Bipolar Disorder - A Life-Changing Diagnosis

Raj (name changed on request), a 37-year-old first-generation immigrant from India came to the U.S. in 2015. He works as an accountant in a large firm in the Midwest and is married to Suniti (name changed on request) who is a U.S. citizen. They have two children, a son in third grade, and a daughter in kindergarten.

Last year, Raj had a lot of pressure at work around the tax season. He also had a strained relationship with his spouse. During this turbulent period, he had a “nervous breakdown,” during which he experienced high irritability, made hasty decisions, did not sleep for a few days..

Due to his irritability, he got into a fight at a store, was arrested by the police, and taken to the hospital. He was admitted for a few days with a diagnosis of bipolar disorder. He has been put on medication since then, but he wants to discontinue his treatment as he feels all right now. He has some questions.

Q: Is my disorder permanent?

Dr. Sharma: Raj, we all experience mood swings from time to time. Sometimes we feel elated and sometimes we feel low. However, with a diagnosis of bipolar disorder, it simply implies that you have higher mood swings. Though you call it a disorder, I like to call it a human condition. These swings can last from one day to months.

The highly elevated mood is called mania, and the severely low mood is called depression. These cycles happen irregularly. Since it is irregular, it can be considered a life-changing condition. While you may never get another manic episode you should still consider it a chronic condition. Because of its irregularity, this condition is hard to diagnose. The fact that you have been diagnosed is a silver lining in your case.

Q: What is the cause of this condition?

Dr. Sharma: The definitive cause of this condition is not known. It is a complex biochemical imbalance in the neurotransmitters in the brain caused by biological (genetic), psychological (both good stress and bad stress), social (deficiencies in one’s social life), and spiritual (not having meaning in life) factors. In your case, stress seems to have precipitated your condition. While one cannot change the stress factors one can change one’s perspective about them.

Q: Now that I am completely alright can I quit taking medication?

Dr. Sharma: Raj, that would be a big mistake to make. As I mentioned, we do not know the cause, and the cycles are irregular, so compliance with medication becomes essential. Further, life is unpredictable, and we do not know when we will face what kind of stress, so medication helps us maintain equanimity during stressful times. Just like a diabetic, a hypertensive person, or any other chronic disease patient takes medication regularly, a person with bipolar disorder diagnosis also has to take medication regularly. Taking medications regularly reduces the chances of relapse to adverse states of mind associated with this condition.

Q: I am worried about the side effects of the medications.

Dr. Sharma: Raj, I will not deny that just like all medications, there are side effects and adverse reactions to psychotropic drugs too. If you take Aspirin, there are side effects and adverse reactions to it too, yet people take it quite frequently.

There has been extensive research done to test the efficacy of these drugs and their side effects for quite some time. It has been largely found that the benefits of these drugs outweigh the risks. Therefore, these drugs are prescribed by physicians. You should have a positive outlook about taking medication and not develop negativity about them. The mind-body connection is very powerful and when you positively think that the medication will help you, it surely will.

Q: What is the role of psychotherapy in treating bipolar disorder? Can it help?

Dr. Sharma: Yes, Raj, psychotherapy plays an important role in the acceptance of this condition. Because of the stigma associated with mental conditions in our society, particularly in the South Asian community, it is very important to accept the limitations of the body and mind. No one has a perfect body or mind and having this condition makes no one inferior.

There are thousands of high-functioning individuals in our society with this condition. Support groups in psychotherapy sessions can introduce such people. Psychotherapy also provides one with coping skills to deal with potential stress factors that are often the triggers for episodes of mania or depression in this condition. The greater the repertoire of skills one has the better equipped they are to deal with this condition.

Dr. Sharma: Sleep is very important in this condition. Maintaining regular sleep for at least 7-8 hours per night is essential. Reading about this condition and recognizing early symptoms is vital. As soon as you recognize these symptoms consult your treating physician. Having social support is quite helpful. Here support from your spouse can go a long way. Avoiding alcohol and other substances must be practiced. Finally, getting involved with satisfying activities in life is very important.

Q: Is there any way based on Indian Philosophy to cope with this condition?

Dr. Sharma: The Bhagavad Gita in Chapter 13, Verse 10, talks about the spiritual quality of samachitvam or equanimity, which is defined as mental calmness, composure, or evenness of temper. Practicing equanimity means not getting elated when life brings something positive or not feeling low when desired outcomes do not materialize. Start this practice in small steps with small things, and with regular practice, it can go a long way in positively influencing the process of coping with this condition.