Alternate depression and hyperactivity

Pekka’s wife Marja had been depressed and weak for several months. Pekka tried to make Marja seek medical advice, but she did not want to see a doctor. Eventually she agreed to seek help. However, these turned out to be just intentions, as Marja soon started to feel significantly better. She felt very energetic and enthusiastic, only slept a few hours a night and spoke a lot. She began to make unnecessary purchases almost on a daily basis, and Pekka began to fear that Marja was living beyond her means.

A few weeks later, Marja’s mood became depressed again. This time, Marja’s condition was worse than during the previous depressive episode. She was not able to go to work; sometimes she could not even get out of the bed. She was apathetic and tearful and told Pekka that she was a failure in everything. She said that she was feeling guilty and ashamed of her previous behaviour. Pekka was worried and even afraid that Marja would attempt suicide in her despair.

What can Marja and Pekka do?

Marja should seek help as soon as possible. Marja is likely to seek treatment because she is depressed and does not have enough strength to go to work. Her occupational health care physician or other doctor will enquire about Marja’s condition, and perhaps ask her to fill in some sort of a depression screening form, i.e. a questionnaire that maps out her mood and level of depression. It is important that Marja not only tells the doctor of her depression but also of the hyperactive period before the depression.

Since Marja has been both strangely hyperactive and very depressed, she may suffer from bipolar affective disorder, in which depressive and hyperactive, i.e. manic, episodes take turns. Seeking treatment is often delayed by the fact that, during the manic phase, the person suffering from the disorder may lack the sense of illness. Marja may feel extremely well and be unwilling to seek treatment or even stay on the necessary sick leave as the manic phase begins.

Bipolar affective disorder is often detected only after a long time after the onset of symptoms. Therefore, at its worse, it may take years before the patient receives proper treatment. The disorder is easily confused with depression. The medication prescribed for depression will not help a person suffering from bipolar affective disorder in the best possible way. If the disorder is correctly identified, it can also be medicated properly. Knowledge of the symptoms involved in the illness will also help a person suffering from bipolar affective disorder. With this knowledge, she can identify the first symptoms of the different episodes and prevent them from getting worse with treatment. Pekka should also be present during some of Marja’s appointments with the doctor. This way, they would both receive information and instructions on the disorder and its symptoms.

If, after seeking treatment, and Marja is diagnosed with bipolar affective disorder, she would probably start taking some form of medication. This can be, for example, a prophylactic medication, the purpose of which is to prevent the depressive and manic episodes, maintenance medication or acute phase medication. Continuous medication is chosen if the episodes cannot be otherwise prevented or if the episodes are particularly harmful.

In addition to medication, the treatment may include, for example, guided peer groups focusing on controlling the symptoms. Marja might also benefit from psychotherapy, especially if she has a history of stressful life events or untreated grief, which may have exposed her to the outbreak of the disorder.

People suffering from bipolar affective disorder should make practical arrangements, which prevent them from causing additional problems for themselves. In this example case, Marja, during her manic phase, recklessly spends money and makes strange decisions at work and at home. Marja could, for example, set balance limits for her bankcards and phone subscription. If possible, Marja should inform her boss about the disorder and apply for sick leave through occupational health care, if the symptoms interfere with her work performance or make it hard for her to cope.

Bipolar affective disorder may put family members and friends under a lot of stress. During the manic phase, a person suffering from bipolar affective disorder may do things he/she would not otherwise do. For example, their finances could get out of hand; some may abuse drugs or alcohol or gamble. Manic episodes can also involve sexual relations, putting the patient or their loved ones at risk or otherwise strongly contradicting the values of the person suffering from mania. It is extremely important to invest in the relationship and for the spouse to have sufficient information on the disorder. It is a good idea to seek professional help together with the spouse or the whole family. Help is available, for example, at family counselling clinics.