Highs and lows: Living with bipolar disorder

She had travelled by bus with a group to a swimming pool, but when the bus departed following the session, Sinead and her friend were accidentally left behind. While her companion was confident the bus would return once those on board realised the two girls were missing, Sinead became severely distressed. Later, at home, despite the fact the bus had promptly returned to collect them, she had a severe panic attack.

“It was terrifying. I could hardly breathe and I couldn’t stop crying. There was an enormity of feeling that I couldn’t describe any other way,” she recalls, adding that in the months that followed, she went from being a happy, extrovert child to becoming withdrawn, anxious, and self-conscious.

She believes she may have a genetic predisposition to bipolar disorder, because, as she later learned, distant family relatives had the condition, in which genetics is believed to play a significant role.

At age 15 she started to secretly self-harm, experienced periods when she couldn’t sleep for days at a time, and became depressed.

“I would be very distressed and crying a lot,” she recalls, but outwardly she still functioned, sitting her Leaving Certificate and attending university, where she studied English and classics and later took a master’s degree in film.

However, in the final year of her undergraduate degree, things came to a head. After waking one day with severe stomach pains, she consulted her GP who believed the pains could be related to stress.

Sinead was referred first to a therapist and later to a psychiatrist, who diagnosed her condition as bipolar disorder in 2008 when she was aged 21, some 10 years after she had that first panic attack.

Bipolar disorder can be difficult to diagnose because of the intrinsic changeability of the symptoms which accompany it, explains Dr Keith Gaynor, senior clinical psychologist with St John of God’s Hospital and a board member of Aware, the mental health support organisation.

A mental health condition which affects an estimated 45,000 people in Ireland, Aware says the disorder can impact on thinking, energy, feelings, and behaviour, and have a profound impact on every aspect of a person’s life, affecting relationships, family, and work life. It’s such a devastating yet common condition — it’s the sixth leading cause of disability worldwide — that there is a designated World Bipolar Day on March 30.

“People have low and high moods and the pattern changes, so it can be hard for the person to recognise their own symptoms and this makes it difficult for the clinician,” says Gaynor.

“It’s often only when someone has been involved with a GP or psychiatrist over a period of time that the clinician will be able to spot the pattern.”

Handbag designer Lulu Guinness and actor and writer Stephen Fry are among those who have suffered from the condition while Vincent van Gogh is believed to have also been a sufferer.

There’s no magic cure, partly because no two people with the condition are exactly the same, says Gaynor, and partly because, from a clinical perspective, trying to balance the cycles of low and high mood can be difficult.

The condition is made even more complex by the fact it is influenced by both genetic and environmental factors. “If you have someone with the condition in the family, you can have an increased risk of getting it,” explains Gaynor.

However, he says environmental factors such as sleep deprivation or over-work also play a significant role.

Although a diagnosis of bipolar disorder may once have been a life sentence, with little hope of independent living, more education and a greater understanding of the condition, along with improved and new treatments as a result of ongoing research, mean most sufferers today can lead full lives.

Medication is one of several crucial aspects to managing life with bipolar disorder, particularly in the acute stages, says consultant psychiatrist Declan Lyons, from St Patrick’s Mental Health Services and a member of the Aware board and clinical committee.

The main medical treatments for managing the elation or manic phase of the condition, he says, are the conventional mood stabilisers, while both traditional and newer anti-depressant medications have been found to have a role in helping to manage the depressive stage of the disorder.

Research is also under way to find genetic markers to identify people who may be vulnerable to bipolar disorder — and what implications that might have for treatment, he says.

Studies are being carried out into the role that the drug ketamine could play in treating the depressive phase of the condition. “Ketamine is still in the trial phase but there are hopes that in terms of rapid alleviation of depression it may have a role,” says Lyons.

He emphasises, however, that education about bipolar disorder, a deep understanding of the illness and an array of psychological strategies, as well as the availability of solid family support, are all crucial elements to effectively manage this condition.

