N

ita, 48, is a housewife. Mother of a teenage girl, she runs a small women’s clothes shop. She is a normal woman but one who takes regular medication.

Living with bipolar disorder, Nita has taken medication every day for the last 23 years.

“By regularly taking antidepressants, I can keep my mood under control and it helps me live an easier life,” Nita told The Jakarta Post recently. She routinely consults a psychiatrist to check if her condition is still being well managed.

Every month, Nita spends about Rp 1 million (US$105) on medicines and counseling. If she skips even just one day, the most trivial things can put her into the worst of moods.

“I can feel sad and cry for the whole day for no reason,” said Nita.

Bipolar disorder is a diagnosis of abnormally high energy levels (mania) interspersed by depressive episodes.

“When I was in a manic phase, I often got into financial trouble because I could not stop shopping,” said Nita, who graduated from Bung Hatta University’s School of Teaching and Education Science in Padang, West Sumatra.

Patients with bipolar disorder need accurate and comprehensive treatment as the condition is progressive: the more episodes a patient endures, the more likely they will get worse.

The prevalence of bipolar disorder in Indonesia now stands at up to 8 percent. Most people with bipolar disorder get no early diagnosis or immediate treatment. The delay results in more serious symptoms.

Margarita Maria Maramis, a psychiatrist from Airlangga University’s School of Medicine and Dr. Soetomo Hospital in Surabaya, East Java, said people with chronic bipolar disorder had accentuated symptoms, such as deeper depressions than before and increasingly frequent mood swings.

“Chronicity will cause increases in suicide rates and co-morbidities, particularly drug use, unsafe sex practices and uncontrolled sexual desire,” she said.

Patients with chronic disorders are also less responsive to therapy.

Margarita said proper medication depends on the stage of the illness. “Medication for patients should focus on preventing or reducing the severity of episodes in the long term.

“Drug choices depend on visible symptoms, such as agitation, depression, and sleep disorders,” she said.

Bipolar patients do not require only pharmacological help. They also need non-pharmacological intervention, such as family support. They need support to both increase their life hopes and levels of optimism, and to encourage them to be more disciplined in adhering to their medication regimes.

Bipolar disorder leaves not only the patients, but also their families, with expensive health care needs. Medication costs for a patient with bipolar disorder averages around Rp 2 million per month.

“They also face heavier financial burdens due to lost economic opportunities,” said Nurmiati Amir, a psychiatrist from the Cipto Mangunkusumo General Hospital (RSCM).