In the preface to her book Bipolar, Terri Cheney writes, “When I look back, I rarely remember events in terms of date or sequence. Rather, I remember what emotional state I was in. Manic? Depressed? Suicidal? Euphoric? Life for me is defined not by time, but by mood.” This is an elegant and concise description of what it is like to live with bipolar disorder. The person can think, feel and interact with the world, but only through the veil of the mental illness.
Living with bipolar disorder means dealing with a mood that can turn on a dime, any day of the week. Some people with bipolar disorder can reach the highest of highs and plummet to the lowest of lows, all within the space of a few days. It can be difficult to maintain relationships, jobs or a productive personal life when the ground beneath your feet is constantly shifting in this way. People with bipolar disorder may never know when the next mood change is going to come.
Bipolar disease may be frightening, and it’s certainly a serious condition, but it can be managed. In fact, doctors are closer now than they ever were before to understanding the disease and the impact it has on the human body. As a result, therapies are growing more and more effective.
Defining Bipolar Disorder
During a standard day, an adult could go through multiple shifts in mood. An unusually quick commute could cause a mood boost, and that euphoria could quickly evaporate when the person views the heaping pile of work that must be done that day. These sorts of mood swings are considered a typical part of the human experience. People with bipolar disorder, by contrast, experience more drastic shifts in mood. They may be elevated and euphoric, and then depressed and suicidal. Small shifts in mood are replaced with wild swings in mood.
While some people with bipolar disorder undergo a mood shift in response to an emotional trigger, some people have shifts in mood in response to no external stimulation whatsoever. One moment they’re up, the next they’re down. The disease chooses when the shift occurs. As mentioned, these moods are exaggerated versions of standard moods. These are not tiny bumps of happiness and small valleys of sadness. Instead, these are movements between incredible peaks of happiness (mania) and incredible pits of despair (depression).
The manic phase of bipolar disorders is widely portrayed as a happy time for the person. He or she might be incredibly productive, able to work or talk for hours at a time without any need for a break. He or she might seem extremely happy or even euphoric, believing that the feeling will last no matter what else happens. According to the American Psychiatric Association, this description doesn’t fit all people who have bipolar disorder. In fact, some people who have bipolar disorder seem irritable and anxious during the manic phase of the disease. They may even act out with violence or seem full of rage. Even people who have the so-called “happy” version of mania may not truly be happy. Instead, they may characterize the mood as jumpy, agitated, wound up or out of control. This mood can last for hours, days or even weeks.
On the flip side of mania is depression. Here, the light seems to go out of the person’s life, and the sadness that follows seems deep and unrelenting. Again, this phase can last for hours, days or even weeks, but for the person experiencing these symptoms, it may seem as though it will never end. During the depressive phase, the person might:
- Cry
- Seem unable to concentrate
- Become convinced that he or she is worthless, hopeless or helpless
- Consider suicide
- Sleep too much, or be unable to sleep
- Refuse to eat, or overeat
- Express no interest in activities that the person once enjoyed
- Hallucinate, becoming convinced that he or she has committed a crime, killed someone or caused another form of harm to a loved one
Some people experience a slow shift between a manic and a depressive state, staying in one place for days or even weeks, and then abruptly shifting into the contrasting state. Other people experience periods of relative normalcy between shifts, where they seem to experience no symptoms at all. Still other people experience only the symptoms of depression and never experience any form of mania. According to the Depression and Bipolar Support Alliance, there are some people who experience both mania and depression at the same time. This can be incredibly confusing and disturbing.
Risk Factors
According to the National Institute on Mental Health, bipolar disorder often begins in childhood. Over half of all cases of bipolar disorder occur before the age of 25, although it’s unclear why children develop the disease more frequently than adults do. It’s possible that the disease has some form of genetic link, meaning that it appears right alongside eye color and hair color, and it isn’t influenced by outside behaviors. Some studies have validated this theory. For example, a study published in the Archives of General Psychiatry found that people who had bipolar disorder metabolized energy in the brain a bit differently than did people who did not have the disorder. In addition, a study published in the journal Neuropsychopharmacology found that people with bipolar disorder used different parts of their brains when asked to perform complicated tasks, compared to people who did not have bipolar disorder. Once again, this seems to indicate that the disorder begins with structural changes in the brain, and it could be that these changes are inherited.
Many mental illnesses, including bipolar disorder, have been linked to substance abuse. This could lead some people to fear that abusing drugs or alcohol could lead to bipolar disorder. A study published in the Journal of Clinical Psychiatry suggests that this is not the case. The researchers suggest that the two disorders use the same pathway, but that using substances doesn’t seem to increase the risk of developing bipolar disorder.
Diagnosing the Disorder
Since bipolar disorder can manifest in different ways in different people, diagnosing the disorder is a bit difficult. In general, a person with bipolar disorder is easier to diagnose during the depressive stage. Here, the person is liable to explain symptoms, be open about experiences, and try to truly describe what he or she is feeling. During the manic stage, when the person feels happy and invincible, the person may deny that any sort of problem is happening in the first place.
Some people in the late stages of bipolar disorder may have trouble communicating their thoughts clearly. According to a study published in the American Journal of Psychiatry, this difficulty can persist throughout both the manic and the depressive phases of the disease. The person may have trouble remembering details, and he or she may have difficulty processing complicated instructions.
During a typical physical exam, this could be incredibly problematic. For example, a doctor might ask:
- When did these symptoms start?
- What was happening in your life at that time?
- Have you taken drugs or used alcohol recently?
- How many hours do you sleep at night?
- Does anyone else in your family have this sort of problem?
These are very detailed questions, and the doctor may expect precise answers that the person may be simply unable to provide. Often, this means that family members must be heavily involved during the diagnosis process. They may have the details the doctor needs in order to provide a complete diagnosis and develop a specific treatment program.
People who have bipolar disorder are often misdiagnosed with simple depression. While the disorder does have some commonalities with depression, it is a completely separate condition and it should be treated in a completely separate way. If the family has a history of bipolar depression, or the person has experienced any form of mania along with the depression, the family should push for more testing in order to gain an accurate diagnosis.
Prognosis
Many people in the United States live with bipolar disorder. In fact, according to the Depression and Bipolar Support Alliance, nearly six million adults have the disease. Many of these people live healthy, happy and productive lives, even with their mental health condition. Through treatment and intense therapy, they learn how to manage symptoms, work with their health care providers, lean on their family members and make the needed changes that can keep severe symptoms from impacting their lives in a negative way.
Bipolar disorder cannot truly be “cured.” According to an article published by the U.S. National Library of Medicine, even people who are undergoing treatment tend to have a relapse of depressive symptoms from time to time. Therefore, the goal of treatment is to help the person understand the disease and learn to manage it effectively. The brain can’t be rewired to function in a different way, but the person can learn how to live with the disease and manage symptoms when they do appear. At Axis, we can provide help for people with bipolar disorders and addiction, helping patients to understand how the two conditions interconnect and intertwine. Please call us today to find out more about our programs.
