Interesting Bi-polar facts

[nandm]

What is bipolar disorder?
Bipolar disorder is a disease of the nervous system that involves the brain and the body. Environmental, heredity, genetic, and biological factors create changes in brain cells and an imbalance in the chemical within the nervous system, resulting in abnormal fluctuations in metabolism, emotions, and thought processes, including attention.

What does the name "bipolar disorder" mean?
"Bipolar" refers to the two physiological states of mania and depression that are associated with the illness. These gave rise to the previous name of "manic depression." Although many people with this disorder have mainly manic or mainly depressive episodes, there is usually a mixture of symptoms at any given time.

Bipolar disorder causes much more than simply mania and depression. It can also cause feelings of irritability, anger, jealousy, resentment, anxiety, avoidance, embarrassment, fear, inadequacy, regret, and confusion. In addition to mood swings, you may experience drastic fluctuations in energy, activity, weight, metabolism, and sleep/wake cycle. Bipolar disorder increases your sensitivity to stress so that you become more vulnerable to life changes.

Bipolar disorder impairs thinking by causing poor focus, distractibility, and poor memory. Poor judgment, impulsivity, repetitive, obsessive thoughts, and overfocused, compulsive activities make you more likely to overwork, overindulge, and take unnecessary risks. Problems with procrastination, poor motivation, and difficulty starting and/or finishing projects make it difficult to attain your life goals.

How many people have bipolar disorder?
It is estimated that 2 to 7 percent of people in the United States suffer from bipolar disorder. Almost ten million people will develop the illness sometime during their lives. About half of those will never receive the correct diagnosis or treatment.

How many people are affected by bipolar disorder?
In addition to the people directly suffering from the illness, bipolar disorder affects the lives of their parents, brothers, sisters, spouses, children, grandchildren, and friends. Parent struggle with the problems of bipolar disorder in their children. Doctors, nurses, therapists, and social workers devote their time to helping and caring for individuals with bipolar disorder. All in all, it is estimated that about twenty million people's lives are touched and changed by bipolar disorder in the United States alone.

If I have bipolar disorder, how much of my life will I actually be sick?
Bipolar disorder is far more serious than most people think. One quarter of the people with bipolar disorder are unable to function for most of the year. Over half of diagnosed bipolar patients have four or more serious outbreaks per year, and some patients experience a mixture of symptoms continuously throughout their lives. However, this picture improves dramatically with successful treatment.

Does Bipolar disorder cause physical health problems?
Yes. Persons with bipolar disorder have more heart problems than the rest of the population. They also have more headaches, particularly migraine headaches. Migraines are even more common in bipolar depression than in common, unipolar major depression.

Bipolar disorder also increases the risk for substance abuse and addiction: 60 to 80 percent of people with bipolar disorder will suffer from alcoholism or drug abuse during their lives.

Overall, the death rate is higher in people with bipolar disorder, especially those receiving insufficient treatment. Compared with the rest of the population, people with bipolar disorder experience more accidental injuries and deaths, particularly from motor vehicle accidents.

What is the worst thing that might happen to me if I have a bipolar episode?
The worst tragedy of bipolar disorder is that it can prevent you from having the kind of life you want and deserve. Without treatment, bipolar illness makes it impossible to use your natural talents and abilities, so that you never live up to your potential.

The second-worse danger from bipolar disorder is the loss of anything and everything you accomplished in your life. In bipolar episodes, people break up their families, destroy their marriages, and alienate their children, sometimes forever. People have destroyed their careers, lost their homes and life savings, and driven away their friends when their bipolar disorder was uncontrolled. People have thrown away fortunes, gotten pregnant, caught diseases, went to jail, and injured or killed themselves and others in accidents during bipolar episodes.

Are people with bipolar disorder more likely to kill themselves?
Suicide is a serious problem in this illness. Thirty percent of individuals with bipolar disorder will attempt suicide during their lives, and 20 percent will succeed. Even failed suicide attempts can cause crippling, lifelong injuries. Fortunately, your risk of suicide decreases dramatically when your bipolar disorder is treated.

Can I be hopeful about my future?
Absolutely. With successful treatment, people with bipolar disorder are healthy and can achieve the kind of life they want and deserve. For the first time in history, we have a broad choice of effective treatments for bipolar disorder, and there are even better, cutting-edge therapies about to be released.

What can I do now to get my bipolar disorder under control?Maintain your determination, find a good doctor, keep a healthy lifestyle, find medications that work, care for your psychological needs, and find strategies to do the things that bipolar disorder makes difficult.

Why do you think I need to learn about my bipolar disorder?
There is so little reliable information readily available about bipolar disorder that you, the patient, must become your own expert on your illness and your well-being. Once you have found a doctor and a therapist who is/are knowledgeable about bipolar disorder, try to learn all you can. Ultimately, you must become the guiding force behind your own treatment, not through intuition or destiny, but by the knowledge of facts.

Why do you talk about bipolar disorder like it is a disease? I think I am a normal person.
In order to diagnose bipolar disorder, the symptoms must cause problems in major areas of your life such as work, school, social activities, and/or relationships with friends or family. Bipolar disorder is certainly a disease if it is keeping you from reaching your full potential in life.

However, if you bring your bipolar disorder under control with proper ongoing treatment, you can then use your full range of normal talents and abilities. At that point, you still have bipolar disorder but it is not an illness. Rather it is like a cancer in remission.

[nandm]

Some but not all people with bipolar disorder experience a dramatic increase in symptoms at certain times of the year. These are called cycles. When the illness is young, cycles are more irregular, but as the disease matures, most individuals develop two to four episodes at about the same times every year. If the disease worsens, the number of episodes per year increases.

