On being bipolar: “Having the motivation to change the world one moment, then not having the motivation to even wash yourself.”
Bipolar disorder is a lifelong mood disorder and was formerly know as Manic Depression or Bipolar Affective Disorder. It is a mental disorder which causes a person to experience extreme and abnormal mood swings that stick around for prolonged periods, cause severe psychological distress, and interfere with normal functioning. Episodes of mood swings may occur rarely or multiple times a year. The average age when people with bipolar disorder begin to show symptoms is 25 years old.
Bipolar moods swing between ‘up’ states and ‘down’ states according to mentalhelp.net.
Bipolar ‘up’ states are called Mania, while bipolar ‘down‘ states are called Depression.
The manic phase
Mania is characterized by a euphoric (joyful, energetic) mood, hyper-activity, a positive, expansive outlook on life, an inflated sense of self-esteem or grandiosity (a hyper-inflated sense of self-esteem), and a sense that most anything is possible. When in a manic state, bipolar people tend to demonstrate a decreased need for sleep, racing thoughts, rapid speech (wherein the words won’t come out fast enough to keep up with their racing thoughts) and heightened distractibility. Manic individuals typically show poor judgment and impulsivity, and are prone to engaging in risky or dangerous behaviors and activities.
The Depressive phase
Depression is, more or less, the opposite mood state from mania. Depression is characterized by feelings of lethargy and lack of energy, a negative outlook on life, low or non-existent self-esteem and self-worth, and a sense that nothing is possible. Depressed individuals tend to lose interest in things that used to give them pleasure and enjoyment (such as sex, food or the company of other people). They may sleep too much or too little. Regardless of how much sleep they actually get, they tend to complain about feeling constantly tired and fatigued. Their mood tends to be dysphoric (e.g., distressed, negative, unhappy), although they may experience dysphoria in different ways. Traditional depressed mood (e.g., sadness, melancholy), irritability, short temper, and even agitation are common mood states reported by depressed people with bipolar illness. Additionally, anger, guilt, failure and hopeless feelings may be present. Such negative feeling states help depressed people lose confidence in their abilities, become pessimistic about their futures, and (sometimes) conclude that life is no longer worth living.
“Bipolar is like being in a roller coaster ride. Sometimes you can predict drop offs and others you just have to hang on because the next turn sends you into an unexpected spiral.
Although bipolar disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan. In most cases, bipolar disorder is treated with medications and psychological counseling (psychotherapy)
There are several types of bipolar disorder. Each type is identified by the pattern of episodes of mania and depression. The treatment that is best for you may differ depending on the type of bipolar disorder you have. Your doctor will look carefully to determine where your symptoms fit.
Bipolar I Disorder (mania and depression)
– Bipolar I disorder is the classic form of the illness, as well as the most severe type of bipolar disorder. It is characterized by at least one manic episode or mixed episode. The vast majority of people with bipolar I disorder have also experienced at least one episode of major depression, although this isn’t required for diagnosis.
Bipolar II Disorder (hypomania and depression)
– Mania is not involved in bipolar II disorder. Instead, the illness involves recurring episodes of major depression and hypomania, a milder form of mania. In order to be diagnosed with bipolar II disorder, you must have experienced at least one hypomanic episode and one major depressive episode in your lifetime. If you ever have a manic episode, your diagnosis will be changed to bipolar I disorder.
Cyclothymia (hypomania and mild depression)
– Cyclothymia is a milder form of bipolar disorder. Like bipolar disorder, cyclothymia consists of cyclical mood swings. However, the highs and lows are not severe enough to qualify as either mania or major depression. To be diagnosed with cyclothymia, you must experience numerous periods of hypomania and mild depression over at least a two-year time span. Because people with cyclothymia are at an increased risk of developing full-blown bipolar disorder, it is a condition that should be monitored and treated.
Medical conditions and medications that can mimic the symptoms of bipolar disorder include:
- Thyroid disorders
- Neurological disorders
- Vitamin B12 deficiency
- Drugs for Parkinson’s disease
- Anti-anxiety drugs
- Adrenal disorders (e.g. Addison’s disease, Cushing’s syndrome)
Bipolar disorder is commonly misdiagnosed as depression since most people with bipolar disorder seek help when they’re in the depressive stage of the illness. When they’re in the manic stage, they don’t recognize the problem. What’s more, most people with bipolar disorder are depressed a much greater percentage of the time than they are manic or hypomanic.
Being misdiagnosed with depression is a potentially dangerous problem because the treatment for bipolar depression is different than for regular depression. In fact, antidepressants can actually make bipolar disorder worse. So it’s important to see a mood disorder specialist who can help you figure out what’s really going on.
Indicators that your depression is really bipolar disorder
- You’ve experienced repeated episodes of major depression
- You had your first episode of major depression before age 25
- You have a first-degree relative with bipolar disorder
- When you’re not depressed, your mood and energy levels are higher than most people’s
- When you’re depressed, you oversleep and overeat
- Your episodes of major depression are short (less than 3 months)
- You’ve lost contact with reality while depressed
- You’ve had postpartum depression before
- You’ve developed mania or hypomania while taking an antidepressant
- Your antidepressant stopped working after several months
A comprehensive treatment plan:
Medication – Medication is the cornerstone of bipolar disorder treatment. Taking a mood stabilizing medication can help minimize the highs and lows of bipolar disorder and keep symptoms under control. Several medicines are available to help stabilise mood swings.
These are commonly called mood stabilisers and include:
- anticonvulsant medicines
- antipsychotic medicines
- Lithium is a long-term treatment for episodes of mania and depression. It’s usually prescribed for at least 6 months.
