Manic Depression Case Study: Overcoming Mood Swings and Finding Stability
Patient Information:
- Age: 32
- Gender: Female
- Background: Pooja is a graphic designer with a supportive family and grew up in a suburb where she felt close to everyone around her. Pooja has two siblings, loving parents, and although currently successful in her work, Pooja has experienced mental illness for most of her adult life.
History or Cause:
Pooja experienced mood swings starting in her late teenage years, where she had experiences of mania and episodes of major depression. Initially, she assumed these were related to the stress of school and later the stress of work. Over time, her symptoms began to overtake her.
There were times during her manic episodes when Pooja felt untouchable; she followed impulses to spend large sums of money, work for multiple days without sleep, and act on impulses without regard for consequences. During her manic phases, Pooja felt untouchable, was working on multiple projects simultaneously, and pushed her body and mind past their limits.
Conversely, Pooja hit rock bottom. There were many episodes of depression where Pooja would feel numb, drained, and disconnected from everyone around her. She would stare at the ceiling, lying on the couch, unable to get up, not interested in anything that had once brought her joy and ruminating on what a disappointment she was risking having to bear.
Pooja was 28 years old when she sought help after a severe episode that left her decompensated, isolated, and unable to work for several weeks. Pooja had previously been diagnosed with major depression, but with the physician's recent review of the history of her mood cycles and her behaviours during manic episodes, it was possible that Pooja may have bipolar disorder. The physician noted that Pooja had not experienced any prodromal symptoms, but Pooja's perfectionistic tendencies and stressful work- and family-related situations aggravated her symptoms.
Diagnosis:
After a full psychiatric evaluation, which included interviewing family members, acquiring a full personal and family history of illness, and working retrospectively from her mood charts derived from the previous few months, Pooja was diagnosed with Bipolar I Disorder. The psychiatrist diagnosed Pooja as having Bipolar I Disorder because of her description of experiencing both manic episodes (episodes characterised by elevated energy, impulsivity, and risk-taking) and depressive episodes (episodes characterised by hopelessness, lethargy, and withdrawal).
Pooja was also diagnosed with Generalised Anxiety Disorder (GAD), adding more stress to her life and further complicating her mood states.
Treatment:
Approach:
Pooja's treatment plan was developed to address the manic and depressed phases of her disorder. Treatment focused on stabilising her mood swings in order to improve her functioning in her personal and vocational life. The treatment plan is a combination of medical treatment and psychological counselling to focus on both the biological and emotional features of her disorder.
Program:
- Psychiatric evaluation and mood tracking: Psychiatric assessment and mood monitoring: Pooja was asked to keep a daily diary of her mood and behaviours, as this would help identify patterns and triggers.
- Stabilisation phase: The first few weeks were for stabilising Pooja's mood and ensuring that she was not at risk of harming herself during depressive phases or acting impulsively during manic phases.
Medical Treatments:
- Lithium: Lithium was prescribed as a mood stabiliser to reduce the intensity of her manic/delusional attacks/relapses.
- Antidepressants: An SSRI was started very cautiously during depressive phases to see if she could use them to help manage her "down" moods, but only after assessing the risk of side effects.
- Anti-anxiety medications: Given that Pooja had been diagnosed with GAD, it was decided to prescribe her an anti-anxiety medication for short periods of use to help relieve any initial anxiety.
Therapy:
- Cognitive Behavioural Therapy (CBT): Pooja received weekly CBT to help her identify and change negative thinking patterns that were causing her to have depressive episodes. CBT also helped her identify coping skills to help her deal with stress and anxiety.
- Interpersonal and Social Rhythm Therapy (IPSRT): IPSRT is a therapy used to treat individuals with bipolar disorder that helps stabilise daily routines and maintain regular cycles of sleep, exercise, and eating. This was also beneficial for Pooja because having a stable routine and predictable schedule was helpful in managing symptoms of bipolar disorder.
- Group therapy: Pooja also participated in monthly group therapy, where she was able to talk about her lived experience with others who were experiencing similar situations. Group therapy made Pooja feel less isolated and alone, and she appreciated the sense of belonging the group provided her.
Improvements/Recovery Timeline:
- Week 1-2: Pooja entered a very intensive stabilisation period where her medical plan was modified in order to keep her safe during the most intense episodes. Her psychiatrist followed her very closely during this time.
- Week 3-4: As medications began to work, Pooja began to attend CBT and IPSRT. She started to monitor her moods more regularly and noticed a small increase in her energy level and mood stability.
- Week 5-8: Pooja had less extreme mood swings, although some clearly persisted; remaining episodes were less hypermanic and manic. She began regular exercise to help manage stress, and with her therapist, targeted some of the emotional triggers for her depressive episodes.
- Week 9-12: Pooja's core symptoms and interstitial mood began to stabilise significantly. She complained of fewer manic episodes, and her depressive episodes shrank in duration as well. At her workplace, she felt empowered to set boundaries in order not to overcommit, decreasing her stress and anxiety.
- Week 13-24: Pooja continued to make good progress with some episodes of relapses into manic or depressive states, but fewer than the previous weeks or months. Her interpersonal relationships improved as she began to speak more openly and honestly with family and friends about her condition, allowing them to support her. By this poin,t Pooja had returned to a much more regular schedule of work, having made important career advancements while not pushing herself to the limits.
Our Success:
Impact on Patient’s Life:
Pooja's quality of life underwent tremendous improvement. She was able to go back to a full-time job without the looming fear of burnout, and her relationships with her family and friends were better because they learnt how to engage and support her better. She could nonetheless feel vulnerable at times, and her greater independence around her emotions and choices has developed with therapy, medication, and self-care. With therapy and her own self-care, she found the means of maintaining her recovery and sidestepping an incident that could otherwise have set her back severely.
Family and Community:
The recovery of Pooja was also beneficial, affecting her family. As her parents became more informed about the extent of her condition, they became more involved in the treatment and began to learn how to support her. Their initial distance was no more, as the sisters came back to be with her as siblings, and this connection helped her to feel less isolated, while adding personal value to belonging. Pooja felt socially connected again, and in her own stability, she was able to help mentor others at work, being able to pass along some of her own experience to her colleagues who have also experienced mental health conditions.
Future Steps:
Pooja agreed to regular outpatient therapy appointments and many visits with the psychiatrist to monitor her medications. She participated in support groups while considering engaging in relaxing new activities such as yoga and mindfulness meditation. The health changes were vital to maintaining her recovery alongside medical treatment.
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