Someone told me I had "rapid cycling" bipolar disorder. What is that?
If you have more than four episodes of mania or depression in a year, you are said to suffer from rapid cycling. All the legitimate research that you will read about rapid cycling uses this definition.

I was told that I'm a rapid cycler because I have lots of angry episodes every day. Is this diagnosis correct?
When people have rapid emotional changes throughout the day, this can be emotional lability, rather than rapid cycling. Actually, sudden, brief outbursts of anger and/or depression are common in many mental and emotional situations. Having emotional lability does not prove that you have bipolar disorder.

Do people have symptoms between bipolar episodes? Yes. Between episodes, people with bipolar illness often experience symptoms like persistent insomnia, anger, social anxiety, and struggles with communication and relationships. Patients often exhibit distractibility , difficulty staying on topic, and poor logical thought. There are sometimes illogical beliefs and obsessions that continue after the more obvious symptoms are gone. These events are much less likely to occur when your illness is adequately treated.

Why do some people in online groups state that they are perfectly fine without treatment? They say I'm an idiot because I take medications.
You are smart, not an idiot. There are lots of claims of self-cures but none have been proven true. Many people have tried to prove to themselves that they are fine by telling others that it is so. Lots of people with bipolar disorder have symptom-free periods, but without treatment, these periods never last.

I had a bipolar episode two months ago. Recently I stopped my medications and I'm fine now. Am I cured? One of the unique features of bipolar disorders is that individuals may feel fine between their cycles. Everyone would like to believe that their illness has magically disappeared, but studies show that you are likely to relapse within two to three months after you stop your medications.

[nandm]

Untreated bipolar disorder usually grows worse with age. In uncontrolled bipolar disorder, the brain deteriorates in brain locations called the pre-frontal and temporal areas, the amygdala, and the hippocampus.

How can I keep my bipolar disorder from growing worse as I age?
When bipolar episodes are controlled the worsening of the disease slows down or might even stop. The correct medications can stop bipolar episodes from happening, and some medications can even stimulate the brain to grow and repair brain cells.

I heard that bipolar disorder "burns out" and goes away when you get old. Is this true?
When people with "burned out' bipolar disorder are examined, what is usually found are burned-out elders who are so incapaciated with multiple health problems that their mental condition is the least of their worries.

How often does bipolar disorder go away on it's own?
Without treatment bipolar symptoms don't just go away.

[nandm]

Bipolar illness can be found in every nation and ever culture from the beginning of written history. Contrary to past theories, bipolar disorder is not caused by hardship, poverty, or discrimination; it is not caused by poor education or poor parenting; and is not a result of early childhood trauma or abuse. Stressful life events do not cause bipolar disorder, but the symptoms of bipolar illness do worsen in the presence of stress.

What causes bipolar disorder?
Bipolar disorder is caused by deficiencies in the physiology and biochemistry of the nervous system areas that control body, mind, and emotions. When someone has been bipolar for many years, the illness influences habits of thinking and behavior. This "excess baggage" is also an important part of bipolar disorder. One possible source of imbalance is too much activity of the natural stress response. Stress causes the release of natural neurochemicals and these neurochemicals worsen bipolar disorder.

What makes me feel like my body is sped up or slowed down?
Adrenaline is a natural substance that is released by the body during the stress response. If your adrenaline level was too high, you would feel many manic symptoms, such as speediness, hyperactivity, anxiety, and irritability. If you adrenaline was low, you would feel many symptoms of bipolar depression, such as fatigue, low motivation, and increased sleepiness. (Note that adrenaline is the commonly used name, but epinephrine and norepinephrine are the correct scientific names.)

Areas deep in the center of the brain called the hypothalamus-pituitary axis, or HP, help control the production of adrenaline. If the HP area is imbalanced, then adrenaline production can be too high, causing mania, or too low, causing depression. An imbalance in the HP area of the brain is one possible explanation for bipolar illness.

What makes my thinking change when my bipolar disorder acts up?
Bipolar disorder causes problems in keeping thoughts in or out of the conscious mind, a process sometimes referred to as gating. Imagine that the conscious mind is a full house that can only hold five to nine thoughts at any one time. If the mind is occupied and the house is completely full, whenever the gate lets in an unwanted thought it pushes one of the existing thoughts out of the gate and that thought is lost. Under these conditions, it becomes difficult to keep unwanted thoughts out of hold relevant thoughts in the conscious mind. You can see that this gating problem makes people with bipolar disorder very vulnerable to distractions, strong emotions, and obsessive thinking. Over time, this deficit can lead to memory problems, difficulty concentrating, difficulty following conversations, a tendency to interrupt others when they are speaking, and a tendency to deviate from the point of a conversation.

Is bipolar disorder inherited?
Bipolar disorder is more likely to occur in children of bipolar parents. Research studies show that if your mother or father has bipolar disorder then you are seven times more likely to have the illness than the average population. If your brother or sister has bipolar disorder, then your risk of getting it increases to fifteen times the average population. If you have an identical twin who is bipolar, your risk increases to sixty-five times the population average.

Do certain genes carry the bipolar disease from parent to child?
When scientists compare the DNA of individuals with bipolar disorder with the DNA from their family members who do not have the disease, they find that certain genes are associated with bipolar disorder. Some of the bipolar genes are named 4p, 18p11, 11q2-23, and 22q.

Scientists do not know the exact way that the genes cause bipolar disorder , but they do theorize. They know that the release of too much adrenaline into the blood can mimic manic symptoms, and too little adrenaline released into the blood can mimic depressive symptoms. Your DNA can produce three similar forms of switches that affect adrenaline response, called receptors alpha-2a, alpha-2b, and alpha-2c. If your DNA produces more alpha-2a switches, then more adrenaline might be turned on to increase your mania symptoms. However, if your DNA produces more of the other switches, your adrenaline response will be reduced and you may experience decreased symptoms. Similarly, a common mutation in the receptor DNA (serine at position 201) can stop nerves from releasing certain adrenaline-like compounds, possibly creating depressed symptoms. These are examples of how changes in DNA level might affect the function of your brain and nervous system.

