i need manic depression explained to me a little. someone please help!

[goddess sparkle]

a person who i love more than anything in the world is disapearing. she has done it before, when i didn't know her and came so close to dying. if i lose her, i don't know what i will do. i would die for her if it meant she could be happy even for a day. she is making horrible choices one after the other. she is bipolar and she takes seroquel, but she drinks almost all the time. she goes to an ivy league college, and the pressure is getting to her again. i talked to her yesterday and she has reverted back to her old self- she is not going to class, she is drinking all the time, she is having unprotected sex with people she doesn't really know and she is tricking her therapist through it all. i know i can't save her and i know i am basically helpless in this situation. but is there ANY thing i can do. if you are bipolar yourself, i wonder if you might tell me what you need when you are spiraling out of control. is it even possible for her to ever come out of it? i feel so hopeless and sad. i don't know what to do for her. i try and try and try to be a selfless loving friend. but sometimes i want to never talk to her again so i don't have to know how she is killing herself slowly. i hate it. someone please offer any encouragement if you have it. i really really need it. thanks guys.
kristen.

[Jon]

here's a start, more to follow. Keep in mind that someone with Bi-Polar who is also an alcoholic/addcit is termed "Dual Diagnosis".

Bipolar Disorder
WHAT IS BIPOLAR DISORDER?
Bipolar disorder, or manic-depression, is characterized by moods that swing between two opposite poles:
Periods of mania (mood elevation, including exaggerated euphoria, irritability, or both). For a diagnosis of bipolar disorder, only one episode of mood elevation needs to be reported.


Episodes of depression.
[ For details, see Box Symptoms of Bipolar Disorder.]
Bipolar Disorder Categories
Bipolar disorder is classified according to symptom severity as bipolar disorder I, bipolar disorder II, and cyclothymic disorder.

Bipolar Disorder Type I. Bipolar disorder type I is characterized by at least one manic episode, with or without major depression. With mania, either euphoria or irritability may mark the phase, and there are significant negative effects (such as sexual recklessness, excessive impulse shopping, sudden traveling) on a patients' social life, work, or both. Untreated mania lasts at least a week or results in hospitalization. Typically, depressive episodes tend to last six to 12 months if untreated. However, untreated manic episodes last three to six months.

Hypomania and Bipolar Disorder Type II. Bipolar disorder type II is characterized by at least one episode of hypomania and at least one episode of major depression. With hypomania the symptoms of mania (euphoria or irritability) appear in milder forms and are of shorter duration. They do not affect social or work life as dramatically, and hospitalization is not generally required.

Cyclothymic Disorder. Cyclothymic disorder is not as severe as either bipolar disorder II or I, but the condition is more chronic. The disorder lasts at least two years, with single episodes persisting for more than two months. Cyclothymic disorder may be a precursor to full-blown bipolar disorder in some people or it may continue as a low-grade chronic condition.
Course of the Illness
Bipolar disorder can be severe and long-term, or it can be mild with infrequent episodes. The usual pattern of bipolar disorder is one of increasing intensity and duration of symptoms that progresses slowly over many years. (Patients with the disease, however, may experience symptoms in very different ways.) A bipolar disorder patient averages 8 to 10 manic or depressive episodes over a lifetime, but some people experience more and some fewer episodes.

Typical Bipolar Cycles. In most cases of bipolar disorder, the depressive phases far outnumber manic phases, and the cycles of mania and depression are neither regular nor predictable. Many patients, in fact, experience mixed mania, or a mixed state, in which both mania and depression occur.

Rapid Cycling. About 15% of patients have a temporary, complicated phase known as rapid cycling, in which the manic and depressive episodes alternate at least four times a year and, in severe cases, can even progress to several cycles a day. (Some experts suggest that rapid cycling may first occur in bipolar disorder patients who are on antidepressants, which trigger a switch to mania and set up a cyclical pattern.)

SYMPTOMS OF BIPOLAR DISORDER
Symptoms of the Depression Phase
The symptoms of depression experienced in bipolar disorder are almost identical to those of major depression, the primary form of unipolar depressive disorder. They include the following:
Sad mood.


Fatigue or loss of energy.


Sleep problems (insomnia, excessive sleeping, or shallow sleep with frequent awakenings).


Weight changes (either gain or loss).


