The Truth About Bipolar Disorder

April 27, 2011 at 4:52 pm , by

Drama and comedyIt’s been quite a week in Hollywood mental health news. Three months after her husband Michael Douglas was declared cancer-free, Catherine Zeta-Jones checked herself into treatment for bipolar disorder II. “This is a disorder that affects millions of people and I am one of them,” Zeta-Jones said in a statement to People magazine. Just days later, Disney star and musician Demi Lovato revealed she also suffers from the disorder, and tweeted her support for the actress.

While it may seem like bipolar is another one of those non-ailments that only happens to celebrities, like “a nervous breakdown” or “exhaustion,” the truth is that it’s a serious diagnosis affecting close to 6 million Americans.

There are two different types: bipolar disorder I is characterized by cycling between episodes of mania and depression. Catherine Zeta-Jones has bipolar disorder II, which is alternating between depression and hypomania, a less intense form of mania. What makes bipolar different from major depression are these manic or hypomanic episodes that make you feel on top of the world, says Jennifer Yashari, M.D., a psychiatrist in Los Angeles and a member of the LHJ Medical Advisory Board.

“That’s why bipolar can be complicated because many times people don’t want to be treated for mania—your mind races, and things come to you so quickly and easily,” she adds. For some patients, those manic episodes may feel creative, productive, even brilliant, while to others they may seem delusional.

So how do you know when you or a loved one needs help? “It’s tricky,” and there are a lot of misconceptions, Dr. Yashari says. Read on after the jump to learn the real story behind symptoms and treatment.

Misconception No. 1: Everyone has ups and downs. This is no different.

Dr. Yashari: Yes, everyone has days where they feel good or bad, but by definition, bipolar interferes with your ability to function normally. There’s instances of depression—you lack energy, you’re fatigued, you experience low-self-esteem, an inability to concentrate and, at its worst, suicidal thoughts. But what people find most confusing about this, I think, is the mania. I’d say the most prominent symptom of mania is a decreased need for sleep. People have told me, “I’ve pulled a few all-nighters before. I can go without sleep.” But it’s more than pushing yourself to meet a deadline. It’s that you can stay up and not even feel tired. You could go days without sleeping, and people who experience manic states will do just that and not feel sleepy.

Other symptoms include racing thoughts and grandiose ideas. Sometimes people can latch onto these big ideas so much that it becomes delusional. Reckless behavior, including substance abuse and spending sprees, is another one. Irritability and agitation can come with it.

With hypomania, the symptoms are similar but it’s scaled back just enough to not be full-blown mania—even though it still interferes with your relationships or work life.

Misconception No. 2: People who have bipolar disorder are always in a manic or depressive state. It’s just who they are.

Dr. Yashari: No, the key is that the behavior is out of sync with their personality. It’s what we call a “shift from the baseline,” where you notice the out-of-the-ordinary behaviors as an episode.

One thing people should understand is that getting a diagnosis like bipolar is not a curse. It can equip you with information that can be really helpful because you finally have a name for what’s been happening. The beauty of bipolar is that you swing this way and you swing that way, but you always have a return to baseline. You don’t get back to that baseline with schizophrenia. There are so many medications out there that can help, and can allow you to find that homeostasis, or even-keel state, and stay that way. But it is a scary first step, which is why finding a good doctor and enlisting support from family and friends is so important.

Misconception No. 3: Medication doesn’t work; it just numbs you and makes you fat.

Dr. Yashari: We use mood stabilizers to treat bipolar—the same drugs used to treat epilepsy. We don’t know very much about why they work, but we know they do. And we also know that the more episodes you have, the lower the threshold is for the next one, meaning you’ll be more susceptible. So if you decide to forgo treatment, you’re really setting yourself up for a worse course. There are side effects, such as weight gain. But there are so many options that sometimes it just takes a little patience and a good doctor to help you find the right medication and the right dose.

I personally don’t believe medication alone ever solves anything. It’s one thing if you have some mild depression or some work anxiety, but bipolar can interfere with so many parts of your life. There is so much to process that I think it’s good to also have someone to talk to and to monitor you. Because with bipolar, you’re not the best monitor of yourself.

That’s also why it’s good to have loved ones involved because when you’re in that state of mind, you’re not able to see what they see. I always recommend a family member or a spouse come to at least one session, so they can better understand what to look for and how to help. Most people have the same pattern, so if you or a family member can catch it early, it can really help.

Misconception No. 4: If you have bipolar disorder, you will have obvious symptoms your entire life.

Dr. Yashari: Not necessarily. For one thing, we all have certain coping mechanisms. People can go through their lives glued together just enough, but there’s a lot of psychological energy invested in keeping yourself together.  When you lose a loved one or you lose your job, or some kind of stressful event occurs, you can become overwhelmed. You can’t continue diverting energy to dealing with something you’ve been handling well enough up until then, which can bring on an episode. Almost always, there is a family history. So if you’re predisposed and then you go through a trauma, it is very possible that it can act as a trigger.

Some people have one sentinel event, one severe manic episode that makes their loved ones say, “Whoa, what’s happening here?” The person will be hospitalized and put on medication, and if they stay the course, they could never have a problem again. Other people will experience a series of episodes before they get help. Still others will get help, start to feel better and stop taking their medication, which starts the whole cycle over again.

But knowing your family history, being cognizant of your triggers, such as a lack of sleep or lots of stress, and taking advantage of the support that’s available is what will help you cope.

Image copyright Eduard Härkönen,

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