What other areas of the brain might cause bipolar disorder?
Experts suspect that bipolar disorder is active in several interconnected brain areas, called the amygdala, frontal lobe, temporal lobe, and the hippocampus. Studies show that brain cells in these areas die at a more rapid rate in individuals with bipolar disorder. They also know that injury, strokes, or epilepsy in the temporal lobe can cause symptoms that resemble bipolar disorder. When bipolar individuals were tested hours to days after their first bipolar episode, cognitive problems associated with the temporal lobe area were found. This may help explain why most of the mood stabilizers that block bipolar disorder can also be used to block temporal loe epilepsy.

Having a manic or depressed episode may also cause permanent changes in the brain cells of the amygdala, so that it is easier for these cells to fire abnormally. This phenomenon is called potentiation. After the response of these cells is altered, the potentiation can then spread to other parts of the brain. This is one explanation of why uncontrolled manic episodes appear to make bipolar disorder irreversibly worse.

Are mania and bipolar depression different disorders?
it is a mistake to view mania and depression as if they were two separate disorders. It is the underlying bipolar disease that causes both mania and bipolar depression. Therefore, it is important that bipolar flare-ups are treated with mood stabilizers, whether they are mainly manic or mainly depressive.

Are mania and bipolar depression like two poles with the normal in the middle?
Bipolar disorder is not like a line with mania at one end and depression at the other with normalcy in the middle. It is an important issue, because if doctors follow this model, they may try to treat bipolar depressed symptoms by giving inappropriate medications "to make the person a little more manic." This would only worsen the disorder.

Instead, bipolar disorder is like a hairpin, with normalcy on the one end and both mania and depression on the other. This is the only way to explain why both mania and depressed symptoms are often seen at the same time. Moreover, when someone switches from extreme mania, they go directly to extreme depression; they do not go through normal on the way from one to another. This is why treating the underlying bipolar imbalance with medications specifically used for bipolar disorder helps reduce mania and keep depressive episodes from happening in the first place.

[historyteach]

Judith,
This is great information.
What's the source?

Shalom!

[nandm]

Thank you HistoryTeach....I thought I added the source to the bottom of my original post but see I did not.

The source is The Bipolar Handbook. Real-life questions with up-to-date answers. By Wes Burgess, M.D., Ph.D.

Anyone with a bipolar person in their lives would probably find this book quite useful. The book comprehensively illuminates every area of the disorder by drawing upon the real questions asked by patients and families during the nearly twenty years that Dr. Burgess has worked as a bipolar specialist.

Wes Burgess, M.D., Ph.D., is a practicing psychiatrist who specializes in the diagnosis and treatment of bipolar disorder. A featured commentator on NPR and network television, he received his training at Stanford University Medical Center and has taught at Stanford, UCLA, and other major universities. He lives in Los Angeles. Visit Home Page

[nandm]

Mania refers to the mental, emotional, and physical experiences that comprise the activated stage of bipolar disorder. These symptoms are called manic symptoms, and when they predominate, the condition is called a manic episode. When manic symptoms are seen in the presence of depressed symptoms, the condition is called a mixed episode.

What is the official definition of mania? What are true manic symptoms?
The official definition of a manic episode used in the United States is found in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR); see appendix A for the official wording (the National Institute of Mental Health has published a useful alternative list of combined symptoms of mania that may be found in appendix B). Here is an adaptation of the DSM definition of mania:
A. A distince period of abnormally and persistently irritable, elevated and/or expansive mood, lasting at least one week, AND:
B. During this period, three or more of the following symptoms (or four if mood is only irritable) have persisted and have been present to a significant degree:
1. Has a decreased need for sleep (for example, sleeps only three hours per night)
2. Is very talkative (may interrupt or finish others' sentances and/or has difficulty stopping the flow of speech)
3. Has rapid thoughts (a feeling that thoughts are racing)
4. Is very distractible (distraction can also affect attention and/or memory)
5. Is overfocused on work, school, personal or sexual activities, and/or has a feeling of physical edginess or agitation.
6. Takes risky chances such as reckless driving, overspending, sexual indiscretions, or entering risky business schemes
7. Has an inflated sense of self-esteem
C. The symptoms cause problems in major areas of life such as work, school, social activities, and/or relationships with friends or family

It is very important to note that the dominant emotion in mania can be (and often is) irritability and anger. Many cases of mania are misdiagnosed because of the expectation that the patient's mood will be elated. To have mania you do not need to be smiling, laughing, happy, high, elated, or show any other elevated emotion. The most common symptoms that are seen are angry mood, rapid speech, and distractibility. Also, note that manic symptoms are usually in the normal range of behaviors but are extreme or exaggerated.

Mania makes my spouse turn into a different person. Is this multiple personalities?
Not necessarily. Mania can change individuals so much that they act like different people. However, as you can see from the list above, mania can produce changes in attention, activity, mood, thoughts, and attitude. These do not represent different personalities. They are all aspects of bipolar disorder.

[RockyGirl]

Thank you for this information...

I have no idea why but it's made me cry...reading through all the symptoms and lifestyle changes etc is like reading exactly what happens in my life...I guess it just brought it all home...

Thank you for the useful information...it's good to know!

- Aimee

[nandm]

Originally Posted by RockyGirl

Thank you for this information...

I have no idea why but it's made me cry...reading through all the symptoms and lifestyle changes etc is like reading exactly what happens in my life...I guess it just brought it all home...

Thank you for the useful information...it's good to know!

