Bipolar therapy finds way out
A new treatment has reduced the number of manic episodes experienced by people with bipolar disorder. Clara Pirani reports
FOR almost 40 years, Jennifer Howell pretended to be someone else. Since her teens, the now 61-year-old Melbourne woman ‘‘ acted happy’’ in front of family and friends, all the while experiencing episodes of extreme despair and sadness.
‘‘ I pretended to be a bright, happy person because I knew that it was not acceptable to be depressed. I was always trying to be a nice person to cover up my feelings of irritability. I didn’t understand why I felt like that. I was looking for reasons, but never quite grasping the fact that it could be a mental illness.’’
Unable to work full-time, Howell worked in a variety of part-time jobs as she tried to understand why she never felt the same happiness that seemed to come so easily to others. Four years ago, she finally had an answer. ‘‘ I went to see a new GP because I had a broken bone in my foot. After a few minutes talking to her, I began to cry. After about five minutes, she said I was really depressed and she called a psychiatrist and I was diagnosed with bipolar disorder. That was the beginning of my recovery.’’
Bipolar disorder, which affects more than 100,000 Australians, is caused by an imbalance of chemicals in the brain and results in extreme mood swings.
The condition was previously known as manic depression, because a person’s mood can alternate between the ‘‘ poles’’ of mania (highs) and depression (lows).
These mood swings can last for hours, days, weeks or months.
Howell was prescribed various medications, including Zoloft, which she says allowed her to feel happiness for the first time in her life.
‘‘ I was on that for about three months and it allowed me to feel happy for the first time in my life. I’d never really known what it felt like. But you can only stay on Zoloft for about six months.’’
Howell tried several medications before finding one that eased her wild mood swings. ‘‘ But medication alone is not a long-term answer.’’ In June last year, Howell enrolled in the trial of a therapy-based treatment aimed at teaching people with bipolar how to realise when they were about to experience a manic or depressive episode, and take steps to prevent it.
The program was developed by a team at the Mental Health Research Institute of Victoria, with funding from the MBF Foundation and beyondblue.
‘‘ We developed a program which assists people with bipolar to deal with their illness in a more coherent way, and enable them to take control of their life by identifying their own individual pattern and early warning signs of relapse,’’ says professor David Castle who led the research.
‘‘ The program taught them skills to reduce stress and to intervene early as soon as they notice signs of relapse. It’s important, because bipolar disease is a lot more common than we originally thought. We used to think that about 0.5 per cent of the population had bipolar, but now we think it’s about 3 per cent of the population.’’
In a controlled randomised trial, the team recruited 84 people diagnosed with bipolar disorder. About half received weekly therapy sessions, in addition to their medication, for 12 weeks, while the remainder only took medication. Those on the intervention program had half the number of relapses after 12 months as the control group which received medication but no therapy.
Relapse rates for people taking medication for bipolar disorder are as high as 75 per cent over five years.
The early warnings signs of a relapse vary between individuals, but Castle says some signs include a slight decrease in appetite, needing less sleep and increased irritability.
‘‘ Sometimes they don’t seem to need as much sleep. It’s not that they can’t sleep, but that they don’t seem to need as much sleep. They have so much abundant energy. They also experience great irritability.’’
Participants were taught strategies to prevent the onset of an episode including increasing medication, resting, avoiding stress and alerting a support network of family and friends.
‘‘ Volunteers kept a diary system which is a hand-held record that allows them to have Continued inside — Page 17
Road to recovery: Medication alone is not a long-term answer to bipolar disorder, says Jenny Howell