Diminished ability to concentrate or make decisions.


Agitation or markedly sedentary behavior.


Feelings of guilt, pessimism, helplessness, and low self-esteem.


Loss of interest or pleasure in life.


Thoughts of, or attempts at, suicide.
Depressive episodes associated with bipolar disorder often differ from those of unipolar depressive disorder in the following ways:
People with unipolar depression can still experience a variety of moods, but the moods are neither elevated nor pathological and the affected person does not meet the criteria for mania. [ See Well-Connected Report #8, Depression.]


Episodes of depression in bipolar disorder are less likely to have a specific trigger than are those with major depression disorder.


Bipolar depression does not typically last as long as major depression (although left untreated some bipolar disorder episodes can still last six to 12 months).


Bipolar depressive episodes develop more gradually than those caused by major depression.


Depressive symptoms in bipolar disorder patients also tend to be atypical, i.e., one sees an increase in sleep and appetite, a feeling of heaviness and slowness in the body, a tendency to feel rejected, and a preservation of volatile mood.


One interesting study reported that many bipolar disorder patients experienced dreams of death at the low point of their depression, and those dreams were soon followed by an upward mood change.
Symptoms of the Acute Manic Phase
The acute manic phase is always characterized by mood elevation, either presented as exaggerated euphoria, irritability, or both. The episode lasts for at least a week or for any duration if it was severe enough to cause hospitalization.

In addition, certain other symptoms are present to assist in making a diagnosis. Some mental health professionals use the mnemonic device DIGFAST to identify them.

In general, for a diagnosis of mania, patient must have experienced either euphoria with three DIGFAST symptoms or irritability with four of these symptoms:
D. Distractibility. This is the most common symptom and is usually characterized by the inability to pay attention to any activity for very long.


I. Insomnia in mania typically means having high energy and requiring less sleep. (This differs from insomnia in depression, in which the patient has low energy plus an inability to sleep.)


G. Grandiosity. Patients with this symptom have an inflated sense of themselves, which, in severe cases, can be delusional. Close to 60% of all manic patients experience feelings of omnipotence. Sometimes they feel that they are godlike or have celebrity status.


F. Flight of ideas. Thoughts literally race.


A. Activity. An increase in intensity in goal-directed activities occurs, which is related to social behavior, sexual activity, work, school, or combinations.


S. Speech. Excessive talking. Is present


T. Thoughtlessness. Excessive involvement in high-risk activities is present (e.g., unrestrained shopping, promiscuity). Mood disturbance may be severe enough to damage one's job or social functioning or relationships with others, or which require hospitalization to prevent harm to others or to the self.
Hypomania. With hypomania the symptoms of mania are milder and of shorter duration (but they last at least four days). They do not affect social or work life as dramatically.

Mixed or Pure Mania. Manic episodes themselves can be characterized as mixed mania or pure mania:
In pure mania, either euphoria or irritability is present along with other symptoms of mania and there are no indications of depression.


In mixed mania (also called a mixed state), depressed mood and manic symptoms occur for at least a week. Depression is present most of the day and nearly every day. Symptoms of mania are also present to a significant degree

[Jon]

WHERE CAN HELP BE OBTAINED FOR BIPOLAR DISORDER?
National Depressive and Manic-Depressive Association 730 N. Franklin St., Suite 501, Chicago, Ill. 60610. Call (800-826-3632) or (312-642-0049) (http://www.ndmda.org/) Makes referrals to local support services and offers a free information package.

Bipolar Network News c/o Stanley Foundation, 5430 Grosvenor Lane, Suite 200, Bethesda, MD 20814. Call (800-518-7326) or (http://www.bipolar disorder network.org/) Write for a free subscription to Bipolar Network News (a joint project of NAMI and NIMH).

Child & Adolescent Bipolar Foundation 1187 Wilmette Ave. #331, Wilmette, IL 60091. (http://www.bpkids.org/)

Depression and Related Disorders Association Meyer 3-181, 550 bldg., 600 North Wolfe Street, Baltimore, Maryland 21287 Call (410-955-4647) or (http://www.med.jhu.edu/drada/)

National Foundation for Depressive Illness P.O. Box 2257, New York, NY 10116. Call (212-268-4260) or (800-239-1265) or (http://www.depression.org/)

Lithium Information Center, 7617 Mineral Point Rd, Suite 300 Madison, WI 53717. Call (608- 827-2470) General information is provided over the phone; literature searches on specific topics cost a nominal fee. The center also publishes many patient guides and reference books.