- Aimee

Thank you. I was diagnosed with bipolar over 5 years ago. It was not until my AA birthday when my partner gave me this book that I realized how bipolar has played a large role in my whole life. I was really surprised at how many things I thought were just habits were actually part of being bipolar. It was a relief yet left me a bit sad. I am going to post some more questions from the book and hope you continue to find it useful. I know I have and I am not even half through with the book.

[hippyhippy]

Judith, this is so helpful, really and truelly. Thank you for this.
Hippy
xx

[RockyGirl]

Originally Posted by nandm

Thank you. I was diagnosed with bipolar over 5 years ago. It was not until my AA birthday when my partner gave me this book that I realized how bipolar has played a large role in my whole life. I was really surprised at how many things I thought were just habits were actually part of being bipolar. It was a relief yet left me a bit sad. I am going to post some more questions from the book and hope you continue to find it useful. I know I have and I am not even half through with the book.

I have been 'primarily' diagnosed with it, because i'm 18 and they can't properly diagnose it until i'm an 'established adult'
But I think I've been experiencing it for over 4 years now.

The book you're reading sounds really interesting! Please do continue to post...I will continue to read!

Thank you!

Aimee

[nandm]

Supposedly, manics can't sleep, but I can't even wake up in the morning. How can I be manic?
In severe mania, little or no sleep is possible throughout the day or night. In less severe circumstances, the most common bipolar sleep pattern is to stay up at night and be sleepy during the day.

I stay up until 3:00am every night. Aren't I a normal night person?
No single criterion can make the diagnosis of bipolar disorder. Many people feel better late at night and describe themselves simply as "night people." However, if you stay up all night and also match enough of the diagnostic criteria for mania, then you are a night person with mania.

My son-in-law talks a mile a minute. Is he manic?
When someone speaks too rapidly, the usual explanation you will hear is that it is cultural, regional, or familial. However, rapid, pressured speech can also be an indication of mania.

Sometimes I think so fast that my mouth can't keep up with my thoughts. Could this be mania?
Thoughts that go by so fast that you cannot follow them are called racing thoughts. When your speech tries to follow your thoughts, plunging ahead despite other people's attempts to speak, it is called pressured speech. These thought patterns are characteristic of mania.

My doctor muttered something about how I was "tangential." What does she mean by that?
In mania, speech can flow from your mouth in a never-ending torrent. This, coupled with distractibility , can cause you to stray from the point (tangential speech) or lose the point entirely (blocking). If you add too many unnecessary details, side remarks, and lengthy buildups to our conversations, it is called circumstantial speech.

I'm told that I smile and laugh too much, even when I'm talking about something sad. Is this a symptom of bipolar disorder?
Although it is not one of the diagnostic criteria, people with bipolar disorder frequently smile, giggle, and laugh without appearing to notice. When the topic is serious or sad, this smiling and laughing can appear quite odd to others. We call this inappropriate affect. When I notice this, I help patients become more aware of their expressions, so they can be more successful in their communication.

Why do I have so many thoughts? They distract me during the day and they keep me from falling asleep at night.
Intrusive thoughts are a primary component of bipolar disorder. During the day, many people learn to mask these thoughts by distracting themselves with work and other activities, but at night when you are trying to go to sleep, the thoughts come back in full force and keep you awake.

Are attention problems and distractibility prominent symptoms of mania?
Unless adequately treated, every person with bipolar disorder has some attention problems, usually arising from distractibility. To the trained eye, distractibility shows itself as lapses in conversation, getting off track, and being interrupted by external or internal stimuli. Distractibility can be measured by a neuropsych examination using tests such as the Connor's CPT or the Gordon test of attention. In these tests, you sit behind a computer or a console that provides stimuli at different speeds and combinations. Then a software program evaluates how distractible you are. These tests are often available in hospitals, testing centers, or in the offices of medical specialists and psychologists.

My memory is awful. Could this be due to my bipolar disorder?
Bipolar distractibility can interfere with the flow of information into your brain and lead to poor memory. In particular, there is a tendency to forget names, numbers, dates, times, amounts, distances, and similar details.

I spend all my time obsessing about famous people and sex. Am I losing my mind?
Associating oneself with people who are famous, powerful, and/or sexually attractive can feed the need to feel special and to look special in the eyes of others. Although it is not part of the diagnostic criteria, many manics show this preoccupation with celebrity and are powerless to stop these intrusive thoughts. However, there are medications that can return control of your thoughts to you.

Why do I feel obsessed with someone I met only once, many years ago?
I have often seen obsessions, infatuations, and sexual attraction to unlikely persons in mania. Sometimes obsessions suddenly develop about friends, neighbors, and acquaintances who never seemed important before. These feelings usually fade after the mania is brought under control.

Periodically I go out and spend way too much money. Is this mania?
Mania often produces spending sprees. I always ask my patients if they have clothes or shoes in their closets that have never been worn or still have their price tags. I remember one patient who arrived in my office late and quite manic. "On the way over here," he told me, "I stopped off in a store and bought a ten-thousand-dollar computer. The funniest thing is that I do not even know how to work a computer." Because insight is impaired by mania, these behaviors seem perfectly reasonable during the manic episode, making spending sprees difficult to combat.

