Once fun-loving, outgoing, and energetic, Ms. R says she began feeling unusually anxious 3 years ago. A psychiatrist diagnosed bipolar disorder type II based on her racing thoughts, irritability, low energy, and history of mood swings. Over 2 years, the psychiatrist tried combining valproic acid with bupropion, citalopram, or extended-release venlafaxine, then tried lithium monotherapy. Nothing worked.
Frustrated, Ms. R left the psychiatrist and consulted her primary care physician, who prescribed gabapentin, 200 mg each morning and 300 mg at night; fluoxetine, 50 mg/d; and quetiapine, 12.5 mg/d. Ms. R noticed no improvement and stopped the medications after 6 weeks. The physician urged her to see another psychiatrist, and she presented to us 2 weeks after stopping the medications.
Ms. R also has been feeling depressed and irritable the past 4 months and has trouble falling and staying asleep at night. She sleeps 4 to 5 hours nightly, constantly feels tired, cannot concentrate, and overeats to try to alleviate her stress. She has gained 6 pounds over 2 to 3 months and weighs 160 lb; her body mass index of 26 indicates she is overweight.
She says her worries overwhelm her and cause heart palpitations and muscle tension in her neck and shoulders. She admits to feeling “worthless,” but denies suicidal thoughts.
Ms. R describes her husband and two teenage daughters as “very supportive,” but admits that her fatigue and irritability have strained these relationships; she says she snaps at them for minor things, such as coming to dinner 1 minute late. She misses her job, which she recently quit because of her decreasing ability to function.
I receive a lot of comments and emails from the spouses of bipolar people on my You Tube Channel. The questions vary from how I handle it, to general inquiries about symptoms. Usually when someone seeks out my videos, they are in a time of crisis and are reaching out. They want to know if things can or will get better. They want to know if their marriage will survive. They want to know if their struggle is worth it. Though I can’t foretell what will occur for each individual couple, I hope to show them that you can have a happy, healthy marriage with a bipolar spouse.
In many ways, my marriage is no different from anyone else’s marriage. This is the second marriage for both my husband and I. We both have children from previous marriages. We both have ex-spouses that are still involved in our lives on a daily basis. We have extended families with varied backgrounds, sprinkled all around the world. We have jobs and mortgages and commitments that pull us in all sorts of directions.
Just like any other marriage, there are things that bug me!
My husband leaves the toilet seat up, doesn’t put the cap back on the toothpaste and leaves dishes around the house like he’s expecting the maid to pick up after him. We don’t have one. I guess he thinks that’s me. We have disagreements about finances and children. See, just like the rest, except for one difference: my husband has Bipolar Disorder.
Bipolar disorder is a genetic medical condition. People with it experience cycles ranging from being depressed with low energy to hyperactive or manic. According to TheMighty.com, “about 5.7 million adults in the U.S. live with bipolar disorder, but the illness is often misunderstood.”
Here are 12 things you should never say to someone with bipolar disorder:
1) Are you bipolar?
People are not bipolar disorder. They have bipolar disorder.
2) You’re crazy.
Improved My Health1
Changed My Life
Saved My Life1
First of all, it’s rude. Second of all, it’s not true. Don’t say anything similar to this to someone who has bipolar disorder.
3) I have mood swings too.
At times, everyone can experience a mood swing wrote Bipolar.About.com, but “only people with bipolar disorder, have repeated and severe mood swings between mania or hypomania and depression.”
When thinking of bipolar disorder, some of the unfortunate associations that spring to mind include Kathy Bates in Misery and Carrie Mathison from Homeland. IRL, Bipolar disorder isn’t anything like as scary or dramatic. Here are 15 things you may not have known about the condition.
1. There is no single or specific cause for bipolar disorder
From psychological stress to childhood abuse and social circumstances, the causes of bipolar disorder are vast. Biologically speaking, bipolar disorder is caused when our teeny tiny chemical messengers (neurotransmitters) fail to do their job and send the happy stuff (serotonin and dopamine) to the brain (you had ONE job, neurotransmitters).
The disorder may lie dormant until activated, usually by an outside trigger (major life event, change in circumstances, increased stress, altered health habits, alcohol or drug abuse, hormonal problems, etc) but can also flare up on its own.
2. Bipolar disorder can can be genetic… but also not
Sure, if there’s a family history of bipolar disorder, then there’s an increased chance of having it, but studies conducted on identical twins have shown that if one twin is bipolar, the disorder does not always develop in the other twin, even though they have the exact same genes. Both men and women can be diagnosed as bipolar and diagnoses usually take place just before or in their early twenties.
