Niall O’Keeffe is one of 45,000 Irish people living with bipolar disorder. “Bipolar disorder, or manic depression as it used to be known, can affect you in two ways,” he says. “Firstly, you can experience deep depression accompanied sometimes by suicidal ideation, then the polar opposite to that is a euphoric mood where you feel irritable, exuberant, talk rapidly and experience delusional and paranoid thinking (psychosis). This is what is referred to as mania.
I first experienced moderate depression in the early 1990s while I was at college. I lost interest in my studies, dropped out of sports and my mood was very low, but at the time I thought the word ‘depression’ was something to do with economics. There was practically no awareness about mental health issues at that time — no posters on campus or discussion in the media about the subject.
“And it is a very unfortunate fact that most people with bipolar do not notice their mood incrementally escalating as it can happen over a period of six months or so, as was the case with me. So it often is too late to stop mania spiralling out of control and even psychiatrists find it difficult to spot early warning signs of an overly ebullient mood.”
The 49-year-old, who lives in Dublin, suffered with low energy, sadness, apathy, and poor concentration. And in contrast he also went through periods of elevated mood, little sleep, overspending and “losing touch with reality”.
“I experienced depression on and off over the years after graduation and it negatively impacted my relationships, my family life and my career,” he says. “In the winter of 2008, I recognised my mood had gone very low and I wasn’t even able to type an email at work or take a call. So I checked myself voluntarily into the local psychiatric hospital in Toronto (where he was living at the time) and was back to a stable mood within five months.
“But I also had two manic episodes, one in 2013 and one in 2019. On both occasions, I did not think my behaviour was unusual as I felt great but was very hostile to those close to me who were alarmed at my mood change. In 2013, I had experienced four deaths in the family including my sister, job losses, bankruptcy and my father was diagnosed with Alzheimer’s.
“However, rather than being laid low by these, I went in the opposite direction. I was ebullient, set up my own IT consultancy company and developed a prototype for online counselling for those who are experiencing mental health issues. I wasn’t sleeping much and by the end of November I was spinning out of control and shutting down anyone who was expressing concern.”
The father-of-two says he was “furious” when his psychiatrist prescribed medication to treat the mania as he believed there was nothing wrong with him and actually thought the medic was “incompetent”. But after being “tricked” by a friend (along with his GP), he agreed to go to hospital to have his medication reviewed and it was there that he began the treatment which put him on the path to recovery.
“I will be grateful to my friend for the rest of my life, but at the time, he was enemy number one when I found out that I was being detained as an ‘involuntary’ patient under the Mental Health Act,” he says. “I had no idea when I was going to be discharged, but after a few weeks of protesting my detainment, I came around to taking medications. The mania gradually wore off and I participated in therapy programmes such as wellness recovery action plan, cognitive behavioural therapy and dialectical behavioural therapy.
“After being discharged in the spring I was shocked at how low my mood had gone as the euphoria was replaced by depression and suicidal ideation — it was so bad that it was an effort to get out for even a short walk. But by the late summer, I was stable and had started job hunting.”
Despite following medical advice “to the letter”, he suffered another manic episode in December 2019 and was detained again for several weeks. “Initially I refused to accept that I was sick, but I gradually got better through medication and therapy and was discharged on February 28, 2020,” Niall says.
“The nurses, social workers and psychiatrists were extraordinarily compassionate and I still marvel at the crucial role they play in getting patients back on their feet. But as sure as night follows day, I had intense depression and suicidal ideation again for a few months after being discharged.
“But suicidal thoughts are very different to actually planning a suicide. They are disturbing to have but you can see them for what they are and it’s important to use the services available such as Aware and Pieta House, who provide free counselling from volunteers. But I know that it is also important to check in with the GP, psychiatrist or, better still, a psychotherapist.”
The IT expert says his condition also affected his friends and family, but he is thankfully now in a much better place. “My texts and emails to loved ones caused a lot of hurt even though the recipients knew I was not well,” he says. “But my family don’t judge me, they are very supportive and are educating themselves more and more about my medical condition.
“Physical and mental well-being go hand in hand and a lot of work still needs to be done to remove stigma surrounding bipolar, schizophrenia, anxiety disorder and depression. It is not a sign of weakness or lack of willpower if you feel depressed or anxious. And it is exhausting for those with mental health diagnoses to continually be upbeat and positive when they feel complete the opposite inside. We take psychiatric medication for conditions such as bipolar to impact our central nervous system, so why not call it what it is — a disease.
“These days, I am feeling very content with my life and in control of my diagnosis. I have finally understood the link between shame and low self-esteem and thankfully have conquered those with hard work and the help of my psychotherapist.”
Having been through years of mental trauma and treatment, Niall says it is vital for people to be aware of the signs of bipolar disorder and to seek help if any concerns. “It is important for those with bipolar disorder to understand that it is possible to have a mostly stable happy life with the diagnosis,” he says. “I reflect on the past 30 years and would say I was stable for 27 years, so that is 90pc of the time.
“Bipolar disorder is inconvenient, to put it mildly and there is no cure. But it is possible to have a mostly happy, stable life providing you keep yourself informed and follow the advice from the mental health professionals you interact with. As a society, we are far more informed now about mental health matters than we were 30 years ago, but we still have some way to go before we are all on the same page.
“So take all the medications you are prescribed, find a psychotherapist, and check in regularly with them, drink little or no alcohol and keep a journal to document any shifts in mood. It is very possible to have a successful career with a diagnosis of bipolar disorder. I know dentists, psychologists and business people who have done very well in managing their condition. However, a lot of effort is required to minimise stress in your career and taking plenty of downtime is highly recommended though not all can afford financially to do so.
“Also, call hotlines such as Aware whenever needed as they are much better than family or friends who don’t often know what to say. Why expect them to give expert counsel when we would not expect a fisherman to paint a house?”
For more information, check out aware.ie and pieta.ie
What you need to know about bipolar disorder
⬤ The condition is characterised by periods of low (depressed) and high (elated) mood separated by periods of normal mood.
⬤ A mood episode can also include both mania and depression which is called a mixed state.
⬤ Bipolar disorder often develops early in life; however diagnosis is challenging as it rests on symptoms, the course of illness, third party information and family history.
⬤ While symptoms can be severe, it is possible to live a healthy and productive life once the illness is effectively treated.
⬤ Correct diagnosis of both bipolar disorder and the type of bipolar disorder a person is experiencing is essential for successful treatment.
⬤ If someone thinks they may be experiencing bipolar disorder, the first step is to speak to a GP or mental health professional to ensure a correct diagnosis and decide on an appropriate treatment plan.