[krissypissy]

thank you for this information-i too, am also in tears as this all describes the train-wreck i call life....i wish for the day that my BP is controlled consistently with medication and therapy--its saddens me that i live in america and im mentally ill and i cant get the care i need to live a productive and sane life. i pray that the people around me dont give up on me before i find the help i need--again, thank you for this excellent info--take care all

[nandm]

Originally Posted by krissypissy

thank you for this information-i too, am also in tears as this all describes the train-wreck i call life....i wish for the day that my BP is controlled consistently with medication and therapy--its saddens me that i live in america and im mentally ill and i cant get the care i need to live a productive and sane life. i pray that the people around me dont give up on me before i find the help i need--again, thank you for this excellent info--take care all

I live in a large city with a high homeless population. I truly believe that if our country would take care of the mentally ill, our homeless population would significantly decrease. I know that if it were not for my partner I would be homeless because I would not be able to afford my medications if it weren't for the fact that she has me on her health plan. Without my medicine I am rather insane. I have not been able to work in 3 years now. Yet, disability says my anxiety and bipolar is not significant enough to prevent me from working. I want to know how they can determine that and where they think I am going to find an employer who is going to be understanding and not fire me when I have anxiety to the point I can not leave the house for days at a time. I would be fired in a heartbeat as employers need people to be there not gone at the drop of a hat. Then there is the shame placed on people with anxiety because of the ignorance and lack of understanding of how debilitating acute anxiety really is. People tend to think that the little every day anxiety that people get about things compares to acute anxiety, and therefore they minimize it.

I have appealed to disability and pray that they decide in my favor. If they deny me again it will be time to hire an attorney.

[nandm]

Bipolar depression is an inactive state where people suffer from low motivation, low energy, good appetite, frequent weight gain, and daytime sleepiness. They often cannot get out of bed and they may say, "I just can't function." We have known about the specific features of bipolar depression since the 1800's, although the names have changed. For example, earlier in history bipolar depression symptoms were called hysteriod dysphoria and neurasthemia. Even the term "depression" is probably a bad choice of words because it suggests that unipolar major depression and bipolar depression are similar. However, these are two different diseases, located in different parts of the brain and driven by different biochemical systems.

Is bipolar disorder mainly mania or mainly depression?
Bipolar disorder is mainly depression. Almost 70 percent of all those with bipolar disorder are depressed at any one time. People who cycle spend three times as much time being depressed as being manic. When bipolar disorder is insufficiently treated, people spend an average of four months of the year in depression. Furthermore, depression seems to increase with age. Many individuals experience mainly manic symptoms during their youth, but as they grow older their disease manifests itself as depression.

How is bipolar depression diagnosed?
Some doctors prefer to rely on establishing a past history of cycling episodes to make the diagnosis of bipolar depression. A few doctors still believe that bipolar and unipolar depression are the same illness. However, I believe that bipolar depression is so distinctive that it usually can be differentiated from other types of depression by direct examination.

At the present time, there is no listing for "bipolar depression" in the official manual of medical diagnoses. "Physical slowing with or without over sleeping" is the way one major authority (Kaplan & Sadock's Comprehensive Textbook of Psychiatry; see chapter 10) characterizes bipolar depression.

From my years of observing and treating bipolar patients, I believe that the diagnosis psychiatrists know as "atypical depression" is more like bipolar depression. However, not all professionals agree with me (yet). The official definition of atypical depression is found in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IVC-TR) found in appendix A. I have adapted this definition of atypical (bipolar) depression for my patients as follows:

• A. A period lasting two weeks or more where the mood is depressed most of the day nearly every day, OR there is markedly diminished interest or pleasure in almost all activities.
• B. The mood can brighten with good news (even if it is only for minutes or hours) AND:
• C. At least two of the following:
• 1. An increase in weight and/or appetite
• 2. A tendency to sleep too much during the day (called hypersomnia)
• 3. A feeling of fatigue and/or paralysis such that it feels impossible to perform daily activities.
• 4. A long-standing pattern of easily hurt feelings.
• D. The symptoms cause problems in major areas of life such as work, school, social activities, and/or relationships with friends or family.

Other features that I often see in bipolar depression includes agitation, anxiety, social withdrawl, distractibility, procrastination, the inability to start or finish projects, memory problems, and deteriorating self-care. The National Institute of Mental Health has published a list of combined symptoms of both bipolar depression and unipolar major depression that you may find in appendix B.

How is bipolar depression different from common unipolar major depression?
The most frequent symptoms of bipolar depression are daytime sleepiness, weight gain, fatigue, low motivation, and easily hurt feelings. In contrast, people with unipolar depression usually experience early waking, inability to get back to sleep in the morning, weight loss, and constant thoughts of death.

Are people with bipolar depression overweight? I eat nothing, but I'm still gaining weight.
Many of my depressed bipolar patients have gained weight even when tey said they were on austere diets. Low activity, low metabolism, and increased appetite can all conspire to increase weight gain during bipolar depression.

I'm a real procrastinator. Is that related to bipolar depression?
The tendency to put things off until the last minute is very common in bipolar depression. It is as if your motivation is so low that only the danger of failure can force you to finish your project.

Am I lazy? I can't get up to go to work, and I seem to lie around all day.
No. Your bipolar depression is not laziness. It is a nervous system disease that turns off your ability to stay active, no matter how hard you try. This issue often comes up when families, friends, and employers see individuals with bipolar disorder. Because they do not know about bipolar illness, they may assume that the individual is just lazy.

When I get depressed, I stay inside and I never answer my telephone or mail. Could I have bipolar depression?
I frequently see bipolar depression causing social isolation, withdrawl, and an inability to keep up communications with others. When this is severe, it may resemble the diagnosis of agoraphobia, although agoraphobia does not come with a history of bipolar symptoms. This kind of avoidance can torpedo friendships, family relations, and employment, but, fortunately, the withdrawal gradually fades with effective bipolar treatment.

I feel paralyzed. Why can't I do anything?
You are describing a state that is specific and understandable to you and others with bipolar depression but has little meaning for the general public. People with bipolar depression use words like "being paralyzed," "being overwhelmed," "unable to function," and "unable to do anything."

This condition is a major cause of problems in bipolar depression. It may involve the brain centers that control conscious movement and activity, such as the substantia nigra area of the brain. For example, insufficient quantities of the biochemical dopamine, an important neurotransmitter in bipolar disorder, in the substantia nigra cause an inability to move and initiate actions in Parkinson's disorder. Happily, this paralyzed state usually improves significantly in both disorders with appropriate treatment.

