Conditions That Can Co
Many people with bipolar disorder also have other mental disorders or conditions such as anxiety disorders, attention-deficit/hyperactivity disorder , misuse of drugs or alcohol, or eating disorders. Sometimes people who have severe manic or depressive episodes also have symptoms of psychosis, such as hallucinations or delusions. The psychotic symptoms tend to match the persons extreme mood. For example, someone having psychotic symptoms during a depressive episode may falsely believe they are financially ruined, while someone having psychotic symptoms during a manic episode may falsely believe they are famous or have special powers.
Looking at symptoms over the course of the illness and the persons family history can help determine whether a person has bipolar disorder along with another disorder.
What Bipolar Disorder Really Feels Like
About 2.6 percent of American adults — nearly 6 million people — have bipolar disorder, according to the National Institute of Mental Health . But the disease, characterized by significant and severe mood changes, is still dangerously misunderstood.
Bipolar disorder is vastly different from the normal ups and downs of everyday life, but many have co-opted the term to refer to any old change in thoughts or feelings. The mood swings in someone with bipolar disorder, sometimes also called manic depression, can damage relationships and hurt job performance. It has been estimated that anywhere from 25 to 50 percent of people with bipolar disorder attempt suicide at least once.
Artist Ellen Forney detailed her diagnosis with bipolar disorder in the graphic memoir . Forney previously shared her story with us, specifically detailing how her bipolar disorder has affected her creative work.
Below are some poignant pages from the memoir, along with unique commentary into how these panels came to be and what they mean to Forney, in her own words.
“I’ve heard from a lot of readers that the carousel metaphor has really clarified the different mood states for them. It’s really satisfying when you’re trying to explain something, and a metaphor that makes sense to you also works for someone else. I was originally going to draw a swing — you know, “mood swings” — but side-to-side didn’t work, I needed up-and-down.”
What Is The Treatment For Bipolar
Treatment for bipolar includes medicines and talk therapy. Medicine can help keep moods stable. But by itself, medicine isnt enough. A person with bipolar needs talk therapy, too.
Each persons treatment is tailored to what they need. A type of talk therapy called DBT helps most people. In this therapy, people can learn skills to manage moods. For example, they can learn to:
- become more mindful of their emotions and thoughts
- manage their emotions
- cope with strong emotions in healthy ways
- set up and follow routines that help keep moods stable
- be patient and kind to themselves
- care for themselves in positive ways
- get along better with others
With time and practice, these skills can become part of a persons daily life.
Therapy also includes making goals and working out ways to move toward them. In therapy, people track their progress. Many find strengths they didnt know they had.
When possible, parents take part in treatment. This helps them understand bipolar moods and how to best respond. It can help families have less conflict, relate better, and feel closer.
What’s Going On In The Brain
Up until recently, researchers hadnt been able to distinguish a person with bipolars brain from a person without the disorder on a scan. But science is making some tracks. A 2019 study that looked at the brains of people with bipolar and those with depression on functional MRI scans correctly differentiated their brains about 80% of the time.
The findings suggest differences in the amygdala, the emotion center of the brain, of people with bipolar when they process emotions like sadness, anger, fear, and joy, and could become a marker to help identify bipolar disorder on brain scans. Likewise, bipolar affects brain biochemistry and neurotransmitters in the brain that produce chemical variations such as oxytocin, GABA, dopamine, and serotonin. These chemicals may be unbalanced in the brains of people with bipolar disorders. But as of yet, researchers arent clear on how too little GABA or too many oxytocin-active neurons play a role in the disorder or whether measuring them can help.
Bipolar Disorder In Children And Teens
Bipolar disorders are most common in older adolescents and teens, but children can also be diagnosed with the disorder at a younger age. While not nearly as common in children as it is in adults, research studies have revealed that bipolar disorder affects as many as 3% of all children and up to 7% of children receiving outpatient psychiatric care. Bipolar disorder has been diagnosed in children as young as 5. When young children experience symptoms, this is called early-onset bipolar disorder.
Bipolar disorder is more likely to affect the children of parents who have the disorder. When one parent has bipolar disorder, the risk to each child is 15 to 30%. When both parents have bipolar disorder, the risk increases to 50 to 75%.
Bipolar in kids also causes distinct mood episodes from mania or hypomania to depression. However, because kids and adolescents can act out, have difficulty in school or at home, and display some of the symptoms of bipolar disorders, like restlessness, impulsivity, risky behaviors, and an inflated view of capabilities, even when they dont have the disorder, it can be difficult to diagnose.
It is important to note that a number of other childhood disorders cause bipolar-like symptoms, including , oppositional defiant disorder, conduct disorder, anxiety disorders, and major depression. Arriving at the correct diagnosis presents challenges because these and other mental health conditions often occur along with bipolar disorder.
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How To Treat It
The main ways to treat and manage bipolar disorder include:
- Medications, like mood stabilizers, antipsychotics, and sometimes antidepressants
- Action plans to educate you about the disorder. These can help you manage it on your own by helping you know when an episode is coming on.
