Chrissie is a carer. She looks after someone with bipolar manic depression. Life is hard. this is part of her story.

Despite all the known and recognised cases of this type of depression, the 1 in 25 people suffering include: Stephen Fry, the artist Van Gogh, the poet Coleridge and even Carrie the Princess Leila out of Star Wars (you may have watched Fry’s biographical documentary) at some stage in their lives, they took the brave step to get treatment - and yet many years of medical experience, cases and medicine used has only brought half acknowledgment. They have not brought about a cure for this rampant and as yet largely incurable condition.

Medication forms the major part of

the prevention of worsening symptoms. At best stabilising the condition. It is not a cure and can be intermittently dispersed to a less or greater degree. Similarly abating for a season only to suddenly and swiftly rear up again rendering the sufferer into a terrible journey. All too often, daunting demoralising and frightening for both the victim and the nearest relative into a process, which sadly can so often be the best one can hope to achieve as far as a “cure” is concerned. There are very few cases that are totally cured - and medication is still even today very much in its infancy; still trial and error.

Counselling sometimes helps using cognitive behaviour therapy, either one to one

or in a small group; Both for the sufferer and the people closest to them it is at the moment the only other accepted supportive form of treatment.

Not enough is known about, or indeed done, to research the devastating effects of the sufferer and families concerned. Here my aim is to de-mistify this strange and baffling condition. To humanise and inform as many as I can about some of the many symptoms.

BI-POLAR MANIC DEPRESSION.

What is it? What is the medication? How does it effect you/signs to look out for, the myths and the why/wherefores.

Now before you all start to panic I ll put this in a simple nutshell This fairly common yet disruptive in every

way mood disorder is the result of a simple imbalance of the chemicals in the brain. It s not the end of the world. What? Is that it, you ask?

Yep that s it. An imbalance in the brain. It causes an array of not so simple symptoms which will be discussed in good detail.

WHAT CAN BE DONE?

Firstly and most importantly hospitalisation either voluntarily or not in a safe and professionally trained environment under the watchful observation of a skilled psychiatrist will be needed to avoid further damage danger and, in some cases, death.

Then of course after careful observation to build up a complete picture of the symptoms and suffering there comes the stabilising medication. In the

main form this is usually “Lithium Carbonate.” This is a powerful but time dependent compound the brain needs in order to function properly, particularly absent in many manic depressives or by normal comparison very low.

With the Manic depressive, the causes of this absence are not known, though doctors argue and have their differing opinions. The brain after all is covered with delicate fluids and hundreds of neuro transmitters, like a tv or a computer. Any major change to the chemicals found in the delicately made brain can cause chaos. Upset.

There are several reasons to consider the contributing factors for the delicate juices of the brain s sensitive balance being swung out of sync.

The chemical imbalance is often

thought to be especially predisposed in certain groups of people and to have a predisposition to its lack in the first place. For example, many patients have an alcohol dependant parent (usually the mother) which has affected the genetic makeup of the child. Or it has been inherited - passed down from generation to generation. In others there can be no major reason at all.

No one has found a hard and fast 100% cure.

Lithium or sometimes Sodium Valproate taken over time is the commonest therapeutic substance known to ease the effects of mania. It is generally well tolerated and of significant help to alleviate the most stressful of the distressing/mania symptoms. (More of mania later).

But, for most,

the effects are not found to be effective immediately, other than as a calming sedative. It has to be taken for at least a year/18 months for any real significant noticeable improvement or benefits. This difficult time period is true in most cases. Depending, of course, on the severity.

Also, and most unfortunately, like some drugs there are side effects which can be off putting to say the least. Not much to show for 2007 in the name of medical scientific advancement then!

Thirst, weight gain, a bloated feeling, and a tremor, coupled with a chance of possible over toxicity and kidney failure are just some of the main side effects that happen….great! Therefore at least every 3-4 months

or bi-annually, depending on the severity and the needed therapeutic dose, simple routine but regular blood tests must be carried out to check the Lithium levels and safeguard against possible toxicity.

But what s the alternative?

