On being bipolar: “The high is tremendous. Ideas and feelings of euphoria flow fast. You chase shooting stars. You have the power to seduce and captivate others. No shyness – driven by the right words that pour out, feelings of ease and well-being empower you to take on the world.
Then the change. The fast-flowing thoughts and feelings become overwhelming. The absolute clarity you had is replaced by confusion. Feelings of fear irritability and being out of control replace feelings of being in control. You enter the blackest of caves in your mind. ” (Goodwin & Jameson, 1990, pp17-18¹)
Bipolar disorder is a lifelong mood disorder and was formerly known as Manic Depression or Bipolar Affective Disorder. It is a mental disorder that 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 alternation between periods of mania and depression is the classic manifestation of bipolar disorder.
The manic phase
Mentalhelp.net describes mania as ”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 almost anything is possible.”
Symptoms of mania are:
- Grandiose thoughts / inflated self-esteem
- A fantastic stream of racing thoughts
- Rapid and forceful speech
- Impulse behaviours – sexual indiscretions, spending sprees
- Decreased need for sleep
To be diagnosed with a manic episode, Susan Nolen-Hoeksema² states ”the individual must have an elevated, expansive or irritable mood for at least 1 week, as well as at least three of other symptoms listed” – as set out in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association).
”Almost all individuals who experience a manic episode, will eventually fall into a depressive episode. Mania without any depression is rare” Susan Nolen-Hoeksema².
The Depressive phase
Depression is, therefore, the opposite mood state from mania.
- feelings of lethargy/lack of energy
- a negative outlook on life
- low or non-existent self-esteem and self-worth
- a sense that nothing is possible
- changes in sleep patterns
- feeling constantly fatigued
- feeling suicidal
It is not easy to diagnose bipolar disorder. WebMD states that as many as 20% of patients who complain of depression actually have bipolar disorder. Patients often have to see more than one therapist before they are diagnosed correctly. There is often comorbidity – meaning the presence of one or more additional conditions often co-occurring with primary disease, for example, bipolar disorder and substance abuse. WebMD names substance abuse as bipolar’s ”partner in crime” with as many as 60% of patients having a substance abuse problem.
“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. Samantha Gluck, Healthyplace.com³
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 counselling (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 and the most severe type of bipolar disorder. It is characterized by at least one manic episode or mixed episode. The vast majority of bipolar I disorder people have also experienced at least one episode of major depression, although this isn’t required for diagnosis.
Bipolar II Disorder (hypomania and depression)
Severe episodes of depression characterize it. If episodes of mania are present, they are usually very mild and are known as hypomania. Hypomania does not interfere with a person’s daily functioning ability. 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 that interferes with your daily functioning, your diagnosis will be changed to bipolar I disorder.
Cyclothymia (hypomania and mild depression)
A less severe, but chronic form of bipolar disorder is Cyclothymia. It also consists of cyclical mood swings. However, the highs and lows are not extreme enough to qualify as either mania or major depression. To be diagnosed with cyclothymia, you must experience numerous hypomania periods 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 = extreme mood swings (happy vs unhappy/ highs vs lows).
- Depression = depressed mood
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 phase and feel on top of the world, they don’t recognize they have a problem. Of course, people with bipolar disorder are depressed to a greater extent of the time.
Being misdiagnosed with depression is a potentially dangerous problem because treating bipolar depression is different from 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 stabilize mood swings.
These are commonly called mood stabilizers and include:
- anticonvulsant medicines
- antipsychotic medicines
- The medicine of choice to treat bipolar disorder is Lithium. It is a long-term treatment – 6 months.
- Please note if you start taking Lithium:
- Stick to the prescribed dose.
- Don’t discontinue taking it without talking to your doctor first.
- Incorrect dosages might cause side effects like diarrhoea or vomiting.
- If side effects do appear – tell your doctor immediately.
- Disclose to medical practitioners that you are on Lithium should they want to give you other prescription medication.
- Avoid taking anti-inflammatory drugs while you are on Lithium unless prescribed by a doctor.
Although anticonvulsant medication is used to treat epilepsy, it has been found they are effective in treating bipolar disorder during episodes of mania. They are considered to be long-term mood stabilizers.
Antipsychotic medicines are sometimes prescribed to treat episodes of mania.
- They are used as long-term mood stabilizers, especially if bipolar symptoms are severe (disturbed)
- Please note that these medicines can cause side effects, such as blurred vision, dry mouth, constipation or weight gain.
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.
Why do you need therapy?
- To get better and stay well.
- To learn coping skills to deal with problems caused by being bipolar
- To address comorbidity problems for example substance abuse
Three types of therapy are beneficial in the treatment of bipolar disorder:
- Cognitive-behavioural therapy
- Interpersonal and social rhythm therapy
- Family-focused therapy
In cognitive-behavioural therapy (CBT), you examine how your thoughts affect your emotions. You also learn how to change negative thinking patterns and behaviours 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 improves how you relate to the important people in your life. By addressing and solving interpersonal problems, this type of therapy reduces stress in your life.
Social rhythm therapy is often combined with interpersonal therapy and is often combined with social rhythm therapy to treat bipolar disorder. People with bipolar disorder are believed to have overly sensitive biological clocks, which are easily thrown off by disruptions in their 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.
Family-focused therapy addresses issues which arise from living with a bipolar patient. It aims to restore a healthy and supportive home environment. Family members have to be educated about the disorder and cope with the person suffering from it.
Education – Know your disorder to know how to manage setbacks and issues. That includes your family too.
Lifestyle management – You have to live by rules. A set sleeping schedule, a healthy diet, no alcohol or drug use, regular exercise and minimizing stress will go a long way to help keep symptoms and moods in control.
Support – Make sure you have a support system (family/friends/ support groups). Bipolar is a challenging lifelong disease. Don’t be afraid to reach out.
¹Goodwin, F.K. & Jamieson, K.R. (Eds.) (1990). Manic-depressive illness. New York: Oxford University Press
²Nolen-Hoeksema, Susan. 6th Edition. 2014. Abnormal Psychology. New York: McGraw-Hill Education