Is it Depression or Bipolar?

 

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 (5^th 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.

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[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 Psychiatry, 64(2), 161–174.

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

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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

Bipolar Disorder – My 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!

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.

Join Me in a Bipolar Mixed Episode

It’s been a day of hard issues. Please forgive my disjointed organization of thought. I’m taking you with me on a bout with Bipolar Mixed episode. I have depression paired with anxiety at the moment. I feel anger, rage actually. I want to die. Not to threaten it but to actually do the deed. I don’t because of my two kids and my mother. I love them too much to put them through a loss like that, so I’m stuck in this mental illness with no real way out. Meds work most of the time. Not tonight. I feel lonely – like I am ultimately responsible for myself, and I hate that. It’s scary and a lonely place to be. I’ve always been a sheltered child and then a sheltered woman. One of my problems is that I can’t organized my thoughts to keep a job for longer than a year but also can’t receive government aid (as income). It’s a terrible cycle which causes me much anxiety and depression.  Here is how it starts – the bipolar/mania cycle. As I type, the words on the screen are blurry, and I make a lot of spelling errors. I long for the long seep. The end of all of these roller coaster of emotions. Medications can only do so much for me. I’ve dealt with this for nine years. I’m TIRED of fighting with it. I hope I can sleep tonight. I hope when I wake, it’s a happy new day. But I don’t know. I hang in the abyss of a universe with stars blinking brightly, hurting my eyes. I float too closely to the planets. It’s sometimes hard to breathe in this dark vast space. Other times I get lungs full of fresh air. Hope is all I have. It stays somewhere deep in my core, a tiny flame that doesn’t seem to go out even when high winds or heavy rains cover it. I am inwardly thankful for that flame. It promises  another day that might be a good one. One with sunshine on my face and bird songs in my ears.

What to do With Myself?

I’m trying to figure out what to do with myself. I have trouble looking into my eyes in a mirror. I tried self-talk . . . maybe regain self-worth. That didn’t work out well. Why can’t I look myself in the eyes?

I’m coming out of an initial “bout” of bipolar 2. I woke up and was full of energy, ideas, and plans. The mania began. I had no idea.
A year and a half later, I fell into deep depression and stayed there for another three years. Yes, really.

Being treated for depression only doesn’t work if you have a bipolar disorder. Ya need a mood stabilizer as well. Didn’t know I had this disorder, so I was spinning in place. Who’d have thought that initial period of weight-loss, extreme exercise, pricey vacations, thoughtless spending, job-hopping, college-flunking, divorcing-a-25-year-husband, taking up with a stranger, drinking, smoking, and other energy-filled activities was actually mania?!

I’m trying to figure out what to do with myself. The old mind is finally coming out of the clouds . . . the fog that encircled my reality. Now I want to know what my reality is. All of the self-evaluation is exhausting, but I see progress in ridding myself of self-hatred.

My mind feels as though it has been shaken and now has small fissures from the traumatic event. The cracks don’t completely heal, however. I’ll be “full o’ fissures” from now on. The injustice makes me mad. In fact, lots of things make me fricking mad. I’ve been over the facts a million times. They don’t change.

I’m trying to figure out what to do with myself.

Frankly, My Dear, I Don’t Give a Damn . . .

 

What do these people have in common?

Vincent Van Gogh, Kurt Cobain, Rosemary Clooney, Patricia Cornwell,

Robert Downey, Jr., Richard Dreyfuss, Patty Duke, Carrie Fisher, Connie

 Francis, Mel Gibson, Ernest Hemingway, Vivien Leigh, Demi Lovato,

 Kristy McNicol, Florence Nightingale, Jane Pauley, Edgar Allen Poe,

Jackson Pollock, Nina Simone, Frank Sinatra, Sidney Sheldon, Jean

 Claude Van Damme, Virginia Woolf, and Catherine Zeta Jones.

All “-Accompanied by verifiable source citations associating them with bipolar disorder  (formerly known as “manic depression”), either based on their own public statements or (in the case of dead people only) reported contemporary or posthumous diagnoses of bipolar disorder.” (Wikipedia)

“It is often suggested that genius (or, at least, creative talent) and mental disorder (specifically, the mania and hypomania of bipolar disorder) is linked.” (Wikipedia)

Sooo, do we run with it and say, “I knew I was a creative genius!” or will we pity ourselves right into a pathetic un-life. I call it an un-life because untreated or improperly treated bipolar disorder is no way to live. It’s not “living” at all.

C’mon, fellow fighters, gather your wits, gather your support system (or find one), and get to a really good psychiatrist and also a counselor (two different professionals). Don’t stop trying until you find the magic mix of meds! You WILL feel better, loves!

XO

❤ Lea

Does Bipolar Disorder Run in the Family?

A note of interest is this: my father was rumored to have this disorder. He killed himself at age 44. My first manic episode (and the one that changed everything in my life) was at age 44.  ~Irony~

This informative article is written by Marcia Purse, Health Guide for Healthcentral.com. Thank you sharing information, Ms. Purse

By Marcia Purse, Health GuideSunday, March 11, 2012

There’s no doubt that there is a genetic component to the risk of developing mental illnesses. Several studies have confirmed this. It’s been found that people with unipolar depression, bipolar disorder and schizophrenia are highly likely to have siblings, half-siblings and children to have one of these disorders or even have symptoms of more than one.