National Institute of Mental Health, D/ART/ (Depression Awareness, Recognition, and Treatment) Program, Room 15-C-05, 5600 Fishers Lane, Rockville, MD 20857. Call (800-421-4211) or (http://www.nimh.nih.gov/)

National Alliance for the Mentally Ill (NAMI) 200 N. Glebe Rd., Arlington, VA 22203-3754. Call (800-950-6264) or (http://www.nami.org/) NAMI is a national grass roots organization providing ways for self-help and support organizations to individuals and families of people with psychologic disorders.

National Mental Health Association 1021 Prince St., Alexandria, VA 22314-2971. Call (703/684-7722) or the Mental Health Information Line (800-969-6642) or (http://www.nmha.org) This organizations will give the names and numbers of regional chapters and also provides information on 200 mental health topics.
Mental Health Professional Organizations
American Institute for Cognitive Therapy. Call (212-308-2440) or (http://www.cognitivetherapynyc.com/)

Association for the Advancement of Behavior Therapy. Call (212-647-1890) or (800-685-AABT) or (http://www.aabt.org/)

The American Psychiatric Association. Call (202-682-6000) or (http://www.psych.org)

The American Psychological Association. Call (800-964-2000) or (http://www.psychologicalscience.org/) and (http://www.dotcomsense.com) for consumers.

The National Association of Social Workers. Call (202-408-8600) or (http://www.socialworkers.org)

The American Psychiatric Nurses Association. Call (202-857-1133) or (http://www.apna.org)

American Academy of Child and Adolescent Psychiatry (http://www.aacap.org/)
Good Internet Sites
Expert Knowledge Systems (www.psychguides.com) This physician group offers excellent detailed information on bipolar disorder.

Mental Health Net (http://mentalhelp.net) Excellent site.

Internet Mental Health (http://www.mentalhealth.com/) is a free encyclopedia of mental health information.

Psychiatric Times' Bipolar Disorders Letter (http://www.mhsource.com/bipolar disorder/letter.html) sponsored by a pharmaceutical agency but good information.

On the Internet

Mental Health Net (http://mentalhelp.net) Excellent site.

Internet Mental Health (http://www.mentalhealth.com/) is a free encyclopedia of mental health information.

Psychiatric Times' Bipolar Disorders Letter (http://www.mhsource.com/bipolar disorder /letter.html) sponsored by a pharmaceutical agency but good information.

[goddess sparkle]

thank you so so much for the info. you know those days when all you can do is ask for help? i should have probably looked up all that on my own, but your helpfulness is SO appreciated because i don't think i am up to it today. i wish there were magic words to save my friend. i want to do something, anything to save her and i know it's impossible. i have thought about talking to her family but they are all so self centered and would be so angry with her if they knew she was not succeeding in school where she is. i can't take this anymore. i want to fly out to her and take her away. it's just gotten so out of control again so quickly and i feel so powerless.... thank you again for your help...

[Jon]

Does she WANT help?

[goddess sparkle]

that's the hard thing to say. she is "getting help" and has been now for a few years. right after high school she tried to kill herself, then a month later she went to yale, then she had a breakdown and left. she was here in ca for about 2 years getting help and then she went back in january. so she has a therapist out there who she lies to. and she has one here who she can't really see unless she is on break. and she has no support at school at all. she hangs out with idiots. when she was here with me and her other therapist, etc. she seemed to be doing so well. and she is miserable at yale. she is only going because everyone expects it from her. that's the key. if i could somehow convince her to leave that school and go somewhere near here i think she would be so much better. so, in some sense she is getting help. and in the other sense, the drinking has spiraled out of control and i think that's the biggest thing right now. i don't know anything about seroquel, but i think that alcohol most likely lessens the effects or almost negates them completely.

[Juls]

Jon,

Thanks for the great info. I am going to power post this.

Goddess,

It is very frustrating to watch someone you care about being in a self-destruct mode. She can come out of this and get better, but bi-polar is a disorder where when the person is in the mainc phase they have what is called "grandiose" thinking. Meaning, they typically don't think anything is wrong with them, they like the euphoria of the manic phase, and it is very difficult for them to see that they have a serious problem. Even after repeated episodes that can have serious consequences.

