With an opioid epidemic brewing and a sharp spike in suicide rates across the US, equitable access to mental healthcare is more important than ever. The Mental Health Parity and Addiction Equity Act, signed in 2008, intended to make mental health treatment as accessible as surgical/medical treatment. But what happened after it was passed?
Behavioral healthcare visits were still 6 times more likely to be out-of-network than medical/surgery visits in 2015. Out-of-network means that the health care provider does not have a contract with your health insurance company. This is more expensive than recieving in-network care. In New Jersey, 45% of behavioral health visits were out-of-network in 2017. In DC, that number is at 63%. The disproportionate percentage of out-of-network visits is troubling, as none of those visits are covered by insurance. Instead, the patient or their family must pay the whole bill.
Here is Just How Costly Psychiatric Treatment Can Be.
An initial consultation with a psychiatrist costs $500 on average, and each subsequent appointment costs at least $100 per hour, according to Angie’s List. Assuming that each appointment is an hour long and is attended once weekly, that’s at least $5700 per year. In three years, the total cost adds up to $16,300. Imagine having to pay $16,300 just to seek psychiatric treatment. Having to pay $16,000 for basic treatment ranges from burdensome yo impossible for many people.
Because many people simply cannot afford that treatment, some people don’t seek out the help they need. Skipping treatment has real consequences for the human body. From a rapid decline in mental health to unexplained chronic pain, untreated mental illness becomes a slippery slope towards serious consequences.
The message is clear: High treatment costs come with an even heftier toll: a worldwide pandemic of mental illness.
Why is this the case?
Because of low reimbursement rates, mental health care professionals are often unwilling to contract with insurers. Hence, there are drastically fewer in-network therapists to satisfy the needs of the patient population. What is left is a vast network of expensive, out-of-pocket mental health professionals, discouraging some from seeking treatment simply because some simply cannot afford it.
Rising costs, however, are only a fraction of the barrier patients face when seeking mental health treatment.
Cultural Perspectives of Mental Illness
According to one review done by the University of California San Francisco and Kaiser Permanente, mental illness is accompanied by “enormous personal suffering and socioeconomic costs.” Because many people still do not believe that mental illness exists, those who actually need treatment are denied by non-psychiatric physicians who do not believe their patients’ concerns and symptoms. In many cases, brain autopsies reveal nothing about certain mental diseases, so mental illness remains largely invisible.
Hence, mental illness continues to be a far-off, abstract concept to many, even when the symptoms are very much real. The refusal to acknowledge mental health concerns reflects a cultural lack of empathy around mental illness, as we continue to only be concerned with tangible as a whole–not the intangible. We need to move beyond that and consider that though mental illness is invisible to the eye, it being invisible does not make it any less real.
I find this denial towards the mentally ill disappointing. Some perceive themselves as being “compassionate enough” for saying a few comforting words. That, however, is not enough. We focus too much on what can be seen, whilst ignoring the unseen. It was common for Neurologists to do this towards the end of the 19th century, and we still do that today.
The Impact of this Widespread Denial
Experiencing a lack of sympathy often discourages people from seeking treatment. In fact, the disdain for mental illness implies that hiding our illness is actually better–when that is clearly not the case. The sad reality is that this delayed treatment worsens mental illness outcomes, as suggested by one study done by the University of British Columbia and the University of Calgary. Hence, those who are suffering are often left in the dark and without treatment. Life for those who suffer from untreated mental illnesses becomes a perplexing whirlpool of denial and hopelessness.
The Normalisation of Hurtful Language
It’s as if the balance of society’s focus towards the visible and invisible is skewed. It is common to replace medically accurate terms with offensive language. Words like “psycho” and “lunatic” need to go. These words only fill the gap between the unknown and satiate the unconscious bias. Using pejorative adjectives to describe one who is seemingly “scary” is unacceptable because these terms isolate and oversimplify. These words seek to villainize, not humanize. Calling a mentally ill person a word such as “psycho” is never productive.
People with mental health issues experience genuine and complex struggles that should not be oversimplified. These words are devoid of compassion and may discourage some from seeking treatment because these words focus not on the treatment, but the condition.
Collin Wong is an Inflammatory Bowel Disease blogger and advocate on Collin’s IBD Chronicles. In the thick of the college application process, he decided to start a blog after realizing the lack of Asian Americans in disease blogging. He was diagnosed with Crohn’s Disease in 2006, and he started this blog as a way to give an Asian American perspective on IBD. Outside of blogging, he is a full time student who aspires to be a doctor one day.