What does bipolar depression feel like?
Many people associate the term depression with feelings of sadness, and sadness is indeed what most persons with unipolar major depression feel. However, by questioning my patients with bipolar depression, I have learned that, unlike those with unipolar depression, they experience a mixture of emotions, including sadness, hopelessness, anxiety, panic, fear, irritability and anger, which are often difficult to distinguish from one another.

Bipolar depression brings with it an intense internal pain so strong that individuals often spend entire days crying. Many feel as though they are immobilized and that they can never reach the goals they have set for themselves.

But I'm anxious and depressed. What is going on?
Based on my experience, I believe that many people who used to be diagnosed with "anxious depression" really had bipolar depression. Bipolar disorder makes worried thoughts by producing repetitive and intrusive thinking and by over focusing attention on what will happen in the future. Physical edginess and agitation are also caused by bipolar disorder. Persons with bipolar disorder describe this feeling as "on edge," "like my body isn't right," "like I'm jumping out of my skin," etc.

[nandm]

Doctors have created a classification system of "types" for bipolar disorder in an attempt to distinguish between people with varying symptoms. Type I describes those who have clear manic and depressed cycles. Type II describes those individuals whose cycles are unequal and have, for example, mainly depressed symptoms most of the time with only occasional manic symptoms. Type III is an unofficial category applied to people with bipolar disorder whose first episode is triggered by an antidepressant medication.

Part of the reason for these extra categories is to overcome the traditional misconception that bipolar disorder always manifests as a cyclic disorder with clear episodes of pure mania and pure depression. While these categories help clear up some of the uncertainty about bipolar disorder, there is still a great amount of confusion in the research and literature about bipolar disorder. One reason is that many people who have personality disorders or organic brain injury are now included in the Bipolar Type II category, although they do not really have bipolar disorder.

I have depression, not bipolar disorder! I am depressed most of the time, and I have never had a mood elevation in my life.
Even if you only experience depression, you still might have bipolar disorder Type II. Remember that you do not have to experience mood elevation to have mania. Many manics experience irritable (angry) or expansive or mixed moods rather than elevation

[nandm]

A clinician friend once told me with disdain, "I don't concern myself with diagnosis." Another asked me, "Why do you have to remind people that they have problems? Can't you just ignore people's differences?"

It would be nice if we could make bipolar disorder go away by ignoring it. However, you will soon see that accurate diagnosis is the most important tool to keep you healthy in bipolar disorder. Getting the correct diagnosis can make the difference between getting successful treatment or dragging along for years without being able to use your unique skills and talents. Correct diagnosis can help avoid erroneous and dangerous treatments. The ability to detect when bipolar illness is worsening can help head off flareups before they start.

What would I see if my loved one had bipolar disorder?
During an activated or manic episode, some of the following symptoms will be present:

• Talking abnormally loudly and rapidly and/or talking too much
• Staying up all night
• Starting new projects that are never finished and making unplanned trips
• Racing thoughts and a feeling that the mind is too full of thoughts, especially at bedtime
• Making impulsive decisions and becoming obsessed about work or relationships
• Exhibiting sudden changes in dress and grooming, particulary at the beginning of an episode.
• Taking risks (such as driving too fast) or other deviations from usual behavior

During an inactivated or depressed episode, some of the following symptoms will be present:

• Oversleeping
• Overeating and/or gaining weight
• Tiredness and low motivation that make it difficult to start or finish even simple tasks.
• Withdrawing from social situations by avoiding telephone calls and mail or remaining in one's room or home

How can I tell for sure if I have bipolar disorder?
Find a doctor experienced with bipolar disorder who will give you a professional evaluation to determine if bipolar disorder is present and what you should do about it. You can ask for a referral from a family physician or therapist or go directly to a medical specialist (psychiatrist).

How can I tell if a doctor is taking my illness seriously?
You want your doctor to work seriously on determining this diagnosis because it is one of the most important things you will ever do in your life. Try to find a doctor who will spend at least thirty to sixty minutes of serious evaluation before he or she offers a diagnosis. Sometimes you may have to visit the doctor two or more times until a diagnosis can be made. At the end of the evaluation, ask your doctor to explain exactly what your diagnosis is and on what the diagnostic decision has been based.

How can you be certain of a bipolar diagnosis? Isn't bipolar different in every person?
People are different but the disease is the same. For example, if you had a party of one hundred completely different people who all had bipolar disorder, you could walk through the group and hear everyone saying similar things about their bipolar illness, sometimes using the same words.

Where else can I find out information on bipolar disorder?
Go out and join national organizations representing bipolar disorder, get and read professionally published magazines and newsletters, and go to national and local meetings of bipolar and mental health associations.

[nandm]

A recent study showed that almost 70 percent of bipolar patients had been misdiagnosed more than three times before receiving their correct diagnosis. Common misdiagnoses include unipolar depression, attention deficit disorder, sleep disorders, personality disorders, obsessive-compulsive disorders, post-traumatic stress disorder, postpartum depression, schizophrenia, "stress," "nerves," and "old age."

[Jrock75]

Originally Posted by nandm

A recent study showed that almost 70 percent of bipolar patients had been misdiagnosed more than three times before receiving their correct diagnosis. Common misdiagnoses include unipolar depression, attention deficit disorder, sleep disorders, personality disorders, obsessive-compulsive disorders, post-traumatic stress disorder, postpartum depression, schizophrenia, "stress," "nerves," and "old age."

I was misdiagnosed with schizophenia before I was diagnosed Bipolar. That misdiagnosis didn't help me at the time at all.

