It was just after eight in the evening at Akeso, a private psychiatric clinic in Parktown, Johannesburg. Kgotso Molefe was waiting anxiously for the results of his blood test.
The 19-year-old had spent the past three days in the institution undergoing medical examinations to determine the cause of "the voices" in his head. The voices were accompanied by "unexplained, severe mood swings, depression and recurrent suicidal thoughts", he recalls.
After what felt like hours of waiting, Molefe says he was finally diagnosed with bipolar disorder – a mental illness that, according to the South African Depression and Anxiety Group (Sadag), was previously known as manic depressive disorder because of erratic mood swings – from extreme lows or depression one moment to hyperactivity or even mania the next.
"These periods are different for different people; they can last for days, weeks, or even months," says Cassey Chambers from Sadag.
"I didn’t know what to make of that. I had never heard of bipolar disorder before," says Molefe. But he was relieved to be able to put a name to his condition. "[Before the diagnosis] I knew something was wrong with me but I was scared of telling people about the voices I kept hearing. I didn’t want them to think I was crazy."
Common symptomsThe voices Molefe refers to are part of the common symptoms of the condition. According to Sadag, other bipolar symptoms include insomnia, excessive changes in energy levels, difficulty in eating or overeating, increased talking and loss of interest in activities one normally enjoys.
"Bipolar is still highly misunderstood and stigmatised and some people still believe in common misconceptions and stereotypes that individuals with bipolar are 'crazy' [or] 'psycho'," Chambers says.
According to the organisation, although 2% of South Africans have bipolar disorder, the condition is often misdiagnosed because "many symptoms mimic emotions and other behaviours such as attention deficit disorder and hyperactivity disorder".
Sadag board member and psychiatrist Jan Chabalala adds that sometimes bipolar is mistaken for schizophrenia – a mental illness in which hallucinations are a major symptom.
"People with schizophrenia will always 'hear voices', whereas only 30% to 50% of bipolar patients will have similar experiences," he says. "The onset of schizophrenia is usually insidious, so it takes more time to manifest than bipolar."
Common disorderChabalala says bipolar is the most common mental disorder in the world and accounts for 20% of all mental illnesses. "Bipolar is becoming more prevalent in South Africa and, though many people are not aware of the illness, it is responsible for a large number of suicides in the country."
Sadag says there are 23 suicides and 230 "serious suicide attempts" recorded daily in South Africa. According to the organisation, 60% of people who commit suicide suffer from some form of depression.
Molefe himself once attempted suicide. It was three years ago and he was struggling to cope with the changes happening in his life – his mother was preparing to remarry and Molefe felt as though he was no longer a priority for her.
So one rainy day in 2010 Molefe resolved to end his life. "I was lying on my bed and my head was spinning. The voices [in my head] kept calling my name," he recalls.
He blindly stormed out of his room into his mother’s bedroom. "My mom usually keeps some medication in her room," he says. "I took all the pills I could find and drank them all in one go. I thought the overdose would end my life."
He struggles to hold back the tears triggered by the painful memory.
TreatmentAccording to Sadag, bipolar is associated with a chemical imbalance in the brain. Although there is no cure for the condition, it is treatable with the aid of medication prescribed to manage particular symptoms.
Chabalala says that the treatment targets three main symptoms of bipolar disorder. Antidepressants, mood stabilisers and antipsychotics help to "sedate or calm down unruly behaviour". He says the medicines prescribed for the condition may have side effects such as "muscle stiffness, drowsiness, loss of memory and in some cases [they might] reduce one’s sex drive".
Certain side effects such as drowsiness will disappear once the body has adapted to the medication, he says.
"Some people with bipolar seek treatment only when their condition has progressed significantly –this makes the treatment less effective. Evidence shows there are more chances of mental deterioration if there is delay in taking bipolar medication," says Chabalala.
Defaulting Because the medicine makes people on bipolar treatment feel better relatively quickly, some patients stop taking the pills as soon as they feel they are improving, says Chambers. Chabalala says that bipolar is recurrent and stopping the medication worsens the condition.
Molefe says this is what happened to his cousin, who was diagnosed with bipolar shortly after he was.
"He [my cousin] stopped taking his medication and would hear the voices 'instructing' him to leave home and wander off to faraway places. In October last year he left and never came back."
His cousin’s body was found in a morgue in January this year. Nobody knows what he died of.
Genetic predispositionBipolar can affect anybody, but Chabalala says there are certain people who are "particularly predisposed to developing the disorder"; for example, people with a family history of bipolar are at a higher risk of having the illness.
Traumatic childhood experiences can also trigger the condition, says Chabalala. Molefe believes that he was adversely affected on hearing as a child that his father had been shot dead five months before he was born.
Today he has not had a bipolar episode in more than a year.
He says he owes a debt of gratitude to his family and particularly to his grandmother, Roseline Molefe, who has been very supportive and encouraged him to take his medication.
"I take tablets every day, one in the morning and two in the evening. At first they made me eat a lot. I even gained weight, but I have adjusted."
Inspired by the help he received from mental health specialists, Molefe has changed his field of study at the University of Johannesburg –from business management to psychology, because "I really want to help people understand mental health better after my studies".
He says the medication prescribed for him has helped him to discard all suicidal thoughts. "I will never kill myself or even try again ... I have to be a role model to my young brother and sister."
Thandeka Moyo is a Bhekisisa fellow
Have something to say? Tweet or Facebook us on @Bhekisisa_MG
Social media fans suicidal fire
Desperate search for answers to schizophrenia puzzle
Go inside the international network of women willing to break the law to give people access to termination of pregnancy services.
Until now, the national and provincial health departments have not been able to say where services are provided. Here's how we found them.
As the death toll rises, we look at the people, the policies and the politicians at the centre of this national tragedy.
Bhekisisa means "to scrutinise" in Zulu
In South Africa, Zulu patients who would like to be thoroughly assessed by a doctor, would ask the physician to "bhekisisa" them.