Bipolar Disorder (”Manic Depression”)
What Is Bipolar Disorder?
Bipolar disorder is also called Manic Depression. The term “manic depression” isn’t the preferred term because of the connotation society has imparted to the words “mania” and “manic”. The word “mania” has become vernacular (commonly used) and has lost the medical seriously warranted in this disorder. In fact, some patients are offended when stores advertise their “July Mania” sales because the patients believe these terms downplay the pain that bipolar disorder brings to their lives and loved ones.
Bipolar Disorder (sometimes abbreviated as BP or BPD) is a neurobiochemical disorder from which a person experiences extreme “highs” and “lows” in mental perception (mood). Physical manifestations of a “high” swing may be extremely rapid thoughts coursing through the person’s head which often does not make sense or the ability for the person to go without sleep or food for several days. Physical manifestation of a “low” state may be excessive sleeping (hypersomnia).
As with many disorders, there is a spectrum of these two poles of mood (hence “bi-polar”) from extreme to mild episodes depending on the individual. Some people can experience the farthest of the extremes of the mood swings and are therefore suffering from “Classical” or Type I bipolar disorder. Along the spectrum are several variations of bipolar disorder which are assigned types II to V (2-5).
To accurately diagnose the type of bipolar disorder an individual has, he or she must consult with a professional with experience in diagnosing and treating bipolar disorders. People who suffer from bipolar disorder have described their moods as an unpredictable yo-yo, or liken the experience as being on a perpetual roller coaster ride.
Patients who experience only the down cycle have Major depressive disorder (abbreviated MDD) or Depression - these patients have Unipolar (one pole of mood) depression.
Who Gets Bipolar Disorder?
Bipolar disorder is estimated to affect approximately 5% of the U.S. population (year 2000 estimate). Bipolar disorder does not discriminate, and affects people of all races and ages. Children as young as two years old have been observed to suffer from bipolar disorder. While many professionals accept that young children can suffer from bipolar disorder, this is still under diagnosed and often misdiagnosed as ADD/ADHD.
Bipolar disorder often has a genetic basis. Therefore, a physician will ask the patient if there were family members who had symptoms of bipolar disorder. Researchers are still identifying bipolar disorder-causing gene(s) and some progress has been made. A potential molecular target that may be altered in patients with bipolar disorder is a protein called Bcl-2. This protein protects neurons (brain cells) from dying and helps neurons regenerate. However the findings are preliminary and has theoretically rather than practical implications at this point. Bcl-2 also plays a role in many disease states including cancer (in this case, Bcl-2 is the culprit and protects cancer cells from dying).
What Triggers Bipolar Disorder?
The onset of bipolar disorder-related symptoms often appear in early adolescence, and young children have also been diagnosed with bipolar disorder.
Triggers are often “invisible”. Recognizing symptoms and potential triggers are important in managing bipolar disorder. A bipolar disorder episode may be triggered by diverse factors such as sleep, stress, diet, physical activity, and the person’s own lifestyle. Each person has a unique “threshold” (tolerance level to an emotional or physical stimulation) that responds differently to triggers.
In conjunction with a medication and/or therapy regimen, some have found it helpful to keep track of certain triggers so they can anticipate symptoms. For example, high sugar content in some individuals’ diet may increase the risk of mania and they can reduce dietary sugar intake. Other non-medical practices like meditation and acupuncture may complement medication and therapy. Exercise is a critical element to relieving emotional and physical stresses.
What are the symptoms of bipolar disorder?
A helpful way of thinking about bipolar disorder symptoms is to see the symptoms in a “spectrum” rather than discrete behaviors because you may miss mild episodes. Mild episodes that did not receive proper medical attention may escalate into more serious episodes. Below is a short list of “gauges” for your reference; the medically accepted criteria for diagnosing bipolar disorder, DSM-IV, includes a more comprehensive list of symptoms of mania and depression.
Manic episode (less severe in hypomania):
* talking excessively and/or rapidly compared to usual character
* decreased need to eat or sleep, even for a few days
* exaggerated grandeur, “having plans to save the world”, “unifying religions”
* extreme cases include hallucinations and severe paranoia
depressive episode (overlaps with dysthymia):
* excessive sleeping or prevalent insomnia - disruption in usual sleeping pattern
* antisocial behavior and irritability
* prolonged feelings of inexplicable sadness, worthlessness
Why?
Many people ask the “Why me” question when confronted with a serious challenge. The alternative question is “why not me?” I find people who ask “Why not me?” inspirational because they used a devastation as a source of strength and growth.
Even though society is becoming aware of the devastating effects mental illness has on an individual and the people surrounding that individual, we are still quick to judge that person as being weak in character or having an immoral personality, and after having justified to ourselves why this is a bad person, we go about our own business. This may be easier for society to accept than to take actions to help the mentally ill, which does take a tremendous investment in time, effort, and money (as with all worthy causes).
