Balanced and Brilliant:
Living a Good Life with Bipolar Disorder
by Natasha J. Thomas, MD
“I wanted to know if you think I’m going into shock.”
“My thoughts and mania are driving me insane.”
“I’m in a season of my life where people are irritating me.”
“I find myself having behavior that is reckless.”
“I’m pretty good right now, no real spikes or lows.”
- Accounts of women experiencing life with bipolar-spectrum disorders.
Colloquial use of the term “bipolar” is often used to humiliate people when we feel they’re being ridiculous, unpredictable or unreasonable. “What’s wrong with you? You must be bipolar!” I’ve heard it all over the internet, on TV, and from patients that feel ashamed when people sling the term around so loosely. It does nothing but build a lack of understanding and stigma. In this article, I’m sharing the information I have on this mysterious “illness” – gained primarily from latest research and my clinical experience. By the end, I hope the nature of bipolar-spectrum disorders is clear, as is the best way to live with them.
Usually, people begin to experience symptoms of bipolar disorder in the second decade of life. Of course, it can happen in adolescents, and even children. In addition, women in their perimenopausal phase of life can have onset of bipolar disorder, too.
Current statistics on the number of Americans with bipolar disorder ranges from 6 to 10 million. We can’t be exactly sure just how many people do have this type of mood disorder, primarily because of people who are not adequately diagnosed. Did you know that it takes most people with bipolar disorder an average of 10 years to get the correct diagnosis?! Of the millions of people impacted, only 25% of them will get the correct diagnosis within a 3-year period.
Bipolar disorder occurs just as often in men as it does in women but due to a diagnosis bias, women are misdiagnosed more often with depression and men with schizophrenia or even ADHD.
Even though it’s seen as a disorder that is just about being really moody, bipolar disorder can take a negative toll on a person’s life when poorly managed. Unfortunately, having poorly-treated bipolar disorder drops a person’s life expectancy by 9 years and up to 20% of people affected with it will eventually go on to commit suicide.
The good news is the majority of people with bipolar disorder who feel satisfied with their treatment, and treatment team, have a much more positive outlook about living and coping with it. They are much less likely to commit suicide. You know what that sounds like to me? Sounds like getting the right team, and approach, is key. More on that later.
You may be affected with bipolar disorder, or know people who are, and notice a pattern – people with bipolar disorder often have a relative with the diagnosis (or symptoms), as well. Scientists do notice a familial pattern, but genetic causes and patterns are not 100% clear. Sometimes in identical twins there will be an affected twin and a twin that does not have the same mood issue.
It’s another one of those “perfect storm” diagnoses. A person with a genetic predisposition or vulnerability, exposed to very stressful life events, major illness, loss of a significant relationship or sudden unemployment, may experience the onset of bipolar symptoms. In addition, substance misuse (like drugs), medications, or even onset of menopause, can lead to the development of the disorder.
When I think of bipolar disorder symptoms, I think of a spectrum. The most involved presentation is Bipolar I disorder. Next is Bipolar II disorder, Bipolar Disorder Not Otherwise Specified (NOS) and then Cyclothymia. The difference between them is basically how long symptoms last and how intense they are. For someone to meet diagnostic criteria for Bipolar I disorder, they must have had at least one manic episode in their lifetime. For Bipolar II, you must have had at least one episode of hypomania, as well as a Major Depressive Episode. In Bipolar Disorder, Not Otherwise Specified, symptoms that don’t quite meet criteria for Bipolar I or II are present. And in Cyclothymia, a person will have both mood elevations and mood drops, neither meeting full criteria for mania/hypomania or a major depressive episode, but definitely disruptive enough to get in the way of responsibilities and relationships.
So, what is a mania? It is an elevation in mood, with an upward shift in energy and change in behavior and thinking. Being manic doesn’t necessarily mean being happy or euphoric. People can feel very, very irritable during a mania. Symptoms must last for at least one week. When it happens, a person may begin thinking they are more beautiful and intelligent than everyone else. They usually struggle to concentrate but can come up with multiple new projects or business ideas and spend day and night working on them. They may start to find people and situations extremely annoying and be prone to getting into more altercations than usual.
Typically, a person feels an energy surge and has a decreased need for sleep. Thoughts are fast and spring-board from one topic to the next. Speech may be rapid, intense and loud. Physical restlessness is common. But the symptoms that get people in the most trouble during mania are serious impulsivity and pleasure-seeking. This can lead to the purchase of a new car without planning, multiple sexual relationships, sudden travel, etc. It’s a constellation of symptoms happening at once over a specific period.
