Living With Bipolar Disorder
Teens normally face ups and downs with school, family, work, and friends. Dealing with bipolar disorder at the same time is a very difficult challenge. One 16-year-old reader who was diagnosed with bipolar disorder at 14 wrote to us about the experience:
“I had mood swings that were the worst anyone could have ever seen. My poor parents thought I hated them, but really I was sick and didn’t even realize it. But now I am on medications for my disorder and I live a pretty normal life. My family and friends support me, and they, along with my therapist, have helped me get to the point where I am today. I just want other teens to know that even though it is hard at times to be bipolar, things will get better.”
If you’ve been diagnosed with bipolar disorder, taking your medications as prescribed, reporting any changes in how you feel or function, and participating in therapy will be key to living a successful life. In addition to treatment, making a few lifestyle changes, such as reducing stress, eating well, and getting enough sleep and exercise can help someone who is living with the condition. And many teens find it helps to join a support network such as a local support group for people with bipolar disorder.
How Is Bipolar Disorder Diagnosed
Most people with bipolar disorder can be helped â but a psychiatrist or psychologist must first diagnose the disorder. Sadly, many people with the condition are never diagnosed or are not diagnosed properly. Without proper diagnosis and treatment, the disorder can become worse. Some teens with undiagnosed bipolar disorder can end up in a psychiatric hospital or residential treatment center, in the juvenile justice system, abusing drugs, or committing suicide.
Because children and teens with bipolar disorder do not usually show the same patterns of behavior as adults who have the condition, a mental health professional will observe a teen’s behavior carefully before making a diagnosis. This includes getting a complete history of the person’s past and present experiences. Family members and friends can also provide helpful insights into the person’s behavior. The doctor may also want a teen to have a medical exam to rule out other conditions.
Diagnosing bipolar disorder can be difficult. As yet, there aren’t any laboratory tests like a brain scan or blood test that will diagnose it. In teens, bipolar disorder can sometimes be mistaken for illnesses like schizophrenia and posttraumatic stress disorder, attention deficit hyperactivity disorder , and other depressive disorders. That’s why a complete, detailed history is so important.
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Suicide And Treatment With Antidepressants
Suicide cannot be treated but only prevented . Research on treatments aimed at suicide prevention, not surprisingly, is very limited because of clinical and ethical problems arising if an inactive or ineffective treatment, such as placebo, were compared to an experimental intervention, with death as a potential outcome. In addition, it is virtually impossible to know when a suicide has been prevented, whereas suicidal acts or surrogate measures can be counted. Rarity of suicide, even among psychiatric patients, encourages research reliance on more prevalent measures related to suicide, including suicidal ideation, threats, self-injurious acts, or emergency interventions. However, the typically distant relationship of such measures to suicide limits their value in testing for therapeutic effects on suicide itself. Relating treatments to suicidal risks is further complicated by uncertain long-term adherence to recommended treatments . Treatments for BD considered for possible suicide-prevention include antidepressants, anticonvulsants and lithium, antipsychotics, ECT, and psychosocial interventions .
Table 3 Treatments aimed at reducing suicidal risk in bipolar disorder patients
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Anxious Versus Anergic Dysthymia
Niculescu and Akisal proposed that dysthymia be divided into 2 subtypes: anxious dysthymia and anergic dysthymia. They described the subset of patients with anxious dysthymia as having pronounced symptoms of low self-esteem, undirected restlessness, and interpersonal rejection sensitivity. They also characterized these patients as help-seeking and more likely to make lower-lethality suicide attempts and to have a better response to selective serotonin reuptake inhibitors . Substances of choice for these patients include benzodiazepines, alcohol, marijuana, opiates, and possibly food.
This group is compared with persons who have anergic dysthymia, characterized by low energy, hypersomnia, and anhedonia. Patients with anergic dysthymia, the authors suggest, may have a better response to treatment with agents that increase norepinephrine or dopamine.
Of note, an estimated 75% of people with dysthymia meet criteria for at least 1 major depressive episode, referred to as double depression. Those with dysthymia who have depressive episodes tend to have longer periods of depression and spend less time fully recovered. In a 10-year follow-up study of people with dysthymia, 75% experienced some period of recovery from major depression the mean time to recovery was 52 months from study entry. In this study, most of those who recovered experienced a relapse into another episode of depression, most commonly in the 3 years following recovery.
Manic Symptoms In Children
Symptoms of a childs manic episode caused by bipolar disorder can include:
- acting very silly and feeling overly happy
- talking fast and rapidly changing subjects
- having trouble focusing or concentrating
- doing risky things or experimenting with risky behaviors
- having a very short temper that leads quickly to outbursts of anger
- having trouble sleeping and not feeling tired after sleep loss
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What Risks And Complications Can Bipolar Disorder Cause
There can be complications and risks for people who live with bipolar disorder. But these risks can be lessened with the right support and treatment.
What about suicide and self-harm?