When I was first diagnosed with anxiety, PTSD, and OCD; I asked my counselor how I could have PTSD when I had never been in the military. There is so much misinformation and stigmas about anxiety and PTSD in our culture. If you have any mental illnesses, and if you have one that is normally tied to certain lifestyles/experiences, you aren’t supposed to talk about it. I have heard many times that it’s all in my head and to get over it; that if I just change the way I think, I will be fine. I developed my PTSD from a car accident I was in and some assaults that had happened while I was in college. Eventually, I had to admit to my “issues” and then talk about it with my counselor in order to try and find the best way to work through it or find coping skills/tools to be able to function in society. I was working at the time and still am working, but I need to watch my surroundings for triggers.
There are days where I struggle with my body, both physically and mentally. I feel like I should be helping more, but cannot due to my body that day. My anxiety makes me argue with myself and go rounds in my head, fighting the mental battle in what I should be trying to accomplish. On bad days, I second guess everything and am afraid of being judged. I give excuses for my choices and slip them into the conversations to defend my choices because I think they are judging me. No one told me that anxiety and PTSD would control every decision I make. I was never told how much it could impact my life and that I would have almost no friends because I was too anxious to go hang out.
After having my daughters, I was diagnosed with PPD and PPA. Prior to
this I had only heard about PPD because of the episode from Scrubs and never
truly knew how often it was diagnosed. I just thought that it sometimes happens,
I was never informed that if you already have anxiety or depression you are
more prone to developing PPD or PPA or that it could develop any time up to two years
postpartum.
My anxiety symptoms
I had such high anxiety that I did not take my daughters anywhere and
refuse to go out into public. I have fears that I am being judged as a “bad”
parent, when in all honesty I am doing the best that I can physically and
mentally do. I have that guilt as a parent that I am not doing enough and then
I hear small comments that my daughters don’t get interactions with others
their age. It then takes me a few weeks before I try to set up a playdate, and
then cancel it again a couple days before to the day of. Sometimes I have
to cancel due to my body not functioning and other times I cancel because my
anxiety gets in the way. It is a vicious cycle that won’t ever stop.
I had gotten a service dog to help mitigate my disabilities, mostly
physical, but some mental. My service dog helps with alerting to anxiety/panic attacks
and she helps lessen my triggers for my PTSD. I have only recently become
comfortable, to an extent, to talk about these things. I never wanted to admit
to having PTSD or anxiety and struggled letting my husband know about them when
we got engaged. I felt broken and damaged when I realized that they don’t go
away, you can do counseling, therapy, etc and they will always be there.
Unfortunately, having my service dog with me can cause more anxiety in certain situations or when I’m having a bad day mentally. Some people can be outright rude when confronting me about my service dog because I don’t seem blind (I am not blind) or I don’t look like I have served in the military (I have not). These are the stigmas in society that can cause misinformation being spread and therefore making it harder for me to get out of the house.
My PTSD Symptoms
Some of the symptoms I have to deal with because of my PTSD are: nightmares (night-terrors), guilt, poor judgement (happens a lot to me, especially through social media), flashbacks, insomnia, anxiety (with having anxiety from separate issues this is a double whammy), avoidance (I do this a lot because I play “what if” scenarios in my head), startle response (my service dog is trained to help lessen these), negative self-image, stress, and isolation. These are some of the symptoms of PTSD, there are many more, but these are the ones that I experience almost daily.
My service dog is trained to help with my PTSD and anxiety by alerting or doing a few other coping mechanisms. She will alert when she notices my heartrate rising before I notice it, which is an indicator that I am about to go into an anxiety/panic attack. Typically, she will then guide me out to my car or to a quieter area where I can then sit on the ground with her. She will sometimes put herself between me and what is stressing me out (I struggle with crowds). When I am putting myself in a situation that I know will cause me to panic or have a PTSD flashback, I will give her a command to guard/watch. This is where she will turn around facing behind me, which gives me a sense of security. If my flashbacks, anxiety/panic attacks persist after she’s guided me to a quieter place, she will then do DPT, which is deep pressure therapy. She will also use DPT for another thing that she alerts to, but this is not associated with my mental illnesses.
I Am Thankful For The Support I Recieve
With my service dog, I am able
to cope better with my symptoms and function out in society better. I did not
initially get a service dog to help with these things, these tasks came about
soon after I was diagnosed with PTSD, which was around 3 years after I had
gotten my first service dog. There are other tasks that I have added slowly as
my body physically gets worse over time and as I am learning that I need more
help.
Along with my service dog that helps me cope and function on my own, I
am grateful for a great support system. My parents, parent-in-laws,
husband, and a couple friends; help me be able to enjoy life and don’t guilt me
(that often) when I bail out or am struggling mentally. I truly believe
that if I didn’t have the support system that I do have, I would not be able to
function as well as I do. Sometimes all I need is a good listening partner so
that I can process how I am feeling and why I don’t want to leave the house.