3. Bipolar disorder is NOT multiple personality (dissociative identity) disorder
These two disorders are usually linked because of the split personality element. However, people who are bipolar have highs and lows (but still know they are the same person) whereas people with multiple personality disorder (MPD) can think they are more than one person, with distinctly different personalities, traits and memories.
MPD is extremely rare whereas bipolar disorder affects approximately one in every 100 people.
4. Bipolar symptoms: the highs and the lows
The main symptoms of bipolar disorder are the highs and lows; the highs being mania and the lows being a depressive state. Let’s break it down.
The ups/highs (manic state)
Bipolar disorder is sometimes misdiagnosed as schizophrenia because of the following symptoms which connect the two:
• Feeling extremely happy or high, bubbly and outgoing for a long period of time
• Feeling irritable
• Fast talking and jumping from subject to subject
• Getting easily distracted
• Taking on new projects, increasing activities out of the blue
• Extreme restlessness
• Not being tired and sleeping very little
• An unrealistic belief of being able to take on the world
• Being impulsive
• Engaging in high-risk pleasurable activities (high spending, drug/alcohol abuse and sexual promiscuity)
The downs/lows (depressive state)
When in a bipolar ‘low’, the symptoms are very similar to clinical depression, which is why bipolar disorder is sometimes misdiagnosed as as such.
• Lack of or too much sleep
• Feeling sad and/or hopeless
• Loss of interest in formerly enjoyable activities (ie sex)
• No energy
• No desire to even get out of bed
• Change in appetite/weight
• Feeling worthless or guilty for no reason
• Lack of concentration
• Suicidal thoughts/thoughts of death
5. You can have bipolar ups and downs at the same time
Having mania and depression at the same time is possible with bipolar disorder and this is called a ‘mixed state’. So, while feeling ‘high’, sleepless, agitated, energetic, and having lack of concentration, you could also feel sad, have no motivation and/or have suicidal thoughts.
6. You can be bipolar and NOT actually have mood swings
You could, in fact, feel absolutely great. This could be something called ‘hypomania’, which is a really toned-down version of bipolar mania. If you’re having a hypomanic episode, you might feel really good and highly productive and that you are functioning really well.
If this is out of the norm for someone with bipolar, a doctor should be consulted because without proper treatment, it could develop into severe mania or depression.
7. Substances can trigger a bipolar manic depressive episode
• Drugs like cocaine, ecstasy and amphetamines
• Over-the-counter drugs in large doses
• Medicine for thyroid issues and corticosteroids
• Excessive amounts of caffeine (although normal amounts are fine)
8. People with bipolar disorder and more likely to have substance abuse issues
The reasons for this are as yet scientifically unclear, but it is thought that sufferers of bipolar disorder are more likely to want to self-medicate with drugs and alcohol.
9. Bipolar sufferers are also at higher risk for other diseases
Thyroid issues, headaches and migraines, diabetes, heart disease and obesity are a few of the other illnesses which could result from treatment for bipolar disorder, as well as causing some of the same symptoms as the highs and lows (mania or depression).
10. There are five variations of bipolar disorder:
Starting from the mildest to the most severe, the five types of bipolar disorder are:
(i) Cyclothymia/cyclothymic disorder
Cyclothymia is mild form of bipolar disorder with ongoing, long-term symptoms (minimum 2 years) which aren’t severe enough to be classed as bipolar disorder.
(ii) Bipolar I disorder
Manic or mixed episodes that last a minimum of seven days usually requiring immediate hospital care.
(iii) Bipolar II disorder
Depressive and hypomanic episodes with no manic or mixed episodes.
(iv) Bipolar disorder (not otherwise specified)
Some bipolar symptoms exist but not enough to be classed as bipolar I or II.
(v) Rapid-cycling bipolar disorder
Rapid-cycling is when someone has four or more episodes of major depression, hypomania, mania, or mixed states within a year. Rapid-cycling can come and go and is more common in women than men.
11. The most effective test to diagnose bipolar disorder is seeing a psychiatrist
Although many tests can be carried out including brain scans, blood tests and physical examinations, none are as effective in correctly diagnosing bipolar disorder as having a thorough interview session with a psychiatrist.
The shrink will take the patient’s family and personal history and will find out everything they need to know to be able to diagnose the patient and create the best treatment plan.
