Living with Bipolar Disorder
Mental health is a topic many of us still shy away from discussing openly. However, according to some studies, as many as 1 in 4 people worldwide may be living with some form of mental illness at any given time. In this article, we shed some light on bipolar disorder and what it’s like to live with it.
Bipolar disorder, once known as manic-depressive disorder, is a serious condition that causes a person to experience crippling changes in emotional states. People sometimes use the term to describe someone who experiences mood swings. We all have up and down days, but our feelings can usually be ascribed to life events or hormone cycles. Bipolar disorder is much more than that.
What is bipolar disorder?
A person with bipolar disorder (BD) experiences drastic swings between extreme emotional states—from manic episodes where they feel euphoric, impulsive, and highly energetic to periods of deep depression, self-loathing, and zero energy, but can also be symptom-free between episodes. The disorder tends to present for the first time between the ages of 15 and 20, although this is not always strictly the case. An estimated 46 million people worldwide are living with bipolar disorder, which destabilizes not only the life of the sufferer but can also influence those close to them.
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Many people with BD struggle to function and fulfil their work and relationship responsibilities. Severe depression can lead to suicidal behaviour, while during manic episodes, sufferers are more likely to engage in risky behaviour such as overspending, promiscuity, and substance use. 17% of those with BD try to end their lives, and up to 60% develop substance abuse. This is a complex condition that requires treatment and significant lifestyle changes, but it is possible to manage and lead a healthy life that includes satisfying work and family relationships.
Diagnosing bipolar disorder
When diagnosing any illness or disorder, doctors and therapists face the challenge of differentiating their patient’s problem from all the other potential conditions that present with some or many similar symptoms. Because of its episodic nature, bipolar disorder can take time to diagnose properly, as the full picture of the patient’s symptoms will only reveal itself over time.
Although we can now share information much more freely than in the past, cultural and contextual differences between countries remain, so diagnostic criteria and terms can differ. In the US, therapists use diagnostic criteria from the 5th and most current edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, or DSM-5.
According to DSM-5, for a person to be diagnosed with bipolar 1, the most severe form of the disorder, they must have experienced at least one episode of mania with symptoms present most of the day, nearly every day for at least a week, and one major depressive episode lasting at least two weeks.
Mania is defined as a period of abnormally expansive, elevated, or irritable mood together with at least three symptoms from the list below, representing an observable change in behaviour that causes significant distress or significantly impacts several areas of life and cannot be attributed to another illness or to substance use.
- Inflated self-esteem or grandiosity
- Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
- More talkative than usual or feels pressure to keep talking
- Flight of ideas or subjective experience that thoughts are racing
- Distractibility (i.e., attention too easily drawn to unimportant or external stimuli)
- Increased goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
- Excessive involvement in activities that have a high potential for painful consequences (e.g., unrestrained buying sprees, sexual indiscretions, or foolish business investments)
Hypomania has the same symptoms, but they only need to last four days, and the symptoms do not significantly impact functioning in daily life.
A major depressive episode is defined as a period of two weeks or longer characterized by depressed mood, loss of interest, or loss of pleasure that includes at least five symptoms from the list below, presenting most of the day nearly every day and not attributable to another illness or to substance use:
- Depressed mood most of the day
- Loss of interest or pleasure in all or almost all activities
- Significant weight loss or weight gain, or a marked decrease or increase in appetite
- Insomnia or hypersomnia
- Psychomotor agitation or retardation (i.e., observable restlessness or listlessness)
- Fatigue or loss of energy
- Feelings of worthlessness or guilt (which may be delusional)
- Diminished ability to think or concentrate, or indecisiveness
- Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt
What is the difference between bipolar 1 and bipolar 2?
Many therapists now think of bipolar disorder as a spectrum with sub-categories. The intensity, duration, and complexity of symptoms are influenced by personality, family history, situation, age, and other factors. The different diagnostic categories influence treatment strategies.
- Bipolar 1 includes episodes of disruptive mania and depression. If delusion or other symptoms of psychosis are present, the diagnosis is always bipolar 1.
