"on top of the world, down in the dumps"
Bipolar disorder is a disorder in which depressive episodes alternate with manic or hypomanic episodes phases. Already in antiquity, mood swings in the context of melancholy were described and many personalities of the past such as Virginia Woolf, Vincent van Gogh or Robert Schumann were "on top of the world, down in the dumps". For people with bipolar disorder (also called manic-depressive disease), the life of a roller coaster, trapped in the extreme emotional spectrum between boundless euphoria and absolute depth, is similar. For the majority of patients, however, the depressive phases predominate.
Bipolar disorder is a disease that usually shows up for the first time at a young age. Affected people sometimes describe their lives as a film in which the scenes get confused and where they no longer direct. In contrast to depression, the typical manic phase develops quite quickly. Within just a few days, the mania lets the affected person pulsate against energy and pushes to apparent peak performance. You are around the clock of an uplifted mood, bursting with desire for action or having many ideas. The wheel of activity is constantly spinning until it falters – often immediately following the mania of the fall of hell into the depression. If one asks bipolar disease patients in hindsight after the disease onset, approximately 73% report that their illness started with a depressive episode. For most of the patients, a unipolar depression was initially treated and the overall course was not taken into account in the diagnosis.
Using modern classification systems such as ICD-10 and DSM-IV, the diagnosis is determined using objectifiable criteria. A detailed anamnesis is of great importance for the first patient contacts. This includes the precise survey of addictions, previous behavioural abnormalities or familial predispositions.
For adults, alcohol and other drug abuse is the most common co-morbidity. Drug abuse occurs especially in the case of additional anxiety disorders and poorly treated depression. In addition, bipolar disease tends to be more prone to other bodily diseases, with cardiovascular diseases being the first priority.
In recent years, new drugs have significantly improved the treatment options of the depressive and manic phases. Phase prophylaxis is always decisive in the therapy of bipolar disease – quasi the "protective agent" for the soul of these patients. A prerequisite for the success of the therapy is the continuous contact with the treating physician. A sensible phase prophylaxis can only be achieved through long-term drug use, sometimes life-time.
As a person affected, it is especially important to take the prescribed medications regularly, even if you feel healthy. Discontinuing without a medical consultation can trigger a renewed disease boost. A stable relationship between physician and patient is also essential in terms of relapse prevention, in order to identify and counteract the first signs of a new acute episode early on. The observance and maintenance of a regular day-night rhythm is also of great importance.
Since the mania for the affected person means a high-phase of feelings, they refuse, especially at this stage, to voluntarily take medications that would end this high period. It is not uncommon for relatives to "sit out" this phase of the disease, which can take several weeks and may have a very negative relationship. Children and adolescents are particularly affected by the fact that mothers or fathers in their disease phases are partially or even completely in the education and in the household. Relatives should also think about themselves. Meanwhile, there are some support groups specifically for relatives. The timely response is extremely important. Often the first signs are trivialized and not taken seriously.
Relationships often break apart, jobs are lost, apprenticeships are canceled, addiction problems can be added. Letting the disease take its course can end fatally: 20 – 25% of the persons affected commit a suicide attempt, 15% commit suicide. People with bipolar disorder need help, early on!