12. Although bipolar disorder can not be cured, it can be treated
Patients are advised to keep a life chart to help their doctor and psychiatrist provide the best possible treatment. There’s a wide array of bipolar disorder treatments available, from scary sounding ones like electroconvulsive therapy, atypical antipsychotics, and light therapy to the more common mood stabilisers, anti-depressants, sleep supplements, cognitive behavioural therapy, and psycho-education (just getting yourself fully in the know). There are also some new, up and coming bipolar disorder treatments that are gaining popularity.
13. Bipolar disorder can get worse if left undiagnosed/untreated
Although patients will often opt for self-help, it is advised that bipolar disorder should not go untreated as episodes could become more frequent or severe over time. The sooner it is diagnosed and treated, the sooner someone with the condition can go about living a normal, healthy and productive life.
14. Here are 20 celebrities with bipolar disorder
1. Catherine Zeta-Jones
2. Demi Lovato
3. Jean-Clause Van Damme
4. Linda Hamilton
5. Sinéad O’Connor
6. Azealia Banks
7. ussell Brand
8. Chris Brown
9. Jim Carrey
11. Tom Fletcher
12. Stephen Fry
13. Macy Gray
14. Kerry Katona
15. Gail Porter
16. Axl Rose
17. Rene Russo
18. Nina Simone
19.P ete Wentz
20. Britney Spears
15. There’s a plethora of information available on bipolar disorder
And here are a few to get you started:
National Institute of Mental Health
For something a bit lighter, check out this blog by bipolar sufferer Beth Evans. It’ll make you laugh and cry. At the same time.
Hello. I am Dr Stephen Strakowski, from the University of Texas at Austin. Those of you who have seen any of my videos before know that this is a new location for me. I am here now as the founding chair and professor of psychiatry, where we are building the brand-new Dell Medical School. In future videos, I will talk about how we are thinking about building this new medical school, and how psychiatry plays a major role in its creation.
But today, I’m going to talk about something else: differences and similarities in managing unipolar and bipolar depression. This is a common clinical problem. Information has evolved over the past few years, and we are really starting to think about these two conditions differently.
Unipolar Depression: Incidence, Heritability, and Causes
Major depression is among the most common conditions affecting humankind. In the United States, about 7% of people will develop depression in any given year; there is around a 17%-20% lifetime risk.
The genetic risk for depression is relatively low among psychiatric disorders. Heritability runs in the 30%-40% range—meaning that in a collection of people, depression genetics explain only about one third of the variants. If the depression is recurrent, and commonly recurrent, however, the impact of genetics raises to about 66%.
However, many cases of depression (we have talked about this in other venues) may simply be representative of an insult to the brain and the kinetic current, [or from] a whole variety of conditions. In fact, if you look at medical, neurologic, and psychiatric disorders, virtually anything that affects the brain is associated with higher levels of depression. So part of managing depression, as we will talk about, is trying to identify the potential cause.
Bipolar Depression: Incidence, Heritability, and Diagnosis
In contrast to unipolar major depression, bipolar disorder and subsequently bipolar depression is much less common, affecting somewhere in the neighborhood of 1%-2% of people over a lifetime. Type I bipolar disorder is defined by the occurrence of mania and cannot be diagnosed in the absence of mania. We will discuss how that affects thinking about depression in a moment. In bipolar disorder type II, there has to be episodes of hypomania that are also then accompanied by depressive episodes.
The heritability of bipolar disorder is much higher than unipolar depression, and runs in the range of about 85%. Bipolar disorder is the most heritable condition in psychiatry. The diagnostic reliability of bipolar disorder tends to be higher (at least of mania) than unipolar depression, but the diagnostic reliability of hypomania is relatively low. The two types of bipolar disorder can be differentially examined; it is often harder to make a diagnosis of type II that someone else will agree with. Nonetheless, because of this high heritability, environmental factors are probably less important, at least in the initiation of episodes of bipolar illness, including depression. However, stress and other environmental factors (eg, drug abuse) certainly can affect the course of either illness.
Depressive Episodes: Do They Look Different?
In general, the depressive episodes of bipolar individuals and unipolar individuals look very similar. From a strict kind of cross-sectional clinical assessment perspective, it’s really not possible to distinguish them without other information.
That said, there are some types of presentations that are suggestive of an evolving or emerging bipolar illness. These include depression at an early age (particularly prepubertal or early teens), postpartum mood changes, and [depression associated with] seasonality. Bipolar depression may have more severe anhedonia, hypersomnia, and psychomotor slowing—”melancholic” types of variants. The presence of catatonia, often in fact a mania syndrome in severe cases, is probably the best predictor despite all of those suggestive symptoms—which again, in a given individual, are often not particularly helpful.
n contrast to that, a family history of bipolar disorder in someone who is young and developing recurrent depressive episodes might suggest that this may be a bipolar individual. However, until mania or hypomania occurs, a diagnosis of bipolar disorder would be premature.