It also helps when I
have someone be able to go out on errands with me so that I do not have to be
alone. Other times, they gently push me to do things that I wouldn’t normally
have the guts to do, like write this article. My anxiety got in the way and it
took me three weeks to write this in fear of being judged. Lots got
deleted, put back in, deleted, and then put back in again. My support system
helped me to feel comfortable to write this and have it published in this blog.
Throughout a person’s life they face multiple events that are potentially life changing. These changes can be stressful and difficult to come to terms with. It can be something small or more significant, for example a relationship breakup, a birth, death or being diagnosed with a chronic illness or disability. Change can be extremely difficult to process. A person might begin to feel sad about what’s happening, they might feel hopelessness, loose interest in anything they normally love doing, as well as crying unexpectedly. This inability to cope with change is called Adjustment Disorder (AD). Today as part of Mental Health Awareness Week, Tylia is going to share her story of how she overcame on Adjustment Disorder
When It All Began
It all started last March I was looking out the window while driving to a regular doctor’s appointment. It was a gloomy morning. I looked at the road and saw all the cows and farms on the country road that led me to the Doctors Office.
I turned to my mom and told her I had been feeling more sad than usual and that I needed to talk to the doctor about it. My mom lowered the volume of the radio. She looked worried, like any mother would. She said it probably causes we just moved to Clermont not that long ago and I don’t know anybody here
Little did she know it was more than that. It was the fact that I was feeling trapped in my body more than usual due to my condition. Cerebral Palsy affects my mobility and my ability to get around. I’m constantly confined to a wheelchair twenty-four hours a day although I’m very sociable and I go out with friends and I’m a college student I tend to always feel like I’m a glitch in video game still trying to find my way. Luckily, I found my passion for writing at a young age, after the death of my friend. But all the sudden the one thing I loved the most since I was a teenager didn’t help me during this time. Although on the outside I seemed to have it all, on the inside I was secretly breaking down each day. Getting angry at my situation and how things weren’t working out in my life at the age of twenty-two.
Seeking Professional Help
I told my doctor about how I was feeling, and she referred me to a mental health doctor. In the meantime, me she prescribed Fluoxetine to help with my anxiety and depression. I Needed to take it every single day, cutting the pill in half and placing it in my orange juice every morning.
At first, when taking Fluoxetine, it helped focus a lot and my emotional state. I was doing okay but after a while, I would become hungry and would want to eat junk food every few minutes while being focus on what I was doing but after a while I started to have the mindset that I needed to take the pills to be happy. I felt like I no longer had control of my life. As someone who is an inspiration to many people, I couldn’t lift myself to see a happy light in my life again.
A few months passed and I finally got to see a therapist. I was very open about feeling trapped in my body and the difficulty of being an adult with Cerebral Palsy. At the end the therapist said, “based on everything you told me I’m going to diagnose you with anxiety and Depression, Adjustment disorder.”
At first, I was crushed. How could someone like me, who has everything going for her, have a disorder like AD at the age of twenty-two? I spent the next couple weeks angry at the world. The Fluoxetine was taking a toll on my body. I started to get pimples all over my body. I was facing this major challenge in my life my now ex-boyfriend walked out on me. That caused me to get more depressed to the point where I stopped eating, writing, and going to school. I basically stopped my life.
The Turning Point For My Adjustment Disorder
Until I woke up one day, with the support of my family and my friends. I told myself I wasn’t going to let AD to take over my life anymore. I wasn’t going to take Fluoxetine anymore either.
As of September 8th, 2018, I haven’t taken a single pill and I’m much happier. I’m now an advocate for mental health and I started to write again. I completed my second novel and I’m continuing my studies.
My message to anyone struggling with mental health is you gotta keep on stomping regardless of the darkness you see they’re always a light.
About The Author
Tylia Flores is a 24-year-old born with cerebral palsy. Although her condition has affected her mobility, it has never affected her will and determination to make a difference in the world. Through her many life challenges and obstacles, she discovered her passion for writing. Tylia’s goal in life is to share her stories with the world.
Writing may be one of my biggest loves in this life, but it’s also one of my biggest struggles thanks to my health. As a person with chronic illnesses and major mental health struggles, I don’t write as much as I would like to or as much as I used to.
I still find the same release in writing that I always have found but, more often than not, I just can’t bring myself to write. Post-exertional malaise from my ME, and cognitive difficulty from my fibromyalgia makes the activity of writing difficult in itself, but there’s more to it than that for me; a different kind of blockage that can be hard to pin down.
The Blockage
This piece has been doubly difficult for me to write. Not just because of the writing process itself, but because of the subject matter. I chose to write an article for Mental Health Week about depression. And depression makes me lose interest in the things I love. There’s definitely an irony in struggling to write about depression because of depression, isn’t there?
I want my writing to make others feel less alone, but how on earth was I going to approach this topic? When it comes to something as multifaceted as mental health, it can be difficult to know where to even start. My brain quickly got to work on bullying me.