Be barking mad? Or be able to be somewhere in-between. The sufferer will instantly say: “mad it s more interesting”! But the voice of conscience, of reason, of propriety in the carer in other words, will roar “LITHIUM PLEASE, and as fast as you can !

THE CAUSES OF BI-POLAR

Some say alcohol/drug abuse causes a trigger into psychosis,(this makes sense considering how much damage binge drinking and Class A drugs can do to the body, much less the brain cells!). Others say it

is an inherited trait - a defective gene gone wrong. Still others argue that the disorder is triggered by some life changing trauma, child abuse, family breakdown, marital breakdown, bereavement and long term stress. These factors are probably all to a degree, true, with much hidden other separate factors too.

Cruelly, many people with a high IQ are affected. The condition is indiscriminate. I m not a doctor and therefore am not qualified to conclude who is right or wrong probably the cause is a multiple mixture of all that - and much, much more besides.

Even in the medical advances we have today, not enough is known, and treatment consists of trial and error medications,

anti-psychotics, sleeping pills/tranquillisers, mood stabilisers and sometimes usually in the worst affected, slow release injections.

No one knows precisely why Lithium works for some and not in others but it is effective in approximately 79% of diagnosed cases. Much is trial and error which poses all sorts of problems and unwanted side effects. Then again, there are sufferers that can be very unfortunately resistant to any treatment, long term. And as much as 40% of all severe diagnosed cases will need indefinite continuing treatment for possible relapse.

Probably Lithium is one of the commonest prescribed drugs in stabilising the moods. There are various different degrees of severity, episodes and symptoms, which can range between fairly mild (allowing the patient to

continue normal life with minimum disruption,) to a full blown severe “hypermanic” episode.

Bipolar, the modern more commonly used name, is classified as having a mixture of exaggerated both high and low moods. Contrasting sides of the same coin, sometimes mingling and overlapping each other in a complex cycle of mixed mood/ contradictory behaviours. Hence the name bipolar - opposites to one another.

THE MYTHS

Let me say now that Manic depression is not Schizophrenia; though in its extreme severity does mimic many of the symptoms. And can be just as alarming. I know that this unpopular stigmatised serious subject has been a long time coming, and in my opinion, well overdue. Exactly why I haven t up to now

trusted myself to fully give this subject the honesty, sensitivity, time, description respect and insight so deserving of those who suffer isn t a fact I m proud of.

Here I want to redress the balance a bit, warts and all, and speak totally openly. Hopefully stimulate discussion, offer insights, open the door of communication dispel myths and pre conceived ideas; offer hope, encouragement of our own experiences; perhaps answer questions that no one else wants to, or can.

WHAT DOES IT ALL MEAN? WHAT ARE SOME OF THE RANGE OF SYMPTOMS ?

Before I launch in I must emphasise that the following range of symptoms are not to be taken for gospel according to Chrissie! Nor is it an

individual, professional diagnosis - just my own frank account from the view of the carer of what I have seen and experienced Ok?

Everyone s case is different. I am just the mediator to give a generalised view as a carer for the past 12 years. You may want to add or take away what I cover; it s entirely up to you.

Firstly I m going to cover some of the complex symptoms and characteristics of the bipolar manic depressive (which, remember, is a baffling complex mixture of two opposite depressive behaviours).

THE LOWS:

Often slow in speech thought and movement
Inability to concentrate
Lack of appetite/over eating
Inattention to wash /dress
Feelings of despair, gloominess, helplessness
A

crippling sensation of impending doom
Irritability
Feelings of inadequacy/unexplainable fatigue, aches pains in the body
Withdrawal from others
Exhaustion
Anxiety
Apathy
Indifference
Exaggerated thoughts of a no way out situation
Argumentative
Aggressive
No energy
Over sleeping/not sleeping
Psychotic (i.e. suspicious thinking that the whole world is against them)
The perceptive thoughts impressions are distorted
Suspicious
Lack of confidence
Isolation
Feelings of low self worth
Panic
Zombie like
Crying,snapping
Mumbling, slurring of the words - or no speech at all
No emotions or/& exaggerated emotion.
Disturbed sleep
Strange dreaming
Relationship breakdown
Sporadic employment

