Depression, mania and bipolar mood disorder

Bipolar mood disorder (BMD) is a condition that causes extreme mood swings, from high, euphoric periods of mania to severe episodes of depression that can make daily life challenging. Yet, with the correct treatment, it can be managed.

Mogamad Nackerdien, who lives in Cape Town, experienced his first manic and depressive episodes at age 18. Yet he was already 32 when he was finally diagnosed with bipolar mood disorder. “That’s when my BMD reached a peak, and I experienced a six-month manic episode,” says Mogamad, who is dedicated to supporting fellow BMD sufferers and breaking the stigma surrounding the disease.

How does bipolar mood disorder (BMD) feel?

Manic episode

“My mania was very damaging and destructive, it could easily have ended my life, or resulted in me being jailed for road rage,” Mogamad explains. “It’s almost like you’re living life through a filter, and everything is amazing, but nothing is good enough for you; you always need everything to be better in every aspect of your life. You start doing a hundred things, but you can never finish them.”

Depressive episode

This manic episode was followed by a depression that lasted for 14 months. “When the mania ended, it felt like I hit this wall and just dropped straight below the ground. It felt like my entire soul had been ripped out of me. I experienced depression like I never had before. I was almost unable to do anything, I was suicidal all the time and could see no light.”

When he realised things were not improving, Mogamad finally sought medical help, received a diagnosis and was prescribed medication. “Once the medication started working and pulling me out of the depression, I felt a lot better,” he says.

Bipolar type 1 and type 2

BMD presents with different degrees of severity and with varying symptoms.

i.   People with bipolar type 1 experience episodes of depression, hypomania, and mania.

ii.  People with bipolar type 2 have episodes of depression and hypomania.

The primary differences between mania and hypomania are how intense the symptoms are and how long they last. Manic symptoms are extremely intense and can last for a week to months at a time.  Hypomania typically lasts for a few days at a time and the person can usually go about their daily life, but their mood and behaviour change, which can be difficult, upsetting, and even distressing.

Understanding BMD symptoms

“The symptoms of BMD differ from one patient to the other,” explains Pebetse Matabane-Monama, a clinical psychologist at Mediclinic Legae. “Some patients may experience symptoms of depression, while others experience manic symptoms and others may experience mixed symptoms – a presentation of both manic and depressive symptoms.”

Depressive symptoms include suicidal ideation, low mood, sadness and anxiety, insomnia or hypersomnia – when you still feel sleepy despite getting sufficient sleep – as well as feeling slowed down, restless and hopeless. Mania is characterised by an elevated mood coupled with extreme irritability, racing thoughts, feeling able to execute a lot of different tasks in a short time or at once, decreased need for sleep and an increased appetite for food, alcohol, and sex.

“All of these symptoms may impact the patient’s functioning as it affects behaviour and their work and social life may change extremely,” Matabane-Monama says. “There will be mood swings and there may be unusual activity levels.”

Possible causes of BMD

We do not know the exact causes of BMD, she continues. “However, factors that may be involved include biological differences or genetics.” This means that if there is a genetic predisposition, a person may be susceptible to the condition. This is the case for Mogamad, whose father was only diagnosed at age 75. Three of Mogamad’s siblings also live with BMD.

But the condition is not always genetic, Matabane-Monama adds. “High stress levels caused by traumatic events, loss or substance abuse may also be risk factors for developing BMD.”

Treatment options for bipolar disorder

While treatment is tailored to the individual, generally the best treatment options include both individual psychotherapy and psychiatric medication, Matabane-Monama explains. “The type of therapy depends on the individual, as the presentations are always different,” she says. “The patient’s background, cultural beliefs, precipitating factors, past traumas, intellectual functioning and so on, are considered when implementing an appropriate treatment plan.”

For example, high-functioning bipolar disorder patients might receive cognitive behavioural therapy (CBT). CBT is a type of therapy that aims to help people reframe their harmful or upsetting thoughts and replace them with more positive behaviour.   

“You always need to take the medication in the dose prescribed by the psychiatrist,” Matabane-Monama advises. “Medical treatment goes hand in hand with therapy as they address different things but have the same goal.”

Counselling and support for BMD

For Mogamad, medication coupled with weekly counselling sessions has helped him manage his BMD. He also frequently shares his story and stresses the importance of face-to-face support groups. His support group currently has 35 members. “It’s the only space that we go to where we can understand and relate to each other,” he says. “As with any illness, you can only understand what it’s actually like if you suffer from it.” He hopes to be able to dedicate himself full-time to opening a space that provides support groups and counselling for those living with BMD to normalise speaking about the condition. 

“Although BMD sounds complex, it is manageable through medical treatment and psychotherapy,” Matabane-Monama assures. “Many individuals are well employed and functioning well in their spaces because they’re complying with their treatment.”

To find a mental healthcare professional at your nearest Mediclinic, go to www.mediclinic.co.za