Free group support for bipolar disorder in the Northern & Southern Suburbs of Cape Town
FAQs

Here are some frequently asked questions for perusal. Alternatively press Ctrl + F to search for a specific word or term.

Q1: What is “Bipolar”?
Bipolar Mood Disorder is a serious psychiatric disorder that causes cyclical changes in mood that interferes with day to day functioning. Changes in mood can be elevated (hypomanic) or abnormally highly elevated (manic) or depressed. Such changes in mood tend to alternate with episodes of hypomania including at least one of mania followed by bouts of depression as in classic Bipolar I or milder episodes (hypomania or normal mood) followed by deep bouts of depression as in classic Bipolar II. In severe cases the patient may display symptoms of psychosis which include loss of insight and / or losing track of reality. Left untreated Bipolar Mood Disorder can wreck relationships, lead to devastating economic loss, self-destructive behaviour and ultimately suicide.
Q2: Could I be Bipolar?
If you experience mood swings or changes of mood that interfere with your day to day functioning and cause you significant distress you are a candidate for Bipolar Mood Disorder. If you take the Mood Disorder Questionnaire on the Resources page of our website and receive a “positive screen” you may similarly be a candidate for Bipolar Mood Disorder. If so, you should follow up with an examination by a Psychiatrist or Psychologist who be able to diagnose you one way or the other. It is important to consult a specialist because some unrelated medical conditions (e.g. hyperthyroidism) can resemble certain aspects of Bipolar Mood Disorder.
Q3: What causes Bipolar Mood Disorder?
Bipolar Mood Disorder has many causes; however they can all be listed under one of two headings: Genetic Predispositions and Environmental Assaults. There is a strong hereditary component to Bipolar Mood Disorder – it tends to run in families. The most common genetic factors are small, hereditary changes to a single letter of the DNA ‘alphabet’ that predispose a person to Bipolar Mood Disorder but do not on their own cause the disorder. The more such mutations that a person accumulates in their DNA, the more strongly disposed they are to develop Bipolar Mood Disorder. The manifestation of a full-blown Bipolar episode or the beginning of the disorder in a person who is genetically predisposed can almost always be traced to an environmental cause such as a highly stressful event or series of events in a person’s life. Common triggers include family discord, relationship troubles, bereavement, being the victim of a crime, job loss and major life adjustments. Recreational drugs can also precipitate the disorder in those who are genetically predisposed as can certain classes of medication such as SSRI’s and SNRI’s.
Q4: What are the chances of somebody being Bipolar?
The global lifetime prevalence of Bipolar Mood Disorder is between 1 and 3%. If one parent of a couple is Bipolar then 1 out of 6 of their offspring are likely to be bipolar. If both parents are Bipolar then 3 out of 4 of their offspring are likely to be bipolar. The situation with other Bipolar relatives such as uncles, aunts and grandparents is more complicated; however the more close relatives a person has that are Bipolar the more likely that person will be Bipolar.
Q5: Can Bipolar Mood Disorder be cured?
No, but it can be managed like many other chronic conditions so that it is possible to live as “normal” a life as possible. Management includes a combination of chronic medication, psychotherapy, social support and psychoeducation.
Q6: Is it possible for some who is Bipolar to cope without medication?
No, like almost all chronic conditions Bipolar Mood Disorder must be medicated on an ongoing basis. It cannot be managed by diet or exercise or complementary therapies alone. It may be possible to remain stable for a while without medication but most will relapse, especially under stressful conditions. A relapse will require going back on medication, usually at a higher dose; therefore the best advice is to stay on the minimum dose of medication required remain stable and well for the long term.
Q7: Can I be forced to take medication?
No. Under South African law anyone may refuse medication and /or treatment. If however a person is unconscious or intoxicated it is not possible to obtain consent therefore such a person may be treated and / or medicated without their consent.
Q8: What if I can’t afford the cost of treatment?