- Psychotherapy, such as cognitive behavioral therapy and family-focused therapy
- Activities that support your treatment, such as exercise and spiritual practices
What To Do Before Diagnosis
Before your diagnosis, you may experience rapidly changing moods and confusing emotions. It can be hard to describe exactly how you feel, but you may know that something isnt right.
Bouts of sadness and hopelessness can become intense. It can feel as if youre drowning in despair one moment, and then later on, youre optimistic and full of energy.
Low emotional periods arent uncommon from time to time. Many people deal with these periods due to everyday stresses. However, emotional highs and lows associated with bipolar disorder can be more extreme. You may notice a change in your behavior, yet youre powerless to help yourself. Friends and family may also notice changes. If youre experiencing manic symptoms, you may not see the need to get help from a doctor. You may feel great and not understand the concerns of those around you until your mood shifts again.
Dont ignore how you feel. See a doctor if extreme moods interfere with daily life or if you feel suicidal.
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What Does Hope Feel Like
If you have bipolar disorder and need support, you can read countless stories from people who have learned to manage their brain disorder and live happy, fulfilling lives. You can find these inspiring accounts at places like BP Hope and Depression and Bipolar Support Alliance .
If you have bipolar disorder, your life is going to include some periods of crushing depression, some periods of whacked-out mania or hypomania, a whole lot of meds, perhaps a psychotic episode here and there, and maybe a hospitalization or two . You can experience all those things and still have a fun, meaningful, productive life.
-Hilary T. Smith, Welcome to the Jungle: Everything You Ever Wanted to Know about Bipolar but Were Too Freaked Out to Ask
I see my illness as a watercolor painting. My medications are the colors, which allow my vitality to show through. The water is my tears. The blurring and running of the paint represent the uncertainty that I lived with during those years. I imagine that this past episode will not be my last as that is the nature of my bipolar illness. The skies are stormy at times, but as in any meaningful painting, there is light and hope shining through.
Cait’s Ongoing Experience And Impact Of Bipolar Which Started At A Young Age
It’s shaped my life because I became unwell in my teens, which resulted in me dropping out of school. Becoming unwell at such a critical period in my life shaped my self-image, and I struggle with social anxiety.
Episodes can be pretty destructive, and it means I find it very difficult to take anything for granted no matter how well my life is going, I know I can get ill, and it can be wiped out, as it has been many times before. I had children for a long time because I was frightened of getting ill.
The positive aspects are that when I started blogging about it, I tapped into an entire network of people who had felt the same, who were living with all, and it gave me hope.
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Patient Quote : On Being In A Mixed State
Itâs like a tornado or a hurricane, an awful thing that comes and take you and you canât do anything. Youâre inside the tornado, and you scream because itâs got you. It takes over your thoughts. The mixed state is when you get really insane, when you get admitted to hospital, when youâre out of controlâ .
What A Depressive Episode Feels Like
The unpredictable nature of cycling through mood states, being unsure of what symptoms may envelop you next, typically creates underlying anxiety, says Colleen King, LMFT, a psychotherapist who specializes in treating people with bipolar disorder, depression, and anxiety.
People with bipolar disorder can experience mixed states or dysphoric mania, she says. King says her clients experience their dysphoric mania as an excruciatingly difficult mood state that simultaneously combines symptoms of mania and depression, though the typical euphoric feelings are absent.
They also often experience psychomotor agitation, insomnia, anxiety, and restlessness. Sometimes they experience irritability or anger.
You might be especially curt with others and feel like no one understands your experience, says Louisa Sylvia, PhD, associate director of psychology at the Bipolar Clinic and Research Program at Massachusetts General Hospital.
You might lash out and not want to interact with anyone, Sylvia says in her book, The Wellness Workbook for Bipolar Disorder: Your Guide to Getting Healthy and Improving Your Mood.
During a depressive episode, Kings clients tell her that they feel broken or dont care about anything anymore.
They say they dont have the motivation or passion for anything except sleep. Her clients say they cry all the time and feel frustrated and helpless. They fear theyll never feel normal again.
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How Is A Bipolar Episode With Mixed Features Diagnosed
Diagnosing bipolar disorder can be difficult. There is no one test. Instead, a variety of tools are used. Once bipolar disorder is confirmed, the type of bipolar disorder will be determined, as well.
Bipolar disorder is diagnosed by a psychiatrist or another mental health professional. They will take a medical history and discuss symptoms. They may work with a primary care doctor to rule out any other conditions that could explain the behavior.
A bipolar episode with mixed features can be diagnosed, per the DSM-5, if:
- there are three or more manic or hypomanic symptoms during a major depressive episode
- there are three or more depressive symptoms during a manic or hypomanic episode
While there are noted risk factors for bipolar disorder and bipolar episodes, risk factors for episodes with mixed features are less clear.
and/or substance use disorders.
Psychotic features may also be more common in episodes with mixed features, so its important to treat symptoms of these episodes and work with your doctor to manage bipolar disorder.