Studies of identical twins show that if one twin has bipolar, the other has very high risk of developing bipolar as well. There is also an increased risk within fraternal twins, but it is much lower than for identical twins.

What about more remote relationships? There are no studies, but here’s a look at a family where four cousins are all diagnosed with bipolar disorder (names changed to protect privacy).

One Family’s True Story

My friend Janet, who has bipolar disorder, also has three cousins on her mother’s side with bipolar. Linda and Stacey are the children of an uncle and Jeff the child of an aunt.

Janet doesn’t know everything about the family history, but was curious enough to put together what she does know in the chart below.

As you can see, the only known factor the four cousins have in common is Janet’s maternal great-grandfather, who was diagnosed with “melancholia” (an old term for depression) and committed suicide.

Janet herself, the only one who had childhood bipolar symptoms, also has a history of mental illness on her father’s side.

Is this a stretch? I don’t believe so. Even though all four cousins also have siblings with no known signs of mental illness, it seems more than a coincidence that the four all have bipolar disorder.

Sources: McGuffin, P, et al. The heritablity of bipolar affective disorder and the genetic relationship to unipolar depression.  Archives of General Psychiatry. 2003 May;60(5): 497-502.

Lichenstein, P, et al. Common genetic determinants of schizophrenia and bipolar disorder in Swedish families: a population-based study. The Lancet. 17 Jan 2009. 373(9659) 234-239.

Edvardsen, J, et al. Heritability of bipolar spectrum disorders. Unity or hetergenity? Journal of Affective Disorders. March 2008. 106(3) 229-240.

Is Bipolar I Worse Than Bipolar II?

The following article, in its entirety is by Marcia Purse, Health Guide for Healthcentral.com. Ms. Purse is an informative writer. I hope you enjoy.

 

Health GuideWednesday, March 28, 2012

People tend to think of Bipolar I as being “worse” than Bipolar II. In discussions about this, people diagnosed with Bipolar I have sometimes said, “I wish I only had Bipolar II.”

 

I’m not here to tell you people with BP I don’t have a rough time – they do. But what those who said they wished they had BP II, and the public in general, don’t realize is that Bipolar II is profoundly different from Bipolar I.

 

If you have ever had soaring mania, perhaps with hallucinations or delusions; if your mania has ever been so out of control that you had to be hospitalized; indeed, if you’ve ever had a manic episode at all, you have Bipolar I Disorder. Mania and the hypomania of Bipolar II and Cyclothymia (also known as Bipolar III) share some characteristics, but the severity of mania makes a great deal of difference. (See Mania vs. Hypomania)

 

But people who have Bipolar II have a miserable time at the opposite pole: depression. In general, these people have far more depressive than hypomanic episodes. Those depressive episodes last longer and are more frequent than in people with BP I. Again, this isn’t to say that people with BP I can’t have very bad depressive episodes. They just aren’t likely to have them as frequently, or for as long as, people with BP II.

 

And there is one more key difference between the two disorders – the one that sometimes makes me wish I had Bipolar I, believe it or not. That is the fact that people with BP II are very likely to feel at least slightly depressed almost all the time that they aren’t hypomanic.

 

It’s true for me. In fact, my psychiatrist told me that on the 1-10 scale he uses for rating mood, 6 is normal, and most of his patients with BP II hardly ever get above 5 (having to push yourself some), and 4 (having to push yourself often) is more common.

 

That’s where I live most of the time – between 4 and 5, with days I’d rate as 3 at least twice a week. And at those levels, my symptoms don’t even qualify as a diagnosable depressive episode! Yet I’m struggling all the time to a greater or lesser degree. “Up” periods generally don’t last for more than a few hours.

 

So don’t let anybody tell you that because you have Bipolar II Disorder you “aren’t that sick.” Both Bipolar I and Bipolar II are serious disorders. It’s just important to understand that they are so different that they can’t be compared.

 

Sources:

Mantere, O., et al. (2008). Differences in outcome of dsm-iv bipolar i and ii disorders. Bipolar Disorders, 10(3), 413-25. Abstract retrieved from http://www.ncbi.nlm.nih.gov/pubmed/18402629

 

Maina, G., et al. (2007). Health-related quality of life in euthymic bipolar disorder patients: differences between bipolar i and ii subtypes. Journal of Clinical Psychiatry, 68(2), 207-12. Abstract retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17335318

Be Careful: Possible Differing Treatments for Depression vs Biploar 2 Disorder

Bipolar 2 disorder sufferers have episodes of hypomania which aren’t generally severe enough for them to think anything is “wrong.” They just seem to be in a great mood and feeling very social and creative. Their depressive states, however, are more severe. The sufferers tend to seek help while in a state of depression, therefore obtaining prescriptions for an antidepressants.

In a study by an Italian psychiatric disorders expert, Franco Benazzi, MD, PhD, says that studies show that antidepressants and a bipolar 2 patient may not make a good combination.

http://www.webmd.com/bipolar-disorder/news/20070315/antidepressants-risky-for-biopolar-disorder

Also, below is an excellent source of links and specific information on the use of antidepressants in those with bipolar. Very, very interesting material.

http://www.psycheducation.org/bipolar/controversy.htm

Take a look, ready a bit. Be informed, my dears.