What is the role of the general physician compare to the one of the psychiatrist?
The general physician has a global approach to health and illness, and has an essential role as a coordinator in the health care process. He/she is not a substitute for the different specialists, like, for example, the psychiatrists. The general physician has an active and complementary role in the global monitoring of prescriptions and treatments.
On the other hand, the psychiatrist intervenes as an expert in mental illnesses and disorders. By knowing their individual and particular characteristics well, he/she is the most qualified to diagnose, prevent, prescribe and adapt the individual treatments specific to the particular disorder.
I have been diagnosed as bipolar, how long is my treatment going to last?
The prescribed treatment is generally of long duration because adjustments to the medications and their dosages are often necessary based on the reaction of each patient to the treatments, with the goal of obtaining the best possible results.
While it is clear that each case is different and, depending on the seriousness, we can, nevertheless, say that once the patient has been stabilized for a period that is sufficiently long (often several years), the psychiatrist can propose to progressively decrease the treatment under medical surveillance, until reaching minimal doses.
If, with minimal doses, the stability continues long enough (months or even years), and considering the benefits of treatment, the side effects and the choice of the patient, the psychiatrist and the patient can, therefore, decide to :
Keep the minimum treatment, for example with a thymoregulator, for the patient comfort or to prevent relapses
Keep decreasing until the total suspension of treatment while continuing to be very vigilant
In certain cases, stopping treatment is therefore possible during a predetermined period (called a « drug vacation » or « medication vacation ») , but this must be planned and instituted by common agreement between the patient and the psychiatrist and with the greatest vigilance and supervision.
A patient must never decide to change or stop his/her treatment without consulting a physician, if necessary, go to emergencies. Every patient must act responsibly and be informed by reading the pharmacy notices about the medications he/she takes, in order to have the best response and to let warn the physician if there are any problems.
We have noticed as well that some patients have only one bipolar episode in their lives without having a definite recurrence. It is very difficult to know the exact moment when bipolarity is triggered. Bipolarity can stay in "sleep mode" or very attenuated for years and be triggered or aggravated suddenly depending on the context.
There can be a familial predisposition or a vulnerability, a susceptible « terrain » weakened by a catalytic event. There is a difference between managing crises (bipolar episodes) and periods of stability. In all cases, the context is very important.
Is bipolarity hereditary?
Currently, we know that the risk of developing a bipolar disorder is greater when one of the parents has developped it. There is no identified precise cause : heredity as well as environment plays a role, but one cannot speak of « transmission ».
Today, the specialists speak essentially of « being prone to have this desease », of « vulnerability », and « aggravating factors » (such as external triggering events) or « influence of family pattern » (mimicry).
Do I need to take medication or is psychotherapy enough?
It is essential to evaluate the severity of the situation. In a crisis (episode of depression or, on the contrary, episode of (hypo)mania), requiring even, in certain cases, a hospitalization, psychotherapy is absolutely not enough. In effect, medications help to manage the crisis, stabilize it and limit recurrences.
Medications are always there to attenuate anxiety, depression, and mania.
Psychotherapy by itself is, therefore, not enough, but it has been proved to be a beneficial complement for the patient, who can learn to better manage his/her behaviors.
In all cases, it is necessary to become informed and to discuss this with your psychiatrist or attending physician.
In the opinion of specialists, psychotherapy based on the techniques of Cognitive Behavioral Therapy (CBT) is particularly adapted to treat individuals suffering from bipolar disorders and lack of self-confidence.
How should I organize myself if I leave my house for several days?
Before travelling, it is essential to discuss this with your physician and to inform your entourage. Generally, it is strongly recommended that you not to travel alone, or even not to travel at all, if your situation is not stabilized.
Depending on your destination and the length of your trip, the preparation is different.
If you travel to another country, remember to take enough medication with you for the duration of your stay along with the prescriptions which justify them.
HINT : The names of medications can change from one country to another. Ask your physician to indicate the active chemical (generic) name on the prescription for your trip. The physician can decide, as an exception, to prescribe treatment for a longer period of time so that you do not run out of medication on your travel. If there is an agreement, you can even have a little extra as a precaution in case you have difficulty to find your medications on your trip or if you are delayed.
IMPORTANT : Think as well of subscribing to or verifying that you have repatriation insurance that covers psychiatric illnesses.
During the trip, be careful to take the time to get enough rest, avoid drinking alcohol or other toxic substances and keep a daily rhythm that includes enough sleep.
