Bipolar Disorder aka Manic Depressive Disorder (for us old folk)

My therapist and I get into some really odd topics. But, I guess after 21 years or so, we probably have a pretty odd relationship. He is the odd one. Anyway, a while back we were talking about the weather and how it was changing 30 degress in two days 40 degress in a week. It was driving me crazy and to be even crazier, my therapist started talking about the weather being manic-depressive (okay we are old) as it was characterized by extreme highs to lows. (I know my thinking is a bit odd...don't all of you think of weather in terms of mental illness?)

I was frustrated, I had fall, spring and summer clothing all over the place in my bedroom and day to day or week to week, I did not know what I was going to wear. Also, I could feel it in my sinus, my body's temperature was really weird and basically, I think, it affected my emotions. Well, if you had manic-depression, which is now called bipolar disorder, this is sort of what it would be like on a day to day or weekly basis depending on the exact diagnosis, not knowing how you are going to be day to day. I don't mean to minimize the severity of bipolar disorder by comparing it to weather. It is just how this article started.

For those not on medications or with rapid cycling bipolar disease. Imagine having so much energy that you don't need sleep because you are not tired, everything seems like it is racing, you feel like you can't keep up with the billions of different thoughts in your head, you can't focus, you speak constantly, you feel like you are just bouncing off walls, your behavior is impulsive and think you can do anything. Then, without any warning signs, you crash hard. Everything seems dark, cloudy, sad and heavy. You don't want to do anything including getting out of bed or eat. You feel like you are in a black hole with no end and that you will never feel better. You probably have suicidal thoughts. Then, without warning, you have super duper energy again, but this time everything seems to irritate you, and you are filled with rage. Imagine, living like this and never knowing which way you will feel. Also, there is very little "normal" feeling in between. For those not on medications and for most who do not cycle rapidly, this is maybe a week or so between "moods."

This is the way it is for many people with bipolar disorder and their family, friends and coworkers. The manic phase is also when people do outragous things because they think they can. I know someone who went to work early and began painting a huge mural on the wall at work. Many go on shopping, gambling, alcohol, drug, or sex binges. It tears familys apart and they lose friends and can't keep a job and have major financial problems.

Most people's symptoms are noticed and begin to interfere in their lives during late adolescenes and early adulthood. Although, in hindsight, most people can see signs in their childhood. With proper treatment, people with bipolar disorder can be treated for this illness and can lead full productive lives.

Medication compliance is one of the most difficult issues and is necessary to stablize the chemical imbalance that occurs in the brain to cause such symptoms. Especially, during the manic phase because many do not want to stop from being on such a high. Medication is also tricky because what works for one person may not work for another. Also, what works for a while may stop working and then they have try new drugs or dosages. It can be very frustrating for everyone. Also, medication does not take away all of the symptoms it usually reduces them enough for someone to learn how to cope with their illness. Remember, their illness is not an excuse for their behavior and some can be responsible for it and others cannot. If you are living with someone or know someone with this illness, you can still set boundaries. It is never okay for someone to abuse you physically, verbally, emotionally, etc.

You will become frustrated and wonder why they make the same "bad" decisions over and over again? Why haven't they learned by this time? Why can't they see the senselessness of their behavior? They seem to get it together and then bottom out. Those without this illness and I will never be able to fully understand what their world is like. It isn't like a broken leg or open wound where you can see where it hurts. Their brain is very different than yours or mine.

(shows normal, manic and depressed activity in the brain)

Even though you cannot see their wound, they do show you. You just have to listen to what they say and do carefully. An excerpt from Bipolar Disorder Today states, "However hear their pain, listen for red flags always of any danger signals were you may need added assistance...Anytime a loved one does not seem in touch with reality (seeing, hearing, sensing, and thinking things that are not true), or seems at risk for suicide, homicide or any high risk behavior, you need to call 911 or their counselor or doctor. Explain what you are experiencing and your concerns."

SIGNS AND SYMPTOMS THAT MAY ACCOMPANY SUICIDAL FEELING:

1. talking about feeling suicidal or wanting to die
2. feeling hopeless, that nothing will ever change or get better
3. feeling helpless, that nothing one does makes a difference
4. feeling like a burden to family and friends
5. abusing alcohol or drugs
6. putting affairs in order (e.g., organizing finances or giving away possessions to prepare for one's death)
7. writing a suicide note
8. putting oneself in harm's way, or in situation where there is a danger of being killed.