- If you’re prescribed lithium, stick to the prescribed dose and do not stop taking it suddenly unless told to by your doctor.
- For lithium to be effective, the dosage must be correct. If it’s incorrect, you may get side effects such as diarrhoea and vomiting.
- Tell your doctor immediately if you have side effects while taking lithium.
- You’ll need regular blood tests at least every 3 months while taking lithium. This is to make sure your lithium levels are not too high or too low.
- Your kidney and thyroid function will also need to be checked every 2 to 3 months if the dose of lithium is being adjusted, and every 12 months in all other cases.
- While you’re taking lithium, avoid using non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, unless they’re prescribed by your GP.
Anticonvulsant medicines include:
These medicines are sometimes used to treat episodes of mania. They’re also long-term mood stabilisers.
Anticonvulsant medicines are often used to treat epilepsy, but they’re also effective in treating bipolar disorder.
A single anticonvulsant medicine may be used, or they may be used in combination with lithium when bipolar disorder does not respond to lithium on its own.
Valproate is not usually prescribed for women of childbearing age because there’s a risk of physical defects in babies, such as spina bifida, heart abnormalities and cleft lip.
There may also be an increased risk of developmental problems, such as lower intellectual abilities, poor speaking and understanding, memory problems, autistic spectrum disorders, and delayed walking and talking.
- Carbamazepine is usually only prescribed on the advice of an expert in bipolar disorder. To begin with, the dose will be low and then gradually increased.
- Your progress will be carefully monitored if you’re taking other medication, including the contraceptive pill.
- Blood tests to check your liver and kidney function will be carried out when you start taking carbamazepine and again after 6 months.
- You’ll also need to have a blood count at the start and after 6 months, and you may also have your weight and height monitored.
- If you’re prescribed lamotrigine, you’ll usually be started on a low dose, which will be increased gradually.
- See your GP immediately if you’re taking lamotrigine and develop a rash. You’ll need to have an annual health check, but other tests are not usually needed.
- Women who are taking the contraceptive pill should talk to their GP about switching to a different method of contraception.
Antipsychotic medicines are sometimes prescribed to treat episodes of mania.
- They may also be used as a long-term mood stabiliser. Quetiapine may also be used for long-term bipolar depression.
- Antipsychotic medicines can be particularly useful if symptoms are severe or behaviour is disturbed.
- As antipsychotics can cause side effects, such as blurred vision, a dry mouth, constipation and weight gain, the initial dose will usually be low.
- If you’re prescribed an antipsychotic medicine, you’ll need to have regular health checks at least every 3 months, but possibly more often, particularly if you have diabetes.If your symptoms do not improve, you may be offered lithium and valproate as well.
Psychotherapy – Therapy is essential for dealing with bipolar disorder and the problems it has caused in your life. Working with a therapist, you can learn how to cope with difficult or uncomfortable feelings, repair your relationships, manage stress, and regulate your mood.
Research indicates that people who take medications for bipolar disorder are more likely to get better faster and stay well if they also receive therapy. Therapy can teach you how to deal with problems your symptoms are causing, including relationship, work, and self-esteem issues. Therapy will also address any other problems you’re struggling with, such as substance abuse or anxiety.
Three types of therapy are especially helpful in the treatment of bipolar disorder:
- Cognitive-behavioral therapy
- Interpersonal and social rhythm therapy
- Family-focused therapy
- Cognitive-behavioral therapy
In cognitive-behavioral therapy (CBT), you examine how your thoughts affect your emotions. You also learn how to change negative thinking patterns and behaviors into more positive ways of responding. For bipolar disorder, the focus is on managing symptoms, avoiding triggers for relapse, and problem-solving.
Interpersonal and social rhythm therapy
Interpersonal therapy focuses on current relationship issues and helps you improve the way you relate to the important people in your life. By addressing and solving interpersonal problems, this type of therapy reduces stress in your life. Since stress is a trigger for bipolar disorder, this relationship-oriented approach can help reduce mood cycling.
Social rhythm therapy is often combined with interpersonal therapy is often combined with social rhythm therapy for the treatment of bipolar disorder. People with bipolar disorder are believed to have overly sensitive biological clocks, the internal timekeepers that regulate circadian rhythms. This clock is easily thrown off by disruptions in your daily pattern of activity, also known as your “social rhythms.” Social rhythm therapy focuses on stabilizing social rhythms such as sleeping, eating, and exercising. When these rhythms are stable, the biological rhythms that regulate mood remain stable too.
Living with a person who has bipolar disorder can be difficult, causing strain in family and marital relationships. Family-focused therapy addresses these issues and works to restore a healthy and supportive home environment. Educating family members about the disease and how to cope with its symptoms is a major component of treatment. Working through problems in the home and improving communication is also a focus of treatment.
Education – Managing symptoms and preventing complications begins with a thorough knowledge of your illness. The more you and your loved ones know about bipolar disorder, the better able you’ll be able to avoid problems and deal with setbacks.
Lifestyle management – By carefully regulating your lifestyle, you can keep symptoms and mood episodes to a minimum. This involves maintaining a regular sleep schedule, avoiding alcohol and drugs, eating a mood-boosting diet, following a consistent exercise program, minimizing stress, and keeping your sunlight exposure stable year-round.
Support – Living with bipolar disorder can be challenging, and having a solid support system in place can make all the difference in your outlook and motivation. Participating in a bipolar disorder support group gives you the opportunity to share your experiences and learn from others who know what you’re going through. The support of friends and family is also invaluable. Reaching out to people who love you won’t mean you’re a burden to others.
You can chat to an online facilitator on our LIVE CHAT helpline. The service is free and you may remain anonymous.