The highs and lows of bipolar disorder

This condition, which is fairly common in Trinidad and Tobago’s adult population, was linked to the recent suicides of two prominent citizens — Taan Maraj, the only son of former government Minister Ralph Maraj, and Nadia Ashraph, a promising young attorney-at-law.

Last Sunday, Maraj, 30, checked into the Hilton Trinidad. He was alone and, according to eyewitnesses, appeared to be very depressed. He was found dead a few hours later. Clues found in the hotel room and a subsequent post-mortem indicated that he had drunk two bottles of the deadly weedicide, Paraquat.

Exactly one week earlier Ashraph, also 30 years old, was found hanging from the ceiling of her Picton Street, Newtown, apartment.

According to the experts, bipolar disorder often begins in adolescence or early adulthood and may persist throughout life. Its causes are elusive — although the condition tends to run in families — and there is no cure. At present, researchers are attempting to identify genes that may make people susceptible to bipolar disorder.

Doctors and researchers believe that a range of biological, environmental and genetic factors can trigger episodes of the illness.

Medical information shows that manic-depressive illness has been with human beings since the beginning of recorded time. In the second century AD, Areteus described a group of euphoric patients who would "laugh, play, dance night and day," then later appear "torpid, dull and sorrowful."

In 1686, Theophile Bonet coined the term "manico-melancolicus" to denote the connection between mania and melancholia.

It was not until the 1830s that two French physicians, Falret and Baillarger were able to isolate and identify the symptoms of the disease which Falret called "circular insanity."

However, it is to Emil Kraepelin (Germany, 1856-1926) that most credit goes for his painstakingly accurate and vivid descriptions of manic-depressive illness (1904). Among the historical figures known to have had bipolar disorder are Abraham Lincoln, Theodore Roosevelt, Winston Churchill, authors E Scott Fitzgerald and Ernest Hemingway and actress Vivien Leigh, who starred as Scarlett O’Hara in Gone With the Wind.

According to information obtained from the Mayo Clinic in the United States, the "flares of bipolar disorder" may last for weeks or months. Left untreated, the condition usually worsens.

However, it can be managed with medications and other therapies.

The condition is characterised by alternating phases of emotional highs (mania) and lows (depression). The intensity of signs and symptoms vary and can range from mild to severe.

In the manic phase, the affected person will display feelings of euphoria, extreme optimism and inflated self esteem. Their speech is rapid and they will generally be agitated and prone to heightened physical activity.

Other symptoms in this phase are:

— Poor judgment

— Recklessness, or taking chances not normally taken

— Difficulty sleeping

— Tendency to be easily distracted

— Inability to concentrate

— Extreme irritability.

In the depression stage the signs and symptoms include:

— Persistent feelings of sadness, anxiety, guilt or hopelessness

— Disturbances in sleep and appetite

— Fatigue and loss of interest in daily activities

— Difficulty in concentrating

— Recurring thoughts of suicide

Factors that may contribute to or trigger episodes of bipolar disorder include drug abuse and stressfully or psychologically traumatic events.

Knowing when to seek medical advice is critical. An article on the condition published by the Mayo Clinic states: "People with bipolar disorder often don’t recognise how impaired they are when experiencing a mood episode and how greatly the disorder is affecting their lives and the lives of others.

"Friends, family and primary care physicians are important in recognising possible signs of bipolar disorder and urging the person to seek profession help.

"If a family member or friend shows signs of bipolar disorder, encourage that person to seek the care of a psychiatrist."

Diagnosis of bipolar disorder involves ruling out other mental health conditions that may produce similar symptoms including schizophrenia, attention deficit/hyperactivity disorder, or borderline personality disorder. The patient or a family member will be asked to describe apparent episodes of mania and depression.

Tests may be done to see if mood swings are due to physical causes such as substance abuse or thyroid disorders.

The doctor may also ask about use of medicates, alcohol and recreational drugs, and diet. Some medications, including those used to treat depression, anxiety and Parkinson’s disease, can cause mood swings. Deficiency of vitamin B-12 may also alter moods.

Medication and psychotherapy are the main treatments for bipolar disorder. Occasionally, in people who have episodes of major depression associated with suicidal tendencies, doctors may use electroconvulsive therapy (ECT).

In this treatment, electrodes are taped to the patient’s head. The patient is anaesthetised and is given a muscle relaxant and a small amount of electrical current is passed through the brain for less than a second. This current produces a brain seizure but because of the muscle relaxant, the body remains calm.