Unipolar Depression: Antidepressant Therapy
When we start talking about treatment, you can see that there are a large number of antidepressants for unipolar depression approved by the US Food and Drug Administration (FDA). There are many different classes, with the selective serotonin reuptake inhibitors (SSRIs) and serotonin/norepinephrine reuptake inhibitors (SNRIs) being the most commonly prescribed today. Tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs) tend to be used increasingly less, primarily because of tolerance. There are some other good antidepressants that do not fit neatly in a class, such as bupropion or mirtazapine.
The take-home [message] from this slide is that there are a lot of good established antidepressant therapies. In general, something can be found that is tolerated and effective in any given patient.
Unipolar Depression: The Role of Psychotherapy
In addition to medications, psychotherapy is helpful in major depressive episodes. Cognitive-behavioral therapy (CBT), particularly in mild to moderate cases, is well established, and the evidence suggests it is as good as any antidepressants and may actually help better in some cases with relapse prevention. It does appear to save money when administrated with antidepressants. Even though there are some initial upfront costs for the therapy, costs get evened out over time by better recovery.
Interpersonal therapy also has a strong evidence base. This is not the same as psychodynamic therapy—it is a focus on interpersonal interactions without assumptions of causality. It essentially bases its “core” on the fact that interaction with other humans represents a major part of our stressors and social supports. This therapy focuses on improving those [interactions] and leads to improvement in depression. In fact, for psychodynamic psychotherapy in the purest sense, there is really only limited evidence that it is efficacious in depression.
There is also a strong interest right now in nutraceuticals and lifestyle management. But so far, unfortunately, those have not been able to hold up in studies particularly well for the treatment of depression. That said, however, they are generally good for you, and so there is no reason not to include them in a treatment paradigm.
Bipolar Depression: Medications
In this chart of medications commonly used in bipolar disorder, only three products at the moment are FDA-approved for treatment of bipolar depression: the combination of olanzapine and fluoxetine, quetiapine, and more recently lurasidone. As you can see, there are a number of other medications, such as lithium and lamotrigine, that have apparent antidepressant efficacy. In general, mood stabilizers that are effective for maintenance seem to be effective for treating depression
Recently, there have been some interesting studies. Historically, we have often used antidepressants in the treatment of bipolar depression. However, as shown in this chart from Gary Sachs and colleagues in the New England Journal of Medicine in 2007, the STEP-BD study showed us that the addition of an antidepressant to a good mood stabilizer in patients with bipolar disorder really added very little improvement of depression. It also did not increase the risk for switching or adverse effects.
The take-home messages were that antidepressants add very little to effective use of mood stabilizers, and that the treatment of bipolar depression is very different from unipolar depression. Antidepressants appear to be much less effective for bipolar depression than unipolar depression. This helps us think differently about treatment guidelines and algorithms.
Bipolar Depression: Switch Risk
There is still an ongoing discussion on what the risk [associated with] antidepressant therapy is of switching into mania from depression. Again, in that previous slide from Sachs and colleagues, it really looked like the antidepressants, at least in the setting of a mood stabilizer, did not increase the risk at all. The risk in studies has ranged from as high as 30%-40% with the older tricyclics to as low as placebo rates with SSRIs and newer antidepressants. Probably somewhere in [between] there is a true rate.
Unfortunately, the natural switch rate of depression into mania in the absence of treatment may be as high as 40%, which was observed in the collaborative depression study in the 1980s. The confounder is that even though we tend to think of patients moving from depression through euthymia through mania, that is not actually how it happens. It’s more of a toggle from one state to the other, and depression itself increases the risk for mania. So the effects of antidepressants just remain confounded because typically, people do not get antidepressants until they are depressed.
That said, certainly with the older antidepressants, there may be a switch risk. The newer antidepressants in the setting of a mood stabilizer seem to have a fairly low risk. Regardless, from STEP-BD and other studies, the benefit of adding an antidepressant appears to be low. SSRIs may be better anxiolytics long-term than antidepressants—they may have an anxiolytic role in bipolar disorder, and we need more studies to determine whether that is true and whether they are safe [in that setting].
Bipolar Depression: Role of Psychotherapy
Psychotherapy is very important. In bipolar depression, CBT has a good evidence base. Interpersonal therapy and social rhythm therapy that came out of Pittsburgh also have a good evidence base, as do family-focused therapies. All of these have been shown to decrease relapse, improve functioning, and help with treatment compliance. They are all used in conjunction with mood-stabilizing drugs, which are necessary in bipolar disorder as a first step. Psychotherapy is a nice second addition.
