Q: My son has been diagnosed with bipolar disorder and is under treatment. He feels lack of sleep, thinks he has the power to stop a running train, is overactive and energetic and talkative. After 15 days of starting the treatment he became quiet, found difficulty in sleeping, was feeling very low and scared. Presently he takes Mirtaz 15, Oleanze 5 and Lithium 400 mg. This is the 13th week and is feeling better now. How can it be said with surety that he is bipolar and not some other milder disease like anxiety disorder? Is lithium fine? How long will he require treatment? Can he lead a normal life? Can he take up a job and marry? Sometimes he becomes very sluggish and lazy. He has also put on weight of 5 kg in the last 2 months. He doesn’t pay attention to his studies. Watches excessive TV, remains irritated, doesn’t remember things. Is it because of this disease ?

A:Bipolar disorder-is an illness characterised by extreme mood swings. The mood can swing from extreme of sadness and depression to feeling high and elated and irritable. The mood swings tend to recur can be of varying duration and severity ranging from mild to severe. The manic episodes can present as an individual feeling very happy, elated, or irritable continuously for longer periods of time, with increased activity levels and energy, reduced need for sleep, rapid thinking and speech, recklessness, grandiose plans and beliefs, feelings of invincibility . Mania is diagnosed when symptoms are present for a week or more, while hypomania can be of shorter duration and lesser severity. The mood can swing to normal from mania or switch to depression - feeling low all the time, reduced sleep, decreased interest, decreased energy levels, decreased appetite, decreased activity or interaction with others. Mental illness, specially in the very first episodes when the course and symptomatology is not very clearly known, can be dynamic and can evolve over time to be completely sure as to what the life time presentation is evolving into. The presentation of symptoms can be affected by drug and alcohol use too. Treatment for bipolar disorder, and any other mental disorder is directed at making the individual as functional and productive to the society as possible. Therefore the treatment has a multi pronged approach of medications, psychological treatment and assistance with psychosocial needs, which goes under the name of bio psychosocial approach. This is the time when your son would require more support and assistance both mentally and other wise. It is suggested that he should be able to meet a Psychiatrist preferably working in a medical college hospital, for further treatment approaches, follow up as well as discussion regarding key areas.