On A Roller Coaster - Bipolar Mood Disorder

On a roller coaster: Bipolar mood disorder
As a psychiatry intern at a Mumbai

hospital, I evaluated a middle-aged
man who wore a red hat, Hawaiian
print shirt and gold chains. Armed
with enthusiasm, curiosity and a little
theoretical knowledge of the subject,
I sat down for what was to become
one of the most interesting interviews
of my training.
Reference By Dr. Shamsah B
Sonawalla
See More - http://www.transmagclinic.com

He greeted me cheerfully and talked about his
appointment with the Prime Minister, his
successful business ventures and the half-done
film he was directing. He said he had a scheme
to discuss with the PM that would end poverty
and corruption in our country . He said he had
been granted special powers by the universe for
this mission. He also said that he did not need
much sleep, was feeling very energetic and had
many ideas to improve the world.

Sonawalla

On speaking with his wife, I found following a
setback in business, he had become irritable and
then euphoric. He hardly slept but continued
feeling very energetic, took up new projects, but
did not complete them. He became more
irritable, angry and even abusive , as 'people did
not believe him' and started neglecting his
family, work and health; this was interspersed
with periods of euphoria and a sense of extreme
well-being . This is when he was brought to the
hospital.

Sonawalla

Even to my relatively untrained mind, it was not very
difficult to make a diagnosis: bipolar mood disorder
(previously known as 'manic depression' ), in which a
person goes through cyclical periods of feeling euphoric,
energetic, grandiose, expansive or irritable (read manic
episode) with periods of sadness of mood, low energy,
lack of enthusiasm and low self-esteem (read depressive
episode). It is like being on a thrilling high and then in a
state of extreme gloom.

Sonawalla

Bipolar disorder is characterised by a distinct period of
abnormal mood, which could be either euphoric,
expansive or irritable, accompanied by symptoms such
as easy distractibility , inflated self-esteem , grandiose
ideas, excessive talkativeness, racing thoughts, need for
less sleep than usual and increase in goal-directed
activity. For example , taking on too many projects at the
same time; poor judgement leading to reckless behavior,
such as spending sprees, reckless driving or promiscuity
and denial that anything is wrong. When this lasts for at
least a week and affects the person's day to day
functioning, it is called a manic episode.

Sonawalla

What causes bipolar disorder ? Why is it that
some individuals suffer these extreme ups and
downs during their lives? We are far from
having all the answers.
Research suggests that bipolar disorder can be
inherited . Excessively high or low levels of
neurotransmitters (chemicals produced by brain
cells or neurons) such as serotonin ,
norepinephrine and dopamine , an imbalance in
neurotransmitter levels, or a change in the
sensitivity of receptors on the nerve cells can
cause bipolar disorder.

Sonawalla

Acommon misconception is that stress or
environmental factors cause the illness.
Stressful life events (such as a death in the
family, loss of a job, relationship difficulties ,
child birth, etc.) can certainly trigger the onset
of bipolar disorder. But once the illness begins,
it is the underlying biological and psychological
processes which keep it active and are the cause
of the illness.

Sonawalla

My first patient with bipolar disorder responded
well to medication and counselling sessions.
Over time, he developed awareness regarding
his illness (often absent during the 'high' phase).
He visited the clinic every fortnight with afamily
member for follow-up sessions and did
progressively better over the following year. He
later resumed running his business, which
continued to be fairly successful . A fascinating
aspect about bipolar disorder is its association
with creativity.

Sonawalla

Research has shown that individuals with
bipolar are as likely to be creative and function
exceptionally well, as they are likely to be
dysfunctional . News channel CNN founder Ted
Turner, psychologist Kay Jamison and actress
Catherine Zeta Jones have talked openly about
being bipolar. Picasso's 'pink' and 'blue' periods
are well known. While one should refrain from
romanticizing an illness that involves immense
suffering, it is evident that some individuals
with bipolar disorder can lead extraordinarily
productive and creative (if trying) lives.

Sonawalla

If you are reading this and wondering if you
have bipolar disorder, please note that
(thankfully) not everyone who is energetic,
creative and takes up many projects is bipolar !
Bipolar disorder spans a wide range of
symptoms and needs a thorough assessment for
a diagnosis.
I find it heartening to see family members often
bring printed information on the subject with a
set of questions to be answered. Research on
mood disorders across various cultures shows
that a supportive family environment
significantly improves the outcome in bipolar
disorder.
Thank You.
(Dr Shamsah B Sonawalla is a consultant psychiatrist ,
a former faculty of Harvard Medical School, US
www.transmagclinic.com

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On a roller coaster: Bipolar mood disorder

As a psychiatry intern at a Mumbai