Do not hesitate to keep a letter or card with you that indicates :
Your treatment and its dosage
The contact numbers and name of a person who should be informed in an emergency
Keep with you as well the name and contact numbers for your physician in case of emergency
Finally, if you have the slightest doubt or sign of recurrence or aggravation of your condition, consult a physician.
I have thoughts of despair or I am thinking of committing suicide - what should I do ?
You should immediately alert someone so that you can share your thoughts and suffering.
Break the isolation, above all, do not stay alone.
As a precaution, don't stay alone, and have someone accompany you until there is further support available or even go with you to seek a psychiatric emergency department if you have the slightest doubt. A physician can prescribe medications for you that help to relieve anxiety and manage these types of situations.
REMARK : The term « Psychiatric Emergency Department » is always frightening .… but know that it is simply the equivalent of an Emergency Department of a hospital, but that in this specific case the emergency physician will be a psychiatrist, therefore a specialist in these kind of emergencies.
The entourage, on its part, should be very attentive to the signs sent by someone who is suffering (gloomy thoughts, threats to commit suicide, talking about death..) you must listen carefully and take the risk of suicide seriously. In case of any doubt, the entourage who has knowledge about the problem should warn a specialist or contact a psychiatric emergency department.
I feel better, can I stop my treatment?
Every patient should act responsibly and get informed by reading the pharmacy notices about the medications he/she is taking, in order to get the best response and to warn the physician if there are problems or side effects.
For example, during a (hypo)manic episode, the patient feels better and can « imagine » that they no longer need treatment. It is not true !…
The treatments for mood disorders (depression, manic-depression or bipolarity) are treatments that take time to put in place and have their desired effects: they have a lot of inertia.
Generally, it is important to follow your treatment regularly to avoid relapses and recurrences, that in the long term, can cause resistance to treatment.
A patient can never decide alone to start or stop his/her medications, or to change the dosages written on the prescription : only a physician is qualified to make this decision or to adapt a treatment in progress.
Can we speak of curing a mood disorder ?
Definition of a cure : Disappearance of the symptoms of an illness and return to good health.
A cure, although temporary, is therefore, in theory, always possible. It is possible to attenuate symptoms, learn to manage the episodes, to prevent relapses and therefore to have some control over the illness.
Medications, psychotherapy and psychologically support are very precious allies to fight the illness.
For example, certain patients have only one bipolar episode during their lives without any relapses. It is very difficult to know when bipolarity is triggered. It can stay in « sleep mode » or attenuated for years, and be triggered or aggravated suddenly depending on the context.
You can never know if the ups and downs of life or events will provoke an episode : this is why, starting with a period of stabilization, the best way of avoiding a relapse is to stay very vigilant and to take special care of living a healthy lifestyle.
There can be a family predisposition, or a vulnerability, sometimes a "terrain" weakened by a catalytic event. You must distinguish the management of a crisis (unipolar or bipolar episodes) and periods of stability. In all cases, the context will be very important.
Should I speak about my disorder to those around me ?
One of the most delicate points is whether to reveal your disorder or not.
The earlier the diagnosis, the more the mechanisms of failure will be stopped (couple, family, friends, professional life)
But this does not make it easy to decide to talk about your disorder to those around you.
Your close entourage, if they are well informed, can be a precious help, a support, an exterior eye that will know how to evaluate your state of health.
On the other hand, from a professional point of view, the subject is very delicate.
Certain professional settings, notably the creative and artistic domains (publicity, marketing, music, arts, cinema, photography...) integrate bipolarity more or less easily, as it is known as the « illness of great men », or, said otherwise, those of creative individuals and artists.
But this is far from being the case everywhere, and even more in the « classic » structures, with their kind of hierarchy and rules. The professional setting is very competitive today.
Revealing your bipolarity to people who cannot understand it can turn it against you, be interpreted as an unmanageable weak point, and therefore, be a disservice to you.
If there is any doubt about the ability of your listeners to understand your disorder, discretion is preferable.
If you decide to speak about it, choose those who you have confidence with, and who will know, if necessary, how to help you to adapt your way of telling it.
** Reader information : This section is mostly inspired of real-life experiences, and was written by the editorial staff of the Mood Institute, exclusively composed with patients - The members of the Medical and Scientific Committee are regularly asked to provide an advisory opinion - Last update