[dor5711]

Just got the book from the library. It's a great resource. Very readable. I am going to buy a copy and hopefully my son will read it at some point. Answers alot of questions in a clear concise format. There's also a book for children, teens and families written by the same author that has the same format. Thanks for the info.

Dor

[nandm]

Much of the stigma of bipolar disorder is based on fear of the different. Unfortunately, people with bipolar disorder contribute to this stigma by unjustified embarrassment over their illness.

Why do people feel uncomfortable about bipolar disorder?
The very existence of bipolar disorder is a reminder to everyone else that they have their own mental and emotional problems. Chronic illnesses and injuries are not so threatening when patients have visible signs of illness such as consumption, bandages, or scars. It is easy to distance oneself from these poor wretches, but bipolar individuals are often attractive, intelligent, and successful. It can be terrifying to others to admit that they, too, could be vulnerable to illness.

What are the popular misconceptions about bipolar disorder?
Television and films usually depict persons with bipolar disorder as violent beasts with strange ideas and immoral behavior. Alternatively, bipolar individuals are sometimes characterized as mystics with special psychic powers or as special messengers from God or the devil.

How can we get rid of the stigma?
Stigma is fueled by ignorance and fear. When the population is more aware of the true nature of bipolar disease, stigma will ebb.

Does our culture value bipolar attributes?
Definitely. While many people malign those with bipolar disorder, our culture almost worships manic symptoms like boundless energy, magnetic charisma, workaholia, the ability to go without sleep, hyperverbosity, and insatiable sexual appetite. If you think about it, you will see that these attributes fit most of the heroes and heroines that appear on our film and video screens. In real life, however, this pattern of attributes is caused by bipolar illness, and it damages people's lives rather than enhancing them.

I read in a book that bipolar disorder makes you smarter and more creative. Haven't famous people been bipolar?
I think that gestalt, a viewpoint that strives to see everything at the same time, and parallel thinking, and ability to process similar thoughts at the same time, are often well developed in people with bipolar disorder. These talents can enhance problem solving and increase creativity, but the illness conspires to keep the bipolar individual from using their talents. There have long been unproven speculations that geniuses like Dostoyevsky, Van Gogh, Orson Welles, and many others suffered from bipolar disorder. Although they became prominent historical figures, their lives were often filled with tragedy.

An internet site said that world leaders like Julius Caesar, Henry VIII, and Mussolini were bipolars. How could you tell?
Try looking throughout history for charismatic, magnetic leaders with boundless energy, little need for sleep, wordiness, and an unquenchable sexual desire, who deteriorated as they aged. Were they bipolar? You can make up your own mind.

What is the cost of bipolar disorder to our society?
Bipolar disorder is among the top ten causes of disability all over the world. Millions of public dollars are spent for hospitalization and medical care that would never have been necessary if people's bipolar illness had been recognized and treated early. Homes are split, loves lost, fortunes squandered, and children made to suffer. There is no end to the toll that untreated bipolar disorder takes on all peoples of the world.

Do you think that the economy exploits people with bipolar disorder?
Absolutely. Knowingly or unknowingly, many businesses prey on bipolar individuals. For example, home shopping channels, thrive on the bipolar tendency toward impulsive spending sprees. Liquor manufacturer's advertisements stressing power, wealth, fame, and sex appeal particularly to bipolars who are at increased risk for developing alcohol problems. Casinos' mixture of grandiosity, free alcohol, and late hours prey on the manic tendency toward gambling and sexual addiction. Corrupt online casinos take advantage of bipolar obsessiveness and willingness to trust others. Pornographic internet sites take advantage of bipolars impulsitity, hypersexuality, and the need for high stimulus levels and immediate gratification. "Too-good-to-be-true" offers of free loans, weight-loss schemes, and exotic cures prey on bipolar fantasies of perfection and hopes for a quick fix. Exploitation of bipolar illness is a gravy train for marally and ethically barren businesses and schemes.

What can I do to help other people with bipolar disorder?
When their bipolar disorder is under control, many people with bipolar illness feel that they have some responsibility to help others. Join national associations that advocate for bipolar individuals in the Congress and in state legislatures. Read bipolar newsletters and magazines published by national organizations and become familiar with the medical and social issues affecting bipolar individuals. Write letters to legistators, doctors', and therapist' organizations, and pharmaceutical companies. Go to bipolar meetings and speak out in support groups. Go to Internet chat and support sites, and tell others what you have learned that works for you. Your brothers and sisters with bipolar disorder need you.

[nandm]

I estimate that, once optimal bipolar medications and therapy are implemented, changing lifestyle and health patterns is the best thing you can do to improve your health. I believe that lifestyle changes can reduce residual bipolar symptoms by 10 to 30 percent. Best of all, lifestyle changes are easy to make, safe, and completely, free of cost.

Overall, I have found that drinking alcohol, staying up all night, missing meals, and working too much are the most common behaviors that destabilize bipolar disorder.

Stress Drives Bipolar Disorder
Bipolar disorder is a stress-related disease. That is, the symptoms of bipolar disorder become worse as stress increases. Therefore, the most important thing that you can do is to purge the sources of stress from your life and make a commitment to keep new stressors under control. Effective stress treatment can be a godsend for bipolar sufferers: It is an effective means of helping to control bipolar illness that is both safe and free.

Unfortunately, stress reduction is often the most difficult treatment to convince patients to follow. When I tell patients to lower their stress levels they usually come up with excuses explaining why it is impossible. They say, "I couldn't possibly cut my workday by two hour," or, "I have to stay up until 3:00 am every night," or, "I have to take on this extra work. I don't have a choice." The most common thing I hear is, "Don't worry, doctor, I'll be free from stress as soon as I finish this big project." Unfortunately, as each stressful project is finnished, another one seems to take its place. It is important to remember that you can always find reasons why reducing stress seems difficult or impossible. Nevertheless, you must make your health a priority in your life in order to beat bipolar disorder.

