Five Things You Need to Know About Bipolar Disorder

Bipolar Disorder, often called Bipolar Depression or Manic Depression, is a genuine psychiatric concern in the United States, affecting about 1% of the population. While the percentage may sound small, when you consider actual population numbers, that means over 3 million people currently suffer from this condition.

The onset of bipolar disorder is typically seen around the ages of 20 to 25; however, patients can exhibit symptoms as early as their teens. The earlier the age of the initial onset of bipolar disorder, the more likely the individual will have long-term struggles with managing the disorder and its symptoms. As a result, early treatment and intervention become even more imperative. While many believe bipolar disorder causes a predictable spectrum of manic and depressive states, this is untrue. In this article, we discuss some of the misconceptions and need-to-know details about bipolar disorder that can help you or a loved one identify the condition and take appropriate action.

“Bipolar is always challenging and often misdiagnosed as recurrent unipolar depression. This misdiagnosis occurs in up to 60% of patients and ultimately delays the proper treatment by years or even decades. No blood test or questionnaire can help us differentiate hypomania, for example, versus ADHD or even certain forms of anxiety. Thus, it requires a clinician with extensive experience treating bipolar disorder and an open-minded approach to mental illness to diagnose properly. As clinicians, we have learned that identifying this is not readily ‘teachable’ from a textbook.”

~ Linda Dolin, MD, Medical Director at The Sylvia Brafman Mental Health Center

Need to Know: There Isn’t Just One Type of Bipolar Disorder

One of the most misunderstood parts of bipolar disorder, confounded by the fact that it is often called bipolar depression, is that there is no single manifestation of this mental illness. In fact, Bipolar Disorder is broken down into two separate categories, Bipolar I, and Bipolar II. People with Bipolar I (one), formerly known as manic depression, experience at least one episode of mania in their lives but do not always experience significant depressive episodes, though major depression is common. People struggling with bipolar I have long periods (7 days or more) of manic behavior that may account for a considerable part of their lives. The manifestations of Bipolar I are often confused with other mental health concerns, including ADHD or varied issues contributing to manic behavior, like traumatic brain injury (TBI), amphetamine abuse, and side effects of certain medications. As such, a comprehensive intake and evaluation process is critical to ensure a proper diagnosis and effective treatment plan.

Bipolar II is the category that falls more in line with the depressive element of the condition. Patients struggling with Bipolar II always experience major depression (2 weeks or longer) and hypomanic (less severe than full mania) states. Hypomanic episodes are often far less disruptive than full mania, and people who do not know the patient well may never know there is a problem. Because the hypomanic state is not as pronounced as full-blown mania, this is often confused with unipolar depression or major depressive disorder.

Cyclothymia is a rare cousin of bipolar disorder that sees patients experience the ups and downs of bipolar disorders but with less severity, and often less frequency. Some patients, especially those with a more positive vs. negative emotional dysregulation, may not be diagnosed due to the relatively less extreme nature of their moods compared to patients with bipolar disorder.

Bipolar can even be classified as unspecified when the symptoms do not fall into the abovementioned categories. This additional enigmatic classification, or lack thereof, shows how broadly this mental illness can affect an individual.

Spotlight: Mania vs. Hypomania

Mania and hypomania are distinct in the severity of the symptoms displayed. Manic episodes are typically very disruptive to the patient and last seven days or longer. Patients may not sleep for that entire time, for example, and it will be obvious to those around them that something is wrong. Individuals struggling with Manic episodes may experience psychosis and delusional thinking and can end up requiring inpatient stabilization due to their manic episodes. Hypomanic episodes, however, are less severe and briefer in duration (at least four days). Emotional dysregulation during a hypomanic episode may be mild enough that only those closest to the patient recognize it as a problem. While mania and hypomania differ in severity and duration, they share many causes and similarities. They also share triggers, including alcohol and illicit drug use, taking certain prescription drugs, caffeine use, stress, sleep deprivation, etc. The need for self-care in an individual diagnosed with bipolar disorder is exceptionally important in preventing the exacerbation and potential impact of stressors and triggers.