You might have an illness where you experience psychosis, such as schizophrenia or bipolar disorder. Your risk of suicide is estimated to be between 5% and 6% higher than the general population.
You are more likely to try to take your own life if you have a history of attempted suicide and depression. It is important that you get the right treatment for your symptoms of depression and have an up to date crisis plan.
There is also research that suggests you are 30% – 40% more likely to self-harm if you live with bipolar disorder.
What about financial risk?
If you have mania or hypomania you may struggle to manage your finances. You may spend lots of money without thinking about the effect that it may have on your life.
You could make a Lasting Power of Attorney. This is a legal process. This means that you pick someone that you trust to manage your finances if you lack mental capacity to manage them by yourself.
You can work with your carer and mental health team. You can form an action plan. This can say what they can do if you have a period of mania or hypomania and you start to make poor financial decisions.
What about physical health risk?
What about alcohol and drugs risk?
If you want advice or help with alcohol or drug use contact your GP.
What about driving risk?
Harms Of Early Detection And Intervention And Treatment
The USPSTF found adequate evidence that the magnitude of harms of screening for depression in adults is small to none.
The USPSTF found adequate evidence that the magnitude of harms of treatment with CBT in postpartum and pregnant women is small to none.
The USPSTF found that second-generation antidepressants are associated with some harms, such as an increase in suicidal behaviors in adults aged 18 to 29 years and an increased risk of upper gastrointestinal bleeding in adults older than 70 years, with risk increasing with age however, the magnitude of these risks is, on average, small. The USPSTF found evidence of potential serious fetal harms from pharmacologic treatment of depression in pregnant women, but the likelihood of these serious harms is low. Therefore, the USPSTF concludes that the overall magnitude of harms is small to moderate.
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Bipolar Disorder: Myths And Facts
Myth: Bipolar disorder cannot be diagnosed as easily as physical illness.
Fact: Bipolar disorder can be diagnosed similarly to physical illnesses. While there are no physical tests that can reveal the disorder, the diagnosis of bipolar illness is based on standard criteria. An accurate diagnosis of a bipolar illness is made by using the tools of a medical and psychiatric history, self-reported symptoms, observable behavior, input from friends and family, family medical history and specific psychiatric rating scales.
Myth: Children do not get bipolar disorder.
Fact: Bipolar disorder can occur in children as young as age six. It is more likely to affect children of parents who have bipolar disorder. Children tend to have very fast mood swings between depression and mania many times during the day whereas adults tend to experience intense moods for weeks or months at a time. NoteBipolar disorder can best be diagnosed after examination of historical behaviour patterns. Parents should attempt to get independent verification and consider carefully any such diagnosis of a very young child.
Myth: It is impossible to help someone with bipolar disorder.
Myth: Bipolar disorder is a figment of one’s imagination.
Fact: Bipolar disorder is a treatable brain disorder that is real and can cause a lot of suffering, especially if it is not well managed. Individuals cannot just snap out of it! Recovery takes time and hard work.
Myth: People who have bipolar disorder cannot work.
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What Is Bipolar Disorder
Bipolar disorder, also known as manic depression, is a mental illness that brings severe high and low moods and changes in sleep, energy, thinking, and behavior.
People who have bipolar disorder can have periods in which they feel overly happy and energized and other periods of feeling very sad, hopeless, and sluggish. In between those periods, they usually feel normal. You can think of the highs and the lows as two “poles” of mood, which is why it’s called “bipolar” disorder.
The word “manic” describes the times when someone with bipolar disorder feels overly excited and confident. These feelings can also involve irritability and impulsive or reckless decision-making. About half of people during mania can also have delusions or hallucinations .
“Hypomania” describes milder symptoms of mania, in which someone does not have delusions or hallucinations, and their high symptoms do not interfere with their everyday life.
The word “depressive” describes the times when the person feels very sad or depressed. Those symptoms are the same as those described in major depressive disorder or “clinical depression,” a condition in which someone never has manic or hypomanic episodes.
Most people with bipolar disorder spend more time with depressive symptoms than manic or hypomanic symptoms.
What Causes Bipolar Disorder
The cause of bipolar disorder isnt clear. Research suggests that a combination of different things can make it more likely that you will develop bipolar disorder.
Genetic factors
There is a 13% chance you will develop bipolar disorder if someone in your immediate family, like a parent, brother or sister has bipolar disorder.
This risk is higher if both of your parents have the condition or if your twin has the condition.
Researchers havent found the exact genes that cause bipolar disorder. But different genes have been linked to the development of bipolar disorder.
Brain chemical imbalance
Different chemicals in your brain affect your mood and behaviour. Too much or too little of these chemicals could lead to you developing mania or depression.
Environmental factors
Stressful life events can trigger symptoms of bipolar disorder. Such as childhood abuse or the loss of a loved one. They can increase your chances of developing depressive episodes.
You can find more information about Does mental illness run in families? by clicking here.