With that in mind, I have included brief guidelines for treatments on each of these conditions. With unipolar depression, the first key is to either start or optimize the antidepressant. Treatment failures are often simply from not waiting long enough, or not using a high enough dose. Again, it’s important to remember that these are not rapidly-acting agents, and it often takes 3-6 weeks to even see the initial response.
The first-line therapies that most people are familiar with are SSRIs, SNRIs, bupropion, and CBT. Then there are what I call “1b” options, which are a little less established—you can read those on the slide. If there is literally no response in 4-6 weeks—the patient is no better, or even worse—probably switching rather than maintaining the current antidepressant is the best step.
If there is a partial response, think about augmentation strategies—which is adding another antidepressant, ideally from a different class. Other things, such as psychotherapy, thyroid hormone, or perhaps one of the approved atypical antipsychotics, have been shown to be helpful augmenting agents. Lithium augmentation continues to be the best-studied augmenting strategy.
Eventually, we get to such things as ketamine, which is experimental but maybe something to consider; repetitive transcranial magnetic stimulation (rTMS); or electroconvulsive therapy (ECT). If ECT had less stigma and was easier to administer, particularly in severe cases, I would move it up this chart to be used earlier.
With recurrent and even single-episode patients, try to use three or fewer drugs and be systematic. Take your time making changes, and [achieve] an adequate dose. Do not chase symptoms. I have talked about this in another video.
Managing Bipolar Depression
The guideline for treating bipolar depression is very different. The first step is optimizing current mood stabilizers or starting mood stabilizers—ideally, those that have some evidence of maintenance efficacy. Those typically roll into being reasonable antidepressants.
Lithium and CBT are good things. It’s a good idea to add CBT to an existing mood-stabilizer program that has generally been effective. If you are not using lithium, consider it. These FDA-approved agents are also good choices: olanzapine, olanzapine in combination with fluoxetine, lamotrigine, lurasidone, and quetiapine.
Maximizing mood stabilization appears to be the best intervention. ECT in severe cases should not be delayed too long. I have it as third-line in my chart—but again, only because it’s not widely available. If it’s available, then it’s a good choice to move up the chart.
Again, like unipolar depression where there are similarities, if it’s not working in 3-6 weeks, get rid of the drug that is not working and add a new one. If it’s working partially, consider augmenting. But keep in mind, you need to keep your mood stabilizer base on board. Augmentation approaches that are listed here are not terribly dissimilar from [those for] unipolar depression. [Remember] the three-medication maximum, and make systematic changes.
With these approaches, I think it’s possible to come up with an ideal program for your individual patient. It is important to keep in mind, though, that the treatments are very different and that antidepressants have an increasingly limited role in the treatment of bipolar depression. A good diagnosis is going to be really important for a good treatment outcome.
Much of what I have talked about here, can be found in a couple of books[1,3] we have published, which you might find useful. I hope this is helpful for everyone. From my new place in Texas, I appreciate your time, and thank you all for listening.
1. Every time you say “I’m bipolar” people respond with a chuckle, until they realize that you’re serious. Describing someone as bipolar has become such a popular saying that I don’t even think people realize that it’s an actual mental illness. The depictions of people with bipolar disorder in the media doesn’t help either. People with bipolar disorder are usually portrayed as angry, over-exaggerated, constantly irritable, and un-approachable.
But in reality most people with the disorder are able to live productively in society just like everyone else. Most people can’t even tell that I’m bipolar until I tell them. And I actually choose not to tell people until I get to know them better, just to show that my bipolar disorder doesn’t necessarily effect my personality or how I interact with other people on a daily basis.
2. Being high off life. The mania (or hypomania). Before I was able to identify my mania I took full advantage of the feelings of over-confidence and indestructibleness. Being so productive and energetic after dealing with such a deep depression felt amazing. It still does. At one point in time I told my therapist that I was excited to be manic again. It’s kind of like being reunited with a friend that you haven’t seen in a while; but that friend happens to be you, just a different version. And of course in those moments of mania nothing matters, you follow your impulsivity without any acknowledgement of possible consequences; until what I like to call a “crash” happens.
Just like being high off of a drug, you suddenly don’t feel high anymore and come to your senses. The feeling of regret is so familiar to me now. The guilt, sadness, and embarrassment that I feel after realizing all of the things that I’ve done while manic ultimately sends me back into depression. And the cycle continues. I find myself seriously questioning if I actually did those things. At this point I know this version of myself so well that I can believe it; but before I felt like a stranger to myself.