- Bipolar 2 includes episodes of hypomania and depression that typically don’t seriously impede normal functioning. However, bipolar 2 tends to be chronic and depressive episodes often last longer.
- Cyclothymia is a less intense type of BD with brief, alternating episodes of depression and hypomania, with periods of stable mood in-between.
- Unspecified bipolar disorder is the term used for related disorders that don’t quite meet the criteria for the other sub-categories.
Psychosis: a symptom of bipolar disorder
In addition to the symptoms listed above, a person experiencing a severe manic or depressive episode may also experience symptoms of psychosis. These can be hallucinations or delusions that have no basis in reality. A hallucination is not a misperception or a mistake, it’s your senses generating false information. Visual and auditory hallucinations are most common with mental disorders. A delusion is a persistent “fixed false belief” that follows a particular theme, such as persecution or omnipotence.
What does psychosis in bipolar look like?
Psychotic delusions can sometimes be a part of both manic and depressive episodes. In depressive episodes, the delusion is most likely to be nihilistic, nothing seems to matter at all, and as nothing has any real meaning, we may as well not exist. Such extreme convictions can lead to dangerous behaviour, including suicide. In a manic episode, psychotic delusion is most likely to have a grandiose character. Whatever their delusion, a person in a manic state will perceive themselves to be powerfully and purposefully at the centre of it. To the sufferer, a delusion is not simply an idea or opinion, it is an undisputed fact. For people with bipolar disorder, such delusions generally subside as the episode wanes, but sometimes medical intervention is warranted.
What are the triggers for bipolar?
Mental illness and mood disorders can have many possible causes. While there is a general template of symptoms and behaviours, each person has their own story. Around 80% of people who suffer from BD inherited some aspect of their condition from one or both parents. Traumatic experiences such as childhood abuse, serious illness, or sexual violence can trigger or exacerbate bipolar disorder. Other contributing factors include insufficient levels of neuropeptides and neurotransmitters, hormonal fluctuations, food sensitivities, limbic impairment, and many others. Although the condition usually first presents in the teenage years, many sufferers go undiagnosed well into adulthood because of the changing nature of the condition, the self-recrimination and self-isolation it inspires, and the social stigma surrounding mental illness in general, all of which discourage sufferers from talking about their experience.
Do men and women experience bipolar in the same way?
While both men and women are more or less equally susceptible to BD, women are much more likely to fall into the bipolar 2 category. They also tend to experience depressive episodes, mixed episodes, and rapid cycling (rapid mood swings) more frequently than men. Men often present with mania first, while women are more likely to present with depression first. Women are also often misdiagnosed as having unipolar depression, which can lead to delays in establishing proper treatment.
Many women with BD find that hormonal changes during menstruation, pregnancy, and perimenopause exacerbate their symptoms. Women with BD also experience a higher rate of co-morbidities, or secondary disorders, such as migraine, obesity, and thyroid dysfunction. Women are also much more likely than men to have late-onset BD, often coinciding with perimenopause. Women with BD are more likely to have experienced sexual violence and remain at greater risk of sexual violence until they get their illness under control. Differences in symptomology and lived experience must be taken into account when creating a treatment plan.
Can you live a normal life with bipolar disorder?
Bipolar disorder can be debilitating. Someone who experiences frequent episodes may be unable to hold down a job, nurture stable relationships, or adequately care for their health. They may harm themselves with substance abuse or impulsive behaviour. They may attempt suicide. Living in thrall to powerful emotional states without being able to regulate them is a heavy burden to bear, which can lead to feelings of shame and social isolation, making it difficult to seek treatment.
Those with little mental health experience are likely to be judgemental and dismissive. Even people with good intentions but little training can be counter-productive when trying to help because they don’t understand the nature of the problem.
Even so, many people suffering from bipolar disorder learn to manage their illness and go on to live healthy, happy, productive lives. Education, support, and following through on effective management strategies are the key to relief and easier living.
Some artists and celebrities credit manic episodes for their creative success, but the price they pay can be high. Celebrities talking openly about their experiences, notably Stephen Fry and Mariah Carey, has helped to destigmatize the condition.
What is the best treatment for bipolar disorder?
