treatment

Because what we do not know or do not understand scares us, we usually ignore it. This is why so often this debilitating illness goes undiagnosed and the bipolar sufferer is left in a world that does not understand them or their sickness.
 
When Charlene, 23, goes to her bedroom, opens her cupboard and takes out the green stockings and orange mini dress with huge circles all over it these days, she knows she is in trouble. She feels reckless and free - in fact she feels great - but at the same time she knows she is heading for a manic period which could last anywhere from a few hours to a week.  “When I’m manic I have no inhibitions and I’m likely to give away half my possessions – sometimes to virtual strangers.” 
 
Charlene was diagnosed as having bipolar disorder at the age of 19 and up to then apart from a couple of bouts of depression had led a normal teenage life. “When I look back now there were some warning signs. I battled to concentrate or finish my work properly at school and every report would say I was not reaching my full potential.  My parents put my behaviour down to being a normal teenager and acting weird to the stress of matric, but inside I knew it was more than that.”
 
Their local general practitioner immediately recognised that this was more than just normal teen behaviour and sent Charlene to a psychiatrist, who, only seeing her depression immediately put her on anti-depressants, which to someone suffering from bipolar disorder is a disaster as this immediately sets off a manic period.
 
So what exactly is bipolar disorder, also known as manic-depressive illness? It is a brain disorder causing the sufferer to experience extreme changes in mood, energy and behaviour – classing it as a mood disorder. Different from the normal ups and downs that everyone goes through, the symptoms of bipolar disorder are severe. One day the sufferer will be in a deep depression and the next feel on top of the world - in fact have so much energy and confidence they think they can tackle anything. Untreated it can lead to suicide, but with the right medication and treatment people with this illness can lead normal lives.
 
The problem though for most bipolar sufferers is simply being correctly diagnosed. According to psychiatrist Dr. Leigh Janet, one of the country’s leading experts on this illness, “Someone with Bipolar will often only be seen by doctors or psychologists while they are in the depressed stage of their illness and will then be prescribed anti-depressants, which will usually bring on a manic phase. Bipolar is very tricky to diagnose and often people with an extreme form of the illness can look as though they have schizophrenia - although this is a totally different illness. A person can be genetically predisposed to bipolar, which means it can be triggered by something like substance abuse or trauma. Very often it is a family gene and once we take a family history and see bipolar this is a sure confirmation of the illness.”
 
This was the case for Lee Loggerenberg, 34, a freelance journalist from Johannesburg. “There was a history of depression and bipolar in our family, but it was not until 10 years ago that I was correctly diagnosed. Looking back I have always had this condition. As a child I was moody and often angry - although my parents did not seem to think it was a problem. School was not easy and after matric I started doing drugs and drinking way more than was normal for a girl my age – that went along with no inhibitions. I could not control my emotions and my moods would swing through ups and downs. Even when I was diagnosed I did not take it seriously and brushed it off – until after I got married and fell pregnant. That was when the real problems started.”
 
Even a normal pregnancy will see a woman’s behaviour change as the hormones kick in, but for a person with bipolar this is around seven times more severe and their moods are severely affected. “I literally had to be held back one day as I wanted to attack my sister and do her serious damage”, explains Loggerenberg. “This was when I was taken to a psychiatrist who diagnosed this as hypomania. I would get very excited and talk very fast one minute and sink to a deep depression the next. Before I saw the psychiatrist the medication I was on, as well as the alcohol I was drinking, had triggered this behaviour. My poor husband, who is a quiet guy, was incredibly patient and a wonderfully stabilising influence for me. One day though I even picked up a kitchen knife and came at him – where did that come from, I’d ask myself later? “ 
 
Loggerenberg’s problems intensified once her twin boys were born. They moved in with her parents just as post natal depression (the normal condition after a bipolar pregnancy) set in.  “One night I was so frantic I held a pillow over my child’s face and said if you do not help me I am going to kill my children.” It was at this point that Loggerenberg’s parents took the children and her medication was changed. Within days her mood had stabilised and today Loggerenberg knows if a manic period is about to start. “Today I look for the signals and simply adjust my medication.” Prevention is of course better than cure. 
 
Early diagnosis is often the key to controlling this illness. Zane Wilson, founder of the South African Depression and Anxiety Group (SADAG), receives daily calls from sufferers or families of bipolar disorder. “If we do not catch them as soon as possible the problem gets so bad we have to get them admitted to hospital to stabilise them to get their lives back on track. What would help is if those close to bipolar sufferers start to see the signs of mania coming on and check if they’re taking the medication – and keep a close eye on them.”
 
SADAG advises family members and friends of sufferers to identify what kinds of things are likely to trigger manic episodes and then try to avoid these as well as making sure they stick to their medication. “When a family member calls us to report someone behaving in a way that sounds like bipolar disorder we immediately advise them to seek psychiatric help. Very often the onset is in quite young people and it’s hard for their families to face this,” adds Wilson.
 
Today, these women are living fulfilled lives, are on medication and see a future in front of them. But how is this illness successfully treated? “We look at each case individually as some people will have one episode a year whereas you can have one when you’re 20 and the next when you’re 70,” explains Janet.  If you have three or more episodes then you would have to stay on mood stabilisers, such as Lithium. For around 15 percent of people Lithium is all they need, but with others it’s often a cocktail of medications. It often takes a little juggling to find the right combinations.”
 
The good news is that there are at least 12 support groups up and running around South Africa for bipolar sufferers. And as Loggerenberg says “We are seen as outcasts but we are not. We are normal people with a disease. A disease of the brain…”
 
SADAG’s Bipolar Helpline: 0800 70 80 90
 
Marion Scher is a journalist, media consultant and trainer at Media Mentors.