Following a treatment plan and support when needed can help with managing bipolar disorder, reducing the frequency and severity of episodes, and improve daily life.
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What Are The Types Of Bipolar Disorder
There are four types of bipolar disorder, including:
- Bipolar I disorder: People with bipolar I disorder have experienced one or more episodes of mania. Most people with bipolar I will have episodes of both mania and depression, but an episode of depression isnt necessary for a diagnosis. The depressive episodes usually last at least two weeks. To be diagnosed with bipolar I, your manic episodes must last at least seven days or be so severe that you need hospitalization. People with bipolar I can also experience mixed states .
- Bipolar II disorder: People with bipolar II experience depressive episodes and hypomanic episodes. But they never experience a full manic episode thats characteristic of bipolar I disorder. While hypomania is less impairing than mania, bipolar II disorder is often more debilitating than bipolar I disorder due to chronic depression being more common in bipolar II.
- Cyclothymic disorder : People with cyclothymic disorder have a chronically unstable mood state. They experience hypomania and mild depression for at least two years. People with cyclothymia may have brief periods of normal mood , but these periods last fewer than eight weeks.
- Other specified and unspecified bipolar and related disorders: If a person doesnt meet the diagnostic criteria for bipolar I, II or cyclothymia but has still experienced periods of clinically significant abnormal mood elevation, its considered other specified or unspecified bipolar disorder.
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What Bipolar Ii Feels Like
Imagine if you didnt fit in anywhere, not even in your own head.
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Ms. Ikpi is a writer.
This bipolar II. This many-sided creature. This life of mine. This brain constantly in conference with the racing heart, reminding me to slow down, stay calm.
Remember the first time you were ever on a Ferris wheel? Remember when you got to the very top and just sat there, the entire world at your feet? You felt like you could reach up and grab the sky. Your entire body tingled with the intersection of joy and indestructibility and fearlessness and that good anxious recklessness. So damn excited to be alive at that moment. You could do anything.
Now imagine feeling that every day for a week, or a month, or a few months. Twenty-four hours a day, seven days a week, without a break. So that everything you do feels like THE BIGGEST MOST AMAZING THING YOU HAVE EVER DONE IN YOUR LIFE!
The first week or so, its great. Until its not.
Imagine you dont fit anywhere, not even in your own head.
Bassey Ikpi is the author of the forthcoming book Im Telling The Truth But Im Lying, from which this essay is adapted.
What Is The Treatment For Mania Hypomania And Depression
You can check what treatment and care is recommended for bipolar disorders on the National Institute for Health and Care Excellence website.
NICE produce guidelines for how health professionals should treat certain conditions. You can download these from their website at:
The NHS doesnt have to follow these recommendations. But they should have a good reason for not following them.
What medications are recommended?
Mood stabilisers are usually used to manage mania, hypomania and depressive symptoms.
The mood stabilisers we talk about in this factsheet are:
- Certain benzodiazepine medication
Mania and hypomaniaYou should be offered a mood stabiliser to help manage your mania or hypomania. Your doctor may refer to your medication as antimanic medication.
If you are taking antidepressants your doctor may advise you to withdraw from taking them.
You will usually be offered an antipsychotic first. The common antipsychotics used for the treatment of bipolar disorder are:
If the first antipsychotic you are given doesnt work, then you should be offered a different antipsychotic medication from the list above.
If a different antipsychotic doesnt work, then you may be offered lithium to take alongside it. If the lithium doesnt work you may be offered sodium valproate to take with an antipsychotic. Sodium valproate is an anticonvulsive medication.
Sodium Valproate shouldnt be given to girls or young women who might want to get pregnant.
- Fluoxetine with Olanzapine
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What Impact Has Bipolar Had On Your Life
For me, this is important because my experience is very unusual. I took antidepressants in my last year of school, which, when I arrived at University and took the control of living away from home, helped to induce hypomania.
I was already aware of my mood swings and studying biomedical sciences. I went to the doctor and said I thought I had bipolar, and he agreed. I met a superb psychiatrist via student health. There were a few unusual people in my extended Irish family, and at least two with probable bipolar a working diagnosis was quick.
Mood swings coloured my school and university experiences. I cycled rapidly between deep depression and hypomania. I ate too much and drank too much, partly because of the medication and partly because of anxiety, and became very obese.
I had some embarrassing moments of drunkenness, self-harm, obnoxiousness, and accrued debt. By the time I felt properly back on an even keel seven years later, I had accrued nearly £50,000 of unsecured debt, which had taken a decade to pay back.
I dont have a house or a postgraduate degree, which Id have liked and which would help now. But. I had my life.
Thanks to my psychiatrist, brilliant GP, online peer support, and carefully nurtured insight, I avoided the hospital. And because I found a sense of purpose through volunteering.
My parents were unquestioningly supportive financially, emotionally and practically. They resolved to push me through my degree at whatever cost. I am lucky they were able to.