Disease Profile: Bipolar Disorder

What comes to mind when you think of bipolar disorder (also called manic depression or bipolar depression)? I polled some users on r/bipolar2 and asked them what they thought were the most common stereotypes about bipolar disorder. Here are some thing that they said: Bipolar people are expected to have erratic, uncontrollable mood changes. Bipolar individuals can’t have genuine or justified emotions. That bipolar disorder isn’t real or that you are simply going crazy. Somehow having bipolar disorder means you can’t form or have meaningful relationships and drive cars.

Bipolar disorder is characterized by periods of extreme high mood (mania/hypomania) and periods of extreme low mood (depression). These periods of extremely high mood typically consist of very high energy and risky behavior. Depression is essentially the opposite, with very low energy and mood. This all seems very extreme, but sometimes bipolar disorder can be very subtle. Hypomania is a less severe form of mania, more like the depression just lifting. It may even feel good to some patients. Or some may experience periods of mixed emotions, both manic and depressive symptoms at once. Sometimes the person can function during these episodes very well and sometimes not so well.

There are two types of bipolar disorder, with some people falling a bit outside of these two categories. Bipolar 1 is the most thought of when it comes to bipolar disorder. These patients experience the manic highs, depressive lows, and occasionally psychosis (experiencing delusions or hallucinations). Bipolar 1s will cycle only a couple times in a year, maybe less. Manic episodes typically last three to six months, while depressive episodes are longer at six to twelve months. Bipolar 2 is the lesser known type, experiencing hypomania instead of mania. The criteria for bipolar 1 diagnosis is only the presence of a manic or mixed episode for one week that significantly impairs normal functioning. The bipolar 2 diagnosis requires both a hypomanic  and depressive episode. This suggests that depressive episodes are more common in bipolar 2s, though not exclusively found in bipolar 2s.

Treatments for bipolar disorder can be any combination of medication, psychotherapy, and possibly other treatments. Medications aim to stabilize mood and prevent psychosis. This can be through mood stabilizers such as lithium, antidepressants such as Prozac, or antipsychotics like perphenazine. Some people need a combination of these and others need just one. Psychotherapy can also be helpful for patients in coping, education, and support. Electroconvulsive therapy (ECT) may provide relief for patients who have not found relief from other treatments or cannot take medication.

Bipolar disorder is a lifelong illness. There is no cure. Treatments are very effective, but at the end of the day a bipolar patient will always have some issues with mood episodes. I took to the website Reddit and specifically the subreddit r/bipolar2 to ask actual patients what their experiences were. Here are some things they said:

  • They are scared of themselves while experiencing an episode. Mania makes them irresponsible and self-destructive. Their decisions while manic affect their mental and physical well-being when the mania ends. They have ruined relationships and their finances. They have to take time off work, especially when depressed. They talked about how horrible finding the right medication can be. How it takes so long and all the while you are still dealing with the disorder.
  • They feel like no one understands them. They haven’t found a good support system. They feel like whenever they are manic they are easier to deal with and they can make friends. When the depression comes, they get the riot act from others about how it is all about their attitude and how hard they are to deal with all the time.
  • Medication keeps them stable, but it makes them feel very numb. They enjoy being hypomanic. The depression makes doing anything hard for them. They mostly try not to be negative, but it’s really hard when the voice in their head is so critical of every choice.
  • When they’re hypomanic, they can do anything and everything. Everyone else is just dumb and slow. They are very productive and goal-oriented. When they are depressed, they get suicidal. They panic with any small thing and that triggers the suicidal thoughts.

These are real people struggling with something they desperately wish they could control. It’s all about finding the right medication and having a good support system. I hope this has increased your understanding of bipolar disorder and of the people dealing with it. I also hope that maybe you can be that support system, not just for those with bipolar disorder, but for anyone with a mental illness.

 

Sources:

NIMH Bipolar Disorder. (2014). Nimh.nih.gov. Retrieved 13 June 2017, from https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: fifth edition. Arlington, VA: American Psychiatric Publishing.

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