Bipolar therapy finds way out Print E-mail
Written by Clara Pirani   

Clara Pirani, Medical reporter
The Australian
August 25, 2007

FOR almost 40 years, Jennifer Howell pretended to be someone else. Since her teens, the now 61-year-old Melbourne woman "acted happy" in front of family and friends, all the while experiencing episodes of extreme despair and sadness.

"I pretended to be a bright, happy person because I knew that it was not acceptable to be depressed. I was always trying to be a nice person to cover up my feelings of irritability. I didn't understand why I felt like that. I was looking for reasons, but never quite grasping the fact that it could be a mental illness."

Unable to work full-time, Howell worked in a variety of part-time jobs as she tried to understand why she never felt the same happiness that seemed to come so easily to others.

Four years ago, she finally had an answer.

"I went to see a new GP because I had a broken bone in my foot. After a few minutes talking to her, I began to cry. After about five minutes, she said I was really depressed and she called a psychiatrist and I was diagnosed with bipolar disorder. That was the beginning of my recovery."

Bipolar disorder, which affects more than 100,000 Australians, is caused by an imbalance of chemicals in the brain and results in extreme mood swings.

The condition was previously known as manic depression, because a person's mood can alternate between the "poles" of mania (highs) and depression (lows).

These mood swings can last for hours, days, weeks or months.

Howell was prescribed various medications, including Zoloft, which she says allowed her to feel happiness for the first time in her life.

"I was on that for about three months and it allowed me to feel happy for the first time in my life. I'd never really known what it felt like. But you can only stay on Zoloft for about six months."

Howell tried several medications before finding one that eased her wild mood swings. "But medication alone is not a long-term answer." In June last year, Howell enrolled in the trial of a therapy-based treatment aimed at teaching people with bipolar how to realise when they were about to experience a manic or depressive episode, and take steps to prevent it.

The program was developed by a team at the Mental Health Research Institute of Victoria, with funding from the MBF Foundation and beyondblue.

"We developed a program which assists people with bipolar to deal with their illness in a more coherent way, and enable them to take control of their life by identifying their own individual pattern and early warning signs of relapse," says professor David Castle who led the research.

"The program taught them skills to reduce stress and to intervene early as soon as they notice signs of relapse. It's important, because bipolar disease is a lot more common than we originally thought. We used to think that about 0.5 per cent of the population had bipolar, but now we think it's about 3 per cent of the population."

In a controlled randomised trial, the team recruited 84 people diagnosed with bipolar disorder. About half received weekly therapy sessions, in addition to their medication, for 12 weeks, while the remainder only took medication. Those on the intervention program had half the number of relapses after 12 months as the control group which received medication but no therapy.

Relapse rates for people taking medication for bipolar disorder are as high as 75 per cent over five years.

The early warnings signs of a relapse vary between individuals, but Castle says some signs include a slight decrease in appetite, needing less sleep and increased irritability.

"Sometimes they don't seem to need as much sleep. It's not that they can't sleep, but that they don't seem to need as much sleep. They have so much abundant energy. They also experience great irritability."

Participants were taught strategies to prevent the onset of an episode including increasing medication, resting, avoiding stress and alerting a support network of family and friends.

"Volunteers kept a diary system which is a hand-held record that allows them to have specific plans to address episode and collaborative partners to help them," Castle says. "We are very excited about the program's success. This is the first time that we are aware of in the world that we've been actually been able to reduce manic episodes and get people to reduce their signs of mania much sooner."

Bipolar is a very difficult disease to live with, for individuals and their families. Some experience depressive episodes that are much more than than just sadness, but lack of self-worth and self-esteem, poor concentration, lack of interest in anything.

"The other side is the manic pole and that's characterised by elated mood, talking fast, they feel they have special abilities or powers, they might think they have lots of money so they'll go on a spending spree.

"They may believe that they are very sexually attractive so it can lead to sexual indiscretion. It can be very destructive."

MBF general manager health product, Michael Carafillis, says the new program provides a much-needed bridge between the mental health services that treat people when they are acutely ill and the GPs and private psychiatrists who would provide ongoing care.

"Bipolar is a complicated disease involving periods of depression and mania, and its sufferers don't alway take their medications when they should," Carafillis says.

"People with the condition straddle the divide between public and private systems resulting in poor continuity of care for many sufferers.

"They tend to gain access to the public system in the most severely disabling phase of their illness, typically mania, and are often too ill and the disorder too complex to be easily managed in primary care."

