Three to four per cent of the adult population suffer from bipolar disorder, also known as manic depression. Yet few truly understand its impact on the sufferers.

Seventy-one per cent of those with bipolar disorder believe that the public does not understand their illness, according to the results a global survey made public in Vienna recently during the World Congress of Biological Psychiatry.

The Thinking Ahead bipolar disorder consumer survey, announced by the World Federation for Mental Health, revealed that almost half (47 per cent) of all people feel that their disease has had a highly negative impact on their quality of life.

Further to this, more than a third (35 per cent) of respondents stated they have been discriminated against as a result of their condition, usually within the context of everyday social relationships.

"Many people who successfully treat and manage their bipolar disorder are highly functioning individuals who sustain jobs, relationships and lead full lives," said Preston Garrison, WFMH chief executive, during an event in Vienna which was attended by The Times.

"Unfortunately, however, there is a critical need to improve awareness and remove the social stigma associated with this growing condition so that others, who do not feel comfortable seeking medical support, can obtain appropriate treatment and, as a result, dramatically improve their quality of life," he said.

WFMH president Patt Franciosi spoke about the fact that mental illnesses were heavily stigmatised and discriminated against.

"People with mental illness don't get the sympathy that others with cancer or diabetes receive. This survey will provide a better understanding - mental health is a global challenge. There is no health for anyone without mental health," she said.

The WFMH partnered with AstraZeneca, one of the world's leading pharmaceutical companies, to implement this survey of 687 bipolar disorder consumers across seven countries - Canada, Germany, Greece, Italy, Spain, the UK and the US.

The survey was overseen by an independent panel of bipolar disorder physicians and advocacy group representatives and conducted by Research International, an independent marketing research firm.

The following are some of the key findings that emerged from the Thinking Ahead survey:

Consumers on treatment want better quality of life

¤ More than a third (34 per cent) of respondents feel their disease has had a highly negative impact on their family and friends.

¤ The vast majority (79 per cent) say successful treatment would lead to significant quality of life changes in terms of increased functionality/improved lifestyle, maintaining a job, having relationships, living independently and achieving goals.

¤ Some of those surveyed voiced their thoughts saying they want to: "be a productive member of society"; "go out without being afraid"; "be able to go on holiday, not be ill"; and "not be a burden to others".

Need for reduced stigma

¤ All bipolar disorder consumers questioned had been subjected to social discrimination, with over one third (35 per cent) stating they have been highly discriminated against as a result of their condition, usually by means of everyday social discrimination within their social relationships.

¤ The vast majority (71 per cent) believe that the public does not understand their illness. This ignorance may be causing the stigmatism that many feel.

¤ A total of 26 per cent never tell people they have bipolar disorder (62 per cent say sometimes and 12 per cent always share their problem). Across most surveyed, the feeling that one's condition is "personal business", coupled with the social stigma, are primary reasons for not telling others.

¤ Almost half of those surveyed (44 per cent) said that they have felt stigmatised or discriminated by their family, who didn't take them seriously.

Need for treatments that work well and limit burden of side effects

¤ People living with bipolar disorder would be more satisfied with their treatment if it were more effective and reduced side effects: for 86 per cent efficacy is a key marker of satisfaction; 77 per cent feel it is fewer/manageable side effects.

¤ A total of 56 per cent of patients currently experience side effects from their medication.

Bipolar disorder: Fast facts

¤ Bipolar disorder (also known as manic depression) is a lifelong, potentially fatal biological disorder characterised by distressing and disruptive mood swings from high (manic) to low (depressed) states.

¤ Recent studies show that bipolar disorder affects three to four per cent of the adult population. As more patients are accurately diagnosed this figure will increase.

¤ Winston Churchill, Kurt Cobain, Virginia Woolf, Sylvia Plath, Ernest Hemingway, Franz Schubert and Robert Schumann all suffered from bipolar disorder.

¤ Research has established that 25 per cent of the first episode of bipolar disorder occurs before the age of 20.