3. Blaming my mental illness. I’ve always struggled with this concept. Ever since I was around 11 or 12 years old I’ve built and destroyed so many relationships, platonic and romantic. I never really looked into why I lost so many friends over the years, I just attributed it to “growing apart.” But now that I have a better understanding of my mental illness, I’ve been able to identify some of the things that I’ve done to cause those relationships to end. So many times have I found myself trying to explain to someone that “I wasn’t in my right mind.”
And that excuse works the first couple of times. But after a while people get fed up, and can you expect them not to? You can fuck up time and time again but it’s okay because you’re bipolar, right? Wrong. No one deserves to constantly be hurt by the same person, bipolar or not. No relationship is going to last with this dynamic in place. Yet I still haven’t found a way to handle this issue. I have so much more to learn about managing my bipolar disorder, and I know there’s a long journey ahead. But the thing I fear most is that I will go throughout life not being able to maintain a stable relationship.
4. That one time you stopped taking your meds for a while.Probably one of the worst decisions I’ve ever made. Everyone has their own views on taking medication to treat mental illness. Some people are able to manage without the help of medication which is great for them. While others need medication in order to control their disorder, and there’s nothing wrong with that either. I am one of those people. Medication has helped balance out my mood so much; but at one point I decided that I didn’t need to take them anymore, for a number of reasons that I wont get into.
I hit my lowest point when I wasn’t on my medication and had stopped seeing a therapist. I had no sense of self-control; I had become so reckless. I was risking the well-being of myself and those around me and didn’t think twice about it. By the time I did decide to go back to therapy I had almost hit rock-bottom and I only had a few options. I had to stop judging myself for being on medication and stop worrying about what other people would think if they found out. At the end of the day my mental health is more important than the stigma and negative connotation attached to treating mental illness with medication.
5. Realizing that bipolar disorder doesn’t define you as a person. You are not bipolar; you HAVE bipolar. Don’t let the diagnosis overshadow who you are as a person. Your amazing spirit is still there, don’t let it become masked by your mental illness. When I was first diagnosed and people would ask me to reveal something about myself, my go-to response was to mention that I was bipolar. But being bipolar isn’t a characteristic. So many people in the world have bipolar disorder and we are all not the same, though the stigma attached to mental illness causes us all to feel the same pain and frustration.
If I had the choice to live without bipolar disorder I wouldn’t. Living with this mental illness has allowed me to be so self-aware; I feel as if I know myself so well. The fact that I have to be so aware of my mood and feelings, and how it affects those around me, allows me to grow and learn with every high and low that I experience. It’s not easy, but it’s life. And I hope that reading this will help you feel less alone in dealing with bipolar disorder.
Source: Photo purchased from iStockphoto, used with permission.
Those diagnosed with bipolar disordermay be at the mercy of extreme mood swings, but they are not powerless. Medication, therapy and a healthy lifestyle can help them enjoy full and productive lives, especially when supplemented by the support of those closest to them. And that’s where you come in. If a friend has been diagnosed with bipolar disorder, here are 11 ways you can help:
Educate yourself. The term “bipolar” is thrown around a lot these days, yet it remains widely misunderstood. (If you need proof, listen to this Fox News commentator’s offensive dismissal of bipolar disorderas a “fad” designed to game the disability system.) Spend some time learning about the disorder, and you’ll be much better able to understand what your friend is going through. Good sources include the National Institute of Mental Health, the Depression and Bipolar Support Alliance, and the International Bipolar Foundation.
Channel your compassion, but ditch the pity. No one wants to hear “I feel so sorry for you.” What they do want is recognition that life holds challenges for them and that you’ll be there to help them meet them.
Accept the lows with the highs. When manic, the person with bipolar disorder can come across as the life of the party. When depressed, however, they may feel as though they have lost their value in their social circle because they are no longer “fun.” Don’t add to that pressure. Let your friend know you are there for them whether they are in the heights or the doldrums, and help them aim for that middle ground.
Don’t say “calm down” or “cheer up.” It can be hard to know how to react when your friend is in the midst of an extreme manic or depressive episode, but platitudes such as these are sure only to antagonize. After all, if they could calm down or cheer up, they would. A better response is to ask how you can help, or suggest some things the two of you might do together, even something as simple as going outdoors for some air. When your friend is no longer in distress, talk to them about what might help next time and prepare strategies.
