Is it Depression or Bipolar?

 

Bipolar-disorder

Thanks to Kitt O’Malley, who posted this before me. And thanks to Michael Pipich for the wonderful information.

Are You Just Depressed or Is It the Onset of Bipolar Disorder?

Michael G. Pipich, MS, LMFT

About two-thirds of people with bipolar disorder are misdiagnosed with other mental health problems before bipolar is discovered.[1] Among those individuals, a significant majority are given a diagnosis of major depression. Most people with a major depressive disorder that is unrelated to bipolar disorder (typically known as non-bipolar depression or unipolar depression) can be treated safely and effectively with a combination of antidepressant medications and psychotherapy. But when people with undetected bipolar are treated this way, a host of mental health problems can occur, making the underlying bipolar condition much worse.

It’s understandable that someone may not immediately be given the bipolar diagnosis if their first mood swing begins in a depression mood zone. This seems particularly true of people who have bipolar II disorder. And sometimes, there may be more than one depressive episode before a manic or hypomanic episode happens in a person with bipolar.

If you’re wondering about whether you may have depression or the beginning of bipolar, there are some keys to keep in mind when seeking treatment.

First of all, when assessing if your depression is a part of bipolar, know that bipolar disorder has distinct genetic foundations. In other words, it runs in families and is passed through family genes. So if you suspect that any family members may have had bipolar disorder, it’s important to inform your doctor or therapist when entering treatment. If the information is available, a thorough family mental health history can really support a proper bipolar diagnosis. Unfortunately, such information isn’t always asked for, so be prepared to volunteer all that you know during an evaluation or treatment session.

Next, your personal history of mood swings should be explored. If you’ve had severe ups and downs during childhood or adolescence, these may be more than the common tumult of growing up. They may instead be early expressions of bipolar disorder. It’s especially important to review periods of hyperactivity, bouts of unexplained rage, self-harm, or suicidal thoughts or actions that could have occurred at any time in life. There certainly may be other explanations for these, such as early life trauma or severe loss and grief experienced during these formative years. But if explosive behaviors or deep depression occurred at different times, especially with little or no provocation, it can point to underlying bipolar disorder.

Usually, most people with bipolar who seek treatment on their own are currently or recently depressed, or are experiencing consequences of untreated bipolar disorder. Any history of mania or hypomania is less obvious, however. And often, bipolar patients will either not understand manic symptoms or will avoid discussion about them. If you have had at least one occurrence in your life of intense euphoria, excitability, unexplained energy and creativity, avoidance of sleep, or impulsive behaviors, inform your treatment professional. But also bear in mind that mania and hypomania may be marked by intense periods of irritability and agitation, know as dysphoria. This is in contrast to the euphoria that most people think about with bipolar mania. Often a dysphoric type of manic or hypomanic episode can be mistaken for the kind of agitation seen in major depression. This can mislead the course of treatment to focus only on depression, while missing the full bipolar condition.

This brings us to the most important part of knowing whether you have depression or bipolar onset. According to the Diagnostic and Statistical Manual of Mental Disorders (5th edition), if a patient is given an antidepressant medication, and it produces manic symptoms, the person is then diagnosed with bipolar disorder.[2] While this is a very clear indication of bipolar, how the mania surfaces in the individual may take different forms. For example, a person in a depression mood zone can improve early in the treatment, and as a result, may not show manic symptoms right away. Any slight improvement may provide a hopeful sign that treatment is working, but when the person starts to get worse because of emerging mania—especially if it’s dysphoric—the unwitting response may be to apply more antidepressant medication. Now we have some real problems.

So, if at some point in your treatment, an antidepressant medication makes you feel more agitated, more irritable, more aggressive, or you start to experience hyperactivity or greater impulsivity, tell your treatment professional right away. This could be the start of a manic episode that is revealing a previously undiagnosed bipolar disorder. Even more importantly, any increase in suicidal thoughts or possible psychotic symptoms, such as hallucinations, should be reported immediately, as these can be life-threatening. Any antidepressants will either likely be eliminated at this point, or possibly paired with a mood stabilizing or antipsychotic drug to keep a lid on mania.

