Is bipolar hypersexuality enjoyable

A life between two extremes

Manic depressiveby Elke Wolf, Frankfurt am Main

Today they could uproot trees, tomorrow they doubt the meaning of life and can hardly be got out of bed. The roughly four to five million people with bipolar disorder commute between these two extremes. The changing mood permeates all areas of life and cannot be deliberately controlled.

Bipolar disorder, also known as manic-depressive illness, is characterized by alternating episodes of depression and high spirits (mania). These excessive mood swings either occur without a corresponding cause or they persist after a certain life situation, such as the loss of a loved one, even if the triggering situation is actually no longer a burden. "The mood swings develop a momentum of their own that can no longer be explained by external circumstances," said Professor Dr. Arnd Barocka, Medical Director of the Hohe Mark Clinic, Oberursel, at an information event organized by the German Society for Bipolar Disorders (DGBS), the Hessian Pharmacists' Association, the BKK and DAK Hessen, the self-help contact point Frankfurt, the Frankfurt City Health Office and the pharmaceutical industry working group. Between the episodes, the patient is usually mentally healthy.

A patient in a manic phase feels energized and productive and hardly needs any sleep. The composer Robert Schuhmann created many of his world-famous works during these phases. But anyone who knows those affected well knows that this behavior is excessive. A manic can lose all inhibitions and be unstoppable. He overestimates himself immeasurably, sometimes to the point of megalomania, and can be aloof when dealing with other people. The sign of mania is excessive preoccupation with enjoyable activities such as rampant shopping or high-risk investments, which often leads to financial distress. The behavior during mania is usually in complete contrast to the way of life as a healthy person and, after the manic episode has subsided, causes violent self-reproaches and feelings of guilt. “During the manic phase, however, there is no insight into the disease. The patients stubbornly deny that they have any problem - which makes therapy so difficult because compliance is lacking, ”said Barocka.

But the mania does not always run according to the scheme F as described above, in which the person concerned believes in euphoric high spirits that they can conquer the whole world. In dysphoric mania, symptoms of euphoric mania are mixed with irritability and aggressiveness. Especially this form, which can even lead to violence, is very stressful for relatives and friends. Hypomania, on the other hand, is the weakened form of a manic episode. The biggest difference to mania is that hypomania lacks clear social and professional problems. Even so, hypomania should be treated. Because hypomania can develop into mania, and there is a risk that a depressive episode will not follow a symptom-free period.

Finally, the depressive phase is the proverbial deep hole for bipolar patients into which they fall. “Mania is fire. Depression is the ashes, ”is how the psychiatrist Athanasios Koukopoulos describes the two episodes of bipolar disorder. During this phase, those affected feel pumped out, sad and empty. Your desire for activities and undertakings dwindles. Common symptoms: poor appetite and weight loss, fatigue, poor sleep, slower movements. A changed day and night rhythm with morning low, early awakening and sleep disorders in the second half of the night is also typical, according to Barocka. People with depression feel unable to cope with everyday life. Most of the time, they have trouble concentrating, feel worthless, and have thoughts of death. The suicide rate is increased in this phase.

Variability is typical

Variability is the hallmark of bipolar illness - and that is true in many ways. The course is unpredictable and individually very different, the expert made clear. The duration of the episodes can vary between a few days, several months, and years. On average, a disease episode lasts between four and twelve months in untreated patients. Manic and depressive phases can occur individually or overlap. Mania and depression can also be present at the same time, for example strong restlessness with a depressed mood at the same time. Then one speaks of mixed states. There are also schizoaffective psychoses in which bipolar disorders are accompanied by schizophrenia.

Some patients experience more manic episodes, others more depressive episodes. Nevertheless: “Bipolar disorders are characterized by depressive symptoms; the depressive episodes predominate ”, said private lecturer Dr. Peter Brieger from the University Clinic Halle-Wittenberg. There can be intervals of several months or years between the individual episodes of illness, during which the patient is completely symptom-free. On average, this time is two to three years. In addition, there is also an individually different number of episodes of illness. One has only one or two episodes in the course of his life, the other significantly more.

Since the clinical picture is very variable, it is hardly surprising that the correct diagnosis is only made after 8 to 15 years on average. It can only be worked out through intensive questioning of the sick and their relatives. There are no laboratory or other examination options. The majority of all bipolar patients experience depression as the first episode, which is why they are often falsely treated for depression. It is estimated that at most every fourth manic-depressive person see a doctor and receive appropriate therapy.

Thrown off track

Not much is known about the causes of the disease. Inheritance seems to play some role. This condition is significantly more common in first-degree relatives of patients with bipolar disorder. If one parent is affected, there is a 10 to 20 percent probability that a child will also become ill. If both parents are manically depressed, the risk increases to around 50 percent. If an identical twin suffers from bipolar disorder, there is a 65 percent chance that his twin has it as well.

The genes are by no means decisive. Experts are currently assuming that external factors must be added to the genetic disposition in order for the disease to manifest itself. "Young people with a kink in their lifeline," summarized Dr. Heinz Grunze, DGBS chairman, put the risk patients together. For example, severe emotional stress such as separation from home, the beginning or end of a relationship, or the death of a partner can lead to bipolar disorder. This is especially true for the first manic or depressive phase. In later episodes, the external factor becomes less important and can often no longer be identified. The first symptoms usually appear between the ages of twenties and thirties. It seldom affects young people. After the age of 50, bipolar disease is relatively unlikely, but cannot be ruled out.

