One of biggest difficulties concerning bipolar disorder is the thorny issue of mistaken identity. It's a wonder that it even gets treated. A lot of people only notice the low mood swings, never mind those unbelievable highs that seem to send them to the moon. Bipolar disorder affects some 2 to 5 percent of Americans, but how can they combat an illness when they don't know what they have?
A recent study showed that 40 percent of patients initially diagnosed with depression were actually suffering from bipolar disorder. Differentiating the two can be tricky because symptoms look pretty much identical: The thing to remember is that bipolar disorder instigates bouts of depression and mania. In fact, patients may assume the mania is part of their personality rather than signs of illness. Besides, who can remember "up" episodes when the depressive ones are so low?
S. Nassir Ghaemi, director of the Bipolar Disorder Research Program at Emory University, adds that many patients don't have the necessary insight to describe or understand their manic symptoms anyway. In turn, patients don't help the situation by downplaying their symptoms (since bipolar disorder comes with a boatload of stigma). And adding to this confusion is a physician's lack of knowledge about a patient's family history and mood patterns.
Now that physicians are thoroughly befuddled, they go forth by prescribing antidepressants that only make matters way worse. A recent study led by psychiatrist Gary Sachs, of Massachusetts General Hospital, found that antidepressants, in conjunction with the standard treatment of mood stabilizers such as lithium, rarely help patients with bipolar disorder. While Sach's study showed that antidepressants do not provoke manic episodes, many researchers argue that they do. They also argue that antidepressants cause other ill effects such as inducing rapid cycling between depressed and manic states, as well as increasing suicidal thoughts.
Bipolar disorder is a recurrent illness, and patients who go untreated can suffer tremendously—both personally and professionally. What's more, among untreated sufferers 50 percent turn to drug and alcohol abuse. And no wonder, manic-depressives experience longer lasting and more severe ups and downs— with fewer "normal" moods in between.
Knowledge may be a manic-depressive's biggest ally. Here are some pointers to keep you informed:
What to Look For
In the Height of Mania:
Increased energy and restlessness
Excessively euphoric mood
Extreme irritability
Fast thinkingInability to concentrate
Difficulty sleeping
Poor judgment
Increased sex drive
Abuse of drugs
Aggressive behavior
Denial that anything is wrong
In the Depths of Depression:
Feeling sad, empty, hopeless, guilty
High levels of anxiety
Loss of interest in activities once enjoyed
Decreased energy; feeling lethargic and fatigued
Difficulty concentrating and making decisions
Change in appetite
Unexplained aches and pains
Thoughts of death or suicide
How to Treat Bipolar
A Stable Mood
While each patient is different and requires individualized treatment, many are prescribed mood stabilizers such as lithium, valproate, carbamazepine, or lamotrigine.
Therapy Therapy Therapy
According to a study published in the Archives of General Psychiatry, incorporating psychotherapy—including family therapy and cognitive behavioral therapy—into treatment is more effective than medication alone. The findings show that patients who receive intense psychotherapy (nine months or longer) in addition to their medication have a better shot at warding off depressive episodes and staying well for a longer period of time. And patients in intensive psychotherapy became well approximately 110 days faster than their counterparts who took medication alone. Although all of the abovementioned therapies were found to be relatively equal in effectiveness, those in family therapy had a slightly higher rate of recovery.
Chart Your Ups and Downs
It's helpful for patients to keep a daily chart of moods, sleep patterns, emotions, current treatments, and life events. Chronicling helps the patient and their doctors manage the disorder.
Talk to the Doc
When you see the doctor, bring your family history and a log of your mood cycles that notes how often they occur. But be truthful when describing symptoms. It also helps to have your friends and family talk to the doctor. They may be able to offer a more honest assessment of the condition
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By Marissa Kristal
"Sometimes bipolar disorder is easy to miss." By PsychologyToday.com (2007)
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