Bipolar Disorder: understanding the causes, diagnosis and getting the right treatment

Hello Dorothee, thank you for agreeing to talk to us. Can you tell us a little about yourself?

I’m 49 years old and I was born at Fontainebleau. My father was French and my mother is Vietnamese. Their marriage was the result of a crazy set of circumstances: my maternal uncle was in the army with my father and he offered to bring his sister from Vietnam so that she and my father could get married. She agreed to come to France, but I was born before the wedding. I learned the truth later…my father had raped my mother before the marriage. My mother carried a lot of bitterness in her because of this, and on top of her pain, there was shame. She was and still is a practising Catholic and having a child out of wedlock was a terrible sin in her eyes and I think she still prays for “forgiveness”.

I had a difficult childhood. An alcoholic military man of a father who was violent and hateful at best. A mother who was completely overwhelmed, timid and often depressed. It was an explosive cocktail that seemed to light up every night: shouting, screams, tears and fear. I know that I’m sick because I was abused as a child by a father who didn’t love me. But what saved me, for sure, was my mum’s unconditional love, whatever other faults she had, she always loved me.

When they (finally) got divorced I was already 22! I asked my mother why she had waited for so long: she told me that before that point in time, she simply didn’t have the means to leave. I understood and accepted her decision.

What are your first memories of depression?

From about the age of 6. I cried all the time in my bed. Every morning my eyes were swollen shut; my mother would wipe warm cotton pads over my eyes so they would open before she took me to school.

After that I suffered through a number of depressive episodes: at 12, 16, 18 and a very long one at 20. Then again at 30 when my younger sister died suddenly at only 19 years old and just a year after the birth of my first child…That bout of depression lasted for a particularly long time, but there were moments of happiness such as when my two other children were born. Then another bout at 40 that I’m just coming out of.

Do you know what triggers these episodes?

A violent, alcoholic and cruel father: it was forbidden to listen to music, to watch television (we didn’t get a telly until much later), to make any noise (we had to learn to open and close doors very softly!). A mother who was beaten down and terrified of her husband, as we all were. It was crazy how different life was outside of the house when I was at school or at my uncle’s! I was so happy to be alive and be joyful and laugh. Maybe that’s why my soul split in two?

Did you see any doctors when you were younger? Were you diagnosed with anything?

Only the GPs who had always treated me for chronic depression, mostly in winter, and without ever giving me any antidepressants. Actually, I refused to take them, so they usually prescribed me Diazepam which took the edge off my anxiety and allowed me to go to work. There were side effects like fatigue, but I eventually learned that fatigue was a side effect of this sickness that I never had a name for. But, I felt like there was something else inside of me other than the depression. How can I explain it? I think you need exactly the right words to correctly diagnose this type of disorder and most doctors don’t have the time to examine anything in-depth.

Until I turned 40, I was never diagnosed with anything in particular.

You saw a psychotherapist in your 20s. Did that help you at all?

My first course at uni was on psychology and sociology at the Sorbonne because I wanted to understand why I was holding onto these of feelings of terror in my heart, in my stomach, in my mind, in my soul. It just made sense for me to study psychology. But I didn’t stick with the Humanities for very long. First of all, because I didn’t like it. But most of all because I didn’t have anything to live on. My father cut me off during my second year because I had written a witness statement in favour of my mother during their divorce. He told me I wasn’t his daughter anymore and I answered right back and told him he wasn’t my father anymore either. After that, I looked for jobs and slept wherever I could.

When I was 19 I got a job at the Journal Officiel (government gazette of the French Republic, Ed.). I had a boyfriend at the time whose parents were therapists. They naturally recommended me to start therapy which I did with a brilliant therapist who I saw for 6 years. I wanted to sweep away all the bad stuff from my childhood and make a fresh start in my adult life.

And I needed the help because I was constantly breaking down in tears, for no good reason. Everything was good in my life: a wonderful boyfriend, trips around the world, a well-paying job, a nice apartment in Paris…and yet…for years I had to fight off these black thoughts. Therapy helped me stay strong and confident even if I never had a name for what I was suffering with.

