Bipolar disorder: When you're on top of the world - and the only way is down - The Telegraph

In February 2009, multi-millionaire businessman Paul Downes asked a film-maker to fly out to Jamaica to make a record of his search to find a wife. Paul, who has never married, had decided he wanted to settle down and have a family, so he had fliers distributed in the Ukraine where the women embodied all the attributes he was looking for in a life partner. He then arranged for a shortlist of 12 women to fly out and spend two weeks with him in the exclusive villa he had rented.

Events did not go according to plan: unsurprisingly, choosing a wife was hampered (largely) by language problems, and the scheme ultimately cost Paul around $250,000. This bizarre story forms the centrepiece of a TV documentary to be shown next week, which looks at what is dubbed the '21st-century" disease – bipolar disorder. It is characterised by extreme mood swings, and during his exploits in Jamaica Paul was in the grip of a manic episode.

Like many other sufferers, during the manic phase of his condition he enjoys extended periods of creative energy. He also experiences "grandiose delusions" where he believes that he has power over others, as well as connections with powerful world leaders.

"During my last manic episode, I hired a private investigator to travel around the country in a chauffeur-driven Rolls-Royce delivering videotaped messages I'd made to people such as Stephen Hawking and Prince Charles," says Paul, 50, who lives in Stratford-upon-Avon with his mother.

Bipolar disorder is frequently in the news, with celebrities such as Carrie Fisher, Stephen Fry, Ruby Wax and Tim Burton talking publicly about their struggle with it. In its most severe form (bipolar 1), bipolar disorder, which used to be known as manic depression, affects one per cent of the adult population. The less severe form (bipolar 2) affects another two or three per cent. One of the big problems medical experts face is diagnosing the condition.

"We don't know where the boundaries lie," admits John Geddes, Professor of Epidemiological Psychiatry at the University of Oxford, who has conducted extensive research into bipolar disorder.

"We all have variations in mood. In its least severe form, bipolar disorder might be seen as just part of someone's character – they might be seen as excitable or moody. But when the mood swings become disabling and interfere with the person's ability to lead a normal life, it becomes a problem.

"At one end of the scale is mania which can involve disinhibition, overindulgence in pleasurable activities, excessive spending, exaggerated sex drive, a lack of need for sleep and sometimes grandiose delusions, when people think they have special powers."

The manic phase can last weeks, or even months, and is often followed by an incapacitating low, with suicidal feelings.

Although some scientists believe that there is a chemical imbalance in the brains of people with bipolar disorder and in the levels of neurotransmitters, such as dopamine, there is still a great deal that is not understood.

"Long term, people are more troubled by the depression than the mania," says Prof Geddes. Nevertheless, some people are willing to put up with the lows in order to experience the highs, he adds. "They value the feeling of creativity when they're manic. But it's not sustainable because of the detrimental effect on normal life."

Usually, bipolar disorder first manifests itself in the late teens or early adulthood, although often sufferers won't be diagnosed until they are in their twenties or thirties because symptoms are often mistaken for other conditions, such as depression.

According to Nick Craddock, Professor of Psychiatry at Cardiff University and Scientific Adviser to MDF, the Bipolar Organisation, pinpointing an exact cause is tricky. "We know from research that people have an inherited susceptibility to developing bipolar disorder, but life events can also bring it on."

Different stages require different medication because of the cyclical nature of the condition. The manic phase (or hypomanic, which is the milder version), is treated with antipsychotic medication, while mood stabilisers, such as lithium, can help prevent both upswings and downswings. In addition, lifestyle management, such as ensuring a good sleep pattern and avoiding excessive alcohol intake, can help.

Drug treatment for bipolar disorder is ongoing – a way of managing the condition, rather than a cure. "Generally people want to avoid the highs because they cause distress to them and to their families," says Prof Craddock. "People act in ways that are completely out of character –spending their life savings, getting in trouble with the police, losing their driving licences – then when they come back down again, they find they are in a real mess."

It's a scenario that Paul Downes knows only too well. Over the

past six years, he has been hospitalised eight times and has spent around £1 million while in the grip of his manias.

"I've checked into a hotel and given all the staff £1,000 each. I've given out £5,000 tips and hired fleets of chauffeur-driven Rolls-Royces. When I'm on a high, I feel I can do anything, The sky's the limit."

Paul experienced his first manic episode at the age of 44, after a life that, until that point, had been characterised by success. "I was an amateur golf champion, I'd set up more than 100 companies and completed hundreds of major business deals. I was a millionaire well before I was 30. Up until I was 44, if you'd have told me I could possibly have a mental illness, I'd have said you were the crazy one."

Yet, in 2004, while on holiday in Jamaica, he began acting out of character. "I'd taken over an hotel, flying friends in to stay, and was existing on no more than an hour's sleep a day. One night, I broke down the door to a room, asked the perfect stranger inside to marry me, then jumped off a nearby cliff into the sea, even though I couldn't swim."

Paul was committed to a psychiatric hospital where he endured a crippling depression following the manic episode. Thus began the cycle of extreme highs and lows which, despite ongoing treatment with medication, have dominated his life ever since.

He worries, in particular, about his overspending: "I've tried to put safeguards in place to protect my money from myself." But he insists that, despite the impact on his personal and professional life, he has no regrets. "I am what I am. If I could cure it, I would, because it holds me back from leading a normal life. But it's an experience like no other. At the time I feel fantastic, immortal. I am the Creator. Who wouldn't want to be God?"

'True Stories: A Bipolar Expedition', Tuesday May 25 at 10pm, More4

www.bdrn.org, the Bipolar Disorder Research Network, is currently looking for research volunteers who have experienced one or more episodes of high mood at any point in their lives.

www.mdf.org.uk (the Bipolar Organisation)

www.bipolar-foundation.org

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