¤ It is a chronic disease and approximately 90 per cent of patients will have multiple recurrences over the longer term with an average of nine episodes per lifetime.

¤ This condition causes more human suffering compared with mania as a result of the disproportionate length and frequency of depressive symptoms, risk of suicide and general disability.

¤ It is estimated that about 25-50 per cent of patients with bipolar disorder will attempt suicide: 10-15 per cent are successful.

¤ Suicide usually occurs during the depressed or mixed phase of the disorder.

¤ Bipolar disorder is under-recognised and under-diagnosed. Only one in four are diagnosed with it and treated.

¤ On average it takes 10 years from the patient's first mood episode to receive an accurate diagnosis of bipolar disorder.

¤ Misdiagnosis of bipolar disorder leads to inappropriate treatment and further progression of illness.

¤ Bipolar disorder is the sixth leading cause of disability in the world.

¤ Its causes are elusive, and there's no cure. The flares of bipolar disorder may last for weeks or months, causing great disturbances in the lives of those affected, their friends and their families. Left untreated, the condition usually worsens. But it can be managed with medications and other therapies.

Misdiagnosis threatens quality of life

Misdiagnosis of bipolar disorder means that around 70 per cent of people suffering from this condition are not getting the help they needed to lead a good quality of life.

Richmond Foundation chief executive Doris Gauci explained that mental health problems are much more common than anyone can even begin to understand, because many cases go undiagnosed and others remain unreported.

"International studies have shown that only about 20-30 per cent of persons suffering from bipolar disorder, or other mood disorders, are correctly diagnosed and treated. This is because very often they visit their doctors only in the depressive - and not the manic - phase of the disorder," Ms Gauci explained.

Equal numbers of men and women develop bipolar disorder, while it is estimated that one adult female in every four, and one adult male in every six will suffer from depression in their lifetime.

"Generally the statistics on the prevalence of bipolar disorder tend to be the same everywhere. However, in view of the fact that in Malta no research has been carried on the prevalence of mental illness we do not know how many people suffer from bipolar disorder or any other mental illness for that matter," Ms Gauci said.

"I believe that Malta needs to start focusing on research on issues connected with mental illness because we have our own reality. It's a fact that the island's social network is very important in any type of illness. Now that this is changing we don't know how it's affecting those suffering from mental illness," she said.

If Malta could have its own studies then mental health services and non-governmental organisations would be able to provide the required community mental health services which are needed.

People with bipolar can live a regular life in society if they receive the appropriate treatment and support. The Richmond Foundation was set up to help provide support to persons experiencing mental health problems.

The foundation is putting the concept of self-help groups for people with bipolar disorder and their families at the forefront.

Ms Gauci said that such groups have proven to be helpful because they help empower patients, as well as help family and carers gain a better understanding of this condition.

At present the foundation is supporting two self-help groups - one for persons with mental health problems and the other for family members of persons experiencing mental illness. Ms Gauci hopes the number of groups will increase to target specific mental illnesses.

Fortunately the majority of those who experience bipolar disorder when receiving appropriate therapy can effectively manage the illness by significantly decreasing the symptoms associated with the condition. Early intervention can lead to better management of the illness.

Founded in 1993, the foundation is a non-governmental, non-profit making organisation. It provides services for persons already experiencing a mental health difficulty as well as services aimed at preventing mental illness from developing. About 11 per cent of its clients have been diagnosed with bipolar disorder.

The foundation runs Villa Chelsea, a rehabilitation facility offering day and residential programmes, to persons with mental health problems; a home support service; a supportive housing scheme; a supported employment programme and a staff and organisation support programme.

New hope?

Lithium has been widely used as a mood stabilizer for those suffering from bipolar disorder and is commonly prescribed. Sometimes doctors also use antidepressant medications to treat this condition. In other circumstances, anti-psychotic medications such as quetiapine (Seroquel), among others, are prescribed.

Seroquel was in the spotlight at June's World Congress on Biological Psychiatry in Vienna following the publication of new data in the Journal of Current Medical Research and Opinion.