Hypomania is pretty similar to mania, it just lasts fewer days (around 4) and is not as intense, though still enough to be noticeable to others and to interrupt typical functioning.
For information and diagnostic criteria for Major Depressive Episodes, see my article “Coming out of the Dark” here.
Reading the information above may be intimidating, but don’t let it be discouraging! It is possible to live well even though one is living with the symptoms of bipolar disorder. The key is knowing how to manage it.
Pick a team
As you’ll find in my other articles, I always recommend working with a team consisting of people you’d consider your support network – as well as medical and mental health professionals. A “support network” is made up of friends, family, clergy, support group members from the community, etc. In order for a relationship to rise to the level of “support” though, you have to feel comfortable enough to share your struggles, ask for help when you’re having a hard time and even better yet, teach this person what your mood episode warning signs are.
Your Primary Care Physician should always be part of your team. So, pick someone that shows true interest in your well-being, listens well, doesn’t make you feel rushed, and who will work with your support network, counselor and psychiatrist to keep you on the right track.
Many people diagnosed with bipolar disorder have difficulty staying on the appropriate medication. They tend to struggle with feelings of inadequacy, anger, embarrassment and guilt about their diagnosis – or things they’ve done or said while in a mood episode. To get in a place where that stuff doesn’t hold you down, a counselor specializing in mood disorders should be consulted.
For optimizing treatment of bipolar disorder, a psychiatrist must be part of your treatment team. They are the only medical provider with expert knowledge on medication management of bipolar symptoms, as well as effective medication alternatives. Like your PCP, your psychiatrist should put your well-being first in session – attend well, collaborate to the degree that is appropriate, talk to your support network, counselor and other doctors when necessary, and encourage you along the way! Your psychiatrist should also be someone you truly feel you can trust. This person will see you at your most vulnerable. You have to be ok with that. In addition, if you’re not feeling well due to bipolar symptoms and you’re having difficulty thinking – you have to trust that your psychiatrist is going to make adjustments to your treatment plan and reach out to your support network. At times, they may have to do this on your behalf – if you’re not well enough to suggest it or figure it out yourself. That’s ok! A good psychiatrist isn’t going to leave you on your own. They’re going to aim to get you completely supported by all the medical and community services available.
But this means you can’t fight with them. You can’t make it difficult for them to help. Really, that goes for the entire team. Though you might feel misunderstood often on this journey those people part of your “team” should be the ones you allow to help, always.
Stick to your plan
Once you’ve devised a plan with your treatment team stick with it! Make changes only after everyone has talked, agreed and knows how to implement the changes. Please do not stop taking medication abruptly, drop out of counseling without talking to the team about it, add supplements or marijuana to help achieve a calm, or start taking the advice of unqualified persons – persons not part of the team. Also, try to never alienate your team, that’s one of the quickest ways to get sick and end up in the psychiatric hospital.
Your psychiatrist will tell you all about your medication options. Though the information may seem daunting, try to be hopeful the medications will be one part of the puzzle to help you live the life you want. Taking medications is typically required, not by the doctor – but by the disease. Try to accept that fact and not let naysayers on the internet make you feel ashamed for taking them. This journey is not about people outside your team and their unqualified opinions on pharmaceuticals, politics, conspiracy theories and whatever else. This journey is about you living your best life!
For various reasons, there is evidence to show people with bipolar disorder may be more sensitive to the changing of the seasons. My patients regularly struggle in the early fall and spring. Researchers have postulated this phenomenon is due to changes in light, allergens and even cortisol levels that may shift with the seasons.
If you or a loved one is diagnosed with bipolar disorder, figure out the seasonal pattern. Over time you may notice a more “high-risk” time of year. If that’s the case, share that information with the psychiatrist.
In the early part of my career, late-February and early-March were filled with phone calls from my patients with bipolar disorder, reporting they were having sudden problems with insomnia and irritability. Now, I adjust medications before my patients’ high-risk times. That technique has been very effective in preventing mood episodes, especially the onset of mania.
I can’t provide you medical advice through this article but you can ask your doctor about their thoughts on this approach.
