State Psychiatric Hospital - Tserova Koria

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What is а bipolar affective disorder?

In one’s life there are happy and gloomy days. Anyone can feel excited or crushed, but usually this is due to specific circumstances. In contrast, bipolar affective disorder is characterized by periods of deep, prolonged, and profound depression that alternate with periods of an excessively elevated or irritable mood that may last for weeks, without any serious reason, or event that might have coused them. During these episodes the overall behavior and the daily routine life is being roughly violated. This is not just a reaction to some external circumstances. It is not a strange feature of the personality, or a fad. Indeed bipolar affective disorder is due to a chemical disbalance in certain areas of the brain and is a disease - such as diabetes or hypertension. Do not think that you come upon some special evil, designed just for you. If you suffer from bipolar affective disorder, you're not alone: ​​the disease affects an average of one out of every hundred people worldwide and is well known in the modern medicine.

Why you?

There is never just one particular reason that has caused the bipolar affective disorder. Your condition though, is not connected with personal disabilities, weak will or inability to manage your life. One of the possible factors is the genetic heritage. Experts consider that some people inherite the mental disorder. On the other hand it might be caused by other systemic diseases, or medicines, drugs, stimulants or alcohol that damage the brain. The impact of different types of stressful events can lead to the mental disorder as well. In most cases the symptoms of the disorder begins in the early ages of the boyhood. 

Manifestations of the bipolar affective disorder quite vary, but the main symptom of the disease is unusually intense and sustained mood swings in direction of one of two opposite poles - elevated mood is significant, known as mania or deep and comprehensive despair and apathy-depression. These conditions might alternate with each other in a different order and with different time intervals between them. This state of mind prevents you from thinking successively and logically, it makes you unable to have normal emotional reactions and behave naturally among people and to perform your professional duties. These are not just usual "bright" and "dark" experiences in the life of each of us, but a serious disease. Of course, such a disease can affect anyone. It is an important fact that the bipolar affective disorder engage not only the mood and thoughts, and the organism as whole, but also they have a comprehensive impact on everyday life. Bipolar disorder can look very different in different people and they vary widely in their pattern, severity, and frequency.  (sometimes - from day to day or even within a single day). The lengths of the episodes vary considerably and they can repeat through life - sometimes after decades of completely normal and peaceful life. In order the control of these events to be possible - as the events in every disease –a specific treatment required.

Some specific signs can show you, your family and your doctor as well, that you need qualified assistance. 

In a state of depression, some of the most often observed symptoms and signs are the following:

  • Permanently dejected, gloomy mood
  • Loss of interest and joy of life
  • Lack of enthusiasm and motivation, giving a sense of unenforceability of even the simplest tasks
  • Inability to concentrate and decision-making
  • Agitation or restlessness
  • Constant feeling of fatigue
  • Change in appetite with a rise or drop of weight
  • Inability to external expression of affection; refusion of sex
  • Loss of self-confidence, avoiding people
  • Irritability
  • Feelings of worthlessness, inadequacy, wickedness, helplessness and hopelessness
  • Thoughts of suicide

At the other  pole (mania) the disease is characterized by:

  • Permanently and abnormally upbeat, confident or irritable mood
  • Motor hyperactivity or excitement
  • Increased self-esteem and ideas of grandeur
  • Decreased need for sleep (eg. Feeling rested after a three-hour sleep)
  • Excessive talkativeness and contactability
  • Scent of a rush of thoughts ( "flight of ideas")
  • Very easy to destract (even minor, negligible external stimuli)
  • Еxtreme engagement in activities bearing pleasure or delight, but having bad consequences (excessive spending, inappropriate sexual activity, stupid and foolish business investments)
  • Extremely superficial and frivolous judgment of actions and situations
  • Feeling of Greatness
  • Many plans, many started and unfinished activities, constant movement, aggressivness

Is the disease curable at all?

It should not be claimed that there is an absolute and eternal cure of your disease, but the symptoms can be controlled and managed fully in longterm with a wide range of highly effective modern drugs. The treatment eliminates the pain and suffering of your illness and with it makes you able to lead a productive, fulfilling and satisfying life: to work, to have fun, to live with your family to communicate with pleasure with friends and close ones.

The appropriate drugs for the treatment of bipolar affective disorder are not sedatives, though they are reducing your stress. They are not addictive and do not develop dependence. They are very effective and you will regain your normal mental state, but their  full effect occurs after two or three weeks and they must be taken for months even after you feel completely well. It is unreasonable to expect that a serious illness will pass completely for a few days. It is possible (as with any other disease) to take one or two treatment courses as you find the right medicine. Do not be desparate, if the first attempt is unsuccessful – the effective therapeutic approaches available are not few.

How to help yourself in order to deal with this disease?

Remember that as with all diseases, the longer you have had a bipolar affective disorder before you seek help, the more difficult your treatment will be. It is a good start if you take earsly and seriously your responsibilities as a patient. This simply means to follow your doctor's advice as conscientiously as possible. Actually it is not difficult - you only need to follow closely few simple rules. To attend all appointments with your doctor; to ask questions about anything you do not understand or you worry about; follow the prescribed acceptance of medicines; report any side effects of treatment; try to register changes in your condition. The only one who knows how you feel is you, yourself so yourfeelings cannot be seen from the blood pressure, temperature or the changes in the blood and urine. So share with your doctor any changes in your condition to get the most appropriate and effective treatment. Always notify him for any unpleasant effect of the medicines. Side effects may be due to body chemistry, your age, your intake of other drugs, as well as other potential diseases that you might suffer from. Your doctor may reduce or eliminate these adverse effects by reducing the dose or setting another reception mode by replacing the drug or adding other remedies. Side effects are the most common cause of unintentional discontinuation of the treatment. If signs of discomfort emerge, immediately seek your doctor without waiting for the specific time of the appointment.