Bipolar Mood Disorder is more expensive to treat than some chronic conditions; however it is nowhere as expensive to treat as, for example, cardiovascular or smoking related disorders. Treatment, including most medication, is usually paid in full by South African Medical Aids. Those who are not covered by Medical Aid may be eligible for treatment by the state at no cost. A means test is used to determine if a person (or family) is genuinely unable to pay for treatment. Those who live in a house or property above a certain market value and whose joint household income is above a certain threshold are usually excluded because it is assumed that their family would be able to afford treatment. Anyone who falls below this threshold is entitled to free treatment, including specialist visits and medication, at a state hospital or community clinic.
Q9: Can I drink alcohol if I am taking medication for Bipolar Mood Disorder?
It depends on the type of medication and the type of drinker. Most people taking medication for Bipolar Mood Disorder will not be significantly affected by literally one or two units of alcohol per day; however each person should discuss this openly with their psychiatrist as there are notable exceptions. Wellbutrin (Bupropion) is one such exception: mixing Wellbutrin and alcohol may increase the risk of uncommon side effects such as seizures, hallucinations, delusions, paranoia, mood and behavioural changes, depression, suicidal thoughts, anxiety, and panic attacks. People who are incapable of drinking moderately or who regularly binge drink (defined as 5 or more units a day) should rather abstain. Whatever a person’s drinking habits, they together with their psychiatrist, should request liver function tests (LFTs) twice a year and not drink more than 14 units a week. Even then, it is best not to drink alcohol every day of the week – it is advisable to have two or more consecutive alcohol free days a week.
Q10: Is there a link between Creativity or The Artistic Temperament and Bipolar Mood Disorder?
Yes. Artists and highly creative people seem to be over represented in Bipolar populations compared to populations of people who are not Bipolar. See the article “Manic-Depressive Illness and Creativity” on our Resources page. Unfortunately, finding a link or an association is not the same as proving causality. For A to cause B means that A is both necessary and sufficient for B, which we have not established for Bipolar Mood Disorder and creativity. It could be that there are several intervening variables or environmental factors that we don’t know about. Also the question of self-selection cannot be ruled out, such as when a person of a certain temperamental phenotype chooses an activity or occupation that is a good fit to their temperament.
Q11: What is the difference between Type I and Type II Bipolar Mood Disorder?
Type I Bipolar Mood Disorder is the classic “Manic-Depressive Illness” characterised by manic or mixed episodes alternating with bouts of depression lasting 2 weeks or longer. Bipolar II Mood Disorder is characterised by depressive interspersed with hypomanic episodes. While the highs of type II are not as extreme as those of type I, the lows of type II are typically more severe than those of type I. Hence there are different risks associated with Type I’s vs. Type II’s as well as different treatment regimes.
Q12: How many hours of sleep should I get?
The amount of sleep that each person ideally needs depends on the individual. All things being equal, a person should get as many hours of sleep as from the time of falling asleep to the time of waking without an alarm. Unfortunately, work and school schedules require that most people wake to an alarm and therefore do not get as much sleep as they ideally require. To complicate the picture: those in a manic phase get very little sleep, while those in a depressed phase sleep more than they need to. Antipsychotic medication in particular can also cause a person to sleep for longer than they normally would. If this is a problem, one can take such medication earlier in the evening or request a slight reduction in the dose from one’s psychiatrist. Otherwise it is best to sleep off the effects of such medication rather than waking earlier while still sedated, especially if one intends driving a motor vehicle to school or work.
Q13: Is insomnia caused by Bipolar Mood Disorder?
