I was trying to figure out how someone close to me could be so depressed and hopeless that she was suicidal one day, and be in a good mood the next. This happened repeatedly, so I looked into the possibility of bipolar disorder. I dismissed it because she never seemed to be full of energy and extremely "up," as I had always heard mania described.
Then one day, I was watching a program about celebrities with mental illnesses, which featured Linda Hamilton and her bipolar disorder. Her mania was described as extreme irritability and sometimes violent aggression. That's when it clicked! You don't have to be extremely "up" to be manic!
Bipolar disorder is usually diagnosed in a patient's teens or early twenties, although some people develop symptoms later in life. Often, it is only the patient's depression that is recognized and reported to doctors. Their mania is when they feel "good," and they don't see that as a symptom, so they don't report it. For this reason, many sufferers of bipolar disorder are misdiagnosed as suffering only from depression. They are given antidepressants, which can send them into mania, or intensify their mania.
Mania sounds good on the surface. Who wouldn't want to have lots of energy and get monumental projects done? But aside from the possible irritability and aggression, there are other negative aspects of mania. Patients who are manic have a tendency to go on unaffordable spending sprees and participate in risky behaviors such as promiscuity or gambling. They might go days without sleeping, and they might also become angry or feel "wired." They might talk a lot and very quickly, changing subjects frequently. Some manic patients delve into unwise business agreements, losing everything they own.
A period of normalcy might come before a bout of depression, which of course, is characterized by overwhelming sadness, hopelessness, lethargy, and a preoccupation with death or suicide, etc. There are also episodes when sufferers might exhibit both manic and depressive symptoms. These are called mixed states, or mixed episodes.
In years past, psychiatrists used very strict criteria about specific length and occurrence of episodes in a year's time, in order to diagnose bipolar disorder. Now, they have a much better understanding of mixed episodes, as well as the more rapid cycling of the manic and depressive episodes in some patients (although many psychiatrists still adhere to the original criteria).
There is also a better understanding in that sometimes the mania might not be so extreme in some patients. Hypomania is a milder form of mania, which many bipolar sufferers enjoy, when compared to their depression.
Cycling refers to the change between the episodes of mania and depression. Rapid cycling bipolar disorder is when a patient has four or more episodes of major depression, depression, mania, hypomania, or mixed episodes in a year. Ultra rapid cycling means that episodes may last no more than 24 hours. In ultra-ultra rapid cycling, episodes may change several times within 24 hours. Continuous cycling is when the patient's mood changes are almost constant.
* Bipolar I Disorder--Manic or mixed episodes lasting at least seven days, or such severe manic symptoms that hospital care is required. The patient also has depressive episodes usually lasting at least two weeks. Symptoms must be a major change from the patient's normal behavior.
* Bipolar II Disorder--A pattern of depressive and hypomanic episodes, shifting back and forth, but without full-blown manic or mixed episodes.
* Bipolar Disorder Not Otherwise Specified (BP-NOS)--Diagnosed when patient's symptoms do not meet the specific diagnostic criteria for either bipolar I or II, but the symptoms are clearly out of the patient's normal range of behavior.
* Cyclothymic Disorder, or Cyclothymia--A mild form of bipolar disorder in which patients have episodes of hypomania and mild depression which shift back and forth for at least two years. Symptoms do not meet criteria for any other type of bipolar disorder.
People who have a parent or sibling who is bipolar are four to six times more likely to develop the illness than those without a family history of bipolar disorder. Genetics, as well as brain abnormalities, are thought to be among the possible causes for bipolar disorder.
There is no blood test or brain scan which can identify bipolar disorder, but these tests can rule out other possible causes of the symptoms. Psychiatrists usually speak with family members of the patient to better get a picture of the symptoms and behavior of the patient. This is important because of misdiagnoses due to patients not reporting their manic episodes.
Bipolar disorder is usually a life-long disease which tends to worsen if it isn't treated. There is no cure, but there are some effective treatments, including psychotherapy and medications. Mood stabilizers are usually the most effective treatment for bipolar disorder.
Atypical antipsychotics are sometimes prescribed for patients who also suffer from a state of being out of touch with reality, which might include hallucinations and/or delusions.
If you are diagnosed with bipolar disorder, it is extremely important that you continue to follow your doctor's orders regarding medications, psychotherapy, exercise, sleep schedule, etc. If you believe that your medication is not working for you, DO NOT discontinue the medication without your doctor's consent. Doing so could be detrimental to your health, so please contact your doctor before making any changes.
It is also extremely important that you keep track of any side effects that you might have. Some of the side effects possible with some medications can be very serious--even life threatening. Notify your doctor immediately if you notice any side effects.
Those who are diagnosed with bipolar disorder have a 10-30% higher rate of suicide than the general population. If you have a loved one who is bipolar, please watch for the warning signs of suicide. Never take the threat of suicide lightly. Do not leave a suicidal person alone.
If you are having thoughts of taking your life, please seek help immediately. If you do not know of a suicide prevention hotline, call 911. Just remember that what might seem like the end of the world tonight, might not seem like that big a deal tomorrow. As long as you're still here, there is still hope for you. Don't make the mistake of preventing yourself from finding happiness. There is help available to you, so reach out and feel better!
Bipolar Disorder. National Institute of Mental Health. www.nimh.nih.gov.
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