Sunday, 30 March 2014

Bipolar Episodes

An episode of illness is really just a reference to the experience, intensity and duration of symptoms. Episodes vary in severity and occur when a person is ill. To have a diagnosis of bipolar disorder, you must have experienced at least one episode of hypomania, mania or mixed symptoms. Once an episode occurs there is a high risk of further episodes.

Depressive Episodes

If you experience depressive symptoms for at least two weeks and if as a result your work and relationships have suffered, the chances are you are experiencing an episode of major depression. Technically at least one of these symptoms must include:

  • depressed mood, which may include sadness, emptiness, tearfulness or irritability, or
  • a loss of interest or pleasure in things, which lasts nearly all day, nearly every day.

In turn a variety of other emotional and behavioral symptoms may cluster around these, such as sleep disturbances, restlessness, feelings of guilt or worthlessness and difficulties in concentration - to mention just a handful. In the case of bipolar, these symptoms may also be accompanied by psychotic symptoms such as delusions (false beliefs) and/or hallucinations (false sensory perceptions).

Manic Episodes

A manic episode is defined as an excessively happy, elevated or irritable mood that lasts for at least a week. At least three of the following symptoms must be present, or four if the mood is irritable:

  • you need less sleep than normal.
  • your thoughts are racing and you find it hard to articulate.
  • you talk more than usual and you feel a pressure to keep talking.
  • you find it easy to get distracted and find it hard to distinguish between what’s relevant and what isn’t.
  • you feel you have very special qualities or talents that you actually don’t have.
  • you become highly goal focused. This may take the form of work or study, or may be sexually focused.
  • you indulge in pleasurable activities with no thoughts of the consequences to yourself or others. This may range from spending money to being sexually promiscuous.

Like a depressive episode, mania may be accompanied by psychotic symptoms.

Hypomanic Episodes

The prefix ‘hypo’ means low, or under. So an episode of hypomania refers to symptoms similar to mania but which are either milder or briefer. Symptoms of hypomania are generally much less disruptive than mania and may not affect everyday activities. Even so, your behavior will be rather more extreme than say a normal happy mood, and will almost certainly be noticed by others. To be classified as a hypomanic episode you must have experiences the symptoms for at least four days. Psychotic symptoms are not associated with hypomania.

Mixed Episodes


Getting your head around the concept of mixed episodes isn’t easy. A mixed episode refers to a simultaneous mix of the lows and highs associated with bipolar disorder. Imagine feeling depressed but at the same time experiencing racing thoughts, a decreased need for sleep and a sense of restlessness. Perhaps now the symptoms don’t seem so implausible? People with mixed states appear to be more vulnerable to psychotic symptoms and for a diagnosis of a mixed episode you need to have had symptoms of mania and depression for at least a week, resulting in severe disruption to your daily life.

Thursday, 27 March 2014

10 Ways to Support a Depression Sufferer

1. Everyone is different: and because of this it stands to reason that depression reveals itself in many different ways. Men may try to deal with depression in different ways to women. In some people depression seems to creep up on them slowly - in others it’s more rapid. Depression may last for a few days, a few weeks, a few months or for years. It may be highly responsive to treatment or it may be treatment resistive. The one consistent issue for supporting a person with depression is that you care, and this is vital.

2. Depression is different too: because it may occur for all sorts of different reasons. Acute depression typically follows upsetting life events such as bereavement. But depression can follow childbirth, or can appear for no apparent reason. Over the past few years the number of people being treated for depression has increased in line with the stress of work. Some people alternate between depression and mania, a condition known as bipolar disorder. Depression is also very common in people with schizophrenia. In supporting someone with depression these differences are useful to know about as they can affect the course, treatment and outcome of depression.

3. Be considerate: of what the person is going through. You can’t put your life on hold but there are some circumstances, such as the death of a relative or close friend, that require a little sensitivity. For example, following the death of his wife, my father-in-law stayed with my family for several months. At first he couldn’t watch the news, or even a movie that might portray a death. So we adapted our viewing habits.

4. Listen: then listen some more. It isn’t necessarily comfortable being with someone who is very depressed. Perhaps it is partly this sense of discomfort and the wish for the person to recover that causes people to talk. The temptation to persuade, encourage, even provoke the depressed person into some kind of action may be understandable but is also completely misplaced. Sometimes the best thing you can do is just listen. Listen carefully to what the person says. Remember that a feature of depression is that the person sees things in very black and white terms. What they say may sound completely misguided or inaccurate but be patient and sympathetic.

5. Hearing isn’t affected: and neither is intellect. A person who is very depressed may retreat inside
themselves for long periods of time. They may be uncommunicative or even angry when approached. They may want to sleep for long periods only to wake and stare into the distance. During such times your patience and perseverance may be tested but don’t allow frustration to steer you towards saying things you may later regret or convey in any way that the person is a burden.

6. When you speak: avoid pointless statements like, ‘snap out of it’ or ‘you’ve got nothing to be depressed about’. Depression isn’t a choice, and it doesn’t respond to logic. When you do speak it can worth reminding the person you care for them, you’ll stay with them, you love them and you’ll work through depression with them.

7. If you hear threats: take them seriously. Thousands of suicides occur every year as a result of depression so if the person tells you they can’t see any point in going on, or they are thinking of ending it all, it’s time to take action by contacting their doctor immediately.

8. Support treatment: especially when the person is becoming more depressed and sees no point it. You need to assure the person that this is depression talking, that treatment is effective and that people care. You can offer very practical help at this stage like accompanying the person to see the doctor, or maybe offering to do some other task that will free them up. When medication is prescribed you could help by monitoring whether they are getting better or worse, whether they are taking tablets as prescribed, or attending for psychological therapy if this is part of the treatment.

9. Stay in contact: and not just physical contact. Unfortunately the course of depression may be short or long. The hardest part of any long-term illness is the stamina required from the caregiver to offer continued emotional support. If you live with a depressed person, no matter how much you love them; there comes a point when their depression saps your energy. It may be difficult and you may have to dig deep, but if the depressed person knows you are on their side by your reassurances and stability it can make a world of difference.

10. Remember Yourself. Depression has been likened to a contagious illness. As a caregiver you can easily find your own health and welfare begins to suffer. If you don’t look after yourself the danger is that you become ill too. At the very minimum you should try to eat well, sleep well, exercise regularly and keep up contacts with other people. Where possible, recruit the support of family and friends and seek the help of health professionals when you need to.