Bipolar or Manic Depression Disorder

Bipolar or Manic Depression as it was once known, is a psychiatric illness which affects p to 1 in 40 to 50 people in Australia, according the Beyondblue Foundation. Bipolar disorder has been characterised in the movies, and revealed in public figure court cases such as with Rene Rivkin, and there is a generalised awareness of this disorder in the community.

Bipolar disorder is related to its manifesting mood symptoms of extremes in which there is a pendulum like effect. This pendulum like effect is characterised by at one extreme the feelings of euphoria or irritability for a period of time, which was always denoted as the manic phase, and from here a drop into periods of deep lethargy, collapse , sadness and profound depression.

This pendulum swing type of cycle varies in both duration of each phase of the mania and the depression, and also the depths of the positive and negative pole of feelings that each phase represents. Typically each state of mania or depression might last from a day to some weeks, and even months, and in between each extreme the person appears to pass through a “middle” phase of some balance and calm where neither extreme is manifesting in the personality.

Some of the Bipolar sufferers spend more time in one extreme than the other, and those who spend more time in the depressed cycle typically report a deeper sense of malaise, whilst those who spend more time in the manic extreme, are less attached to a grounded and reality based view of themself and life.

An aspect of Bipolar disorder is that their ungrounded manic state leads to a psychotic outcome  where they are not in touch with reality. Clinically there are specialisations within the Bipolar disorder characterisations which relate to the degree of time spent in either phase, but these are applicable to a diagnosing Psychiatrist.

Bipolar disorder is attributed to genetic, in-utero, and environmental factors depending on the research one reads. There is no agreed theory but the successful role that modern drugs play in alleviating the extreme mood swing symptoms, plus blood test analysis, shows an in-balance in some key brain functioning chemicals in afflicted sufferers.

Neuroscience is also starting to show damage in the Hippocampus region of the brain is correlated to many sufferers. A trauma model of this disorder proposes that in the womb, the child was receiving increased Cortisol from a stressed mother during pregnancy.

Cortisol is now understood to affect Hippocampus neural connection development in the developing foetus in the womb. The general “fight or flight” mode that the mother is in which creates the increased Cortisol levels, also affects the development and release function of the HPA axis chemicals in the brain.

In this theory, the later Adult Amygdala brain interaction with the HPA Axis releases mood regulation chemicals in an abnormal way. The analysis of Bipolar sufferers show that Cortisol, Norepinephrine and Serotonin levels can fluctuate in extremes.

These brain chemicals both help to stabilise and regulate mood as well as being functions of the Autonomic Nervous system  when in either the “fight or flight” Sympathetic mode, or in the Parasympathetic “relaxed” mode.  Neuroscience notes that the human brain does not finish its development until a person is in their early 20’s, and it is at this stage that most Bipolar sufferers are first diagnosed with their condition.

In adult Bipolar sufferers the two extremes show their own different defining symptoms as seen in their behaviour and reality. During the manic phase one may see one or more of the following symptoms, according to literature and also the psychiatric Diagnostic and Statistical Manual of Mental Disorders(Version IV)(DSMIV ):

  • Making and executing plans not anchored in objective reality
  • Thinking and speaking quickly
  • Having a grandiose self-image that may see them as great leaders, God etc.
  • extended periods without sleep
  • Lacking boundaries and judgement that leads to taking risky decisions and actions
  • Emotional outbursts if frustrated or blocked, and aggressive lashing out when provoked
  • Promiscuous behaviour with addictive qualities
  • Anxious, jumpy and irritable

During the depressive phase one may see one or more of the following symptoms, according to literature and also the psychiatric Diagnostic and Statistical Manual of Mental Disorders(Version IV)(DSMIV ):

- Heavy, lacking energy in the body

- Lacking energy and wanting to sleep extended periods

- Victim stance and felt helplessness and hopelessness

- extended despair and associated crying

- No interest in life or relationships

- Lack of self care

- Lack of appetite

- Overwhelmed at need to make small decisions. Avoids and procrastinates

- Irritable and lacking focus and concentration

- Loss of interest in friends, spouses, hobbies and interests

- Suicidal thinking, plans and attempts

- Anxious at imagined threats or disasters

Bipolar disorder requires the training of a Psychiatrist for such a diagnosis to be made for a person. We are not able to offer diagnosis or assistance for such a diagnosis other than referring a person to a Psychiatrist. A psychiatrist should be the primary source of care for a Bipolar sufferer.

Treatment for bipolar disorder is best placed in the hands of a Psychiatrist as normally sufferers require medication to help stabilise their moods. The modern medications for Bi-polar disorder are considered very effective in many cases.

People with bipolar disorder can also benefit from counselling or therapy with a professional counsellor or psychologist to help them understand and better handle their illness. Psychologists or counsellors will work with clients to better recognise the onset of a particular phase and will often look for triggers as well developing management plans for the onset of manic or depressive symptoms.

We will only work as a secondary and complementary support service for Bipolar sufferers who are under primary care of a Psychiatrist who approves of the client undertaking counselling and Psychotherapy with us.

Counselling can complement the Psychiatric work by supporting the client with their cognitive distortions that arise in both manic and depressive phases, and to help the sufferer become self-aware of the perceptual triggers and BodyMind indications that signal they are undergoing a shift in their present state towards the other extreme.

The professional support helps the client deal with any stigma or shame about their condition as loved one’s may struggle to remain empathic and understanding of the extreme behaviours that may arise in either end of the extremes. Management plans for the sufferer and their loved ones can assist in managing this condition.

If upon reading this information you think you may have a possible Bipolar condition then you should consult with a mental health professional and get a referral to a psychiatrist for further advice and assessment. If there is an immediate crisis and extreme behaviours then contact a psychiatric hospital or the emergency department of your local hospital for advice about where to go.

Copyright 2015 Richard Boyd

Psychotherapy & Counselling

Private Therapy