Talking openly about mental health is considered by some of society as a taboo. To them, It shouldn’t be discussed in public, if it is spoken about it is in whispers and hushed conversations. Thankfully in recent years, the taboo has lifted slightly, more and more people with mental illnesses are opening up to friends and family, seeking medical help, even turning to social media to raise awareness for mental health. May 16th to 22nd is Mental Health Awareness Week, a week for educating others about the varying mental health issues including depression, anxiety and bipolar disorder. We may think we know and understand what bipolar disorder is, BUT after reading Tracie’s story we will truly know what it is like for her and others living with bipolar disorder.

Tracie’s Story

When I was in junior high school my parents wanted to send me to anger management, as I was usually very irritable. My moods and emotions could sometimes be all over the place. However, what none of us knew at the time was that these symptoms were an indicator of something far more complicated and involved than simply being angry.

When I was 32, I went to see my doctor after experiencing a difficult event in my life. I thought I was just depressed. However my doctor had another idea. She told me that she suspected I had bipolar disorder and not just depression, which I thought was bad enough. Needless to say, I freaked out! I had no idea there were two types of bipolar disorder.  All I knew was what most of you know; bipolar could either make you suicidal or crazy energetic. I had no idea what it all really meant, so my doctor sent me to a therapist to confirm the diagnosis.

Right after my appointment with my doctor, I called my then fiancé practically hysterical, which in hind sight probably scared the crap out of him. I met him at his work still crying, and showed him the bipolar pamphlet my doctor gave me. I had all but a couple of the symptoms and a bleak outlook on how my life would be from then on. I even told my fiancé that I would understand if he didn’t want to be with me anymore. He then told me that he wasn’t going anywhere, and was still looking forward to marrying me; that we would get through it together.

The therapist confirmed my diagnosis and explained the difference between Type 1 and Type 2. It actually answered questions I didn’t even know I had. I finally had an explanation to why my behavior and thoughts sometimes seemed out of my control. Once I knew what the diagnosis was, I started learning everything I could about bipolar disorder.

Over the years I’ve tried several different medications. Some have worked well, while others just made things worse. More days than not, I experience some mild to moderate depression and anxiety. Thankfully I’ve only had two episodes of full-blown hypomania, a milder form of mania that causes a noticeable difficulty in day-to-day activities, in the last 10 years. Unfortunately, they lasted for about 6 months each. My latest one, last year, was a mixed mania episode called agitated depression which resulted in extreme depression coupled with intensive crying, irrational behavior, uncontrollable anger, and sporadic anxiety. I was extremely depressed and crying ALL the time, while being irrational, angry, and very anxious. I describe this type of episode as being in an airplane that got hijacked. I knew what was going on, but I had absolutely no control over my words and actions. Many times I would say some awful things to my husband, who I married just a few months after my diagnosis. As soon as the words were out of my mouth I would burst into tears. My ups and downs were so rapid that I was seriously thinking of checking myself into the mental ward of the hospital.

Thankfully, I was able to get in to see a psychiatrist who started me on medication right away. The prescriptions she gave me were for my new bipolar diagnosis, my hyperthyroidism, and my Delayed Sleep Phase Disorder (which complicates my other diagnoses). In addition, I began seeing a therapist for talk therapy. All of this combined has worked very well at managing my symptoms, to include the depression and anxiety. Even though I don’t really care for taking a lot of medications, I also know they are necessary to the quality of my daily life.

Living with bipolar isn’t easy by a long shot. Not just for me, but those around me. My husband is a saint! As a disabled veteran, he has his own conditions to deal with; however, he is able to be very supportive and understanding of what I go though, even if he doesn’t understand much of it.

Describing bipolar disorder as a roller coaster is quite accurate. The lows, the highs, and the in betweens can be very scary, but with treatment, I’m able to manage them quite well. 

What Is Bipolar Disorder?

Bipolar disorder, formerly known as manic depression, is a mental illness that causes dramatic shifts in a person’s mood, energy and activity levels, the ability to think clearly, and the ability to carry out day-to-day tasks. People with bipolar experience high and low moods, known as mania and depression, which differ from the typical ups-and-downs most people experience.

