People with bipolar disorder often suffer from frequent alternation between two extreme emotions, depression and mania. Photo: Li Hao/GT

Chen Hao, 25, had been holding the phone for about four hours. His hand had made it warm to the touch, and his mouth had dried out. As his throat became hoarse and his body began to tremble, he felt dizzy from a light case of dehydration and low blood-glucose levels.

But he continued to hold the phone and talk, until the friend on the other side of the line became sleepy, apologized, and hung up the phone.

Lost in silence, Chen found himself unable to stop talking. Chen's mother, surnamed Li, was happy to see his excitement at first, because she thought it was a sign of recovery from the depression that had swamped him for weeks.

She sat up with him for another four hours, until 4 am in the morning, when she had to give him a sleeping pill to help him rest.

By then, the tired, sleepy and scared mother felt something was wrong.

"The depressive episode, due to an exam failure which came before that manic episode, lasted for weeks," said Chen. "At that time I was tired and sleepy all day, losing interest in everything, and often thought about suicide."

But when he passed another important examination, Chen's mood swung to the other extreme. The sudden change and more energetic lifestyle made him rather exhausted, and is what made his family and friends first suspect he might be suffering from a certain mental disorder.

Looking back over the emotional rollercoaster of the previous four years, Chen realized it had been a nightmare.

"Sometimes I am excited, energetic, satisfied, delirious, and sleepless," said Chen. "And for several days or even weeks afterwards, I can be rather low, depressed, tired, sad and sleepy, and I sometimes sleep for 15 hours a day."

 

Psychologists say that people with bipolar disorder experience depression and mania only some of the time, and thus many people are incorrectly diagnosed with depression, or are mistakenly believed to have no disorder. Photos: IC

Hidden problem

Chen was suffering from manic depressive disorder, or bipolar disorder, a condition which involves alternating between extreme emotional states. According to the 10th version of the International Classification of Diseases (ICD-10), the disorder is defined by instances of having rapid swings between two emotional extremes, depression and mania.

Yu Xin, a psychiatrist at the Peking University Sixth Hospital, said in a Xinhua news report that bipolar disorder is a common mental condition in China which affects more than 1 percent of the population, and 70 percent of the patients develop symptoms before 20. Despite this, it has long failed to attract awareness.

Yu said the patients are normal people most of the time, but around 33 percent of time they are depressed and 11 percent of time they experience a mania.

As a result, bipolar disorder patients are very easily incorrectly diagnosed with depression or other mental disorders.

"Additionally, the alternation of extreme emotions are hidden behind normal mood swings and overlap with certain events encountered in daily life," Tian Chenghua, chief physician of psychiatry at the Peking University Sixth Hospital, told Metropolitan. "The periods of depression and mania and the frequency of alternation are also uncertain, which increases the difficulty of making a definite diagnosis."

Wei Wei (pseudonym) was diagnosed with bipolar disorder months ago, but over the past eight years she has been treated for both depression and schizophrenia.

"At first I was just like any normal person, only sometimes I was depressed," said Wei. "But the depression could not be relieved, even when I increased the dose of antidepressants many times."

After taking antidepressants for six years, Wei's mania began to get out of control. She began to show an increasingly severe mania featuring hysteria. "But I know I was not losing my mind," said Wei. "I only wanted to blow off steam."

However, Wei was diagnosed schizophrenia in 2010 in her hometown, a small city in Shandong Province, and both antidepressant and antipsychotic drugs did not help her. As her mental health deteriorated, Wei was taken to Beijing and finally diagnosed with bipolar disorder.

"I told them I was not insane during the previous eight years but no one believed me," said Wei. "Who trusts a mental patient's words when she says she's not mad?"

Confusing symptoms

According to Tian, the depressive period of bipolar disorder has the same symptoms as depression, but the manic period is different from schizophrenia. "Schizophrenia features hallucinations, delusions and incongruity of affect [when the topic and mood do not match], while mania seldom has this," said Tian, telling Metropolitan that some of the patients are incorrectly diagnosed with schizophrenia and some are misdiagnosed as having no condition, with the symptoms being attributed to their personality. "I saw one bipolar disorder patient whose relatives even refused to acknowledge that something was wrong with the patient's mental health after the patient was diagnosed, and insisted that the symptoms were due to the patient's character."

According to a Wen Wei Po report, Zhang Lizhi, a psychiatrist at the Mind Pro Psychological Medicine Center in Hong Kong, said about 10-20 percent of depression patients show signs of bipolar disorder. If they are treated with antidepressants, the mania can get out of control.

"There was a woman who was diagnosed with depression who suddenly turned from a stay-at-home girl to having a social mania, and could not help being addicted to one night stands," Zhang told Wei Wei Po. "After detailed analysis and diagnosis, the woman was confirmed to have bipolar disorder, and her sexual addiction was released after definitive treatment."

Tian pointed out that the alternation between extreme emotions and sudden change of mental states should be noticed to identify bipolar disorder. Also, Tian said that bipolar disorder is a recurrent disease with no cure, but with early diagnosis and long-term treatment, the recurring aspect can be brought under control, thus making the patients' lives healthy and normal.

"The treatment should focus on mood stabilizers such as valproate and lithium carbonate, and be used in conjunction with appropriate levels of tranquilizers and antidepressants," said Tian.

Manic talent

To identify bipolar disorder, Tian said it is necessary to recognize mania. But a separate condition, known as hypomania, is sometimes viewed as a beneficial condition.

 "A great number of people are living with hypomania, and they can not be classed as mental disorder patients and don't need treatment if there is no unbearable inconvenience," said psychiatrist Song Zhenzhu. "They may feel extremely energetic and creative, so most of them just love the feeling brought about by hypomania."

Song said there are many famous people who have or had hypomania, such as Vincent van Gogh, whose works were mostly created during hypomania.

"However family members and friends of such people should take good care of them, for hypomania may develop into severe mania, which may bring extreme emotions and self-mutilation behaviors, with Vincent van Gogh as a typical example, who cut his own ear and killed himself," said Song. "And if the hypomanic people drop from their emotional peak and begin to get depressed, they must be taken to the hospital for professional help."

Chen has received treatment for bipolar disorder for about five months and he now feels better. He says he is more calm towards his life and more able to control his own emotions. "Compared with simple depression or mania, bipolar disorder patients are in more pain," concluded Chen. "We are tortured by the feeling of the sudden rise and drop, the weightlessness we feel during the alternation."