Bipolar Disorder: Causes, Treatment, and Family Support

Bipolar disorder

Dear Doctor,
My mother is 50 years old and was diagnosed with bipolar disorder earlier this year.
Since I was studying abroad at the time, I did not have detailed knowledge of her condition.
With her mental illness, I can only speculate on the causes, so I would like to ask you about the possible causes of bipolar disorder.
Is it closely related to family relationships, or is it more significantly influenced by personal growth experiences?
Additionally, my mother has been on medication for about two months, transitioning from mania to depression.
As of October this year, her depressive symptoms have not improved; in fact, they have sometimes worsened, with her frequently expressing suicidal thoughts, although there are times when she seems fine but just feels low.
The doctor told us that bipolar disorder can be cured, but my mother does not seem to show any signs of improvement.
In early November, my father decided to change hospitals, but my mother took it upon herself to stop taking her medication and deceived us into thinking she was still taking it.
She has been unable to accept that she is ill and often worries about her memory.
However, the doctor mentioned that the purpose of the medication is to help her not to overthink, which seems to cause her distress instead.
Is there a better approach? Or is her memory decline simply due to aging?
At the end of November, possibly related to stopping her medication, my mother experienced another manic episode.
Does this count as a relapse, and could it worsen her condition? Furthermore, during manic episodes, do patients really forget what they did while in that state? Will long-term use of medication require higher doses in the future to manage her condition?
Can better outcomes be achieved through a combination of psychotherapy and medication? Where can we find resources for psychological counseling? What is "electroconvulsive therapy," and under what circumstances is it performed? How should family members support a patient with bipolar disorder, especially since my mother is already 50 and unlikely to return to work? I genuinely doubt whether my mother has any chance of recovery.
Thank you.

Neo, 20~29 year old female. Ask Date: 2000/12/02

Dr. Zhang Zhehong reply Psychiatry

Hello, in response to the issues you mentioned, here are my comments:
1.
Currently, the etiology of bipolar disorder is believed to be more related to genetics; however, not every patient with bipolar disorder has a family history, and not all children of bipolar patients will develop the disorder.
Therefore, the genetic factors and modes of transmission require further research.
Additionally, life experiences and stress may be related to the timing of bipolar episodes, serving as triggering factors.
2.
Bipolar disorder is a mental illness that can remit but also relapse.
During the remission phase, if complete remission is achieved, it is indistinguishable from the pre-illness state.
The frequency of relapses varies from person to person; some may experience a relapse once a year, while others may have several relapses in a year or even go years without a relapse.
In terms of treatment, if a relapse has occurred (whether manic or depressive), lifelong medication (mood stabilizers) is generally recommended to prevent future episodes.
These medications are non-addictive and do not lead to tolerance requiring higher doses unless clinically necessary.
3.
Poor memory can indeed be a side effect of medication, but it may also stem from cognitive dysfunction caused by depressive states.
Clinically, memory impairment due to depression seems to be more common, so it is advisable to discuss this with a physician before deciding on a course of action.
4.
Psychological counseling can assist patients in accepting the reality of their mental illness, understanding how to cope with it, and enhancing their ability to manage life stressors, potentially reducing the likelihood of relapse.
There are various forms of psychological counseling, one of which is engaging in therapeutic conversations with a physician during consultations.
5.
Electroconvulsive therapy (ECT) is a treatment method for mania and depression, typically used for cases with poor medication response or severe symptoms that pose a risk to the patient or others.
It can rapidly alleviate symptoms, but long-term treatment still relies on medication.
The incidence of significant side effects from ECT is low, with the most common side effect being memory loss lasting three to six months, which is usually fully reversible.
6.
Family members should not only encourage patients to adhere to their treatment and medication schedules but also provide consistent psychological support, empathizing with their discomfort related to the illness and medication to assist in their adjustment.
However, family members themselves endure considerable stress, and their own adjustment is also crucial.
7.
During severe manic episodes, patients may sometimes experience a state similar to delirium and forget events that occurred during the episode.
However, it is also possible that after mental status normalizes, they may employ a denial defense mechanism regarding their loss of control.
In such situations, family members can adopt a respectful approach while encouraging the patient to discuss their feelings with their physician.

Wu Yu-Chuan

Reply Date: 2000/12/02

More Info

Bipolar disorder, also known as manic-depressive illness, is a complex mental health condition characterized by extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). Understanding the causes, treatment options, and the role of family support is crucial for managing this disorder effectively.

Causes of Bipolar Disorder
The exact cause of bipolar disorder is not fully understood, but it is believed to be a combination of genetic, biochemical, and environmental factors. Family history plays a significant role; individuals with a family member who has bipolar disorder are at a higher risk of developing the condition themselves. This suggests a genetic predisposition, although not everyone with a family history will develop the disorder.