The smartphone can be of help — apps can be used for mood observation and to help identify stress triggers and patterns of relapse, which can be revealed by daily mood ratings. “This can be very illuminating for the patient and their clinician,” says Lyons, adding that many patients use their devices to practise mindfulness, for example.

Social rhythm therapy, which identifies a person’s individual rhythms that promote personal well-being — for example, a healthy sleep regimen, an avoidance of overwork, a reduction of alcohol or caffeine intake, and the practise of active relaxation strategies, as well as the avoidance of family conflict — also plays an important role along with cognitive behavioural therapy, interpersonal therapy, and psycho-education.

Education about the condition is extremely powerful.

"It makes a huge difference when people become informed and start to understand their own individual patterns — as a therapist I sit down and work out these patterns with people,” says Gaynor, adding that warning signs could include more energy or irritability a few days before a period of elation.

When you know your own triggers — it may be lack of sleep, or overwork, or doing too much — you can help yourself manage the triggers and that works really well.

There is some work involved in training in this but when people get good at it, he says, it can really help.

In 2016, Aware developed a successful education programme for relatives of people with BPD or depression, which, according to director of services Bríd O’Meara, provides information about the condition and tools to assist families in supporting a loved one with bipolar disorder.

This year, she says, Aware plans to go one step further by developing a bipolar group programme offering education about the condition and skills to manage it for people with the condition as well as two versions of an online bipolar programme, one for the newly diagnosed and one for those living with the condition in the longer term.

World Bipolar Day, believes O’Meara, provides a great opportunity for mental health organisations worldwide to come together and bring a global awareness to bipolar disorder, to educate and improve public understanding of the condition, as well as ensuring that those with a diagnosis are familiar with the supports available to them.

For Sinead, now married, aged 30, and living in Maynooth, and attending the same psychiatrist since her college years, medication and family support have played a significant role in her life for the last 10 years.

Having bipolar disorder has had a major impact on my life, particularly in relation to work.

“The illness is very difficult to manage and you have to have continuity of care and family support,” says Sinead, who works as a peer support facilitator with the mental health support group Shine.

“My consultant, has been an enormous support and has had great impact on my wellbeing.”

She says her husband Joseph is also hugely supportive: “He is aware of my condition and is absolutely wonderful.”

In recent months, and with the support of her psychiatrist and GP, Sinead has been gradually weaning herself off the medication in preparation for starting a family. “It has to be planned and managed.”

She explains that it was decided that she could come off medication because of the stability of her life and her high levels of self-management but “it must be carefully monitored”.

For more information on Aware’s Support Services or to register for the Aware Relatives & Friends Programme, visit aware.ie

‘For a long time I had no idea what was going on’

RICK Rossiter, a father of two, has experienced the symptoms of bipolar disorder since the age of 13 but wasn't diagnosed until his mid-20s.

Back then, says Rossiter, a native of Newfoundland who has lived in Ireland for about 20 years, his behaviour was probably just perceived as ‘bold’.

“At that age, nobody was thinking about a mental health disorder. I was in trouble in school and I was stealing so I got in trouble with the police,” he says.

At 15 he tried to end his life by jumping off a building, causing horrendous damage to his back and legs yet his condition was not diagnosed until he was 26.

I was hospitalised on several occasions and over the years there were more suicide attempts.

“All through my adult life I had symptoms. I was experiencing highs and would be very on-the-go, no sleep and spending money. These periods could last for weeks or months.”

Managing his condition requires a combination of medication, cognitivebehaviour therapies, talk therapy and support from “key people” in his life such as his wife. On top of that, he believes, for him it was crucial to learn about the disorder and how it worked.

“For a long time I had no idea what was going on and my wife had less. Then we both got educated about bipolar disorder, about the symptoms and the triggers and warning signs. Knowing about it helps tremendously,” says Rick, who lives in Celbridge Co Kildare.

He volunteers with a number of mental health support groups, including Aware and See Change and is planning to begin a degree in social policy and sociology next September.

“Volunteering has helped me because it means getting out there and engaging with people,” he says.

Bipolar disorder can be very exhausting, but I find that volunteering and getting support from volunteer groups has been a key issue in my health as has educating myself about the disorder.