On average, the age of onset is about 25, but it can occur in teenage years and even childhood, and affects men and women equally. There is around 2.6% of the U.S. population diagnosed with bipolar disorder, and almost 83% of diagnosed cases are classified as severe.

There are two types of bipolar disorder, with another two “sub” types; all of which involve clear changes in mood, energy, and activity levels.

• Bipolar I disorder involves periods of severe mood episodes from mania to depression. You need to have had at least one manic episode lasting at least 7 days, or have manic symptoms that are so severe that immediate hospital care is needed. This may precede or follow a hypomanic or major depressive episode, which tend to last at least 2 weeks. In some cases, mania can trigger psychosis, or a break from reality. A mixed mania episode is also possible.
• Bipolar II disorder is a milder form of mood elevation, involving milder episodes of hypomania that alternate with periods of severe depression, although it’s actually an entirely separate diagnosis from bipolar I disorder. You need to have had at least one major depressive episode and at least one hypomanic episode, but you’ve never had a manic episode. Typically in manic episodes of bipolar I disorder, they can be severe and dangerous. However, those with bipolar II disorder can be depressed for much longer periods, which can cause significant impairment in their daily lives.
• Cyclothymic disorder describes brief periods of hypomanic symptoms alternating with brief periods of depressive symptoms that are not as extensive or as long-lasting as seen in full hypomanic episodes or full depressive episodes. You need have had at least two years, or one year in children and teenagers, of these symptoms. However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.
• “Mixed features”, also known as “mixed mania”, refers to the occurrence of simultaneous symptoms of opposite mood polarities during manic, hypomanic or depressive episodes. It’s marked by high energy, sleeplessness, and racing thoughts. At the same time, the person may feel hopeless, despairing, irritable, and suicidal.

Regardless of the type, moods range between the “ups” and the “downs”. When you’re “up”, or in a manic episode, you may feel elated, have energized behavior, or be unusually irritable. When you’re “down”, or in a depressive episode, you can feel very sad, have hopeless periods, and lose interest or pleasure in most activities. Less severe manic periods are known as hypomanic episodes. All of these mood swings can affect sleep, energy, activity, judgment, behavior and the ability to think clearly. Episodes of mood swings may occur rarely, or even multiple times a year; some of which may last months at a time. Some people will experience some emotional symptoms between episodes, while some may not experience any.

Symptoms

Bipolar symptoms, and their severity, can vary. A person with bipolar disorder can have very distinct manic, hypomanic, or depressed states. They can also have extended periods, sometimes years, without symptoms. In addition, these states can also present both extremes simultaneously or in rapid sequence.

When a person with bipolar experiences severe bipolar episodes of mania or depression, they may also include psychotic symptoms such as hallucinations or delusions. Most often these psychotic symptoms are a mirror of a person’s extreme mood. When these psychotic symptoms present, they can be wrongly diagnosed as having schizophrenia.

To receive a bipolar disorder diagnosis, a person must have experienced at least one episode of mania or hypomania. Hypomania is a milder form of mania, and usually doesn’t include psychotic episodes. People who experience hypomania can often function well at work and in social situations. Episodes of mania or hypomania can happen many times throughout life, or be rarely experienced.

Typically someone with bipolar can find elevated moods of mania appealing, especially if it occurs after a depression episode. However, the “high” that is felt with mania doesn’t stop at a comfortable or controllable level. Their moods can very quickly become more irritable, behavior more unpredictable, and judgment more impaired. During periods of mania, people frequently behave impulsively, make reckless decisions and take unusual risks. Some of these include impulse purchases, dangerous activities, and unsafe sexual practices.

However, most of the time, people in a manic state are unaware of the negative consequences of their actions. They don’t think of the financial downfall, such as purchasing big ticket items that you can’t afford or going on a shopping spree that drain your accounts. There are health risks associated with them as well, such as suicide. Suicide is an ever-present danger for someone with bipolar disorder, due to the fact that some become suicidal even in a manic state, and not just during depression. So many think that you only attempt suicide if you’re depressed, but with bipolar mania your moods, energy, and racing thoughts can create a false sense of fear, which leads to thoughts of a permanent ending.