Need to Know: Family and Friends Are Critically Important in Treating Bipolar

If you have been around a friend or loved one during a manic episode, they may be unsettlingly unaware of what they are experiencing. Some patients, for example, may not sleep for days or even up to a week. As someone who has never had a manic episode, you may think that it would be obvious they were aware of this sleep deprivation. In actuality, they may not even realize that they have been up for as long as they have or do not seem to understand the consequences. Oftentimes, they actually experience a decreased need for sleep during an episode.

Similarly, you may believe your loved one knows and understands that they are easily distracted, speak rapidly, have delusions of grandeur, or are scattered in their thoughts – all indications of mania. Again, however, they often don’t comprehend their disease or have insight into its presentation. When a patient begins mental health treatment, the family must be by their side to offer the medical and clinical staff context that may not be gleaned from early sessions with the patient.

For example, we do not know if they are at the beginning or the end of an episode or how often these episodes occur. While we can ask patients to describe their symptoms, they may be unable to give us a satisfactory or accurate answer. This is part of The Sylvia Brafman Mental Health Center’s foundational principle, which strongly emphasizes the family program. Family members are often critical in providing the contextual information we need to develop the proper treatment plan.

Need to Know: Your Loved One Is Suffering, Too

Without a proper diagnosis or after years of dealing with bipolar behavior, living with or being around your loved one can be very frustrating. Things may have been said or done that have caused a great deal of pain within the family system, and you may not be able to take it anymore. We understand these feelings, and you are not alone. At the same time, however, it’s important to remember that the patient is also suffering. Significant psychological and physical consequences often result from these manic and depressive episodes. Even if most of their lives are spent in a state of normalcy, emotional dysregulation catches up to them sooner or later. During these periods between manic and/or depressive episodes, patients often find themselves in difficult or compromising circumstances caused by dysregulation (and the substance abuse that often accompanies it). They may not know how to get out of the toxic and compromising cycle they continue to repeat. Does this mean their actions are justified? No. It simply means that as a loved one, it is imperative that you view this as a DISEASE. While it may not have the physical manifestations that would keep you by their bedside in a hospital, mental illness, and bipolar, is no less serious.

Need to Know: There Are Genuinely Effective Treatments

While mental illness may seem like an insurmountable challenge, and frankly, there is no cure for many conditions, the fact remains that there are effective treatment options for bipolar disorder. From the traditional psychotropic treatments with lithium, first understood in the 1940s and ultimately FDA-approved in the 70s, to emerging treatments like ketamine in modern-day psychology and everything in between, we have the tools to treat this condition effectively. A mental-health primary treatment center like ours, which focuses on the whole human, can implement appropriate psychological and medical therapies while also using effective talk therapy like Cognitive Behavioral Therapy (CBT) to create an environment of recovery that lasts well after treatment. If patients suffer from co-occurring addiction and substance abuse concerns, or any physical medical problems, we have the ability and depth of knowledge to treat them effectively simultaneously.

Need to Know: You Can’t Diagnose Bipolar at Home

Although there are obvious signs and symptoms of Bipolar, it is important to remember that the ability to attribute someone’s characteristics or behaviors to a diagnosis of Bipolar requires the knowledge and expertise to navigate through the many confounding factors and contextual details that make up the constellations of symptoms of this multifaceted disease.

For example, the symptoms of bipolar, as stated above, can be confused with substance abuse or brain injuries. ADHD, major depressive disorder, and borderline personality disorder also have overlapping symptoms and presentations. Yet these other conditions must be treated distinctly. Further, bringing a loved one into treatment with preconceived notions often limits their willingness and ability to accept treatment.

It is important to understand that people with bipolar disorder cannot control their manic and/or depressive episodes. This is an actual disease of the mind, and it must be treated professionally. There is no amount of conversation or support from those around the bipolar patient that can substitute for proper care.

The Bottom Line

We don’t pretend that treating bipolar disorder or any other mental illness is simple. If it were, mental illness in the US would not be the epidemic it is. Instead, we provide the framework for patients and their families to understand the disease and take steps toward improving their lives and lifestyles. We encourage you to ask questions about mental illness and speak to an admission specialist. If you or a loved one suffers from bipolar, we encourage you to call us. As a mental health primary facility with an evidence-based substance use disorder program, we are one of the few facilities in Florida, and even nationwide, that can offer comprehensive care for the widest range of behavioral health issues.