With bipolar finally recognized, bipolar medications can be introduced to decrease manic-type symptoms, while keeping depression in check. Alongside medications, it’s important to have therapy focus on the unique challenges facing people with bipolar disorder. Major depression is frequently considered an acute condition because it often can resolve in time, so medications may be discontinued at some point, along with a shorter overall approach to therapy. But bipolar disorder is a lifelong condition. Even though its symptoms can come and go in episodes, the genetic nature of the condition means the bipolar patient will need continuing care through the lifespan.


[1] Hirschfeld R. M., Lewis, L., & Vornik, L. A. (2003). Perceptions and impact of bipolar disorder: How far have we really come? Results of the National Depressive and Manic-Depressive Association 200 survey of individuals with bipolar disorder. Journal of Clinical Psychiatry64(2), 161–174.

[2] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author, 128-130.


 

Michael G. Pipich, MS, LMFT is a psychotherapist and author of Owning Bipolar: How Patients and Families Can Take Control of Bipolar Disorder, (Citadel Press, Sept 2018). He practices in Denver, Colorado, and can be reached at MichaelPipich.com.

Press Contact: Janet Appel Public Relations
205 West 54 Street, New York, New York 10019
212-258-2413

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A Country Wife . . . A Poem

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A country wife

Gravel under her feet

Rain clouds above her head

Wind whipping the willow at her side

 

She walked

She had done it again

 

Most called it cheating

She called it surviving

 

Red nails at her fingertips

Smeared make-up at her eyes

Despite watching the time

It had been an hour of instinct

 

She left him behind

Like every other time

And walked toward home in haste

 

He filled her in more ways than one

Something marriage could not

 

Raindrops – between her lashes

Pasted curly locks in place

Her lips formed an evil grin

She imagined his square handsome face

 

Back into the kitchen

Back to cooking peas

He would get his supper

She would go to bed pleased

I’ve Been a Bad Girl . . . A Poem

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Rainy Sunday, Mother’s Day

Mama was at home

I took a shovel from the shed

And cracked her collarbone

 

Then I used the handle part

to gouge out her right eye

To my surprise it burst inside

then shed upon her cheek

 

Oh, Mama, silly woman

I told you I’d be back

to stop the strife

to end your life

then stuff you in a sack

 

 

People! That’s Nasty, Rude, and Irritating!

I KNOW you have pet peeves. We all do. Here are some of mine!

man-spitting  Yesterday, a man walking in front of me decided to spit. The wind was blowing MY way. Gross, folks! Think before you do nasty things!

man-chew-mouthopen  Last night at dinner, a man sat a couple of tables across from me and chewed with his mouth SO open that I was amazed the food stayed IN his mouth when he chewed. Gross, dude. Stop it!

man-burping  Last week, a grown man belched loudly in a restaurant and never said, “Excuse me or Sorry.” He looked proud of his sickening accomplishment. What’s up with these people? Were they raised in a barn?

man-waiting-tooclose  Ever have people standing waaaay too close to you in a line? If I can smell your breath, your lack of deodorant, or feel your breath on my neck, you are TOO CLOSE. Ick.

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Ah, yes . . . the person on the cell phone who is talking too loudly over a meal. Never mind how rude that is to whom the person is dining but the one on the cell phone is often yelling into the phone and disrupting all of the diners around her. Please put the phone down when you are at a table, people.

The public in general has adopted many frustrating habits. I’m from the South, and my Mama taught me better than that!

Stairs to Nowhere – A Poem

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A quick glance. A pic on my phone. I saw stairs. And then they were gone.

Driving by.  Was saying a prayer. Then I see. Stairs that lead nowhere.

Neither to heaven nor to hell. Just some steps.

Just a pair. Steps that lead to open air.

Is that my fate? Are we all so gullible?

Clinging to what’s not there. Thinking we’re a holy heir?

That day brought clarity. Of the mystery.

Stairs that lead nowhere.

 

I Diet. I Exercise. Why Can’t I Lose Weight?

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Okay. I’m being honest here. I tried Atkins/Ketogenic Diet for two months and lost 12 pounds but sticking with that strict of an eating plan was torturous. I had to remain on the “Induction” (introductory) phase so I could lose at a decent pace (I have a LOT of weight to lose, as well). Plus, I stopped losing and stayed the same weight for another month after losing the 12 pounds. So, I joined Weight Watchers for the 1,245,391st time! It’s been five days and the scale has not budged even 1/10 of a pound. That is despite exercising AND watching what I’m eating!