In extreme cases:

Suicide/attempted suicide - death

THE HIGHS:

A false yet very real euphoric feeling
An exaggerated sense of grandiosity (sometimes a complete exaggerated and switch of

identity crisis that is convinced of ideas quite beyond reason that they are, say, a king/queen/prolific famous person yes, it sounds hilarious doesn t it?!)
Ego driven
Inpatient
Intolerant
Self absorbed
Fast speed of thoughts, racing through the brain
Disturbed sleep pattern
Spending sprees/running up debt - insolvency
Sexual Libido very very high
Extra marital affairs

Happy (Yey!)
Risk taker
Broken relationships
Confrontational
Aggressive
Belligerent
Manipulative
Fast talking
Incoherent speech
Inappropriate giggling
Laughing, shouting swearing, screaming
High energy
Restlessness
Pacing up and down
Not eating
Extreme Boredom
Hyper activity
Losing money
Not sleeping (this, long term, brings its own problems; hallucination, agitation extreme irritability, violence aggression headaches dizziness)
Confusion
Bewilderment
Nervous exhaustion
Hyper Mania -

a serious condition of a euphoric type, and nature causing emotional and irrational behaviour characterised by high nervousness, extreme energy, extreme mood swings, thirst, hunger cravings
The inability to reason properly
The potential to cause harm to yourself &/or others.
Everything on the run
Starting projects and never finishing them
Chaotic mood swings and violence towards others
Short attention span.
Eccentric clothing - e.g. summer clothing in the height of winter and vice versa
Clashes with authority/law/social etiquette -another embarrassing experience!
Eventual physical as well as mental breakdown/exhaustion
An unusually high number of sufferers can also suffer with vertigo causing extreme dizziness, stumbling, giddy, fainting
Panic attacks
Inability to control emotion
Loss of inhibitions,including multiple affairs / an addiction to sex
Fights/punches/confrontations
Reduction in the work front with the inability to live in the real world
Unemployment

WHAT MEDICATION IS OFFERED?

Depending on your severity if you are having what s called a high mood disorder interspersed with anxiety you will probably be given a therapeutic dose of Hyperperidol - a common anti psychotic drug to combat psychosis, bring down any irrational fears and to tranquilize (with varying degrees of success) the effects of mania, bringing the heightened mania side of things to a safer more manageable level.

This is the thing - trial and error.

Lithium Carbonate one of the commonest prescribed drugs to even out mood disorder has had much success in

stabilising conditions. Some people are resistant to treatment, where higher doses need to be maintained to have any benefit. Also it can take up to a year or so before any benefits are noticeable. And Lithium can be toxic

Lithium is found naturally in healthy brain chemical balances, and doctors are keen to mimic this so what they discovered was that the Manic depressive has very low levels of this compound in the brain. By raising Lithium levels this can often stabilise the condition. However not without a cautionary price.
Over time it can have a toxic effect on the kidneys and strict monitoring by way of bi-annual blood tests are carried out to safe guard against kidneys failure.

Trial and

error is the name of the game which can be frustrating difficult and occasionally cause more harm than good.

Today, 11 years on. the person to whom I care for is considered a moderately stabilised fortunate man.
His psychiatrist whom he is currently consulting once every 2 months at the moment has classified his patient as a low risk, to himself and others and wants to start him on the drug Valproate - apparently a relatively new mood stabilising drug.

There are so many different drugs to try and they are changing all the time. But no one has come up with a cure/treatment that doesn t bring with both initial and long term use; its own batch of side effects.
Please

rest assured that the majority of suffers will NOT necessarily experience all of the above alarming list of symptoms at once, and I have painted the very worse scenario so that you can know what you re dealing with here and what you re up against. The ability to empower yourself with some indication of success in what to do should you need help, or know someone close who would benefit from a mood stabilising prescription cannot be overestimated.

If this is the case, then I can only stress and repeat to you,

Please see your doctor and get a referral if you or someone you know suffers from at least 4 of the above listed symptoms. With

any luck it wont be bipolar but if it is there is someone and somewhere to turn to and at least you ll know.

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