Understanding and treating of Bipolar Disorder in Kenya

“Which of my feelings are real? Which of the me’s is me? The wild, impulsive, chaotic, energetic, and crazy one? Or the shy, withdrawn, desperate, suicidal, doomed, and tired one? Probably a bit of both, hopefully much that is neither.”
― Kay Redfield Jamison,

Bipolar Disorder in Kenya

Bipolar disorder is a mental health disorder that causes varying changes in a person’s mood, energy, thoughts and behavior. These mood episodes are categorized as manic or hypomania which is characterized by an abnormally happy and elevated mood or depression. These changes and fluctuations in moods are easily noticeable by other people.

Bipolar disorder can be diagnosed at any age, but symptoms usually begin showing at teenage years or in the early twenties. As of 2021, 46 million people have been diagnosed with bipolar in the entire world. Prevalence in males and females is almost the same, standing at 2.9% and 2.8% respectively. With proper treatment, support from loved ones and self-care people diagnosed with Bipolar disorder can receive treatment and continue to lead normal, healthy and fulfilling lives.

There are three different types of Bipolar Disorder, namely: Bipolar I, Bipolar II and Cyclothymic Disorder.

Bipolar I is also known as manic depression and its main symptoms include an abnormally elevated mood, high energy levels and often some irritability that disrupts normal day to day life. This goes hand in hand with periods of low, sad moods which gives it the name, manic depression. Patients diagnosed with Bipolar I have had at least one manic episode in their lives.

Bipolar II is similar to Bipolar I, and only differs in the case of mania. Patients diagnosed with Bipolar II experience a mild form of mania called hypomania. These patients experience similar symptoms of low and highly spirited moods, but have not yet reached the criteria of a full manic episode.

Cyclothymic disorder or Cyclothymia is a long term condition that is known to be a milder form of Bipolar disorder. It is characterized by both depression and hypomania, but these symptoms are often mild and do not cause too much disruption to a person’s life. Symptoms begin around teenage and early adulthood and it is common for Cyclothymic patients to be wrongly diagnosed with either Bipolar I or II.

Causes and Risk Factors

Bipolar has been found to run in the genes of families. There is an 80 to 90% chance that each diagnosed patient has a relative also diagnosed or experiencing the same symptoms as a bipolar patient. For every parent diagnosed with bipolar, there is a 10% chance that their child may develop the disorder. If both parents are diagnosed bipolar patients, there is a 40% chance that their child will also be diagnosed.

Other environmental factors such as acute stress, lack of sleep, drug and substance abuse have been found to trigger severe mood problems in the brain. Other triggers include traumatic life events, physical and emotional abuse, severe loss and grief, and overwhelming life problems such as finances, school, work and relationships.

It has been reported that Bipolar may be triggered by pregnancy and breastfeeding, due to an influx in hormones during these periods. Some medicines prescribed during acute physical illness such as steroids and opioids may also induce manic and hypomanic symptoms in an individual. Stimulants, including caffeine, may also trigger Bipolar-like symptoms.

Signs and Symptoms of Bipolar in Children

• Hyperactivity; child talks and plays excessively for hours without breaks.
• Impulsiveness; the child often does things without proper thought, reason or permission from parent.
• Risky and reckless behaviors in school such as noisemaking, dangerous activities in the playground or handling sharp objects without supervision.
• Aggression e.g. bullying and harassment
• Sexual curiosity and promiscuity
• Poor performance in school
• Lack of interest or overindulgence in previous hobbies.
• Drug and substance abuse
• Irritability; the child gets severely impatient and gets annoyed over simple things.
• Tantrums
• Extreme mischief; they start being excessively naughty both at school and at home
• Sadness and crying all the time.
• Excess tiredness and fatigue.

Signs and symptoms of Bipolar in adults

• Bouts of extreme energy and extreme fatigue.
• Speech becomes increased in fast delivery and high volume.
• Multiple thoughts and ideas racing through the mind at once.
• Interrupting others while speaking.
• Taking on multiple projects at once.
• Being easily distracted.
• Impulsive behaviors are ones done without careful thought such as excess spending and shopping, drinking, gambling, binge eating and even fighting.
• Drug and substance abuse.
• Sexual promiscuity.
• Intense sadness and despair.
• Suicidal ideations.
• Difficulty concentrating.
• Changes in sleep patterns e.g. insomnia (lack of sleep) or excess need for sleep.

Relationship between bipolar and depression

Bipolar and depression are similar in that they both affect mood. They both have symptoms of intense emotional lows and complete despair, only that bipolar also includes moments of high energy and extremely happy moods.

Bipolar Test and Diagnosis

Bipolar disorders can be tested by a psychiatrist or a certified mental health professional who can be referred by your general physician. Your healthcare provider will ask a series of questions followed by an oral test in order to determine whether or not you meet the criteria for diagnosis. Depending on how severe your symptoms are, your doctor may put you on a drug prescription and recommend mental health therapy.

Treatment for Bipolar Disorder

• Medication, which may include antidepressants and mood stabilizers.
• Counseling and mental health therapy, whereby a therapist will help you navigate your moods, improve your quality of life and encourage you to adhere to medication.
• Therapy may include management of other issues that may be precipitating the Bipolar such as drug and substance abuse, trauma and stress.
• Psychological and lifestyle approaches are aimed at providing long-term prevention of relapse, building resilience, and improving quality of life.
• Patients diagnosed may be hospitalized in case of a manic, suicidal or psychotic episode. Here they will be kept safe and stable within the right environment for recuperation.

Most people experience high and low moods often, this is normal but if symptoms make it increasingly difficult to perform daily functions one should seek medical help. It is important to note that even with a bipolar diagnosis; one can live a normal healthy life so long as treatment and psychotherapy is adhered to properly.

Psychotherapeutic Treatment

While undergoing therapy, it is important to talk to your therapist about the following:

1. The meaning, causes, impacts and treatment modalities of bipolar disorder.
2. The diagnosis of bipolar disorder and any other illnesses that occur alongside it.
3. A plan that looks at your overall wellbeing in the long-term.
4. How to manage the impact of the diagnosis on yourself and on your family and friends
5. Medication, treatment plans and drug adherence education.
6. How to increase self-awareness when experiencing symptoms, and how to stabilize your mood naturally.
7. How to create a balance between work, school, leisure, family and friends.
8. How to practice self-care.

Natural tips to manage bipolar disorder

1. Taking Vitamin B₁ supplements has been discovered to reduce symptoms of irritability and anxiety.
2. Eating a balanced and nutrient-dense diet while staying properly hydrated always helps with symptoms of mental illness. Food is the first medicine the body needs and medication does not work if the patient is not feeding well.
3. Mindfulness practices such as meditation, deep breathing and yoga also work to increase calm and self awareness.
4. Avoid screen time and other stressful situations before bed time to improve sleep quality.
5. Establishing a routine like setting exact times for waking up, meals and bed time helps to stabilize brain activity.
6.  Avoiding drugs and alcohol altogether since they are psychoactive and alter brain functioning.
7. Avoiding stressful people and situations altogether reduces the chances of triggers and relapse.

References

1. “Bipolar Disorder,” (September 2022) Retrieved from:

• Block, (8^th January 2021) Bipolar Disorder

• Howland et al., (January 2021) What Are Bipolar Disorders?

• Purse, (23^rd  January 2023) Cyclothymia (Cyclothymic Disorder)

• Team, S., Team, S., & S. (2023, January 20). Bipolar disorder statistics 2023. The Checkup. 

• Treatments for Bipolar Disorder – Black Dog Institute. (2020, May 3). Black Dog Institute.