Dr Milan Balakrishnan, Psychiatrist & Psychotherapist throws light on a subject that even care givers in a family don't know much about. Bipolar Disorder is a serious Mental Illness which affects 60 Million in the world including over 9 million in India. Yet, awareness about this illness is dismal and Stigma, debilitating.
This presentation was used by Dr Milan during his talk at bipolarindia.com's Event in Mumbai on World Bipolar Day, 2017.
This comprehensive presentation covers the causes, remedies, symptoms and red flags of the dreaded illness that has not spared even renowned World figures.
Lets talk about how the moods alternate. Along a continuum there is a high end, middle, and low end that reflects a person with bipolar disorder and their mood. There are two opposite polls at each end reflecting very different moods, this is why it is called “bipolar disorder.” A person with this disorder can swing from one end to the other. Mania is at the extreme of one poll, with severe depression at the other poll, with normal mood being in the middle.
Mania is defined as an episode that lasts more than a week and consists of an abnormally high mood. Sometimes these are the people who are the loudest in a crowd, the most daring, and confident people. At first they can appear happy, energetic, and animated but they continue with this behavior longer than what is considered the norm. This level of high energy physically and mentally takes a toll on their body depleting them of energy when they eventually come crashing down.
Mania can be displayed in a variety of symptoms. A manic person will not necessarily have all of these symptoms but most likely a few in a variety of combinations. They can feel they are unstoppable, take risks they usually would not take while finding it difficult to sleep due to racing thoughts. Many times they find it is difficult to relax in one place due to the increased physical and mental energy. They can become overly aggressive or irritable and feel a increase in their sexual drive. Due to their impulsiveness some people feel the need to go on spending sprees buying things they want in the moment. These symptoms can lead to dangerous acts and intervention from family and friends is needed to keep the person safe and get them help. People are less likely to seek treatment when they are in the manic phase because they usually do not realize that anything is wrong and most describe it as a good feeling (NAMI, 2011).
Depression is the other end of the pole. Major depression is defined as a serious medical illness that affects 15 million American adults in a year (NAMI, 2011). It is more then the “blues” lasting much longer affecting the daily life of those experiencing it. People with depression lose interest in things they once loved to do and isolate themselves from others.
Like mania there are many symptoms of depression and one does not have to exhibit all of them to be diagnosed as depressed. They may eat too much or not feel like eating at all. Some people have difficulty sleeping and others sleep hours and hours through the night and day rarely leaving their beds. They may feel emotionally and physical tired, sometimes unable to get out of bed at all. Decision making is affected because they cannot concentrate well. Feelings of worthlessness and being a burden to others can bring thought of death and suicide. It is in this mood that people with bipolar disorder are more likely to seek help (NAMI, 2011).
Hypomania is a shorter duration of manic symptoms that are less severe lasting at least four days as is considered a mild functional impairment (Stovall, 2012). People may experience this if they are usually more on the “low” or depressed side and do not have elated manic symptoms. A mixed state is often referred to as rapid cycling because a person they have both depressive and mania simultaneously. Depressed people are more likely to seek treatment and lays the groundwork for diagnosing bipolar disorder.
Depression can lead to suicide. Steps should be taken to assure a depressed person gets the help they need. These are some of the ways that you can help someone. Make time for a depressed person or it may be too late.
People affected by bipolar disorder can help themselves through keeping track of their moods, making choices that support wellness and managing stress levels. A plan should be in place for support if the need should arise. Seeking education on their own or through support groups about the disorder can help them understand and manage the disorder, realizing that they are not alone.
Demystifying Bipolar Disorder
Dr Milan Balakrishnan
Mystery of Bipolar
• Inadequate information
• Casual use of the term
Bipolar disorder awareness
• Increase awareness of bipolar disorder (including
both mania and depression)
• Promote early detection and accurate diagnosis
• Reduce Stigma
• Minimize the Impact on those who live with this
Major Public Health Issue
• 60 million suffer from BPD with about 9 million in
• DALYS 141.7 /100000
• 1 in 3 get diagnosed
• 1 in 3 people with bipolar disorder fail to comply
• Non-adherence to treatment often results in
hospitalization and suicide
Prevalence Rates and Course
• Bipolar I
• Lifetime: 1 in 100
• = in men and women
• Ave. age onset = 20-25
What is Bipolar Disorder?
Bipolar disorder is
a serious mental
illness that is
swings from mania
Mania is an
is an abnormally
Moods Alternate Between “Poles”
high or low levels
is the cause.
• 35 years old male brought forcefully by
family. Since a week had not slept, and
had been busy writing a novel, getting
banners published and building huge
projects. His children were afraid of his
aggressive behavior and he had
recently started using recreational
drugs too. He was usually flirting and
acting inappropriately with women. He
was fired from his job but he said that
he didn’t need it as he was going to
launch his own company soon.
• 23 year old female presented with crying
spells, no interest in activities, disturbed
sleep, decreased appetite, social
withdrawal and a suicidal attempt of over-
dosing of sleeping pills.
• Her mother often suffered from the same
symptoms and was diagnosed with
Famous people with bipolar disorder.
Catherine Zeta Jones
• Winston Churchill-
• British Prime Minister.
• Isaac Newton-
• Vincent Van Gogh-
Symptoms of Mania
Decreased need for sleep
Racing thoughts or "flight of ideas"
Increased physical/mental energy
Increased sexual drive
• Feeling down
• Loss of interest in
• > 2 weeks
Symptoms of Depression (Cont.)
Psychomotor agitation/slow down
Fatigue/loss of energy
Decreased ability to concentrate/make decisions
Recurrent thoughts of death/suicide
Between Mania and Depression
• Hereditary Factors
• Biochemical Hypothesis
• Stressful Life Events
• Family environment
• Cognitive Styles as Vulnerabilities
2. Presence of a personality disorder
3. Quality of family and social support
4. Substance use
5. History of severity of prior episodes
6. Bipolar I type is most severe
7. Treatment onset-the sooner the better
8. Age of onset-the younger the more severe
• Seek Help
• Early detection of Individual ‘signature’ signs.
• Ensure the safety of patient and others~
• Suicidal behavior
• Homicidal behavior
• Risk taking behavior ( financial, sexual, driving
The Warning Signs of Suicide
Talking about death, self-harm, or suicide
Withdraw from friends/family
Putting affairs in order or saying goodbye
Seeking out weapons or pills
Recognize Warning Signs
Take It Seriously/Get Them
How to Help Someone Who
therapy in acute mania
• Psychoeducation for
patient and family
• Psychological therapy
social rhythm therapy,
CBT & others)
Monitoring and prevention
• Continually monitor psychiatric status
• Identify individual’s triggers
• Identify early warnings and seek help
• Prevent relapse and encourage adherence to treatment.
Help for care givers
• Take care of own
professional help for
• Family, couples therapy,
• Join a Support group.
Self-Help For Bipolar Disorder
Monitor your moods
Make healthy choices
Keep stress in check
Dr Milan Balakrishnan