Prof. Wulf Rössler, MD; MSc.
Seventy-two-year-old Wulf Rössler studied medicine and psychology in Heidelberg. For many years he was Director and Head of the Psychiatric University Hospital in Zurich and Professor at the University of Zurich. Now he is a Senior Professor at the Charité in Berlin, teaches at the University of São Paulo in Brazil and is Chief Medical Officer at the Kusnacht Practice near Zurich.
Bipolar disease is a mental health disorder characterised by severe mood swings with phenomenal highs and crushing lows. In 2014, 3.4% of young adults in the UK aged 16-24 screened positive for bipolar disorder. This disorder is well documented and studied but left untreated it can wreak havoc on the life of an individual, as well as their immediate friends and family.
We sat down with Prof. Wulf Rössler, MD; MSc, Executive Medical Director at The Kusnacht Practice, and spoke to him about bipolar disorder. Below, he shared his expertise and experience that comes from nearly 50 years of treating bipolar disorder.
Studies show that it takes an average of 9 years to get a correct bipolar diagnosis. What makes BPD so difficult to diagnose?
Wulf Rössler: About three per cent of the population suffer from bipolar disorders. Bipolar disorders are highly recurrent and chronic psychiatric conditions that shorten life expectancy, cause functional impairment and disruption to social, work and family life.
There are several forms of bipolar disorder, mainly bipolar I and bipolar II disorder. Bipolar I is characterised by recurrent episodes of depression and mania, whereas Bipolar II disorder is characterised by recurrent depression and hypomania, a milder form of mania.
Individuals having manic symptoms are more likely to abuse alcohol, cannabis or benzodiazepines. In particular, persons with manic symptoms rarely seek help, and when they do seek help, their substance use disorders are mostly in the foreground. Affected persons who face delayed diagnosis, a wrong diagnosis or are unwilling to seek help are the main reasons for the significant treatment gap.
How does someone know if they have BPD and what can they do to get help? What are the first signs of bipolar disorder?
WR: Psychiatric diagnoses do not constitute natural illness entities. They are categories without natural boundaries. Because most human behaviour is located along a continuum, no clear cut-off point exists to separate good health from illness. As such, it’s challenging to define a point where the need for treatment exactly starts. Thus, most of the symptoms which characterise bipolar disorders, are known to all of us. Sometimes we feel low and are quite inactive, sometimes we feel high and are full of energy and active. What then constitutes a bipolar (or any other mental disorder), is the severity, degree of distress and duration of the symptoms and if these symptoms and how these symptoms affect the ability to work, and function in family or partnership.
What are the main symptoms of bipolar disorder?
WR: The poles of bipolar disorder are, on one hand, mania, and on the other hand, depression. Sometimes we find mixed states of both. The affected person repeatedly changes between these states.
We diagnose mania if the mood is unusually elevated or even irritable for at least a week, and at least three of the following characteristics are present: increased activity, restlessness, urge to speak, a flight of ideas, loss of social inhibitions, reduced need for sleep, overestimated self-esteem, distractibility, reckless behaviour, increased libido.
Hypomania does not meet the criteria of full-blown mania and can be described as its attenuated form. We speak of hypomania, if the mood is elevated or irritable for four consecutive days, and at least three of the following symptoms are present: increased activity, unrest, difficulties to concentrate, distractibility, reduced need for sleep, increase of libido, careless or irresponsible behaviour, increased sociability. The personal lifestyle is usually not affected.
And finally, we speak of depression if, over a period of two weeks, the following main symptoms are present: depressive mood, loss of interest and joy, lack of drive and additional symptoms like loss of self-esteem, self-reproaches, feelings of guilt, thoughts of death and suicide, suicidal behaviour, reduced ability to think and concentrate, psychomotor agitation or inhibition, insomnia, increased or decreased appetite.
Do we know what causes bipolar disorder?
WR: Actually, as with all mental disorders, we follow the stress vulnerability model here. On the one hand, many people have a specific vulnerability to mental disorders. However, there is not one particular gene responsible for this, but many different genes contribute to this vulnerability, which is also expressed in certain personality traits. On the other hand, environmental factors, such as occupational stress or severe stress in the family or partnership or stressful events such as death or job loss, can trigger a bipolar disorder under these circumstances.
Who is most at risk of bipolar disorder?
WR: As mentioned above, there are various factors which, when combined, can promote the onset of the disease. Vulnerable people, who are under severe environmental stress, are most at risk and vice versa.
How does BPD affect daily life? Is it possible to lead a healthy life with BDP?