I’m sick of trying SO hard only to see minimal (or no) results. Yes, I take one or two meds that might be hindering my weight-loss efforts but THIS much? So, I’ve decided to stay with the Weight Watchers plan because it offers so much variety and group support BUT I’m doing a “no-no” according to their rules; I’m going to cut my daily calories (or points).

A fat woman using an elliptical machine

I’m almost 54 years old and so age isn’t my friend anymore when it comes to losing fat. I’ve become pre-diabetic but refuse to let myself get any more out of shape. I do notice that carbs make me very sluggish. That is an awful feeling. Sometimes, I have to actually take a nap to get over the sleepiness. It’s ridiculous.

So, instead of 24 points tomorrow, I’m only having 20. I’m sure there are W W leaders and members out there who will chastise me for trying this but SOMEthing has to give. I’m already exercising every day. I’m also still refraining from desserts, sweets, regular sodas, and things made with white flour, rice, or pasta. Whew!

A fat woman using the treadmill to lose weight

 

I’ll keep y’all up to date on how it’s going. I WILL find a way out of this fat-trap I’m in. I’ll share it here with you, too! Honesty all the way.

Anyone have advice for a fed-up fat woman? I’m going to Cozumel in November! This is my time to lose unwanted pounds. I have 8 months.

 

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Love you guys, Lea

lea88

Low Carb Flu? Get Back into Ketosis.

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Have you recently begun a low-carb diet and are feeling MORE fatigued than usual? Having a few muscle cramps, brain fog, dizziness, or headache? Ready to throw in the towel and chock up this eating plan as another failure? Don’t give up right now! It’s likely what we call “low-carb flu.” It is a state of transition. Your body is adjusting to burning fat instead of carbohydrates, and it will definitely pass. If you lowered your carb intake markedly, you are inducing ketosis. Soon, the opposite will be true, and you’ll be brimming with energy. Really!

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Once you have cleaned your body of sugar and junk foods that had nothing but empty calories, your life will be much more focused, and your body will join your brain in a state of clarity.

But for now, you need help getting through the low-carb flu (no, it’s not a true flu with fever, etc). Try eating more fat since it’s key in this way of eating. Fat is not the enemy as was once preached. Read a few up-to-date nutrition articles from reliable sources. You’ll see that low-carb, higher fat, and low carb eating is what our bodies thrive on. It can be difficult to make the switch after decades of believing the other way. If you fuel your body with fat instead of carbohydrates, it will adjust to burning fat instead of sugars and empty carbs. The energy you’ll experience will be SO worth your living this diet. Think mayo, cheeses, butter, steak, chicken with the skin on (not battered), half and half in your coffee, avocados, nuts, and sauces without sugars but with fat as a base (ex: Hollandaise sauce).

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In addition, be careful how much protein you consume. About 4-6 oz a meal is plenty. Your body might decide to convert protein you are eating into sugars and burn those instead of the fats. Balance is key.

You’ve heard that drinking water is vitally important to feeling your best. It’s even more important when you are on this type of eating plan. However, you flush away electrolytes (potassium, magnesium, sodium) when you drink good amounts of water. So, take a multi-vitamin every day. Also increase your sodium intake. I know, we’re flying in the face of recently-modern medicine but it’s now been researched and is becoming the norm given by health professionals.

 

Another idea if you are in a low-carb flu is to avoid sweeteners. They can cause cravings by their sweet taste.

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One last idea – move! It may be the one thing you do NOT want to do right now but just move a little. Just walk at a slower pace, and encourage yourself to do something besides lay around.

When you’ve eaten, had a drink of water, taken your multivitamin, and followed other actions to combat the low-carb flu, sit back and look forward to energetic days ahead!

Love you guys! Hang in there. It’s only temporary. Remember . . . good-bye sugary junk and hello new, healthy life!

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Carb-Sensitive? Want a Low Carb Diet?

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The above photo shows what many, many health professionals still believe should be a staple of our diets for breakfast, lunch, dinner, even snacks. Have you taken a look at the Food Guide Pyramid lately?

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Please don’t take this guide seriously. I’m living proof that this way of eating is NOT healthful for every adult. Too many carbs. They are telling us that they majority of our eating should contain carbohydrates. After decades of fighting my overweight body (yet using doctor-recommended and professionally recognized “well rounded” diets), I figured out why I didn’t feel well most of the time and why I couldn’t maintain weight loss.

I tried a very low carbohydrate way of eating. I felt 75% better after just the first day!