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Other Treatments And Suicide
Evidence is growing that the glutamate NMDA-receptor antagonist ketamine and its active S-enantiomer can exert rapid, short-term reduction of suicidal ideation along with rapid reduction of symptoms of depression, including in BD patients, although effects on suicidal behavior are uncertain . There is considerable uncertainty about how to continue use of racemic or S-ketamine following initial benefits, and some concern that its discontinuation may provoke adverse clinical responses . ECT often appears to be lifesaving in suicidal emergencies but lacks evidence of sustained antisuicidal efficacy . Other methods of external electrical or magnetic stimulation of brain, vagal nerve stimulation, and deep brain stimulation are being investigated or introduced for the treatment of otherwise treatment-resistant depression but remain to be tested adequately for specific effects on suicidal behavior, particularly in BD.
Additional interventions of potential value include emergency hospitalization as well as psychotherapies, in particular cognitive-behavioral, dialectic, and interpersonal methods, which can improve depressive symptoms and may reduce suicidal risk . However, results from studies of psychosocial interventions may be limited by the self-selection of patients who adhere to such prolonged treatments.
Signs You Are Not Going Crazy
How to find out if I am not losing my mind? That is a question many of you might have. So, here is the answer. If you have the following three signs, the chances of you being insane are pretty thin and dismissible.
You know what is right and wrong. If you can make rational decisions, you do not need to ask, Am I crazy? Psychosis and other severe mental conditions leave people with the inability to do everyday tasks. And people with such conditions often find it difficult to say what is good or bad for them.
You determine reality from fantasy. You do not need to be concerned about going insane if you are not living in an altered reality. Most insane people seem entirely disconnected from real life. And they tend to believe their delusional or illusional thoughts to be true.
You are worried about your mental health. Even the fact that you wonder, Am I crazy? is a positive sign. Insanity reduces self-awareness. So, you would not be able to ask such self-oriented questions if you were out of your mind or mad.
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Schizophrenia And Other Psychoses
Schizophrenia is a severe mental disorder, affecting 20 million people worldwide1. Psychoses, including schizophrenia, are characterized by distortions in thinking, perception, emotions, language, sense of self and behaviour. Common psychotic experiences include hallucinations and delusions . The disorder can make it difficult for people affected to work or study normally.
Stigma and discrimination can result in a lack of access to health and social services. Furthermore, people with psychosis are at high risk of exposure to human rights violations, such as long-term confinement in institutions.
Schizophrenia typically begins in late adolescence or early adulthood. Treatment with medicines and psychosocial support is effective. With appropriate treatment and social support, affected people can lead a productive life and be integrated in society. Facilitation of assisted living, supported housing and supported employment can act as a base from which people with severe mental disorders, including schizophrenia, can achieve numerous recovery goals as they often face difficulty in obtaining or retaining a place to live and normal employment.
Developmental Disorders Including Autism
Developmental disorder is an umbrella term covering intellectual disability and pervasive developmental disorders including autism. Developmental disorders usually have a childhood onset but tend to persist into adulthood, causing impairment or delay in functions related to the central nervous system maturation. They generally follow a steady course rather than the periods of remissions and relapses that characterize many mental disorders.
Intellectual disability is characterized by impairment of skills across multiple developmental areas such as cognitive functioning and adaptive behaviour. Lower intelligence diminishes the ability to adapt to the daily demands of life.
Symptoms of pervasive developmental disorders, such as autism, include impaired social behaviour, communication and language, and a narrow range of interests and activities that are both unique to the individual and are carried out repetitively. Developmental disorders often originate in infancy or early childhood. People with these disorders occasionally display some degree of intellectual disability.
The community at large has a role to play in respecting the rights and needs of people with disabilities.
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Other Approaches To Prevention
The Community Preventive Services Task Force, which makes evidence-based recommendations on preventive services for community populations, recommends collaborative care for the management of depressive disorders as part of a multicomponent, health care systemâlevel intervention that uses case managers to link primary care providers, patients, and mental health specialists. More information about the Community Preventive Services Task Force and its recommendations on depression interventions is available on its website .
Bipolar Disorder And Depression
Bipolar disorder can have two extremes: up and down. To be diagnosed with bipolar, you must experience a period of mania or hypomania. People generally feel up in this phase of the disorder. When youre experiencing an up change in mood, you may feel highly energized and be easily excitable.
Some people with bipolar disorder will also experience a major depressive episode, or a down mood. When youre experiencing a down change in mood, you may feel lethargic, unmotivated, and sad. However, not all people with bipolar disorder who have this symptom feel down enough to be labeled depressed. For instance, for some people, once their mania is treated, a normal mood may feel like depression because they enjoyed the high caused by the manic episode.
While bipolar disorder can cause you to feel depressed, its not the same as the condition called depression. Bipolar disorder can cause highs and lows, but depression causes moods and emotions that are always down. Discover the differences between bipolar disorder and depression.
Bipolar disorder is a common mental health disorder, but its a bit of a mystery to doctors and researchers. Its not yet clear what causes some people to develop the condition and not others.
Possible causes of bipolar disorder include:
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