WR: Again, this depends on the severity of the disorder. Even if it is a recurrent disorder with phases of recovery in between, the affected person’s behaviour during an episode, either depression or mania, can harm their daily life, but also can have consequences for their future life. The spectrum of potential consequences ranges from suicide when depressive to gambling away one’s wealth or displaying other risk behaviours like uncontrolled sexual behaviour when manic. A bipolar disorder regularly is also a heavy burden on a partnership, which often ends in separation.
What are some coping strategies for people with BPD? How can they self-help?
WR: It is of utmost importance to build a sustainable relationship with an affected person and the assisting professionals. Should the individual deteriorate during recovery, all necessities must be prepared for. With more severe cases, insight into the patient’s own disorder is crucial. He or she can also contribute favourably by leading a healthy and regular lifestyle and also not using any substances.
What are the medication and treatment possibilities for people suffering from BPD? How does The Kusnacht Practice use their resources to organise treatment for clients with bipolar disorder?
WR: The Kusnacht Practice is following the international guidelines in the treatment of bipolar disorders. There are various effective medications and treatment strategies, mostly combined. Lithium, a salt, is one of the best researched psychiatric medications. It is used as prophylaxis and significantly reduces the suicide risk and the risk of relapse. There are other so-called mood stabilisers, mostly antiepileptics. There is a professional discussion about the use of antidepressants, as some experts assume that this medication could possibly provoke manic episodes.
Medication is combined with different psychotherapeutic approaches depending on the particular mental problems and the preferences of our patients. We also highly value psycho-education by providing information about the various disorders, risk factors and what the patient can contribute to a healthy life if possible without relapses. Furthermore, we also try to balance the brain’s metabolism with micronutrients and trace elements to increase vitality and wellbeing. Part of our healthy life strategies are also balanced diets and exercising.
Finally, we use cutting edge technologies in the treatment, as various kinds of brain stimulation and neurofeedback and biofeedback, enabling our patients to handle stressful situations more healthily and effectively. When the treatment with us is finished, we also offer continuous ongoing aftercare to all our patients. All this together creates the special and unique approach of The Kusnacht Practice.
What are the steps in BPD treatment? What does this process look like at The Kusnacht Practice?
WR: The order of all the treatment elements and the strategies described depend mainly on the stage the patient is at. If the patient arrives at The Kusnacht Practice in an acute phase, naturally, medication has priority. In other stages, medication gets adapted, but psychotherapeutic approaches and brain stimulation, as well as balancing brain metabolism, is in the foreground. If a patient has serious substance use problems, we also focus on the root of these problems. Thus, each treatment gets individualised when the patient arrives at the clinic.
Severe, long-lasting mood swings are devastating not only to the sufferer but for the family also. Are there successful strategies for families with a member who has BPD?
WR: As mentioned before, bipolar disorders put a heavy burden on families and partners. It is not uncommon for a family to break up over this challenge. Thus, involving the families, the partners and their children must be a central element of a comprehensive treatment of persons with a bipolar disorder. The onset of mental and physical health problems are common among relatives and caregivers. Thus, being close to the relatives as well as the affected persons themselves is a central and effective treatment approach for the benefit of all.
The social perception and understanding of the disease are now changing due to celebrities speaking out about the issue. What advocacy do people with BPD need?
WR: The stigma of mental disorders is still prevalent, though not as dramatic as it used to be. While some decades ago the mentally ill disappeared for the rest of their lives behind the wall of mental hospitals, today many of them live among us – although most of them silent, not disclosing their mental problems.
The stigma of mental illness is not the same for all mental disorders. Most stigmatised are persons with a schizophrenic disorder, because it is assumed that they are dangerous and unpredictable. Indeed, with bipolar disorders, there is a process of de-stigmatisation as quite a few celebrities have indicated that they suffer from this disorder.
The process of de-stigmatisation is ongoing. The best argument is that about 50% of the population suffers from a mental disorder during their lifetime. This means that practically everybody knows a person or even has a member of their family with a mental disorder. We need to break down this wall of silence to make clear that mental problems are at the centre of our society and not something that only affects a few outcasts.
Thank you very much for sharing your expertise and your time with us today.
WR: Thank you very much.
If you or someone you know is showing symptoms of bipolar disorder, or has been struggling with it for a while, please reach out for professional support. The medical professionals at The Kusnacht Practice are experienced in dealing with a wide range of mental health disorders, including bipolar and many other disorders. To get help, visit our contact page or email us at