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I have several low carb eating plans but stayed with Atkins because it was more familiar and because I needed the structure of their Induction phase. I used to think that the more variety I was given, the better I could work the diet. Not so this go round. I went a different route, and it’s working well. After reading much research on carbohydrates, I realized I was likely carb-sensitive. Another phrase that stuck with me was Insulin Resistance.

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What is carb sensitivity? It’s How your body processes sugars and starchesSome of us can down a pint of ice cream and not be affected. Others, like me, can eat a half a cup and stall their weight maintenance. I know, it’s not fair but that’s life. All bodies are not created equally. “Carbohydrate-sensitive people have exaggerated responses to sugars and starches that set the stage for increased appetite, carbohydrate cravings, and very efficient fat storage (Georgia Ede, MD).”

Try a low carb diet and see if it helps you lose unwanted pounds. Fat pounds, not lean muscle. Look up Atkins Diet or the Keto Diet and see if they’re for you. I’m glad I did!

The difference between Atkins and Keto Diets

Good luck on your journey, and enjoy the natural foods you eat.

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Low Carb vs Junk Food Diet

path-fork

I’ve made a discovery. I had to choose a path to travel when I approached a fork in the road. Ironic that it’s called a FORK when my diet is what drastically changed. Over the last couple of decades, I made junk food my go-to when I felt stressed, bored, afraid, or whatever other emotion I was dealing with. I was alone a lot in my first marriage and fell to food as a coping mechanism.

You’ve heard this tale before by many others BUT mine hit me square in the face tonight. With hubby number two off at a meeting, I was bored and hungry. Instead of choosing the low carbohydrate foods in my pantry, I turned backward and drove to a taco stand. It sounded so tasty, and it HAD been a month since I’d changed my diet. I deserved one meal I craved, right?

taco

I crushed the tacos in a bowl and added salsa. I sat down to watch a sit-com  – anticipating the first bite of an old delicious friend, a taco with an actual crunchy shell on it.

Boom! There was the taste. Only it wasn’t what I remembered. It had a stale, kind of burned taste, and the texture of the meat was odd. It was packed together tightly but get this . . . there was almost no taste at all. It WASN’T delicious. It was greasy and bland and not even close to what my mind remembered.

I finished the tacos anyway, secretly hoping each bite would find me enchanted again with my old habit. Nope. So, I ate until I was too full (like I once did) and felt like crap! Within fifteen minutes, I had a headache. I kid you not. MSG? I knew there was no “going back.”

path-dark

I had taken a path of clean eating over the last month, and it prevailed. I was both encouraged and disappointed. I didn’t have the old habit I once counted on as my Band-Aid.

Yet, I faced a new path . . . one with a healthier destination.

path-light

I now walk in the light of health and won’t have the old unhealthful habits. I guess that’s one way to quit a habit you hate. It becomes something you detest after a while.

My bare feet take me to a happier and tastier place, and I do enjoy the journey much more than I used to. Soon, there will be no fat, headaches, mood-changing sugars, or any other detriment that I once held so closely.

path-woman

I wonder what else 2018 has in store.

Happy February, dear ones ~

Bipolar Disorder – My Shadow

 

shadow

A mood disorder is tough to deal with – whether you are the sufferer or the loved one of a sufferer.

It’s like my own shadow but one that often catches up and overcomes me, Bipolar Disorder. And it doesn’t play fair. I go along with my life “normally” for a few weeks until a dark mood sneaks up behind me and bites me in the behind. I’ve had a few episodes of severe mania but now mostly experience the severe depression side when the disorder kicks in.

I dutifully take Zoloft and Abilify to even things out. Thank goodness for those. They allow me to live a life of being stable most of the time. However, when PMS hits or when perimenopause changes my hormone levels, watch out!

zap

An old friend and I text now and then. She never knew I had been diagnosed with this disorder, and I had hurt her feelings a few years back. I tried to apologize many times  but she kept me at arm’s length in fear of being treated poorly again. I finally told her why I’d been on a roller coaster of emotions back then. I imagined she didn’t want to complicate her life with a friend who had mood issues.

Can’t say I blame my old friend. I don’t like having me around at certain times, either. However, I do the best I can to treat others with respect and understanding (when I have my wits about me).

So, please, if you know someone with this (or other) type of mental challenge, consider being as understanding as possible with him or her. It takes a lot out of a person to ride this coaster.

roller-coaster