.

Bipolar is usually a combination of mania (elevated mood and high energy) and depression. There are several types:

  • Bipolar I disorder. Intense manic episodes that may include psychotic symptoms such as hallucinations or delusions, preceded or followed by major depressive periods.
  • Bipolar II disorder. A milder form of mania (called hypomania) along with major episodes of depression.
  • Rapid-cycling bipolar disorder. At least four episodes per year of any combination of mania, hypomania or depression.
  • Mixed state bipolar disorder. Mania and depression at the same time or alternating frequently during the day.
  • Cyclothymia. A milder form of the disorder, with shorter and less-intense cycles of hypomania and depressive symptoms, and no hallucinations or delusions.

Because of the extreme mood swings involved, as well as a tendency towards impulsivity, people with bipolar disorder are at greater danger of addiction, risky sexual behaviour, overspending and suicide. This is something Paquette knows all too well. She recalls in one manic episode, “giving my money away to people on the street.”

Treating bipolar disorder

Once a diagnosis has been made, interventions are needed right away, says Dr. Erin Michalak. As well as being Associate Professor in the Department of Psychiatry at the University of British Columbia, Michalak is team leader of CREST.BD, a collaborative research team dedicated to the study of psychosocial issues in bipolar disorder. She says medications are usually offered first to stabilize the patient. “Most, but not all, people with bipolar disorder will need medications,” she says. These can include anti-psychotics, mood stabilizers, antidepressants, anti-anxiety drugs and, as sleep issues are common, sleep aids.

But other approaches are necessary as well. “Psychological treatments are critical at the point of diagnosis,” says Michalak. “It’s important to build resilience as soon as possible. Evidence-based psychological treatments include self-care, coping techniques, strategies for improving sleep, lifestyle, measuring mood over time, measuring quality of life and addressing stigma. If we provide people with comprehensive treatments at the point of diagnosis, it can have an excellent impact on the course of their illness.”

Michalak cautions that even when these techniques are followed, it can take a lengthy period of “trial and error” before the patient finds a combination of drugs and therapies that works. She says that, though relapse is common, “with hard work, support, education and ongoing attention to the condition, some people can have very long periods of stability – years and years. Health and quality of life are absolutely possible.”

Paquette has reached a place where she now feels in control of her illness. “When I reflect upon my own life, I felt broken. But now I feel there’s hope.”

What to do if you’re having symptoms of bipolar disorder:

  • Talk to your doctor about your symptoms. Consider a variety of approaches in your treatment plan.
  • Involve your friends and family in your recovery plan.

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