The lows of bipolar depression can be so debilitating that some may not be able to get out of bed, let alone able to do the basic functions of life. Many who experience a depressive episode have difficulty falling and staying asleep, while others sleep far more than normal. When people with bipolar are depressed, even the most minor decisions of life, such as what to eat for dinner, can be extremely overwhelming. Obsession with feelings of loss, personal failure, guilt or helplessness can lead to thoughts of suicide. To receive a diagnosis of bipolar, the symptoms of depression that hinder a person’s ability to function must be present almost every day for a period of at least two weeks, and is usually much more difficult to treat.

Symptoms in children and teens

The symptoms of bipolar disorder can be difficult to identify in children and teens, which is why I wasn’t diagnosed until my 30’s. Many times it’s hard to tell if these are normal ups and downs of childhood, the results of stress or trauma, or signs of a mental health problem other than bipolar disorder.

Children and teens may have distinct major depressive, manic, or hypomanic episodes, and the pattern of these episodes can vary from that of adults with bipolar disorder. Moods can also rapidly shift during these episodes, and even include periods without mood symptoms between episodes.

The most prominent sign of bipolar disorder in children and teenagers typically presents as severe mood swings beyond their “normal” mood swings.

Mania and hypomania

Although mania and hypomania are two distinct types of episodes, they tend have many of the same symptoms. Mania causes more noticeable problems and impairments at work, school, social activities, as well as relationship difficulties. Mania can also trigger psychosis, and hospitalization is typically required due to hallucinations, delusions, or lack of self-awareness. 

Hypomania includes the same symptoms, but in a milder form. A person experiencing hypomania usually feels very good, is highly productive, and functions well in their day to day lives. They may not feel like anything is wrong, however, family and friends can typically recognize the mood swings and changes to their activity levels. Without being treated properly, people with hypomania can sometimes develop severe mania or depression.

Both manic and hypomanic episodes include three or more of these symptoms:

• Abnormally upbeat, jumpy, or wired
• Increased activity, energy, agitation, irritability, or feeling “touchy”
• Exaggerated sense of well-being and self-confidence; a feeling of uphoria
• Decreased need for sleep
• Unusual talkativeness about a lot of different things
• Racing thoughts
• Distractibility
• Think they can do a lot of things at once
• Poor decision-making — for example, going on buying sprees, taking sexual risks or making foolish investments

Major depressive episode

A major depressive episode typically includes severe symptoms, which can cause noticeable difficulty in day-to-day activities, such as work, school, social activities, or relationships.

An episode includes five or more of these symptoms:

• Depressed mood, including sadness, feeling empty, worried, hopeless or tearful (in children and teens, depressed mood can appear as irritability)
• Marked loss of interest or feeling no pleasure in all, or almost all, activities
• Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in children, failure to gain weight as expected can be a sign of depression)
• Either insomnia or sleeping too much
• Either restlessness or slowed behavior
• Fatigue or loss of energy
• Memory and cognitive issues
• Increased or decreased appetite
• Feelings of worthlessness
• Excessive or inappropriate guilt
• Decreased ability to think or concentrate
• Indecisiveness
• Thinking about, planning or attempting suicide

Other features of bipolar disorder

The signs and symptoms of both bipolar I and bipolar II disorders can also include other features. Some of these are anxious distress, melancholy, psychosis or others. In addition, bipolar symptoms can also occur during pregnancy, or even change with the seasons.

Causes and risk factors

As of now, scientists haven’t discovered a single cause of bipolar disorder, and they do not believe there is one cause. They currently believe there are several contributing risk factors that can trigger the first episode, including:

• Genetics and family history: If a child’s parents or siblings have bipolar disorder, the chances of developing the disorder are increased. However, the role of genetics is not absolute. A child from a family with a history of bipolar disorder may never develop the disorder. In addition, studies of identical twins have found that, even if one twin develops the disorder, the other may not even though they share the same genes. Researchers are currently trying to find which genes are involved in causing bipolar disorder. However, it’s important to know that most people who have a family history of bipolar disorder will not develop it.
• Stress: A stressful event such as a death in the family, an illness, a difficult relationship, divorce or financial problems can trigger a manic or depressive episode. This leads to a belief that a person’s handling of stress may also be a contributing factor in the development of the illness.
• Brain structure and function: Even though brain scans cannot diagnose bipolar disorder, some researchers have identified subtle differences in the average size or activation of some brain structures in people with bipolar disorder. It appears that people with bipolar disorder have physical changes in their brains. Although the significance of these changes is still unclear, but will hopefully help pinpoint causes in the future. 
• Drug or alcohol abuse: Some researchers believe that extended drug or alcohol abuse may contribute to bipolar disorder, as they change pathways and synapses in the brain.

Diagnosis

A proper diagnosis and treatment plan can help people with bipolar disorder lead healthy and productive lives. Speaking with a doctor, or a licensed mental health professional, is the first step for anyone who thinks they may have bipolar disorder. In order to properly diagnose bipolar disorder, a doctor may conduct an interview with you, perform a physical examination, and order lab tests. In addition, a person must have experienced at least one episode of mania or hypomania. Even though bipolar disorder can’t be seen on a blood test or even a body scan, these tests rule out other illnesses that have the same symptoms as bipolar disorder. If there are no other illnesses (or medications) causing the symptoms, the doctor may recommend mental health care at that time.

Mental health care professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose the “type” of bipolar disorder a person may be experiencing. To determine what type of bipolar disorder a person has, mental health care professionals examines the pattern of symptoms, and how impaired the person is during their most severe episodes.

Related Conditions

Some of the bipolar disorder symptoms are similar to other illnesses. This can make it hard for a doctor to make a diagnosis.

In addition, people with bipolar disorder may also experience other health conditions that need to be treated along with bipolar disorder. These include, but are not limited to:

• Anxiety disorders
• Eating disorders
• Sleep disorders
• Attention-deficit/hyperactivity disorder (ADHD)
• Post-traumatic stress disorder (PTSD)
• Alcohol or drug problems

People with bipolar disorder also have a higher risk for thyroid disease, heart disease, diabetes, obesity, migraine headaches, and other physical illnesses.

They can also be wrongly diagnosed with schizophrenia, due to the possible psychotic symptoms, or Borderline Personality Disorder (BPD). Sometimes, if a person with severe episodes of mania or depression can also have psychotic symptoms, such as delusions or hallucinations. Someone experiencing psychotic symptoms while having a manic episode may believe they have a lot of money, are famous, or even have special powers. In addition, someone having psychotic symptoms during a depressive episode may believe they have committed a crime, or that they are ruined and penniless. 

Due to these other illnesses and misdiagnoses, it can make it hard to treat bipolar disorder. Some medication for other illnesses and disorders may worsen symptoms of bipolar disorder, and can even trigger a manic episode. If you have more than one condition (called co-occurring disorders or comorbidity), you’ll need to get a treatment plan that’s individual to you.

Treatments and Therapies

Getting the proper treatment can help many people, even with the most severe forms of bipolar disorder, get better control of their mood swings and other symptoms. For a treatment plan to be effective, it typically includes a combination of medication and psychotherapy (also known as “talk therapy”). Because bipolar disorder is a lifelong illness, episodes of mania and depression typically reoccur over time. In between manic/hypomanic and depressive episodes, many people are free of mood changes, but some people can have lingering symptoms. Long-term, in order to help control these symptoms, continuous treatment is required.

Some of the ways bipolar disorder is treated and managed are:

• Psychotherapy, such as cognitive behavioral therapy (CBT) and family-focused therapy.
• Medications, such as mood stabilizers, antipsychotic medications and sometimes antidepressants.
• Interpersonal and social rhythm therapy
• Psychoeducation
• Self-management strategies, like recognizing of an episode’s early symptoms and education.
• Complementary health approaches, such as aerobic exercise, meditation, faith and prayer can support, but not replace treatment.

Psychotherapy, also called “talk therapy”, combined with medication, can be an effective treatment for bipolar disorder. It can provide education, support, and guidance to people with bipolar disorder and their families. 

