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Bipolar: alife of extremes
More than a million South Africans may have bipolar disorder, an illness that causes manic highs and deep depression. With Bipolar Awareness Day coming up on Monday, Lindsay Ord asks two sufferers how they manage it ENTION the word bipolar and people think they understand it — they've seen a celebrity admitting to having it or they know someone with mood swings and casually label him bipolar. But the reality of the disorder is far removed from the glamour of the red carpet and it is more than mere moodiness. Durban electronics engineer Wesley* describes it as "the worst kind of hell". The 54-year-old says it has cost him his career, his first marriage and his social life. "It's an illness characterised by recurring bouts of hypomania, which is like a feeling of invincibility, followed by bouts of depression, where your world comes crashing down," he says. Wesley ran a successful IT company and would work obsessively in a manic state, with extraordinary levels of energy, which would always be followed by black depression. When hypomanic, there was no stopping him. He once bought 11 houses in a month. "I plunged my family into financial chaos," he says. He was forced to sell them at a loss. Durban photojournalist, Eve, 41, also tells of an upward spiral during manic episodes. "On the upside, I would be very creative and have fantastic ideas, but I would hardly sleep for weeks," she says. "I was impatient with people who were moving too slowly for me and I thought nothing of taking huge risks in every sphere of my life." According to the South African Anxiety and Depression Group (Sadag), people with bipolar disorder experience unusually intense emotional states that occur in distinct time frames. From the overjoyed highs of a manic episode to the crushing lows of depression, they swing between these two opposite moods. Extreme changes in energy, activity, the need for sleep and food, and behaviour are part of these mood changes. Bipolar is a chronic mental illness that affects about 2 percent of the population and it is thought that there are more than a million people in South Africa with it. It is misunderstood, stigmatised and hurtful stereotypes abound, and, according to Sadag, individuals are sometimes labelled "psycho" or "crazy", or are told they should not have children and they cannot live normal lives. Severe symptoms recur unpredictably and often make it impossible for the sufferer to function at work, socially or at home. As a result, many people with bipolar disorder battle to keep their jobs. For Wesley, depression, often triggered by workplace stress and what he describes as "corporate bullying", forced him to close his business. "I have been ill for long periods of time and I have been in and out of rehab over the years. Although my bipolar is well controlled with medication now, I am taking a break from work and monitoring my situation. I hope to return to work at some point." Wesley's bipolar disorder has also been hard on his loved ones. "Bipolar depression is always accompanied by acute anxiety, incredible fear, feelings of worthlessness and hopelessness and often thoughts of suicide. That is not easy to live with. I would not be alive today without the support of my second wife. Family support is crucial." Eve, who has a diploma in journalism, has also had a chequered working life, symptomatic of her condition, working as an estate agent, make-up artist, missionary, store manager and, finally, photojournalist. She has been hospitalised several times and endured tumultuous relationships. The birth of her daughter, now 5, has given her the most stability she has ever had. "I attempted suicide many times in the past, but she is what stops me from doing it now As a single mom, I am wholly responsible for her, though I have a fantastic support system in my mother and friends. Interestingly while pregnant, I was the most 'normal' I have ever been and was off most of my medication." Wesley and Eve were misdiagnosed with depression and it was many years before they were correctly diagnosed. Some research suggests that 50 percent of people with bipolar were first incorrectly diagnosed with depression or Attention Deficit Hyperactivity Disorder (ADHD). "It can be difficult to make a diagnosis of bipolar disorder," says Sadag founder and director, Zane Wilson. "And possibly bipolar isn't the first diagnosis you received from a mental health provider." People are more likely to go to a doctor when they are in depressive distress: they rarely seek treatment when they feel elated or hypomanic. Moods Wilson advises people to consider all their moods (not just the depressive ones), including signs of excess energy, hypersexuality or racing thoughts. "It's vital that mental health professionals have all the information - not just part of it." Psychiatrist Dr Frans Korb says: "Many people, including health professionals, have no idea what bipolar is or what a diagnosis means - they have stereotyped misconceptions and there is a general lack of awareness about the disorder and its symptoms." Getting the correct treatment, too, can be difficult. "It is often hit-and-miss until you get the right medication and you can manage the condition well with the right medication," says Wesley "It is important to keep taking it, no matter how well you feel. I learnt that the hard way" Eve also learnt not to stop her medication. "When you are high, you do not want anything to take the edge off. When you are depressed, you can't see the point. Also, what works for you now might not work in two years' time and it is important to stay in contact with your doctor and monitor the effects of the medication." Going off medication is a serious problem because patients mistakenly feel they no longer need it. However, even a stable mood can, without treatment, spiral into mania or crash into depression without warning. "Many patients require the use of medication, and often a combination of medication, to be well," says psychiatrist Dr Leigh Janet. "Helping patients understand their diagnosis is key Patients need guidance and support in understanding what their diagnosis means and what their treatment entails, what medication they are taking and why Research has shown that patient compliance occurs as a result of patients' motivation, ability and willingness to take and sustain treatment. The more difficult that treatment is, the more challenging it is to stick to and the more support the patient needs." Lori Barausse, of the Solos survivors of suicide group, says bipolar disorder is utterly debilitating and if not treated can lead to suicide. "It must be taken seriously and we need to learn to be empathetic," she says. "Sufferers need treatment." Wesley and Eve have both had electro-convulsive therapy (ECT) which, they say is not for the faint-hearted, but which worked well for them. And so, for people with bipolar, like Wesley and Eve, it is a matter of managing a lifelong condition through vigilance and medication compliance. "I take it a day at a time, sometimes and hour at a time - and even, occasionally a minute at a time," says Eve. *Not his real name BIPOLAR Disorder affects up to 4 percent of people in South Africa. It is the sixth leading cause of disability in the world. It is not restricted to any social or educational class. It was previously known as manic-depressive illness. It is a physical illness marked by extreme changes in mood, energy, thinking and behaviour. It is typically seen as episodes of deep depression and manic highs. It often disrupts work, school, family, and social life. Men and women are equally affected; however men tend to have more manic episodes while women experience more depressive episodes. Famous people in the past, like Winston Churchill, Isaac Newton, Abraham Lincoln, Vincent van Gogh and others were all bipolar sufferers. It is believed to be a combination of biochemical, genetic and psychological factors. Bipolar disorder typically begins in adolescence or early adulthood and continues throughout life. It can also affect children, however, diagnosis is difficult as many symptoms mimic emotions and other behaviours such as ADHD. In children, it significantly impairs functioning in school and at home with the family It is not always recognised as an illness, and people who have it may suffer needlessly for years or even decades. It is treatable, and is not a character flaw or a sign of personal weakness; very effective treatments are available. South Africa has more than 15 support groups around the country Ask the doct Sadag has a toll-free line sponsored by Adcock Ingram. The Bipolar Helpline, 0800 70 80 90, has a linked SMS service (31393) to enable callers, even from rural and isolated areas, to call Sadag for expert advice, information and counselling. The line is open every day from 8am and 8pm. Visit the website for more information: www.sadag.org point. Also, what works for you now might not work in two years' time and it is important to stay in contact with your doctor and monitor the effects of the medication." Going off medication is a serious problem because patients mistakenly feel they no longer need it. However, even a stable mood can, without treatment, spiral into mania or crash into depression without warning. "Many patients require the use of medication, and often a combination of medication, to be well," says psychiatrist Dr Leigh Janet. "Helping patients understand their diagnosis is Actress Catherine Zeta Jones and television star Stephen Fry, below, are said to have bipolar disorder.