It is important for you to take care of yourself so that your emotional stability does not become dependent on what is happening to her. You can be a much better friend to her that way. I know it is hard though.

You are correct in realizing that there really isn't a whole lot you can do in this situation. And of course the drinking just makes it all worse. Hopefully at some point she will be able to recognize that she needs more help and will get involved in a recovery program for her drinking.

Please feel free to come her anytime to talk, ask questions, or for support.

Juls

[goddess sparkle]

thank you guys so much for your help. you have no idea how much this means to me. i will definitely spend some time on these boards trying to learn as much as i can. unfortunately at this point it is kind of consuming me. i hope it tapers off. thanks again so much for your kind approaches and your helpful words. they are totally meaningful to me.
kristen.

[Juls]

Goddess,

It is normal for something like this to consume you at first, but as you learn more about it, and how to take care of yourself, while being concerned for your friend, you will get things in perspective, and will not be as consumed by it.

Juls

[clancy]

I used to work in mental health and bi polar is a funny thing. thing is when the individual is manic, she is often having the greatest time ever, she feels incredible invincible. Many people with the disorder are are loth to take the appropriate meds,(its usually lithium, it works, but its a really toxic substance,, you got to monitor the levels in the body so carefully, or you can get seriously ill.)

I meaan they can some times feel absolutely fabulous, like many of us have never known, and never will, looking on you got no idea how good that person feels. They sometimes feel that to take the meds is to give up something precious, i can understand that. To the onlooker they may seem utterly bonkers though.

When they get low, sometimes they are almost comatose, either way convincing them of the need for meds is quite a job.

Bi polar people are kind of special. I have a theory about'madness' maybe we just medicalise people too much,and too quickly. Maybe the 'mad' arent really 'mad' at all. Maybe this isnt a disorder but just a human state, part of life. If you are at all interested in this idea read 'The Myth of Mental Illness' by R.D Laing. its quite a famous book,it turned my head around.

But you got to remember every thing is just a theory. We are subjective beings and objectivity it is just not possible for us.

You know what i mean, you can only ever look at life thru your very particular pair of spectacles. Its all you can ever have. You can never put on a ' neutral' pair,(Oh, if only we could! we would know all the answers!)

The strange thing is there is really no such thing as 'the truth', only the truth as we see it ,and we all see it slightly differently!

Hope i didnt confuse anyone, but my sister is going thru a phase of 'psychosis' right now and im thinking about it alot.

love, clancy - in thoughtful mode

[Lilya]

Juls,

Could you make this stay on the board? I think it woulde be a good idea. It has so much information.

Love and light,

Use adversity

[Juls]

Yes Lilya,

I can copy the information, and put it in with the other "power posts" for the board.

Juls

[negritail]

what do you do when one is not officially diagnosed but receives medication, antipsychotic such as seroquel in high dosage after an alcoholc DT and 3 weeks of total delusion. the mood in the mornings is usually low but peacful. but should one disturb his holy sleep he gets pretty hostile. i am confused where alcoholism ends and a medical condition begins. but he does not participate in life, partake in any activities, and avoids responsibilities/ people contact. in fact it is so bad, i have to make calls for him too. his real outbursts are rare while on meds, but he gets irritable, anxious after i already do everything and goes off on me. the last time scared me. the verbal abuse is always there. he is degrading and demeaning in his ways. yet the other side is sweet, gentle, sensitive. he has a fixation over his money and lacks regard for others. it is obsessive compulsive at best! he can get quite reckless which also caused his last dui. he is careless with other's feelings, ruthless in fact, yet very touchy about his. in fact he is not approachable when it comes to discuss problems. he avoids any reponsibility for anything. he lies, deceives, manipulates, controls, whines, and is self centered. he calls himself slippery and lets one hang until one gets to her breaking point, then he lets up and may come through with his word or promise. he demands one's full attention but gives none. 46 years old he has no motivation, sex drive, interest, social outlet, healthy life style...and he will quiy eating all together when alone and the drinking starts. he will fall into a depression then, and barricade himself in his house. i am lost trying to figure or reason here what i can do, what i should do! his shrink isn't worth a damn either but a pill pusher at best without an answer.