There are different types of medications that are helpful in controlling symptoms of bipolar disorder. Sometimes several different medications, before finding ones that work best, are needed.

The most common medications used to treat bipolar disorder include:

• Mood stabilizers: A mood stabilizer is a psychiatric pharmaceutical drug used to treat mood disorders characterized by intense and sustained mood shifts.
• Atypical antipsychotics: The atypical antipsychotics are a group of antipsychotic drugs used to treat psychiatric conditions.
• Antidepressants: Antidepressants are medications that can help relieve symptoms of depression, social anxiety disorder, anxiety disorders, seasonal affective disorder, and other conditions.

As with any medication you should talk with a doctor to understand the risks and benefits of the medication, to report any concerns about side effects to a doctor right away, and before stopping a medication. Suddenly stopping a medication may lead to “rebound” symptoms of bipolar disorder, which can be uncomfortable or have potentially dangerous withdrawal effects.

There are other treatments that work well for people with bipolar disorder. Some of these include:

• Keeping a Life Chart: Mood changes can occur, even with proper treatment. When a client and doctor work together and talk openly about concerns and choices, treatment is most effective. Keeping a life chart that records daily mood symptoms, sleep patterns, treatments, and life events can help both the patient and doctor track and treat bipolar disorder in the most effective way.
• Sleep Medications: Having trouble sleeping is common with bipolar disorder. Medications can help with sleep, and therefore with the bipolar symptoms. However, if your sleep doesn’t improve, a doctor may suggest a change in medications leading to possibly prescribing sedatives
• Electroconvulsive Therapy (ECT): ECT, formerly known as electroshock therapy, can help provide relief for people with severe bipolar disorder symptoms who haven’t been successful with other treatments. Sometimes ECT is used for bipolar symptoms when other medical conditions, including pregnancy, make taking medications too risky. ECT is a psychiatric treatment where seizures are electrically induced in patients to provide relief of bipolar symptoms. It can also cause some short-term side effects, including disorientation, confusion, and even memory loss. 

Prevention

Bipolar disorder has no sure way to prevent it. However, by getting treatment at the first sign of mental health symptoms can help prevent bipolar disorder, or other mental health conditions, from worsening.

Some strategies that can help prevent minor symptoms from becoming full-blown episodes of mania or depression in bipolar disorder are:

• Paying attention to warning signs. By addressing symptoms early on, you can prevent episodes from getting worse. If you’re able to identify a pattern to your bipolar episodes and what triggers them, you have a greater chance of ensuring they aren’t severe. If you feel that you’re falling into an episode of depression or mania, call your doctor as soon as possible. Involving your family members or friends in watching for warning signs is also a great tool.
• Avoid drugs and alcohol. Using alcohol or recreational drugs can worsen your symptoms and make them more likely to come back.
• Take your medications exactly as directed. Many times, those with bipolar disorder may be tempted to stop their treatment. Please don’t. Stopping your medication, or reducing your dose on your own, may cause your symptoms to worsen or return, or even suffer withdrawal effects.

When to see a doctor

People with bipolar disorder, despite the mood extremes, often don’t recognize how much their emotional instability disrupts their lives and the lives of their loved ones. This results in not getting the treatment they need.

Some people with bipolar disorder might enjoy the feelings of euphoria and cycles of being more productive. This euphoria is always followed by an emotional crash. It can leave you depressed and worn out; possibly in financial, legal or relationship trouble.

Bipolar disorder doesn’t get better on its own. If you have any symptoms of depression or mania, please go see your doctor or mental health professional right away. Getting treatment as soon as possible can help you get your symptoms under control.

When to get emergency help

Suicidal thoughts and behavior are common among people with bipolar disorder. If you have thoughts of hurting yourself, call 911 or your local emergency number immediately, go to an emergency room, or confide in a trusted relative or friend. Or call a suicide hotline number. In the United States, call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255).

If you have a loved one who is in danger of suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.

Sources:

National Alliance on Mental Illness

https://www.nami.org/Learn-More/Mental-Health-Conditions/Bipolar-Disorder

National Institute of Mental Heath (NIMH)

https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

Mayo Clinic

https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955

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