Six years ago, when my sister was diagnosed, I remember that moment clearly. I was just sitting there in the hospital waiting room, not knowing what was going on. For a couple of weeks, she had been acting a little off. She had spent the whole night talking without any breaks, somehow having boundless energy. Suddenly, she would start crying uncontrollably and be so tired that she couldn’t even get up from bed. Her boyfriend, in the end, pushed us to get her checked, and the psychiatrist was the one who said, “bipolar disorder“. I thought it was just a more sophisticated way of saying that she was moody; I was wrong.
The Wild Ride of Mania
It was terrifying to observe my sister in her manic state. She would be up at 4 a.m., full of energy. By the time she was 12, she had completely messed up her flat, come up with a new business plan, and booked flights to some unknown destination. She was convinced that it was all great. Her speech was rapid, and if you tried to interrupt, she would give you a nasty look as if you were interfering with her valuable time.
Their shopping sprees were over the top. She kept charging her cards for things she didn’t really need, like new outfits, tech, and miscellaneous online stuff. She would ring me at 2 a.m. to tell me about her “brilliant” schemes, and if I advised her to sleep, she would be rude to me. Why sleep, when she could be conquering the world?
And then there was the grandiosity. She seriously thought there was nothing she couldn’t do. She would uncontrollably send her boss emails about changing the company, or go over her boss’s head by applying for totally unrealistic job positions. In her mind, her ideas were brilliant; hence, they were unachievable in reality. These manic episodes would last for around two to four weeks until she finally came down.
The Crushing Weight of Depression
It was nerve-wracking enough that she had these manic episodes, but when she came down, it was as if depression was breaking her down. Most days, she wouldn’t get out of bed; she would just lie there in her pyjamas without taking any of the phone calls. When she finally answered the phone, it would be a faint voice, a hollow sound, like an empty shell. She uttered sentences like, “I’m a complete loser, ” “Nobody loves me, ” which were like a knife in my heart.
Everything was boring to her. Eating? Not a bit. Talking? No way. She just needed to disappear. Her bedroom was getting untidy and dirty. She left dirty cups, used tissues, and clothes were just thrown around. She was crying, but it was not emotional; it seemed to her body to be doing it automatically while her mind was far away.
These spells of losing control and feeling down were way longer than the periods of ups; sometimes they might even go on for three months. That was the moment she was unsafe, she would let me know a few things that she didn’t want to continue living and the thought of it really scared me.
Kicking Off the Treatment Journey
My parents almost dragged her to get someone from psychiatry, she tried to fight, she claimed we were exaggerating. But her doctor, an experienced lady who went by the name Dr Chen, had seen and treated many bipolar patients. She told her it would take time to get the right treatment. A miracle drug just doesn’t exist.
They put her on lithium. My sister was so against it that she started trembling, going for blood tests every month, and feeling dull and confused. But after six weeks or so, the wild swings disappeared; the depressed phases did not get as low, and the manic episodes were less extreme. She was in a kind of compromise that made her at ease.
Changing the dosage was quite a challenge. They changed it, added anxiety meds, and changed treatments to deal with side effects. It was almost eight months of ups and downs before she started to feel a little normal.
Therapy: The Mind, Shifter
Besides the meds, she got a therapist, Marcus, who was experienced with bipolar disorder. He was not only a sympathetic listener but also helped her with cognitive behavioural therapy (CBT) to recognise and challenge her out- of- control thoughts. When she fantasised about getting famous immediately, he would ask, what supports that? Do you have any real evidence?
It was amazing to see her get the lesson from this. She started to get her patterns and knew when her mind was getting too fast. She would alert Marcus or us, I feel mania coming, even before it got worse.
When she was down, therapy helped her stay in touch with reality. When she thought nobody liked her, Marcus brought to her mind the people who cared about her. If she were losing hope, he would take her to little successes like making coffee or sending a text. Baby steps.
Why You Can’t Skimp on Proper Care. One of the biggest lessons was from her first psychiatrist who gave her antidepressants without any stabilisers. That was a mistake. It worsened her manic symptoms and made her more impulsive. Just treating bipolar depression only makes it harder because these medicines can make the bipolar patients’ highs even worse.
The Hidden Keys: Habits and Rest
She changed her day-to-day life completely. Doctors and counsellors kept telling her how crucial sleep every day is, no exceptions. At the same time, going to bed and waking up, even on days off. She wouldn’t even stay out if she wasn’t tired; she’d rather go home and follow her schedule.
Why? Irregular sleep can be a powerful trigger for mania. If you skip a night’s sleep, then all of a sudden, your brain runs a hundred miles an hour. She got really strict about her sleep, and as a result, her manic episodes drastically decreased.
Mood journaling contributed as well. By jotting down her feelings each day, she was able to pinpoint what caused her moods to spiral, stressful events, people who drained her, and doing things that kept her balanced. Besides that, she incorporated exercise not as a means to get fit but as a way to improve her mood. Her mood would just be lifted after doing some sort of physical activity.
The Temptation to Quit
After nearly two years, when everything was going well, she felt that she was “cured” and stopped taking her medication. Dr Chen gradually reduced the medicines for her. For three weeks, everything went very well. She had no issues; her thinking became even clearer.
However, all these symptoms returned. She couldn’t sleep; her thoughts were racing, and she spent money imprudently. Within a few days, she had full-blown mania. She was sent back to the hospital.
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