The data confirms Seroquel's efficacy and tolerability in the treatment of bipolar mania symptoms as a simple agent.

However, while this treatment is licensed in 70 countries for the treatment of mania associated with bipolar disorder and schizophrenia, it is not currently licensed for the treatment of bipolar depression.

Hans Eriksson, AstraZeneca global brand physician, said that it was now hoped that following further clinical studies Seroquel will be licensed for the treatment of bipolar depression.

"Seroquel has been used successfully in the treatment of schizophrenia for the past 10 years. It has also proved to be effective in treating the mania side of bipolar. We are now awaiting additional results to be able to obtain regulatory approval to treat the depressive side of this condition," he told the international media.

Eduard Vieta, from the University of Barcelona and a guru in his field, said that the data that was presented on this compound at Vienna's world congress offered real hope for bipolar patients.

"We know that Seroquel can provide broad-based efficacy and trusted tolerability, which allows us to be confident that patients will comply with their treatment in the long term, thereby significantly improving the likelihood of a successful treatment outcome," he said.

A sufferer's perspective

Clare*, 49, had a very happy childhood with her family in Australia and she was settled down in her married life, content to raise her three girls.

Sixteen years ago her Maltese husband persuaded her to move the family to Malta to start a new life here.

"My depression started soon after I came here. I felt cheated because my husband painted a rosy picture of Malta and it didn't turn out that way at all. I think moving here was one of the biggest mistakes," she mused.

"I guess that's when I got my first taste of depression. At the time there were financial and marital problems, plus, since I was in my 40s, I put it down to the onset of menopause."

To heighten her concern she started suspecting that her husband was having an affair. When she confronted him, he "naturally denied it" and mistrust started creeping in together with depression.

"I'd start spending days in bed and then wake up one morning and feel as if someone switched on a light in my head and I'd be in a good mood and cook up a feast for the family. I'd go on a high for three to four months, then hit a low," she said.

Clare didn't seek medical help for a good three years and only sought advice following a friend's suggestion to check whether her mood swings boiled down to menopause - the tests proved negative, which was a surprise for Clare.

The trouble started brewing around Christmas time of 1999, after a wonderful evening with family and friends. Boxing Day dawned and with it a foul mood that kept Clare in bed.

"My husband angrily questioned if I was heading for a depression and left the room. My brain went into overdrive. I grabbed a pen, paper and a knife and drove off to the Mosta garden. I hid in the bushes and prayed fervently as I started to slit my wrists."

Clare didn't do such a good job of hiding herself because an old man who was passing by saw her and shook her to her senses. However, he didn't fully realise the extent of her actions and he soon walked off. Alone again Clare continued hacking at her wrists, as she drifted in and out of consciousness.

"After several hours in this state I dragged myself into the car and thought of driving off Dingli Cliffs, but my biggest fear was that I would kill an innocent bystander instead. So I took a detour to the Mosta clinic and was admitted at midnight," she recalled, admitting that memories of this period in her life were fuzzy.

Clare was properly diagnosed with bipolar disorder last November and the proper treatment and diagnosis has given her a new lease on life.

"I had never heard of bipolar disorder until I was finally diagnosed with it. While I remained misdiagnosed my life stood at a standstill. I'm strong now and I've just landed a new job. However, life for anyone is no bed of roses, especially for those with mental health problems," she pointed out.

Clare gets frustrated that her family sometimes don't take her seriously and often disregard her opinion, setting aside her comments with: "What do you know? You're crazy".

She insisted that family had to be involved in the client's therapy so that they would better understand the condition and know what to expect. More people had to be aware of bipolar disorder, she insisted, adding that without support "you'll hit rock bottom".

"I've got my life going on the right track now. It won't be easy, but I have a good feeling that everything will fall into place."

* Names have been changed to protect the person's identity

Helpful websites

www.mooddisorderscanada.ca
www.psych.org/public_info/bipolar.cfm
www.nimh.nih.gov/publicat/bipolar.cfm