Howell says the program has changed her life. "I can't believe how helpful the program was. It helped me to understand the role of medication, but also how responsible I am for how I feel. It provided practical advice and incredible support."

"They taught us to monitor our thoughts because your thoughts influence your actions. That was crucial for me to learn to watch what I think.

"Before I was diagnosed, I used to stay up later and later, to two or three in the morning to try and lose myself in movies so I couldn't think. I can't speak highly enough of it. I'm a different person."

Carolynne Holdsworth, an occupational therapist and research clinician at the Mental Health Research Institute, says the treatment will change the way health-care professionals treat bipolar disorder.

"In the 1990s the idea began to emerge that rather than being just a biological illness, other factors, including the social environment, contributed to a person's bipolar. This program put those ideas into practice."

Holdsworth has trained 28 clinicians including occupational therapists, psychologists, psychiatrist and social workers to conduct the treatment, and hopes it will be rolled out nationally.

"At the moment it's only offered in Victoria but we're also training staff in Rockhampton and in South Australia."

People with bipolar disorder typically have to endure almost 13 years of manic-depressive mood swings before being correctly diagnosed.

A report from Melbourne researchers last year also found that during that time, 55 per cent of those with the condition will be misdiagnosed and given the wrong medication or treatment.

The study, which tracked 240 people with bipolar disorder, has found many doctors confuse the condition with other mental illnesses.

"It's usually misdiagnosed as a personality disorder or depression," said lead researcher Jayashri Kulkarni, director of the Alfred Psychiatry Research Centre in Melbourne.

Castle says 80 patients are now on waiting lists in Victoria to undergo the treatment.

"We didn't want this to just be a research project. We know it can prevent nasty relapses and hospitalisations."

A combination of the right medication and the therapy helped Howell to the point where her GP says she will no longer require medication.

"My doctor says that if I keep going the way I am, she won't need to see me for another six months.

"My friends can't believe how I've changed. And my husband and I can now communicate because I'm not always snapping his head off. I'm just so grateful that I'm finally happy."


Jarvis Walker     Arlec

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Featured Articles

The 'Forgotten People'

by Anna Malbon from the Progress Press October 22, 1996

WHEN nine-year-old "Tom" was asked to draw a picture of himself with his mother be drew her trying to strangle him.

Tom entered the world of adults too early. If he was ever immune to the complications and pain of life that adults try to shelter from children, he says he can't remember.

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I had to struggle extra hard

Her doctors did not bother to enquire about my father and I.

They only listened to her stories ”

“ I grew up thinking - Nobody wanted to help. Nobody wanted to know.”

Hi, I had a mentally ill mother. She passed away last year. I literally grew up hanging around mental hospitals because my Mom's condition was a cycle that always ends in a mental hospital. When I was younger, there was a long period when I cried my eyes out every time I was separated from my mentally ill mother because she had to stay in a mental hospital. After I grew older, my Mom's mental illness became impossible for me to bear.

Literally, my Mom's mental illness ruined my life. I think. I had to struggle extra hard for everything because of my big handicap at home. There was no support at all from anyone other than my father. Nobody else wanted to know about it. My mother's own cousin even said to my father not to bring my Mom to their place. I grew up thinking - Nobody wanted to help. Nobody wanted to know. My mother's own sister has been complaining since 2000 and her last complain was on 5 July 2014. This particular aunt keeps complaining about the same thing. That she had to take my Mom for her weekly injections and complained that my father and I was not around to do it. Then, she goes on to say that she saw my Mom beat me up with a cane. When she said that, I asked my Aunt, you saw my Mom beat me up with a cane? She said yes and than, she walked away.

I feel very sore with this aunt. Number one, the period she was complaining about was when I was still schooling and my father's and my mental health had deteriorated so badly that we had to leave the state for our own sanity. Before joining my father, I had to live alone with my Mom and my baby sister for almost a year. My aunt who lived a few minutes drive away did nothing when my Mom beat me up every day for months until my father managed to cut the red tape to remove me. My body was full of bruises and I was terrified to go home after school. Nobody helped. Not the neighbours who can hear all my mom's shouting at me, nor my aunt, nor my grandparents, nor my school's teachers. Someone should had intervened for a 12+ little girl. No adult helped. My father was trying his best to get me away to stay with him. Nobody helped him.