How did your diagnosis finally come about? Did you have a sense that your diagnosis for chronic depression just didn’t fit?

It was in 2010, at the Centre Expert Bipolaire in Creteil, France founded by Marion Leboyer. I was 40 years old and finally, there’s a name for my sickness: Type 1 Bipolar Disorder. But I wasn’t ready to accept the diagnosis at that time. I decided to go see a psychiatrist in the suburb where I live who prescribed one Depamide per day which I took for 2 years, refusing to take anything else. Finally, I broke down and went back to see Mrs Leboyer because I knew and could finally accept that I was sick and that I needed to get treated if I was going to get any better. She referred me to a psychiatrist at a Parisian hospital who’s been treating me for the last 7 years. For two years I took a higher dose of Depamide supplemented by Escitalopram, an anti-depressant. Then we decided to try Seroquel and it worked well enough that it’s been the only thing I take for the past 5 years, 300mg by day.

What symptoms does someone suffering from bipolar disorder experience?

When you’re in a depressive state: apathy (lack of interest or motivation), procrastination (every day seems impossible to get through), isolation (no desire to see anyone), dark thoughts, inconsolable sadness, no desire to do anything, not even to eat or drink, nothing at all….When I’m feeling like that, every single action I take has to be willed by the brain. If I don't will myself to eat, well then I won’t eat. It’s like that with every little daily act.

In a manic state (which are much rarer than depressive states): exuberance, acting without thinking about the consequences. Spending money for example: once during a manic episode, I had a garden wall built that impinged on my neighbour’s property. I shouldn’t have done it, but I told myself she wouldn’t get excited over a centimetre and half. Well, that episode cost me  6 years in court and I ended up losing. I was ordered to tear the wall down and rebuild it, but I didn’t have the money to do that, so I had to move…for the 18th time in my life!

My diet and lifestyle, they’ve never been stable at any time in my life. The only thing that’s always served me well is getting enough sleep. I always make sure to get that.

What treatments do you take to control your bipolar disorder? Are they effective?

Depamide, Escitalopram for 8 years and now Seroquel for the past 5 years. It works quite well for me, except for the weight gain which I’m starting, little by little to get a hold of. Now I volunteer in an association where I conduct a gym class for people in the neighbourhood once a week.

How do you feel now?

I’m not working, I smoke a bit to pass the time and I’m bored out of my mind. An unstable love life nearly killed me and destroyed my social circle; I don’t have any friends these days. My psychiatrist has talked to me about the scars this illness leaves behind: I still don’t really understand why I don’t have any friends. On the positive side, I’ve been with someone for the past two years and we get along well. We don’t live together full time (his family lives in southern France and he’s often down there with them), but I like it like that.

I managed to buy an apartment in the centre of my town. It’s not a house, and I’ve always lived in houses, but I’m happy to have invested my money in something.

I volunteer at an association for the homeless in Paris, where I reorganised all the job descriptions for all the volunteers in France. Mission accomplished, we now have a new catalogue! I’m hoping to work with them again at the end of September during their budget audit.

I know that I’ll never be able to work again like I did for 30 years. But I need to stay busy and I’m happy to lend a hand for a few hours per week to an association that’s doing great things and I have my volunteer job at the athletic association.

What sort of advice would you offer to a patient who’s just been diagnosed with bipolar disorder?

To take their meds regularly, to live a quiet, alcohol and drug-free life and keep a healthy lifestyle.

Athletic activity has also done me good. I went to the gym for 20 years at work (between the ages of 20 and 40) and in the office athletics club that I helped manage. But I had to stop because my executive job ended up taking too much time and energy.

I’ve always wanted to write, it’s the only desire that’s always stuck with me. But I’m too much of a procrastinator, I’ve never written a single word. So, it’s great to finally be able to write about this illness and thank you Carenity for giving me the opportunity and the desire to do so!

Thank you Dorothee for sharing your moving testimonial. What about you? Do you or someone you care for live with Bipolar Disorder? What symptoms led you to get diagnosed? And how do you live with the condition on a day to day basis? Leave your response in the comments below.