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Understanding And Dealing With Bipolar Disorder


Bipolar disorder is a mental illness that will cause mood, energy and intellectual processes to cycle. Between 3% and 5% of Americans have bipolar disorder. That is about 4 million people. Bipolar disorder used to be called "manic depression" because that term described the most severe cases. The term bipolar was adopted in a effort to describe how this disorder has symptoms that range between two "poles".

The symptoms of Bipolar disorder vary along a spectrum in which the symptoms can be very different from one person to the next. Two people with bipolar disorder can look and act very different. Symptoms can varies from one hour to the next, from one day to the next, one week to the next, or they can cycle over a period of months.

Many people with this disorder can go undiagnosed for years. In rare cases, there are distinct manic episodes followed by an episode of pure depression. People are more likely to go see a doctor when they are depressed and so many people are misdiagnosed and are told they suffer from depression. As result, they are treated for depression with little or no benefit.

Symptoms of a Depressive Episode

  • Persistent sad, down or empty moods
  • Feeling helpless, hopeless and pessimistic
  • Feelings of guilt or being worthlessness
  • Loss of interest or pleasure in ordinary activities
  • Decreased energy, a feeling of fatigue or of being "slowed down"
  • Difficulty concentrating, remembering, or making decisions
  • Restlessness or irritability
  • Sleeping too much or excessively
  • Loss of appetite and weight loss
  • Increased appetite and weight gain

In a depressed phase of bipolar disorder, a person can have great difficulty thinking. These people tend to thinking more slowly. In a deep depression that will often stare off and seem disconnected from others. There is a loss of creativity and they have difficulty seeing the relationship between events, feeling and thoughts. They tend to remember depressing times and can't remember better times. The depression tends to deepen and become worse before it changes. The slide into depression is emotionally painful as the person realizes that their life feels less interesting, less rewarding and less meaningful. Nothing seems to matter. Desire and motivation tends to slip away. They tend to isolate and come to feel like they can't do anything to feel better. They believe their situation won't change, will be this way forever and that their situation is hopeless (even when it is not). They forget about things in life that matter. Many depressed people try to fight their depression by involving their self in stimulating and high risk behavior or drug and alcohol abuse. Depressed people are drawn to and find momentary relief using stimulants like cocaine, meth, tobacco and amphetamines. This can include drugs like Adderall and Ritalin that are used to treat attention deficits.

Treatment of a bipolar patient during a depressed phase with an antidepressant can in 8 to 15% of individuals, cause a severe reaction. The reaction can include increased irritability, low frustration tolerance, hyperactivity, anger, aggression, suicidal behavior, and even violence. In some cases, a depressed person will become extremely manic.

Manic symptoms are high energy and accelerated states. Giving people an antidepressant (a type of stimulant) can trigger in some people a manic episode on top of a depressed mood. The rapid onset of a mixed phase of depression and mania can cause people to lose control and become very impulsive, reckless, self-destructive or dangerous. Their behavior can be very unstable and reactive.

Pure manic episodes are rare. They can last hours or many weeks. There is seldom a set pattern. The severity and duration is never the same.

Symptoms of a Manic Episode

  • Increased energy, activity and restlessness
  • Racing thoughts and rapid speech
  • Denial that anything is wrong
  • High risk behavior
  • Impulsiveness or reckless behavior
  • Excessive "high" or moderately positive feelings
  • Poor sleep or decreased sleep
  • Unrealistic beliefs in one’s ability
  • Poor judgment
  • A sustained period of behavior that is different from usual behavior
  • Increased sexual drive
  • Abuse of drugs and alcohol
  • Provocative, intrusive, or aggressive behavior

In bipolar disorder, a person’s mood may swing from an elevated "high" mood to an irritable "low" that is sad and hopeless, and then back again, with periods of normal and mixed moods in between. In nearly all cases there is a mixed phase to some extent in which a person can look both depressed and manic to some degree. In a mixed  case, people can appear very impatient, irritable, easily, frustrated and even angry or aggressive. Their emotions are brittle and can change rapidly. They can feel angry, happy and sad all at once, or swing from one extremely emotional state to the next quickly. In addition to a mixed phase some people will "cycle" through mostly manic episodes to mostly depressed very quickly. They can appear very moody and emotionally unstable during the day. Rapid cycles can be extremely exhausting to patients as well as those around them. People living with a bipolar person often wonder what kind of mood a person will wake up with in the morning.