Early therapy particularly effective

The prognosis of the disease depends largely on how quickly the diagnosis is made and how long the therapy begins. In principle, the following applies: the fewer phases the patient has gone through before starting therapy, the better he or she will respond to the treatment. Not insignificant is the fact that early treatment can avoid many psychological and social problems, reports the DGBS.

The risk of suicide is greatest in the development phase of the disease. In psychiatry, manic-depressives are considered to be those patients with the highest risk of suicide, according to the DGBS. At least one in four people with bipolar disease makes a suicide attempt, often in the first few years of the disease.

In about half of all sick people, there is evidence in the medical history of the abuse of alcohol, drugs or medication. With this they try a kind of self therapy. Of course, it does not succeed in reducing the level of suffering, and they become dependent. This problem is sometimes so in the foreground that it affects life more than bipolar disease itself.

The faster the affected person is adequately treated, the higher the chance that an existing partnership will not be shattered under the pressure of the illness and that the sick person's workforce will be retained, informs the DGBS.

If bipolar disorder is not recognized as such, there is a risk that unsuitable medication will be used. In the worst case, the disease worsens or a new episode is triggered.

Lifelong therapy

The treatment of bipolar illness has two goals: It is to compensate for acute mood swings during manic and depressive episodes and to prevent further episodes. For this purpose, the drug treatment is divided into three sections:

  • acute treatment to get the patient out of their current episode.
  • the relapse protection immediately following this, in order to further stabilize the patient's still unstable situation and to prevent a direct relapse (duration of treatment: between 9 and 12 months).
  • the so-called phase prophylaxis, i.e. protection against new disease attacks when the intervals between the individual episodes become shorter and shorter. In doing so, the dosage of the drug is reduced to what is necessary to maintain a balanced mood.

There is one thing that patients need to be clear about: As a rule, bipolar disorder must be treated for life. The intensity of the treatment can be different, but a permanently stable mood cannot be achieved without therapy. In addition, all drugs do not work immediately, but only after a start-up period of one to three weeks.

For long-term therapy - both during symptom-free times and during acute episodes and for relapse prophylaxis - mood-stabilizing drugs are used, also known as "mood stabilizers". They accompany the patient throughout their life. As their name suggests, they serve to stabilize the patient's mood both acutely and in the long term - regardless of whether he is going through a manic or a depressive phase. The drug of choice is lithium, "but only if the disease has only existed for less than five years," Grunze presented study data. Otherwise, the three anti-epileptic drugs carbamazepine, valproate and lamotrigine do a good job. The subject of current studies is the stabilizing active component of atypical neuroleptics.

Lithium and the three anti-epileptic drugs are also used in acute manias. If the first signs of mania appear, the dose is first increased. If this is not enough to intercept the episode, neuroleptics are also prescribed. Increasing the dose of mood stabilizers is not sufficient to treat a depressive episode. Grunze: “You can get a grip on the mania relatively quickly. The depressive episodes are more difficult to treat. ”During bipolar depression, the additional intake of an antidepressant is necessary. This should be taken for at least six months, better for a year. The patients should then gradually reduce the dose in order to stop using the drug completely. The mood stabilizers will also continue to be taken during this time. "On average, patients have to take three to four drugs in order to lead a largely normal life," said Grunze.

Experience shows that bipolar patients do not show reliable compliance. Studies have shown that half of the patients discontinue lithium medication on their own after five years. With significant consequences: Abrupt withdrawal shortens the time to the next relapse by almost two years, warned Grunze. The study participants stated that the reason for stopping therapy was that they felt controlled by the medication and no longer felt themselves to be themselves. “This is probably the real problem: Bipolar patients have to learn that they are suffering from a chronic disease. They have to learn to take their medicine constantly, just like a diabetic has to inject his insulin to avoid dying, ”explained Grunze.

“Despite all the advances, pharmacotherapy is not 100 percent effective,” said Barocka. Therefore, additional treatment methods are used, of which psycho- and electroconvulsive therapy are the most important. Through psychotherapy, the patient should learn to deal with the disease and to accept it. It is intended to help prevent certain individual triggers of an episode of illness.

Electroconvulsive therapy is better than its reputation, according to a DGBS brochure. It is probably the most effective therapy method for the treatment of severe depressive, manic and psychotic episodes. It is used for severe symptoms, when the patient's condition does not allow waiting for the appropriate drugs to work. The electroconvulsive therapy is carried out under short-term general anesthesia. With the help of two electrodes, a twenty to forty second seizure is set, which stops by itself and stimulates the neurotransmitter system. This releases important neurotransmitters such as dopamine or serotonin for mood stabilization. Electroconvulsive therapy is only used as an acute treatment.

 

Not alone The role of family members in bipolar illness should not be underestimated. Their understanding, but also their knowledge of the disease and its episodes, mean great security for the patient. For example, a family warning system is of paramount importance at the beginning of the manic episode, as the patient feels excellent and will not see why a doctor's visit should be necessary. Those affected and their relatives get support from the German Society for Bipolar Disorders e. V (DGBS), Postfach 92 02 49, 21132 Hamburg, email: [email protected], www.dgbs.de

 

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