What is stress anyway?
Stress refers to a physiological reaction of the body that overstimulates the adrenal glands, resulting in the overproduction of body stress steroid hormones such as cortisol and stress neurochemicals such as adrenaline. Among other things, these body stress biochemicals increase blood pressure and change blood flow, heart reactivity, urinary and bowel function, breathing rate, body temperature, perspiration, tremor, memory, and attention. Stress hormones are meant to be released only briefly in times of stress. However, modern life stresses are often constant. When stress steroids are present continuously in high concentrations, they produce permanent, unhealthy changes in the body and brain. Some studies have even shown that steroid hormones can kill brain cells when present at high level for a prolonged period of time.

What are some examples of stress that can affect the body?
Examples of stress include working too many hours, not getting enough sleep, going to sleep too late, working under pressure or at the last moment, having or nearly having an accident, and so forth. Stress may also come from intense, pleasant experiences such as getting married, having a birthday, taking a trip, or having a child.

How much stress do I have to cut out of my life to be healthy again?
I recommend you start by spending 25 percent less time in activities that cause you stress. For example, if work is the main source of your stress and you work seven days a week, cut back to five. If you are working fifty-five hours per week, cut back to forty. Believe me, you can do it.

What is the connection between stress, bipolar disorder, and the immune system?
The exact connection is not clear, although the immune, hormonal, and neurotransmitter systems are very closely interconnected. For example, an injection of naturally occurring immune system compounds (Called inflamatory cytokines) can trigger depression. So can the administration of stress hormones involved in the immune response.

How can I be under stress? I like working all night long with no sleep.
Stress refers to things that overstimulate our bodies. The secretion of stress steroids makes our hearts beat faster, our blood pressure rise, our hands shake, our body sweat, and our stomach acid churn. It really does not matter whether you like something or not; it can still cause damage to your body and health.

Try going to a bipolar support group or online forum and notice how much outside stressors increase other people's bipolar symptoms and severity.

If I reduce the stress in my life, will I be able to cut back on my medication?
You probably would not have to take much medication if you moved to Siberia and lived alone in a Quonset hut, eating bonbons and watching MTV all day. However, most people with bipolar disorder choose to live a more complex life with higher levels of stress. If you choose to live a life with typical amounts of stress, you will probably have to take medications and manage your life stresses to keep yourself healthy.

[CatsPajamas]

Judith,

This is truly great stuff. I have a nephew who has struggled with this disorder for many years, and I dated a man who was bi-polar. It's an incredibly challenging and frustrating disorder for sure, not only for the patient but for the family members as well.

Thank you for sharing this information. I'm going to print it out and save it, and I'm going to recommend the book to my brother and his son.

[nandm]

I am so glad that many have found this book to be as useful as I have. I have had the bipolar diagnosis for over 5 years now and the more I read this book the more I realize that I am not insane, I am just bipolar. For the longest time I felt ashamed, broken, not good enough, etc....because of my mental illness. This book has helped me realize that I am who I am and that I can live a normal life as long as I take responsibility in managing my illness. It explained so much of the things I do and why I do them. It gave me hope. I can now see it as no different than a diabetic managing their diabetes. I have certain things I must do daily to manage my illness. That is what it is an illness it does not mean I have to feel less than. It does not mean that I can not function in society, I just have to be an advocate for myself and take responsibility for my care. I am glad I made the decision to share excerpts from the book.

[nandm]

I suggest that you learn one or more relaxation techniques, such as muscle relaxation or meditation. You can do relaxation exercises daily to reduce your overall stress level. When you know you will have something stressful to deal with, you can practice your relaxation exercises beforehand. If all else fails and you find yourself in the middle of a stressful situation, you can excuse yourself for a moment, and do your relaxation exercise. There is no etter way to learn to cope with stress.

What are muscle relaxation techniques?
Muscle relaxation training refers to a variety of physical exercises for relaxing your body and mind. Here is one I use. Sit comfortably in a chair. Now tense all the muscles in your toes, feet, and legs. Tighten the muscles as hard as you can while breathing in slowly, then breathe out slowly and relax them. Next, tighten the muscles in your hips and abdomen as hard as you can while inhaling slowly. Hold your breath for a moment, then exhale slowly and relax those muscles. Now, tighten all the muscles in your fingers and arms while you breathe in slowly. Hold your breathe momentarily, then exhale and relax. Finally, tighten the muscles in your shoulders, neck, and face and breathe in slowly. Once again, hold your breath for a moment, then relax and exhale. Now notice your breathing. As you slowly breathe in, imagine you are gathering together all the stress in your body. Then breathe out slowly and exhale all your stress along with your breath. You should continue this breathing for at least a minute, although you can do it longer if you like. You can use this technique regularly, twice a day, or any time you have to deal with a stressful event.

What is meditation and how can I use it to manage stress?
Meditation refers to a diverse collection of mental, emotional, and physical exercises that have been devised over the last several thousand years for the purpose of changing the way we experience our lives by increasing our control over our thoughts, feelings, and physical bodies. Meditation can be useful in bipolar disorder to aid relaxation and reduce stress as well as to exercise our ability to focus and control our stream of consciousness.

What if I can't stop my wandering thoughts? My mind is racing.
If you can't keep intrusive thoughts out of your mind no matter what you do, then you are too distractible and your thoughts are too repetitive and obsessive. The next step is to talk to your doctor and make sure you are taking enough mood stabilizer(s) or other bipolar medications that can stop intrusive thoughts.

What about hypnosis? I think that would work for me if it were safe.
I do not recommend hypnosis for bipolar disorder. In bipolar illness, we are always working to improve control of thoughts and emotions, whereas hypnosis is a process of relinquishing control.