Why would anyone want to read something you wrote anyway?
You have nothing interesting to say. All your work is bland and rubbish, just like you.
I don’t know why you even bother.
There are too many better writers out there. You’ll never be taken seriously.
Your thoughts aren’t valuable enough to be paid attention to.
So here I am, scrambling around inside my foggy brain trying to ignore the bullying thoughts in my head and to figure out whether anything I have to say about depression will even make sense enough to shape into an article.
Describing The Indescribable?
Up until a few years ago, I thought of depression as an intruder. It would fully catch me off guard, kind of like a huge predator stalking in the shadows and then jumping out in front of me when I least expected it. Some people describe depression as a black dog which won’t leave you alone. As my life has gone on, I’ve come to see it more as some kind of dangerous plant, thriving in the darkness and slowly growing; creeping its way into my life until I’m swamped.
Its roots are deep, and its vines reach further and further into my present consciousness until I can feel them grasping me by the limbs and the throat, pulling me backwards into the dark. Sometimes the vines loosen their grip and retreat, and I can breathe again but, even then, I still know they’re only biding their time. They’re still there, lurking…ready to creep out of the shadow again at some point. And as the years have gone on, each trauma or stress that life has thrown my way has only strengthened the roots in those murky depths of my psyche.
As well as the stigma, there’s a lot of misconceptions out there about depression. People often think that feeling down for a few days or a couple of weeks is being depressed. It’s not. That’s just feeling blue, which is something that most people experience at some point in their lives. Feeling down occasionally is part of our normal range of human emotion, just like feeling sad is. Feeling sad when something bad happens is not depression. That’s a normal reaction to something bad happening, and will usually dissipate with time. When the low mood persists long-term, that’s when it becomes a problem.
Doctors and psychologists usually look out for common symptoms when diagnosing depression, such as a loss of interest in things that you normally enjoy, feelings of worthlessness or of despair, feelings of unrealness and even urges to harm yourself in some way. Check out this guide from the charity Mind to find out more about symptoms, causes and potential treatment options. Their website is also full of resources about other mental health disorders and information about where to find help.
The Numbness
Perhaps my least favourite symptom that comes from being in a depressive episode is what I now call the nothingness. This is something that I have experienced since I was a teenager and still frightens me to this day when it happens. It’s not that I feel sad, or upset or even down, I just feel…nothing. In these times my emotional range seems to just shut down. I can’t feel anything or recall how emotions normally feel. It is the complete absence of feeling, and I wouldn’t wish it on anybody. It is the most isolating thing I have ever experienced, and every time I feel my mental health slipping I become fearful of that emotional numbing.
When I’m numb, I would kill to feel sad or angry because then at least I would feel something. Many people I’ve tried to express this to simply can’t wrap their heads around it. I discovered a few months ago that this kind of emotional shutdown can be a response to past psychological trauma.
Going back to writing, it’s really no surprise that I struggle to do it a lot of the time. It’s sometimes like the parts of my brain that feed into creativity have been boarded up like an old abandoned house. It’s like somebody cauterized by ability to even think clearly, let alone comprehend those thoughts and translate them into words.
Depression
Depression makes it feel as though my brain just won’t work in the way it’s supposed to; the way I know it can work. It feels like there is a thick cloud of fog filling up the spaces in my head. Things don’t seem right; things don’t make sense. I can’t even make decisions. The smallest of decisions feels disproportionately impossible. Do I want a glass of water or a glass of juice? Do I prefer red or blue? Am I a good person or a bad person for the answers I picked? I can’t decide what I want to watch, what I want to read, what music I want to listen to.
I know that I’m passionate about things, somewhere beneath all the fog, but those things seem shapeless; far away from me. I feel completely disconnected from myself, as though the body and mind I inhabit do not belong to me. I interact with my surroundings, but it’s all robotic. I’m not sure what is real.
It’s a cruel state of mind to be in. Perhaps it’s even crueller that all of this is invisible to the world around you and can be masked by a simple “I’m fine!” when somebody asks you how you’re feeling.
We have to be brave enough to answer “I’m not fine.”
About the Author:
Charlotte is a 26 year old writer from West Yorkshire in England. After a spinal cord tumour left her disabled at 19, she started writing about her experiences alongside her university studies. Her blog is called Of Books and Stardust. She also has ME and fibromyalgia, and has experienced mental health problems for most of her life. She writes to raise visibility and to help others feel less alone. Charlotte adores literature, has always loved caring for pet bunnies (or do they care for her?) and is passionate about spirituality, paganism and witchcraft.
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:
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.
Tracie Ennis is a chronic illness warrior who deals with Fibromyalgia, CRPS, DSPD, Bipolar Disorder Type II, and Hypothyroidism. She helps The Unchargeables’ founder in the daily running of the community, and currently lives in WA with her husband and fur kids.
