They concern 2% of French people, or nearly 1.5 million people. The bipolar disorders, formerly called manic-depressive disorders, are among mood disorders where every emotion is experienced excessively. These disorders are characterized by a cyclical alternation of two phases of abnormal moods. “The first is a phase of depression, marked by a loss of cravings and appetite, a motor slowdown and dark or even delusional thoughts. The second is an excitement phase including restlessness, lack of sleepacceleration of speech and delusions“, describes Doctor Marc Masson, psychiatrist at the Château de Garches clinic (Hauts-de-Seine) and author of the book “Bipolar Disorders” (Que sais-je n° 4040, puf editions). The second edition of the world day of bipolar disorders, organized by the association Argos 2001 and the Foundation FondaMental this March 30, 2016, is an opportunity to look at ways to treat bipolarity.
Seizure medication…
Bipolar disorder is a serious psychological condition, which can have serious consequences (relationship problems, job loss, Dependenciesrisky behaviors, suicide attempts…). A range of treatments, medicinal or not, is now available to patients to calm crises (depressive or manic episodes). One of the factors of these disorders is a cerebral pathology. In bipolar people,the regions that generate emotions in the brain are overactive and their regulation is faulty“explains Doctor Masson. Biological treatments will therefore make it possible to act directly on the brain.”For manic attacks, the patient will be prescribed sedatives and sometimes two to three weeks of hospitalization” reveals the psychiatrist. “But depression is more complex to treat: we cannot necessarily give antidepressants because they can cause a shift to the excitement phase. They must therefore be handled with care, and other molecules will more often be prescribed such as antipsychotics (formerly called neuroleptics)“adds the doctor.
… and against relapses
But it is not enough to appease the crises, it is also necessary to control the disorders durably, because “in bipolar people, the relapse rate reaches 80%” deplores the psychiatrist. For this, the reference drug remains the lithium. Doctors generally combine it with antiepileptics or antipsychotics to gradually reduce its dosage. Because taken for a long time, it can cause side effects such as thyroid dysfunctions and kidneys. Annie Labbé was diagnosed as bipolar. She is now president of the Argos 2001 association, which she founded in 2001, and testifies: “personally, lithium did not suit me because I presented mixed states: I alternated different phases several times during the same day. So I took antiepileptics, which still suit me perfectly.“Medical supervision by a general practitioner or a psychiatrist is therefore essential, even when the disorders have stabilized.
Another biological technique considered by doctors:electroconvulsive therapy (ECT), formerly called electroshock. “Improved and modernized over the past 20 years, ECT consists of briefly stimulating the brain with an electric current, under general anesthesia“explains Dr. Masson. ECT would be particularly effective in reducing depressive attacks in the medium and long term.
Alternative non-drug treatments: combined therapies
But biological treatments are not the only ones that are effective in treating bipolar disorder. Many alternative techniques are emerging and are proving their worth, allowing patients to better live their pathology on a daily basis. First, psychoeducation (or therapeutic education) helps to better understand and accept the disease. As a result, it reduces the number of relapses and hospitalizations. This therapy is often conducted in groups. It teaches patients to respect simple rules, for example to limit stimulants (alcoholcoffee…) and to adopt a healthy lifestyle with stable sunrise and sunset times. Psychoeducation is also aimed at relatives of patients: “they must learn to protect themselves. For this, discussion groups help to understand, learn about and accept the illness of the loved one.” advises Annie Labbé.
Another treatment is cognitive and behavioral therapies (CCT). They consist of teaching the patient to identify risky situations and crisis triggers in order to better manage them.
At the same time, so-called cognitive remediation therapies aim to “re-educate the bipolar person’s attention, memory and concentration“, explains Dr. Masson.
Likewise, the mindfulness meditation (mindfulness) helps bipolar people to “better channel their stress, their emotions and their hypersensitivity” says the psychiatrist. Practiced daily, it reduces the number of relapses once the disease is stable.
Furthermore, bipolar disorder may be linked to an underlying mental disorder. In this case, the bipolar may have recourse to analytical therapy. “In addition to the drug treatments, I carried out a psychoanalysis because I also had a deep neurosis. As they say, one train can hide another!“says Annie Labbé.
Finally, theart therapy is often offered during hospitalizations. “This type of therapy is quite appropriate, especially since bipolar people often possess a little above average creative capacity.“explains Doctor Masson. Whether it is therapy through drawing, music, painting, theatre, dance or even sculpture, it will facilitate attention management and will have a liberating effect.
The person suffering from bipolar disorder can combine several of these therapies. “In addition to psychoanalysis, I also followed a course of art therapy, cognitive and behavioral therapy and psychoeducation. I also created the Argos 2001 association 15 years ago, which was of great benefit to me.“reports Annie Labbé.
It is possible to live well with the disease
But can we speak of healing? “If by cure we mean a total disappearance of the disease, then no, we do not cure a bipolar disorder” reveals Dr. Masson. Because even if the treatments regulate the neuronal dysfunction at the origin of the disorder, their cessation leads to the reappearance of the symptoms. “However, we must remain optimistic“, reassures Doctor Masson. “We can quite lead a normal life thanks to an optimization of the care, by finding the most suitable and simplest treatment formula.” he details. “Like any disease, there is an acceptance phase. Once this phase is over, you can really live with it, provided you are vigilant.” adds Annie Labbé. “We are vulnerable, especially in the face of hard knocks. This is why it is necessary to combine psychic, psychiatric and somatic care in order not to relapse, and to dialogue with your doctor who constitutes a real crutch” she also advises. And to add: “It is especially necessary to live beyond the disease, to play sports, theater… because bipolarity does not prevent living.“
Find the program of events organized for the 2nd World Bipolar Disorder Day on the fondaMental Foundation website.
Sources:
Interview with Doctor Marc Masson, psychiatrist at the Château de Garches clinic (Hauts-de-Seine)
Interview with Annie Labbé, founder and president of theassociation Argos 2001
Bipolar Disorders, Doctor Marc Masson. Que sais-je n°4040, puf editions, March 2016. (Price: 9 euros)
>> To read also:
Bipolar disorder: nothing to do with simple mood swings…
Creativity and mental illnesses would have common genetic roots
Bipolar disorders: early diagnosis to avoid the risk of suicide
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