Be understanding when they are less of a friend than you need. Those with bipolar disorder are dealing with mood swings that can leave them irritable, overly sensitive, distracted, impulsive, and prone to explosive outbursts – all of which can be taken as a personal affront if you don’t understand its source. Try to show the same patience and understanding you would hope to receive if you were the one dealing with the illness. And remember that the frustration they feel is with the disorder, not with you.
Realize that they did not bring this on themselves. Your friend didn’t choose to have bipolar disorder. It is neither a character flaw nor a weakness. Instead, research points to a variety of factors thought to be acting in concert, including genetics, environment and brain structure. This means they can’t simply snap out of it or choose to be happy, no matter how well-intentioned your advice.
Encourage a healthy lifestyle. Eating well, getting enough exercise and sleep, and avoiding alcohol and drug use can help your friend maximize their control over their disorder. They don’t need you acting as their nanny, but they do need a friend who will share healthy activities with them rather than a friend who simply wants to party, especially because addiction and bipolar disorder so often go hand in hand.
Listen. Lend a sympathetic ear, and let them know you don’t expect them to put on a brave face. Ask how they are doing and truly listen. If they speak of self-harm, take it seriously and be sure their therapist or doctor is informed.
Don’t get angry if your friend stops taking their medicine. They may be dealing with a host of distressing side effects from the medication – sedation, weight gain, emotional blunting and sexual dysfunction, to name a few. Or they may blame the medications for feelings of depression even if the medicine is not responsible. They don’t need you to wag your finger. Your best hope for getting them back into treatment is to remain understanding about what they are experiencing but to encourage them to make an appointment with their psychiatrist straight away.
Stay connected. When a friend is ill with diabetes or cancer, we know the protocol – visit, send cards, bring meals. When the illness is mental, however, we are often at a loss as to how to respond. Those who are struggling can be left feeling isolated and abandoned. There is great power in anything you do to stay connected, no matter how simple – drop by, send a note, visit if they are hospitalized, hug them, make cookies, tell them you’re there for them.
Don’t give up on them. Keep making suggestions for things you can do together, and be understanding if they cancel at the last minute. Your friend may not always be able to follow through on an invitation, but they are hoping you’ll keep trying.
I was diagnosed with bipolar disorder just six months ago after years of being treated under the mental health services.
Despite receiving help in the form of therapy from the age of 15 and my mother having a bipolar diagnosis, I wasn’t totally prepared for being diagnosed myself.
It led to me having a lot of misconceptions about what the diagnosis meant and how I would be viewed as a person as, I’m sure, is the case for many people.
Here are 8 things I wish I’d known before being diagnosed with bipolar disorder.
1. It is not what defines you
I’ve got so used to people describing themselves as ‘being bipolar’ that I forget that what they mean is they ‘have bipolar’. I feel it’s important to remember that bipolar disorder is an illness, and not simply a personality trait.
2. There isn’t a quick fix
As far as I was concerned, I’d be totally okay once they put me on the right medication plan. What I didn’t realise is how long that medication plan can take. I’ve come to learn it’s all about (lots of) trial and error.
3. It’s not as black and white as it seems
I assumed bipolar was being up and down, manic or depressed. I didn’t realise how much went on in between, that you can have periods of feeling normal or even mixed-state episodes where you’re feeling both up and down at the same time.
4. Manic doesn’t equal happiness
Before being diagnosed myself, I’d assumed manic meant you were happy and depressed meant you were sad. I didn’t realise manic was also classed as being agitated, irritable and angry, with the inability to slow your mind down.
5. Being manic is scarier than being depressed
Though I must admit I am much more motivated when I’m manic, I’m also like a ticking time bomb. And that’s scary. When I’m manic, I tend to not sleep much, I carry out every idea in my head, I’m impulsive and my credit card becomes my best friend (and worst enemy). And that’s dangerous. Alongside this, when I’m manic, I’m forever waiting for my mood to crash.
6. My depressed side highlights my insecurities
When I’m manic, I feel like I have the world at my fingertips. That the world owes me something. I convince myself that I’m going to do great things and I have a million ideas run through my head all at once. When I’m in a depressed state, all of my insecurities come out and I have some sense of realness again. Though it’s not nice, it’s comforting to know that there is that part of me that wants to do better.
7. The diagnosis is made easier to understand when a loved-one is suffering with the same thing
I must admit, bipolar disorder for me has been easier to deal with knowing my mum is living with it too. She can offer me advice, experience and can lift me up when I’m at my lowest.
I was first diagnosed with bipolar disorder, also known as manic depression, when I was 24.
Since then I’ve spent many years hiding it from friends, family and colleagues.