Intellectual processes can cycle as well. Intellectual processes that are most affected include creativity, the ability to form associations, and speed of thought. Moderate "highs" can make a person appear very creative. But extreme highs can make them appear out of touch with reality. Speed of thought can in some cases be so fast that people have difficulty speaking their mind. The result is rapid or extremely rapid speech.  Accelerated intellectual processes can cause a person to become overwhelmed with thoughts and ideas that can intrude and make it hard for a person to focus, concentrate and stay on task. They often have difficulty starting an finishing tasks, projects and activities. Ironically, some people in this state become obsessed with something like a computer, TV, video game, a romantic interest, taking things apart, or driving a car to help them stay in control. Highly accelerated and mixed states can result in extremely careless, reckless, erratic or impulsive behavior. Fixations and obsessions like these can become for some people a comfort and escape from a chaotic  and unstable brain.

Symptoms can be minor or severe in the early stages of bipolar disorder. More often, bipolar symptoms are very "soft" and "mixed". These soft or mixed states can make it difficult to diagnose bipolar disorder. Bipolar disorder is extremely difficult to diagnose in a single office visit. Tests and questionnaires are often not useful. Many people with Bipolar disorder are incorrectly treated for depression, anxiety, or attention deficits and hyperactivity. In some cases people respond to medications for these problems. But the benefit usually does not last. The medication can seem like they help but in reality the person may simply enter a new cycle that creates the illusion that the medication is working. One should never assume that a medication alone, or counseling for that matter, is the right treatment just because the symptoms change or go away for a period of time. Symptoms can go away for many reasons that have nothing to do with medications or counseling. The key to diagnosing Bipolar disorder is to recognize a pattern of changes in behavior and the changes in symptoms over time.

Although a specific genetic link to bipolar disorder has not been determined, studies show that 80 to 90 percent of people who suffer from this illness have relatives who have some form of depression. The family history will often have more than one relative with multiple problems like alcoholism, emotional breakdowns, "affairs", inability to keep a job, gambling, severe marital and family dysfunction, or chaotic life styles. This is an important clue as this disorder tends to run in families. It can also skip a generation where two grandparents were bipolar yet their children were not.

Bipolar Disorder and Children

Bipolar disorder typically begins in adolescence or early adulthood and continues throughout life. The diagnosis of children is often missed and children who have it may suffer needlessly for years or even decades. Bipolar symptoms that are not treated can have tremendous negative impact on the character of children and their social development.

Bipolar disorder has been diagnosed in children under age 5, although it is not common in this age bracket.
At this age it can be confused with attention-deficit/hyperactivity disorder and depression, so careful diagnosis is necessary. Some cases of bipolar disorder have a late onset. Some people are not fully symptomatic until age 30 or so.

The cycles of bipolar disorder put children out of “sync” with others in terms of their mood, energy and intellectual processes. In the beginning, the changes are so minor that a parent might not notice.  Many people conclude that early signs of Bipolar disorder are merely normal childhood or adolescent behavior.  But for the bipolar child their experience is something else entirely.

A very important challenge of adolescence is to harness our mind, learn how to regulate our emotions, and to focus our energy in activities where we can make a meaningful difference. There is a sense of joy and belonging that children experience together when they learn self-mastery. Despite their efforts, the cycles of bipolar disorder give children only fleeting glimpses of what others might think and feel. In time, social interactions become a challenge, and over time, it can become an ordeal

Bipolar children experience fluctuation in their energy, mood and intellect that are at times completely independent of the events in their life. A child can be functional for hours or even weeks. Then for no apparent reason, their neurological functioning changes in a minor or severe way. Changes in their feelings can cause them to “misread” how others feel and how one would feel if they did not have this disorder. Bipolar children have great difficulty predicting the emotional impact of their behavior. This "disconnect" has a profound impact on their sense of trust and confidence in their self and others. At some point they may discover that they are very different from everyone else. This can be a horrific shock that is never shared with others. There can be profound sense of shame. This is where the bipolar child may begin to "fake" their way in the world.

Bipolar children respond to their "disconnects" in variety of ways. Some become avoidant, isolating and dependent. Others become outwardly social, controlling and forceful. Ironically they don't know how others feel but they do their best to observe and figure out how to predict, if not control, how others act and feel. Instead of being with people, and allowing relationships to unfold, the bipolar child tries to predict and control others.