Environmental factors, such as significant life stressors, trauma, or major life changes, can also trigger episodes in individuals who are genetically predisposed. Additionally, personal experiences during formative years, including relationships with family members, can influence the development of bipolar disorder. A close, supportive family environment may provide resilience, while a tumultuous or neglectful upbringing could increase vulnerability.

Treatment Options
Treatment for bipolar disorder typically involves a combination of medication and psychotherapy. Mood stabilizers, antipsychotics, and antidepressants are commonly prescribed to help manage symptoms. It’s important to note that medication adherence is crucial; as you've mentioned, your mother has been inconsistent with her medication, which can lead to relapse or worsening of symptoms.
Psychotherapy, particularly cognitive behavioral therapy (CBT), can be beneficial in helping individuals understand their condition, develop coping strategies, and address any underlying issues. Family therapy may also be helpful, as it can improve communication and support within the family unit.

Family Support
Family support is vital in the management of bipolar disorder. Encouraging open communication and understanding can help the affected individual feel less isolated. It’s essential for family members to educate themselves about the disorder to better understand what their loved one is experiencing.
In your case, it seems that your mother is struggling with accepting her diagnosis, which is not uncommon. Many individuals with bipolar disorder may experience denial or feel embarrassed about their condition. This can lead to non-compliance with treatment, as you've observed. It might be beneficial to approach the topic with empathy, emphasizing that seeking help is a sign of strength, not weakness.

Addressing Concerns
Regarding your concerns about memory loss during manic episodes, it is common for individuals to have little to no recollection of their actions during these times. This can be distressing for both the individual and their family.
As for the long-term use of medication, it is possible that over time, some individuals may require adjustments in their dosage to achieve the same therapeutic effect. Regular follow-ups with a psychiatrist can help monitor this.

Psychotherapy can indeed complement medication, and many find that a combination of both yields the best results. You can seek out licensed therapists who specialize in bipolar disorder or mood disorders through local mental health clinics or online directories.

Electroconvulsive therapy (ECT) is a treatment option for severe cases of bipolar disorder, particularly when other treatments have failed. It involves electrical stimulation of the brain while the patient is under anesthesia and can be effective in rapidly alleviating severe symptoms.

Conclusion
In conclusion, managing bipolar disorder is a multifaceted process that requires a comprehensive approach involving medication, therapy, and strong family support. It’s understandable to feel overwhelmed, but with the right treatment and support, many individuals with bipolar disorder can lead fulfilling lives. Encouraging your mother to engage in her treatment plan and seeking professional guidance can make a significant difference in her recovery journey.

Similar Q&A

Understanding Bipolar Disorder in Family: Questions and Support Strategies

Doctor: Hello! My family member (married) lives in a different county and experienced a major depressive episode 10 years ago. After taking medication and shifting life goals, they gradually stabilized. Early last year, due to work stress, they experienced another major depressiv...

Dr. Lin Mianzhang reply Psychiatry
Hello: Regarding your questions, here are the answers: 1. If mild mania is already affecting normal life, it is advisable to seek medication treatment to avoid adverse consequences. 2. Mild mania does not necessarily lead to depression. If your family member has Type I Bipolar...

Understanding Bipolar Disorder: Signs, Symptoms, and Seeking Help

Recently, I have been experiencing extreme emotional fluctuations. Normally, I feel very happy and believe that nothing can defeat me. I have thoughts and behaviors that make me feel like a genius, and I often express to my family and friends how smart I am. However, I also exper...

Dr. Li Zhengfeng reply Psychiatry
Hello: As mentioned in the letter, there are indeed significant emotional fluctuations; however, an online diagnosis is not possible. It is recommended to consult a specialist. I hope this is helpful to you.

Supporting Family Members with Bipolar Disorder: A Guide for Caregivers

Hello doctor, my brother has been struggling since around January when our father had a stroke, which added to his work stress, leading to insomnia. By February, he started exhibiting exaggerated speech and compulsive shopping behaviors, after which he quit his job. In late Febru...

Dr. Wang Chongren reply Psychiatry
Dear Ms. Wang, Regarding your description of your brother's manic episode, although he has completed treatment, it appears that he has not fully achieved remission after discharge from the hospital. This may be due to a longer duration of the manic episode and insufficient ...

Navigating the Challenges of Bipolar Disorder in a Family Crisis

I'm very sorry to trouble you, and I hope you can assist me as much as possible. I appreciate you. My husband is a bipolar disorder patient. Background: Over two years ago, my husband had an affair and lived with a third party for a year. In late October 2003, he had a sev...

Dr. Chen Guangpeng reply Psychiatry
Dear Lulu, After reading your detailed account, I deeply sympathize with your situation. I would like to summarize my personal opinions regarding your circumstances as follows: 1. Although your description is vivid and detailed, I am unable to identify symptoms of "bipol...