Recently, rapper Honey Singh opened up about the challenges of living with bipolar disorder that cost him his music career. He would be a psychopath, his mind, in his own words, “There will be more work and it will spiral out of control.“And while everyone chalked it up to mood swings born of a busy work life, it took Singh a while to diagnose.
Diagnostic challenges are not new for Dr Shaunak Ajinkya, a psychiatrist at Kokilaben Dhirubhai Ambani Hospital, Mumbai, who has seen many youngsters go through similar symptoms, which he feels are often dismissed as anxiety arising from mood swings or performance pressure. Seen as a mental health problem. Listen on:
Signs and symptoms
Alok, a 28-year-old software developer, had been experiencing severe mood swings for a year when he came to see me. He was hyperactive, unable to sleep more than three hours each day. He was impulsive, a shopaholic, a compulsive gamer (he lost a lot of money) and was into rash driving. But what scared his family was the day he became paranoid about his fiancee, thinking he would harm her. He will swing between manic and depressive episodes, and feel depressed, guilty, with a sense of worthlessness. Alok reported feeling tired all the time, feeling isolated, struggling to find interest in activities he once enjoyed, and having difficulty concentrating at work.
Analyzing his symptoms, and ruling out substance abuse and other medical conditions, we diagnosed him with bipolar disorder.
What causes bipolar disorder?
Research suggests that genetics may be responsible for about 80 percent of the causes. Alok had episodes of mood swings since his teenage years but his parents attributed it to the stress of academics and late sleeping. But uncle was also sick.
Stressful life events, such as the death of a loved one, a relationship breakup, or physical or emotional abuse can trigger or worsen symptoms. An imbalance in neurotransmitters, which are chemicals that help brain cells communicate and regulate mood, may be linked to bipolar disorder. Use of alcohol or certain recreational drugs may increase the risk.
What is the cure for all?
It involves a combination of strategies. Severe patients require mood stabilizers and antipsychotics to cope with paranoid delusions. Antidepressants can be used with caution to address symptoms of depression.
Alok had cognitive behavioral therapy (CBT), which helps manage negative thought patterns and develop coping skills. We also reached out to family members to improve communication and support. We set up a lifestyle routine to get Alok back to normal, such as sticking to sleeping, eating, and activity schedules. He exercised regularly (physical activity helps regulate mood and reduce stress), ate clean, avoided excessive sugar and caffeine. Patients should avoid alcohol and drugs as these worsen mood swings and may interfere with medications. Alok practiced yoga and mindfulness exercises for stress management.
Peer support groups help. Now there are mood tracking apps or journals to monitor changes in mood, sleep, and activity. Identifying triggers that can cause mood episodes, such as stress or lack of sleep, can help a person seek help during a crisis. So they should also have a trusted contact and healthcare provider. There is a need for regular check-ins with a therapist as healing the mind is a long process.
After six months of treatment with regular bi-monthly follow-ups, Alok reported a significant reduction in the frequency and intensity of mood swings.
Can bipolar disorder be managed without medication?
This approach may be more feasible for people with milder bipolar 2 disorder. Many people benefit from a combination of medication and therapy for long-term stability. Otherwise erratic mood swings can disrupt their personal and professional lives.
More severe episodes have an increased likelihood of recurrence and progression. Medicines are the mainstay of treatment for those with moderate to severe symptoms.
Why is sleep important?
People with bipolar disorder often have irregular biological clocks, causing irregular sleep-wake cycles. Lack of sleep can trigger manic episodes. Excessive sleep or irregular patterns can contribute to depressive episodes. Sleep helps regulate brain chemicals important for emotional balance.
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