No. Bipolar Mood Disorder is not the cause of insomnia, though it can contribute to it. While people going through a hypomanic or manic phase may sleep very little, they seldom complain about it because the feel energised and aroused. The inability to sleep may be stress related; this includes work, school, relationship and financial stress. Sometimes insomnia is related to temperament: anxious types tend have difficultly going off to sleep, while depressive types tend to have difficulty staying asleep, often waking in the small hours of the morning, finding it difficult to go back to sleep again. The way a person’s sleep environment is arranged also has an impact on sleep quality. Blue light emitted by screens such as TVs, tablets, cell phones can “trick” the brain into thinking it is day time. Placing documents or work material within view from the bed is likely to draw attention to them. Gaudy or eye-catching posters or pictures on the wall are also a distraction. Rather take them down from the bedroom wall and hang them somewhere else. A room that is too hot or that has inadequate ventilation is not conducive to good sleep. In the hour before sleep turn down the thermostat a few degrees and use a mosquito repellent dispenser if necessary. Too many pillows cause the windpipe to “kink” making natural breathing difficult. The head should be supported at the level of the shoulders. It is important to establish a sleeping routine and stick to it. Try to get to bed and wake up at the same times every day. Avoid afternoon napping as this will reduce the number of hours of sleep required in the evening. Many other ideas for making the most of one’s seep environment can be found by searching for “Sleep Hygiene” on the internet. Sleeping tablets are useful, when taken as prescribed, but tolerance (needing more of the same) and addiction can develop over time; therefore their use should be restricted to a few weeks as needed. An alcoholic “nightcap” of two units of spirits before bedtime does help one get to sleep but it tends to defragment the sleep cycle in the second half of the night; therefore it solves one problem but creates another. Under no circumstances should sleeping tablets be mixed with alcohol or other central nervous system depressants.
Q14: Can I be fired from my job or demoted for being bipolar?
No, not simply for being bipolar. It is illegal to discriminate against someone on the basis of a mental disorder or disability. If an employee has been working for a company for some time and the company happens to find out that the person is bipolar, they have no grounds for action. If however an employee is subject to a performance appraisal and it is found that he or she falls well below the expected level of performance for their position, they may be given a warning letter. If their level of performance does not improve after a reasonable amount of time, the employee may be dismissed. Employees may also be dismissed irrespective of their bipolar status, for conducting personal business on company time, insubordination, bringing the company into disrepute, breach of contract, being drunk while on duty etc. Finally, there are just a few positions that bipolars are NOT allowed to occupy, with good reason. These include airline pilots, flight traffic control officers, school bus drivers and so on. A bipolar person who performs one of these jobs can be instantly dismissed, without recourse if their employee finds out about their diagnosis. This is not a case of discrimination as the bipolar employee would never have been allowed to occupy such a position in the first place.
Q15: What if I believe that I have been unfairly dismissed from my job?
The Commission for Conciliation, Mediation and Arbitration (CCMA) should be your first port of call. Go to https://www.ccma.org.za/ for further details. The CCMA is a dispute resolution body that provides mediation and conciliation of disputes as well as binding arbitration, should conciliation not be successful. Their services are free and are designed to work without engaging outside legal services, although parties may bring witnesses or representatives depending on the stage of resolution. Please do not accept the services of a “labour representative” as they often conduct themselves unethically and typically demand a percentage of whatever settlement is reached. The CCMA is definitely not a toothless tiger: they can order a reinstatement or an award up to 24 times the former employee’s monthly salary, should they be found to have been unfairly dismissed. Only after you have exhausted the CCMA process should you approach a labour lawyer, who may refer the matter to the Labour Court.
Q16: What are comorbid conditions?
Comorbid conditions are additional medical conditions that exist along with the primary condition. People with Bipolar Mood Disorder often have coexisting psychiatric conditions such as anxiety in its various forms, obsessive-compulsive disorder, substance-use disorder, eating disorders, attention deficit hyperactivity disorder, personality disorder and premenstrual syndrome (including premenstrual dysphoric disorder). Sometimes comorbid conditions fail to be diagnosed because either patients do not volunteer additional information about other aspects of their mental life and/or because the therapist is exclusively focused on their primary condition. People with Bipolar Mood Disorder often have other coexisting medical conditions including metabolic syndrome, migraine, obesity and type II diabetes. The existence of comorbid conditions complicate treatment and worsen the outcome of the primary condition. Therefore, if you have other medical conditions or are simply worried about seemingly unrelated symptoms you should disclose this at the outset so that they can be treated together.


A peer lead, non-profit, support group for people with bipolar disorder and their supporters

follow me on facebook