It’s only recently I’ve started writing and speaking openly about it, in the hope that other people, with or without mental health conditions, feel less afraid of them.
While I can’t speak for everyone with manic depression, bipolar disorder, ups and downs or whatever you choose to call it, I believe we have some things in common.
Here’s 21 things you only know if you’re bipolar.
1. It’s hard to finish one thing at a time
On the way up, you start doing the washing up, then you think of a poem and get a quarter of the way through it, then you remember you wanted to alphabetise your books, then you start watching a film, then you do more of the (now cold) washing up.
2. Sometimes the world turns black and white
When you’re depressed you stop enjoying things you used to, nothing seems worthwhile and all you want to do is sleep for a thousand years.
3. It doesn’t mean you’re up and down all the time
Everyone’s different – you can have rapid cycling (where you quickly go from high to low), mixed state (when you have symptoms of depression and mania at the same time), or go gradually up and down with periods of ‘normality’ in between.
4. You may be mildly amused by people who take drugs recreationally
There’s something rather tame about pill-popping in a field of muddy campers on a Bank Holiday weekend when you’re walking around with what feels like a permanent pharmacy dispensing random chemicals in a Russian roulette style in your head.
Everyone experiences mania differently, whether it’s delusions such as thinking you have superpowers, suddenly getting it into your head to get on a train to Scotland instead of the train home, not sleeping because you have so much to write or paint, or suffering hallucinations.
Losing control of your mind is odd to say the least. Imagine losing control of your limbs – having them dance about or do things without your input. Then apply that to your daily thought processes.
Talking about mental health can be so scary that many people decide not to tell anyone.
The ignorance and discrimination surrounding mental illness isconsiderable.
Although sometimes the person who discriminates the most against you is you.
7. You are probably a great listener
Somehow you have become the one friends turn to with their troubles.
You don’t know whether this is because you’ve had counselling and therefore have picked up how to listen sympathetically, or because you are more guarded than others about yourself so others fill silences with chatter.
8. Pill podge
Oh great, so as well as being mad I have to be fat too, thanks for that, THANKS VERY MUCH.
9. Sometimes pills have unexpectedly cool side effects
I used to have poker straight hair. My pills have made it curly. Honest to God.
10. The buzz
The buzz of hypomania isn’t fun – it’s more like having espresso in your veins.
Admittedly you can get quite a lot done during these times though.
11. You don’t find suicidal thoughts scary
They’re more like preteens hanging round Justin Beiber’s hotel in the rain – sometimes they change, sometimes they go, occasionally we pay them attention but mostly they just linger.
12. Some people apparently don’t believe mental illness exists
If physical diseases were treated like mental illness…. (via@elvis717) pic.twitter.com/EtxijduqFh
— Stephen Fry (@stephenfry) January 27, 2015
Such people will say things like the above, and things like ‘he was signed off work for stress – not a real illness like gastroenteritis’.
13. You can remember it all
All the times you thought you could breathe under water, bring back the dead, or however mania’s hit you. And you can’t even laugh it off by saying you were drunk or high.
14. You can act
Your most celebrated role? ‘Normal person who is totally fine and there’s nothing wrong at all’.
15. You’re probably a perfectionist
You need to sleep but you told the office you’d bring in homemade cupcakes the next day so you’re still up at 1am rolling edible flowers in egg yolk and sugar.
16. How not to cry when you really want to cry
And where to bolt to when your usual methods fail you.
17. That sinking feeling when you see another ‘crazy’ stereotype on TV or film
People who have suffered from mental illness are far more likely to hurt themselves, or be the victims of attacks.
Despite this, lazy scriptwriters still rely on tropes when they need a scary character.
18. Sometimes you’re a shopping liability
You’ve gone over your overdraft more times than you can remember buying things you don’t even want during a manic phase.
During mania or hypomania your brain makes weird connections and all of a sudden it makes perfect sense to buy a set of golf clubs when you haven’t played a day in your life.
19. Alcohol is usually best avoided
Alcohol is a depressant.
Adding this in to your natural brain chemistry and mood stabilisers isn’t fun the morning after.
Normal hangovers are bad enough – yours are worse than a coke come-down and often leave you a weeping, morose mess.
20. Relationships can be hard
I once dumped the man I loved during a manic phase and we never recovered.
Not everyone can face mental illness, but then relationships can be challenging for everyone, in all kinds of ways.
A friend who is also bipolar has been married for years, which gives me hope.
21. You are stronger than you know
Sometimes getting through another day is a huge achievement. Don’t give up.