"People with bipolar, they experience that in a much more intense and extreme way," said Celine Bart, public educator, the Canadian Mental Health Association, Toronto branch.
People with bipolar have various cycles of mood changes (depression and mania) over various periods of times that change depending on the person. According to Treatment of Bipolar Disorder: A Guide for Patients and Families by doctors David A. Kahn, Ruth Ross, David J. Printz and Gary S. Sachs, there are four types of episodes:
• Mania
• Depression
• Hypomania (a milder form of mania but which often is followed by escalated mania or depression)
"If I can bottle hypomania, I would be rich," said Karen Liberman, executive director of the Mood Disorders Association of Ontario in midtown Toronto who explains someone in a hypomania episode is a multi-tasker who is constantly on the go. The hypomania episode doesn't last, though, and sufferers crash into a depression that can last from two weeks up to six months.
• Mixed episode, where people have mixed symptoms of mania and depression at the same time throughout a day
Each person is different but some "people can cycle rapidly between highs and lows, sometimes two to three times (episodes) a week," Liberman said.
According to Treatment of Bipolar Disorder, some people have an equal amount of episodes of mania and depression, others seem to have seasonal episodes while still others have one type of episode more than others.
The episodes themselves can last days, months or years, with the average mania episode lasting a few months, while the depression stage lasts about six.
Eric Jonasson's bipolar disorder started in his mid-30s, although he said he was always moody with ups and downs throughout his life. He also had psychotic episodes.
"With me, because of the psychotic (episodes), it made it that you couldn't function quite quickly, not making sort of normal decisions ... or (not) seeing things the way they should be."
Jonasson, who has an uncle with the same illness, said he was put on various medications and was hospitalized while doctors tried to find the right combination of drugs to make him stable and bring balance back to his life.
"You have a really hard time sleeping, your mind is racing, you are always given some kind of tranquilizer to slow things down. ... You have to be relatively calmed down before (the drugs) work."
His hospital stays ranged from two to four weeks. It was the fear of going in and out of the hospital that helped him stick to his medication.
But not every one stays on their medication and there are various reasons for that, Liberman said.
"Finding the right medication is not always easy, it's trial and error," Liberman noted.
Jonasson agreed.
There were "terrible side effects," with drooling and a feeling of sedation. "It felt like you are mentally ill," he said.
Liberman said sometimes medication makes sufferers feel worse. Weight gain and nausea are common side effects until the right combination of medications can be found.
Other reasons people go off their medication is because the drugs are working and they think they have the mental illness beat.
"It just doesn't work that way," she said.
According to the Treatment of Bipolar Disorders, people may also miss the feelings they have when they are in periods of mania or hypomania.
Liberman agreed.
The manic feeling, she said, is "very seductive, very addictive."
However, eventually there will be a relapse.
Liberman sees people who have bipolar disorder requiring constant medication, psychotherapy and a continual source of support for the rest of their lives.
And that support must not only be from their friends and family, but also in the workplace, said CAMH's Bart.
By law, the workplace must accommodate people with mental illnesses.
And if an employer notices a change in an employee's behaviour, it must take the initiative to ask if everything is OK and get the employee the help he or she needs, Bart said.
Jonasson said in his experience, some workplaces are supportive while others are not.
Regardless, people who have bipolar disorder must speak out.
Bart said despite the fact that one in five Canadians will have some type of mental illness in their lifetimes, two-thirds of people don't seek help because they are afraid of the response they may get. Bart calls mental illness a hidden disability.
"Often, mental illness is something people don't talk about," she said.
Liberman agreed.
"We need to recognize symptoms early and treat people early, not just depression but mania because people get in a lot of trouble."