Some cases of bipolar disorder can be extremely distressing and disruptive. Like other serious mental illnesses, bipolar disorder is extremely distressing and difficult on family members, friends and employers. Children with bipolar disorder have many of the following behaviors and symptoms

Behavior and Symptoms of Bipolar Children

  • Argumentative behavior
  • Feeling misunderstood
  • Academic failure
  • School suspension or expulsion
  • Destruction of property
  • Theft or shoplifting
  • Recurrent irritable moods
  • Recurrent anger and aggression
  • Rapid emotional swings
  • Frequent misunderstandings
  • Social isolation
  • Poor social interactions
  • Drug and alcohol use
  • Changing topics in conversations
  • Fixation on activities or relationships
  • High energy
  • Periods of being restless and unable to stay still
  • Rapid speech
  • Rapid thinking (often with talking fast)
  • Thinking of too many things at one time
  • Starting things and not finishing them
  • Inability to sleep or sleep well
  • Periods of excessive sleep
  • Strange ideas of belief (not in all cases)

Some researchers believe people may inherit a vulnerability to the Bipolar "illness", which can be triggered by psychological, social, health and environmental factors such as stress. Other research suggests the illness may be caused by neurological problems. This dysfunction may be due to irregular hormone production or recurrent excessive and deficient neurotransmitter levels. Still other view bipolar disorder as a form of seizure that affects mood, intellectual processes and energy.

Family members of people with severe bipolar disorder are forced to cope with many serious behavioral problems and the lasting consequences of these behaviors. In other cases, the disorder is rather minor in terms of the influence it has. There are less intense forms if bipolar disorder that have high and lows that are not severe. In some cases, the lows are not that low or the highs are not that high. But these mood swings invariably are disruptive to healthy relationships and development. Children with mixed phases can appear very dramatic, hysterical, moody, irritable, difficult to deal with and easily upset.

Treatment

Bipolar disorder is not the result of a "weakness" in one's personality or character. People with bipolar disorder have limited or no control over their moods, intellectual processes and energy. Bipolar disorder can become disabling, but it is also a treatable or manageable mental illness in most cases. A combination of medications and psychotherapy helps a vast majority of people with this illness return to happy fulfilling lives. The challenge is to provide treatment as soon as possible. Unrecognized and untreated symptoms of Bipolar disorder can have a profound and lasting impact on personality and one's character.

In many cases, the symptoms of bipolar disorder will occur with other problems such as substance abuse, poor school performance, family conflict or trouble a work. People with bipolar disorder are very prone to medicate they symptoms with alcohol, stimulants and sedatives. Some will turn to stimulants to help them cope with their depression. Treatment of more that one problem may be necessary.

Most people with bipolar disorder are usually treated with medications such as Lithium which tends to manage mania. Tegretol (Carbamazepine), Valproate (Depakote), Lamotragine (Lamictal) are three additional medications that were originally used to control seizures. These drugs have been found to act as a mood-stabilizers and to manage bipolar symptoms. Benzodiazepines such as Lorazapam and Ativan are sometimes prescribed for insomnia. A number of medications are used to manage mania especially when it cannot be controlled. Combinations of medications have been used with some success. Some of these include antidepressants and antipsychotic medications. A relatively new medication, Zeprexia, has been used to quickly manage and control manic symptoms in bipolar disorder. However this drug is often associated with severe side effect including massive weight gain and increased risk for diabetes. Treatment of bipolar disorder is not always easy, especially in the early stages, and requires a great deal of trial and error.

If a person is in the midst of a manic episode, he or she may not recognize or appreciate the impact of their behavior. Children may not feel at risk or that they are impulsive, reckless or taking any risks. In fact, many people conclude that a manic episode is just normal adolescent behavior. While it may appear that way at first glance, the cycles in a child's behavior will tell the difference. A person in the midst of a manic episode may experience an elevated sense of well being or over confidence that he and her or she may refuse to get help. They can be very difficult to deal with. People in mixed phases can be very irritable, even volatile, aggressive and difficult to interact with. Parents may notice a change but not know what is causing it. In some cases, a person who is very manic, severely depressed, or mixed, may need to be hospitalized for his or her own protection in order to receive treatment. Education, guidance and support from a psychotherapist is often very helpful when a manic or depressive episode resolves. A therapist can help the person to deal with personal relationships, maintain a healthy self-image and ensure that the person complies with his or her treatment. Family counseling and support can be very helpful where the family is willing and able to participate productively. Psychotherapy can also assist the person in coping with the side-effects of the medications.

Serious and Critical Symptoms

  • Suicidal behavior, thoughts, feelings
  • Dangerous, threatening or self-harming behavior
  • Extreme neglect and lack of self-care

Information And Steps You Can Take

  • Seek immediate help if a child has any serious and critical symptoms.
  • Consultation with a qualified mental health professional or crisis intervention specialist is recommended if a child is in the midst of a manic or depressive episode.
  • Anyone with symptoms of bipolar disorder should have a comprehensive medical, social and psychological evaluation.
  • Ongoing encouragement and support from friends and family are also very important. It may be helpful to join a self-help or support group to help those coping with this illness.
  • Ask about, evaluate, and address any suicidal, self harming or dangerous behavior.

Dated: December 30, 2007

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