What Treatments are Available?
There are many “first-line” treatments available. Often, these medications alone can control both the manic symptoms and depressive symptoms. However, an antidepressant may be added if depression is not alleviated with the mood stabilizer alone. It is extremely dangerous for a person suffering from bipolar disorder to take an antidepressant alone, because this can induce mania in the person.
New medications and treatment methods are becoming available for bipolar disorder, to improve the symptoms and quality of life for patients.
Is there Hope?
Yes.
Bipolar disorder does not have a “cure” but it can be managed with education, therapy, and healthy lifestyle practices (exercise, proper diet, enough sleep).
As with cancer and diabetes, bipolar disorder requires a ‘regimen’ of medical, dietary, and behavioral management. People with mental illnesses can lead productive lives. The key is to seek help before something catastrophic happens to our moods.
There is Hope when we create it for ourselves.
Where Do I Begin?
Finding out you have a mental illness is very frightening even when you probably have been living with it long enough to know something is wrong. You have talked to your friends and family members and nothing seems to be getting better. You suspect this may be more than just “psychological” or an occasional case of the blues. What do you do? Based on personal experience, here are important steps I’ve found that helped:
Write down a list
Write a list of what has been going on with you that puts you at the current point you are in. The reason why you’ll want to write this down (ex. “losing productivity at work, not eating, trouble sleeping”) is because you will have to recount them on the spot when you call a doctor. Answering questions can put you in an uncomfortable spot, so it will be easier to have things written down. When I first made the phone calls, I was embarrassed and nervous. I almost changed my mind and hung up the phone!
Here’s a short list to get you started; the list is actually based on a few of the criteria for diagnosis of major depression. For bipolar disorder, you may want to also include any extremes in behavior such as sexual indiscretion, spending sprees, incomprehensible and racing thoughts, or extreme euphoria.
You’ll probably need only a few items here for the initial phone call to make an appointment. Bring the entire list with any new information you can think of with you to the actual doctor’s appointment:
* How long have I felt this way?
* Have I lost sleep or slept more than usual?
* Have I gained weight or lost a weight in the past few weeks?
* Have I felt like doing nothing, including things I used to enjoy doing?
* Do I feel like if I were to disappear from the world no one would notice or care?
* Have I begun to try alcohol or painkillers (or any other drugs or substances) to try to “dull” the pain?
* Have I felt constantly irritated or aggravated for the past several weeks?
Call your insurance company
Find out who may be participating providers under your insurance. This is so you know what will be covered and what the policies are. The insurance companies will ask you for the symptoms and this is where your list comes in. When you are speaking with an insurance representative, remember to ask about coverage on medications and numbers of visits. Most health plans only cover a number of therapy sessions - after that you may have to pay a large percentage of the doctor’s fees. Medications may also have a copay.
Call the doctor
The receptionist will ask you why you believe you need help. Tell them what’s on the list.
Now you have a doctor’s appointment. Unless you got lucky (I didn’t!) and could see the doctor THAT AFTERNOON, you have to wait a few days - maybe even a week. What do you do till then?
Take control by learning
Educate yourself on what you may be facing. Chances are, you have a clue to what may be wrong (for example, “I feel more than just blue” or “My mood swings seem to be getting out of hand”). Even if you aren’t sure, there are places where you can browse to start homing in on what might be going on with your moods.
There are many shades of depression or bipolar disorder or traumatic disorder - you may learn which category you may fit in. Don’t be tempted to look at all the disorders and think that you have all of them! I want to emphasize that it is important NOT to make a self diagnosis. Many disorders have overlapping symptoms. If you make up your mind before speaking with a professional, you may cloud the presentation of the clinical symptoms by emphasizing what you believe should be emphasized.
Try to remain objective about the severity of the symptoms. Losing a few nights of sleep because you’re blue is not the same as losing 2 months of sleep because your mind is racing constantly.
Get support
The fastest means of support may come from a newsgroup. Newsgroups are also a wonderful resource for support. Why would you want to do that? Because one of the best things you can do for yourself right now is to seek support and know that you are NOT alone. Ask for email support if that is what you need. People posting there are likely to be going through what you may be going through and will be very glad to communicate because they have been where you are.
Getting support from news groups has been a tremendous help for me. One of the “common” characteristics of people who are depressed is a feeling of isolation and loneliness: “I’m the only weird nut feeling this way and no one else is as crazy as I am.” Getting in touch with people who understood how I was feeling was a big relief.
Remind yourself that it’s all right to “feel bad” then go through the motions of daily life. Sometimes people invalidate their feelings by telling themselves that they shouldn’t be feeling bad. They end up being angry with themselves, which makes them feel worse. Allow yourself to feel bad, but keep doing the boring everyday stuff. Even if you only get one thing done today, you did it, and it wasn’t easy.