The most important way to assist a person with bipolar disorder is to treat them with respect and care and to become a part of the treatment team if the person will allow you to do so. Then, you can speak with the psychiatrist and find out the best way to support the person because it is individualized. In the meantime, you can educate yourself. Websites will be provided at the end. Do not become codependent or enabling with your loved one. Remember that you do not have control over someone else. (Hmmm...need to do post on codependency)

The following is taken from the National Institute on Mental Health:

Signs and symptoms of mania (or a manic episode) include:

• Increased energy, activity, and restlessness


• Excessively “high,” overly good, euphoric mood


• Extreme irritability


• Racing thoughts and talking very fast, jumping from one idea to another


• Distractibility, can’t concentrate well


• Little sleep needed


• Unrealistic beliefs in one’s abilities and powers


• Poor judgment


• Spending sprees


• A lasting period of behavior that is different from usual


• Increased sexual drive


• Abuse of drugs, particularly cocaine, alcohol, and sleeping medications


• Provocative, intrusive, or aggressive behavior


• Denial that anything is wrong

A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly everyday, for one week or more. If mood is irritable, four or more additional symptoms must be present.

Signs and symptoms of depression (or a depressive episode) include:

• Lasting sad, anxious, or empty mood


• Feelings of hopelessness or pessimism


• Feelings of guilt, worthlessness, or helplessness


• Loss of interest or pleasure in activities once enjoyed, including sex


• Decreased energy, a feeling of fatigue or of being “slowed down”


• Difficulty concentrating, remembering, making decisions


• Restlessness or irritability


• Sleeping too much, or can’t sleep


• Change in appetite and/or unintended weight loss or gain


• Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury


• Thoughts of death or suicide, or suicide attempts

A depressive episode is diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer.

I often wonder about the genius (or creative talent) of the world and the fantastic artwork created by those with mental illness. If there were medications during their time, would we have had Beethoven's 9th Symphony, Van Gogh's Starry Night or The Scream by artist Edvard Munch. Both had bipolar disorders. Just something I ponder from time to time. I am definitely not saying that medication should not be used. On the contrary, I believe that medication can save lives, assist them with leading full lives, and can stablize symptoms. For bipolar disorder, it is essential.

Many famous people have been diagnosed with bipolar disorder. These are only those who have been confirmed as having this illness: Adam Ant, Ludwig van Beethoven, Lord Byron, Dick Cavett, Kurt Cobain, Samuel Tayleor Coleridge, Ray Davies, Charles Dickens, Richard Dreyfuss, Patty Duke, Carrie Fisher, William Faulkner, Stephen Foster, Macy Gray, Alexander Hamilton, Linda Hamilton, Mariette Hartley, Ernest Hemingway, Abbie Hoffman, Margot Kidder, Kristy McNichol, Edvard Munch, Issac Newton, Florence Nightengale, Sinead O' Conner, Ozzy Osbourne, Jane Pauley, Edgar Allen Poe, Charlie Pride, Axl Rose, Nina Simone, Britney Spears, Robert Louis Stevenson, Mark Twain, Jean-Claude Van Damme, Vincent Van Gogh, Kurt Vonnegut, Brian Wilson and Virginia Woolf.

Remember if you or anyone else recognizes any of these symptoms talk to your doctor and seek professional medical treatment and psychotherapy. If someone seems to be in immediate danger, call 911.

My hope is that this was informative and gives people a new perspective on bipolar disorder and mental illness in general. All information in this post was from personal/professional experiences, http://www.mental-health-today.com/, http://www.nimh.nih.gov/, http://www.bipolar.com/. You can go to any of these sites for more information or assistance. Also, you can educate yourself further from the book, the Bipolar Disorders Survival Guide by David J. Miklowitz, Ph.D. (All this because we had some major weather swings...you never know where my inspiration to write will come from...this one is a bit strange, I have to admit.

(Disclaimer: Although I have worked with mentally ill persons for twenty years, I do not have a Master's Degree or a license. This is not meant to be a substitute for mental health care or treatment. Please obtain professional assistance from the above resources, if needed. And call 911 if you or someone is in immediate danger.)