If there are suicidal thoughts in your head, do not hesitate, seek your doctor immediately!

  • Resist the temptation to drown sorrows in alcohol. This will further complicate the things and it will prevent the full treatment.
  • Do something: go outdoors and exercise, walk. If you are unable to deal with your routine work, do something around the house. This will keep your physical shape and will distract from the painful feelings associated with your disease.
  • During the disease episode do not take important life changes and do not make important life decisions.
  • If it is hard for you to explain to the close once your illness arrange a meeting between them and your doctor and he will explain your condition in the most acceptable way.
  • You should understand that if it takes time to develop a disease, then it takes time to make the same disease go away. Remember that after the symptoms have been successfully managed you will need quite a long time to become a full person. Therefore you should not bother with more commitments than you can take. Create a realistic timetable. Others would understand it better if you find strength in yourself to talk openly with them about your disease.

Is the medication alone enough?

Those who suffer from bipolar affective disorder are vulnerable to develop future diseases. For example, the easy tears might be considered by others as a weakness of character. People who are always in a bad mood may be less attractive to others. Since people with bipolar disorder are often unfairly judged by others, their ability to create friendships or intimate relationships and career prospects are not always optimal. The efforts to impose in similar circumstances could further undermine the confidence. A psychotherapeutic intervention  can help in case of such promblems.

Can you get pregnant, give birth and breastfeed, if you suffer from bipolar affective disorder?

You should realize that you have a serious disease and you should not take unnecessary risks. This includes your decisions to stop taking drugs or to become pregnant. The bipolar affective disorder does not interfere with your fertility. Altough, it is possible to get pregnant harder than you might expect. In case you have been trying for a long time to get pregnant, and you fail, go with your partner and consult a specialist. Planning pregnancy helps your doctor to adjust a treatment regularly monitored and appropriate for your mood. These things are important because some drugs can harm your baby, they have to be terminated during the first three months of the pregnancy. The better your interaction with your doctor is, the better chances you and your baby to feel healthy all the time are.

Postpartum period (puerperal period) is a time of changes for every woman. She should adapt to serious hormonal changes, and to a completely different lifestyle. Do not be startled if your mood immediately after birth is depressed or irritable, but keep in mind that women with bipolar affective disorder are at increased risk of developing a manic or depressive episode in the first three months after birth. In case you have stopped taking drugs that stabilize your mood, be sure to start taking them again in the same doses, after consulting a psychiatrist. Do not be discouraged from breastfeeding just because you are taking medicines. Ask for an advice your doctor if medicines you are taking are safe and in which circumstances it is better not to breastfeed. If you have your baby is taking any medications (eg. Antibiotics) tell the child doctor what medications you take, in order the doctor to assess whether the combination is safe. If you do not get enough sleep if you do not eat properly or have suicidal thoughts, your child will also suffer. Remember that your health is the most important prerequisite for the proper development of your child!

Is it possible your child to inherit your disease?

Although it is possible, the bipolar affective disorder is not automatically inherited by your child. Do not fall into unnecessary panic - the risk in case of a sick parent does not exceed 1:8. Share your concerns on this important issue with a psychiatrist and ask for an advice of experts, you can take a reasonable and balanced solution based on the complete information. It is better you and your partner to check whethere there are other people of your families who have complained of mood disorders. If there are more affected people by the disease in the family, the risk increases.

What can you do to prevent this happening again?

There is no a defenite drug that is best for everyone, since each person, suffering from bipolar affective disorder has his/her own set of symptoms. The symptoms might not disappear completely, it is also possible the natural tendency of the disease to not be suppressed easily and quickly.

The aim of the initial acute treatment is to remove the symptoms until the moment you start to feel better. Long-term maintenance therapy aims to prevent recurrent disease episodes. Taking the drugs continuously will reduce the risk of recurrence of the disease symptoms, and if they appear again, usually they are much lighter and short-lasting.The drugs have a very powerful effect on the desease episode, so one of the most serious problems faced by your doctor is that the drugs, can "switch" your mood at the opposite pole, and so this can make the suffering period longer. There are already drugs that stabilize the mood and prevent similar polar "switching".

Tips for the family and close friends

Living with someone who is sick of bipolar affective disorder is very difficult and often unsettling, especially if that person threatens to suicide or becomes easily aggressive. It is confusing and hard to see how a perso you love becomes absolutely different than the one you have known. Sometimes it seems that whatever we try to do in order to help, it still is never the right one. Try not to get too critical and not to make comments like "Pull yourself together". The disease of your close is not imaginery. No offense - remember that your close one does not do all this deliberately or defiance and he/she hasn’t become ill on purpose.

Try to convince your close one that the desease is just temporary. Incite him to consult his doctor regularly. Try to motivate your close one to take the drugs, do not tell him: "If I were you I would not take them!" Or "Why do you need a psychiatrist – you are not crazy!" When it comes to suicide, take it seriously and seek urgently a professional help. If you have any doubts or suspicions about the treatment approach, discuss them with an expert before you tell your close one. Keep in mind that your close one will often need your financial support. Sympathize and support your close one much as possible, but at the same time you should try to give yourself an adequate rest and try to live normally.