The first step is getting a diagnosis. If you or someone you know is experiencing symptoms similar to those described in this article, take the time to find a therapist you feel comfortable working with. Not all therapists suit all patients, but help is out there if you keep looking. Self-diagnosis, especially with mental health issues, can be misleading and cost you recovery time. We are very good at making up stories about our lives, especially when things are tough. An experienced therapist can help you understand what’s going on so you start taking steps that help much more quickly than you can do it on your own.
Once you have a diagnosis, your therapist may work with a prescribing psychiatrist to find a medication that will relieve your symptoms. This may be an antidepressant, a mood stabilizer, an anti-psychotic, or some combination, depending. However, the old story about mental illness being caused by chemical imbalance in the brain is losing credibility. New evidence shows that antidepressants work for only about 30% of patients and can cause serious side effects in some people. When they work, they work well. When they don’t, other strategies such as electro-convulsive therapy, transcranial magnetic stimulation, or psychedelic therapy can help.
Another cornerstone of treatment is therapy, and many people get good results when therapy and medication are combined. Certain types of therapy have a good track record in treating bipolar disorder. These include Cognitive Behavioural Therapy, Dialectical Behavioural Therapy, Family-Focussed Therapy, Interpersonal and Social Rhythm Therapy, and Group Therapy or Group Psychoeducation. Knowing that you’re not alone and that others have had similar experiences can help you feel more grounded. Group members can serve as a sounding board, provide a reality check, and be accountability buddies to encourage you to follow through with your treatment.
Proactive steps for managing bipolar disorder
- Identify the triggers that can lead to manic or depressive episodes. These will differ from person to person but often include things like stress, arguments, and not getting enough sleep.
- Keep a mood diary to help you notice when things are changing. You can set your phone to ding every two hours to remind you to jot down your emotional state and the circumstance or reason if you can identify it. While this is not a difficult task, it takes some discipline to make it a habit. However, doing this over time can help you become aware of how your moods shift, making it much easier to manage them.
- Establish a daily routine with regular waking, sleeping, and mealtimes so that other responsibilities and activities can be organized around these anchor points. This will help you stay grounded when triggers threaten to destabilize you.
- Have a list of low-stress activities you enjoy at hand that can help you minimize depressive episodes. When you feel yourself withdrawing or sleeping longer and longer, you might take your dog to a dog park, go to the library, do some gardening, meet up with a safe friend who understands for a walk around the neighbourhood—anything that injects some activity and motion into your day.
- Use blue-light blocking glasses (or keep yourself in a dark environment) from 6pm to 8am to facilitate the healthy functioning of your body clock when entering a manic phase.
- Be aware of the manic prodrome, the early signs that a manic episode is coming. The most common are elevated mood, decreased need for sleep, and increased activity. Symptoms can build for weeks or months preceding a manic or hypomanic episode. A good friend or therapist can help you recognize prodromal changes and take appropriate steps to halt the progression of your symptoms or lessen their severity.
- Talk with your therapist about establishing strategies to avoid or minimize the effects of your triggers.
Lifestyle considerations
Of course, eating a healthy diet, regularly engaging in moderate exercise, practising stress-reduction techniques, and ensuring good sleep hygiene are beneficial for everyone, even more so for those of us suffering from illness.
The Mediterranean Diet has been shown to be particularly beneficial for people with BD. Foods containing phytochemicals and bioflavonoids support healthy brain function. Supplements such as omega-3 fatty acids, curcumin, and magnesium can boost dopamine levels, while L-tryptophan and 5-HTP boost serotonin.
Drinking or using drugs might make you feel better temporarily by numbing strong emotions but will be detrimental in the long term. Limit your use or cut them out entirely to feel better sooner.
Getting a minimum of 150 minutes of moderate exercise, such as brisk walking, per week is an achievable goal. This adds up to just over 20 minutes a day, which isn’t much, but can be enough to help you get through the low periods. When you feel better, do a little more.
Final thoughts
If you or someone you know has been diagnosed with bipolar disorder, or you suspect you have it, take heart. You are not alone and there are ways to improve your situation. The first step is finding one safe person to talk to about what you have been experiencing, then go from there.
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