On XXXXXXXXXXXX, my Mom's sister let slip she saw my Mom beat me with a cane. And yet she did nothing! My aunt even had the cheek to say that my Mom beat me up because I said I wanted to go live with my father. The way my aunt said it was like the beatings were wholly my fault. What is wrong with the picture? You have a 12+ girl being beaten up daily, you are an aunt who knows something is going on and did nothing. Yet for years later you complain about having to take your own blood sister for her injections. And, I do not think she did it for longer than my own experiences. Probably only a few times because my father and I had to travel frequently to see to my mother. Due to the cyclic nature of her illness.

I have been going with my father when he took my mother for her weekly injections as a little girl, knee high, ever since I can remember. My own aunt is so calculative. There was a nurse that visits my Mom to give her her injections. But, the problem is my Mom will not let the nurse into her house that is why the intervention is needed. I have lost count on the number of times I had to go with my Mom for her injections as a little girl.

Her doctors did not bother to enquire about my father and I. They only listened to her stories and full stop. I think my Mom's doctors are the most heartless people I have ever met in my life. Until today, I do not like anyone who officially practices psychology because those doctors etc... contributed to my life being ruined. That is how I feel. I have been scolded by my Mom's medical team and they even dumped my Mom on me after I just turn 18 and there was no other adult around. And, they knew the situation. I was terrified because my Mom was a very violent. My Mom has pitched me, beaten me up, she has biten me with her teeth, she has smashed my head against the table and threatened to beat me with a piece of hard wood. I experienced all these as a little girl at the tender age of 12+ I had to learn karate to protect myself from her violent ways. And, when my Mom was home, I would lock my room's door and place a chair against it. I was that terrified of her.

All our belongings can go missing because my Mom is good at that sort of thing. You never know what is what with my Mom. It is like having a criminal live under the same roof as you.

My aunt kept repeating to me that on my mother's death anniversary I will have go visit her cemetery. I live in a different state from where my mother's cemetery is located. And, my aunt knows that very well. However she repeated her question to me until I said yes. I hate being forced to do something against my will because I have been forced to do things against my will my whole life.

My life is in ruins because of my mother's mental illness and people like my aunt is perpetuating the troubles for me after my mother's death. When I was 12+, my mother's mother said to me that it is my father's job to take care of my mother. In other words, my father's job and mine. And, they never lifted a finger to help. Just helping a little, my aunt has been complaining about the same thing for more than a decade. Unbelievable. Shameful.

Even though my father and I lived in a different state from my mother, we had to travel up and down every weekend because that is demanded of my mother. Sometimes, we had to travel after school and upon our arrival, she won't let us in and we had to travel all the way back. And, my father will not let me sleep at home as it is a school day, I had to go to school. My education was very important to my father. My mother could not be bothered if I succeeded or not.

I have seen more than any of my Mom's relatives have seen with regards her mental illness but people whom I just met behave like I have no idea about my Mom like they are the authority on her behaviour and her illness. Goodness gracious.

Despite this huge handicap in my life I persevered with my studies. My Mom did not give me any moral or emotional support at all. In fact her mental illness cycle will peak just or during my important exams. In other words, I had to deal with my exams and on top of them a mentally ill mother. By my final year in university, I could not take the pressure of exams and a mentally ill mother's break downs anymore.

When I was in my teenage years and early adult years, I was suicidal. I had to call Befrienders a lot. Thank God for Befrienders.

Before XXXXXXXXXXdate, I do not wish my experience to be experienced by anyone else because it is torture. However, after feeling how hard hearted my aunt is. A so called holy person, a church goer, rich person who has successful kids and grand kids. And, she can talk like it is my fault that my Mom beat me up and she (my aunt) had to take her (her own sister) for her injections when I was a kid. I really wish that my aunt must reincarnate as my father (a few lifes) so that she can eat her own words. If my aunt reincarnates and is put in my father's shoes, she would really deserve it. Hope she learns compassion through it all.

Why can't the world give children of the mentally ill a break? I am so fed up with all this troubles that stem from my mother's sister's attitude towards my father and I. After all shel lives a great lives. Rich live. What is wrong with these people? I really cannot stand them. This is my story.

After I wrote the above - I am more myself now, and I totally forgive my aunt and everybody who did nothing to help my father and I. And, everybody else who were heartless towards my father and I. However, I still think that by living a few life times as my father (my aunt) - would do her some good. But, knowing her character, she might become a psychopath and pose a threat to humanity. My father is a very, very kind soul. My aunt is a hard hearted, prejudiced, narrow minded, one tracked mind person.

How I cope? Trying my best to keep out of their way, and hang out with positive people. There are plenty of great people out there. Nnaami is included :)


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