This is the third article in a four-part series on bipolar disorder
“Some people feel they have been given a life sentence when they hear they have bipolar,” says clinical psychologist Mark de la Rey, whose younger brother of 50 has been living with the mood disorder since he was 16.
It does not have to feel that way even though bipolar is a serious illness, says De la Rey, head of the adolescent unit at Akeso Kenilworth Clinic in Cape Town. Bipolar usually presents in late adolescence or the 20s.
“At first, most people think: how will my life fit into this diagnosis? They feel their life is being squashed, there are things they can’t do, but they [usually] transition to finding out how the diagnosis fits into their life,” he says.
The adaptation becomes part of their routine, he says, as with other chronic medical conditions. “If you get diabetes, you can’t eat sweets. Just like some people pop vitamins, you take meds. You must check your sugar, like people at the gym monitor their heart rates.”
“People [with bipolar] can function fine and have regular lives with sufficient medical, psychological and social support,” says Suntosh Pillay, a clinical psychologist at a public hospital in Durban.
Not only did mindfulness reduce the symptoms, but it also normalised some of the brain changes with bipolar
— Psychiatrist Dr Neil Horn
Nearly everyone needs medications — typically mood stabilising drugs, antipsychotics and antidepressants — therapy and healthy habits to manage their condition.
Johannesburg psychiatrist Dr Antoinette Miric says no two people are the same and bipolar is “very complex to treat” at each phase of the disorder, moreover the different phases of mania and depression are confusing to patients and family.
Pharmacological medicines can get people about 70% of the way to healing, she says, but they also need to commit to therapy and do work themselves. “People need to learn how to self-monitor their sleep, eating, energy, exercise and avoid substances,” she advises.
“Those people with structured lives do much better, and therapy helps to keep them well,” says Miric, who has some patients who see her only every four to six months. Studies show patients whose families are involved and supportive also do better.
“Therapy is not going to cure bipolar, but it can manage the stressors,” says De la Rey. Containing stress is critical since high stress can trigger a manic or depressive episode, even among people who are adherent to their medications.
The Covid-19 pandemic and lockdowns had a negative impact on South Africans with mental illnesses and raised the risks of defaulting on treatments.
Therapy can help people develop skills — such as stress, anger and time management — to avoid feeling overwhelmed and anxious. Regular therapy can help people deal with the losses and trauma typically wrought by bipolar, including catastrophic social and financial fallout from mania.
De la Rey says “radical acceptance” is a useful tool in the therapeutic kit, where people accept they have bipolar, which “allows people to make healthy choices for themselves” — but it doesn’t mean they feel happy about it.
On the barriers bipolar can throw up, he says: “My brother is brilliant, his IQ is points higher than mine, but bipolar caused him difficulty in finishing matric and going to university.”
Pillay says bipolar does not get enough attention despite affecting many people — potentially one in 20 among adults. “Often it is misdiagnosed [as depression] and underdiagnosed, but in the private sector it can be overdiagnosed,” he says.
Medical aids provide more comprehensive cover for bipolar treatments in the private sector than they do for depression.
CONTACT
• SA Depression & Anxiety Group: call 0800-456-789 or visit sadag.org
• Schizophrenia and Biopolar Disorders Alliance: call 011-326-0661 or vist sabda.org.za
VISIT
READ
• 'Life Interrupted: A Bipolar Memoir' by Sam Smirin
LISTEN TO
• 'Let's Talk Bipolar' podcast
• Huberman Lab: The Science and Treatment of Bipolar Disorder
— BIPOLAR SUPPORT & INFORMATION
Psychiatrist Dr Neil Horn, who focused his clinical practice on bipolar, confirms this pattern has fuelled the overdiagnosis of bipolar among insured patients, though it is underdiagnosed in the general population — and the diagnosis is typically delayed by up to 10 years.
Unipolar depression affects roughly four times more people than bipolar, at about 20% of the population, he says. The disorder can overlap with others such as attention deficit disorder and anxiety.
Horn says there are newer, better medications for private patients with bipolar but still the decades-old treatment of lithium remains the “best treatment in patients who can tolerate it”. Lithium protects again the risk of brain degeneration (from neurotoxicity) during mood episodes.
But he says: “The side effects of some medications are unacceptable to some people.
“Another problem is that when people recover and feel well, they are not motivated to take their medication or attend psychotherapy.”
Horn supports a greater focus on effective psychological therapies including cognitive behaviour therapy and mindfulness.
In a study he led at the UCT psychiatry department, on mindfulness for stress reduction among people with bipolar, the team found: “Not only did mindfulness reduce the symptoms, but it also normalised some of the brain changes with bipolar just like other medical treatments.”
Horn said suicidality is a major problem among people with bipolar “whose depressive episodes can be very sudden and very severe”, while their manic episodes can be destructive to their relationships and careers.
De la Rey encourages people to get informed about bipolar, not rely on the latest sensationalist film or book, and to ask their loved ones with bipolar: “What is it you experience? Are there some things you want me to do more or less of?”
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