Prioritize rest and minimize stress
Sleep is so precious in the pursuit of mood stability – don’t skimp on it. I have repeatedly seen that purposeful reduction of uninterrupted sleep (to watch tv, work, chat online or stay out socially, for instance) has been a huge risk factor for the onset of a mood episode – usually mania. I have always recommended my patients get at least 6 hours of uninterrupted sleep. I am a stickler about it. And if someone is not able to sleep that way naturally, I recommend a combination of self-relaxation techniques and sleep aids (or mood stabilizers that help with sleep) to make sure we protect it.
Stress plays at the intersection of lack of sleep and bipolar mood episodes, too. Obviously, lots of stress about work, personal issues and more, can cause a spinning mind, the inability to sleep and anxiety. These factors trigger a mania – but can cause a depression as well.
Keeping a regular schedule, eating healthily, spending time doing fun things, getting social with friends, pampering yourself with extra care and any other thing you can do to relax is paramount in the effort toward mood stability.
Participate in support groups
There’s really no need to go this road alone. Some great online and in-person support groups are being held every day in our communities. Many are lead by peers and people who are experiencing the symptoms of bipolar disorder themselves. The National Alliance on Mental Illness (NAMI) and Depression and Bipolar Support Alliance (DBSA) host meetings that have been life-changing for some of my patients. Groups show you you’re not alone, teach you innovative ways to cope and prevent relapses, and help to relieve the embarrassing feelings that remain after mood-induced impulsivity. DBSA also has multiple podcasts available on their website that specifically address real concerns of people living with bipolar disorder. Adding support groups to your plan is highly recommended!
Keep a journal
One of my favorite ways to stay ahead of major mood shifts associated with bipolar disorder is to follow-along with my patients through online symptom journals. You can do this with your doctor and treatment team as well. Set up a profile on a site like Moodtracker.com. Have your psychiatrist and therapist create profiles as professionals. Then share your site with them. They can check what’s happening with you every few days and call or change something in your medication regimen if things seem to be declining. Mood journal apps are available as well. In general, you’re looking for something that lets you note not only how your mood is every day, but allows you to track if you’ve taken medication, slept, had a new stress, started your period, etc. These programs typically align all your data in a graphical representation, which shows you how the different factors of your life correlate with each other. This helps find daily, monthly and seasonal patterns. Once you truly know how bipolar disorder manifests in you, you will be able to stay ahead of it most times.
A word about bipolar disorder and brilliance
We’ve all heard the stereotype – people with bipolar disorder are “creative-types”. Studies about increased creativity and intelligence in those with bipolar disorder have been performed both in the US and the UK. Results seem to indicate a link between depression and introspection, and mild elation and increased creation in people diagnosed with bipolar-spectrum disorders. The same has been shown in the children of those with bipolar disorder. Some studies seem to challenge these results, but the anecdotal evidence abounds.
As a mental health provider, I hate that we have the paradigm of labeling people with “disorder” though I understand the term. And it’s true, if you are experiencing a mental issue that makes you incapable of functioning well, there is dis-order.
However, I truly have to say that each and every patient I’ve cared for that is diagnosed with bipolar disorder has been a brilliant, creative and deeply introspective person – without exception. Obviously, I’m not doing a clinical trial, so these experiences with my patients all count as anecdotes. But I thoroughly enjoy working with people with bipolar disorder. They are always trying to figure life out – and put themselves in the center of their discovery. This allows them to live and love deeply and make the world just that much more beautiful.
I don’t believe it’s a good idea to try to induce mania to get to creative spaces. That pursuit usually ends up in a hospitalization. Studies have found that extreme mania is counterproductive in creative efforts anyway. Mania can be followed by crippling depression. On both ends, these mood episodes increase the risk for suicide and other negative outcomes, like repeated or more severe mood episodes.
However, there is no need to look at bipolar disorder as an embarrassing life sentence. Just as there is a tendency to have certain vulnerabilities, there is the tendency to have certain gifts in bipolar disorder. Manage it well with your "team" as we discussed above, so you can access those gifts. Strive to be balanced and hone your brilliance!
For more information, see these sites:
If you’re concerned your child may have bipolar disorder:
* If you or a loved one is in a mental health crisis, please call 911, go to the nearest emergency room or reach out to 1.800.273.TALK or other national crisis hotlines.
*This article is for informational purposes only, is not intended to diagnose or treat any condition, and does not take the place of a medical assessment or treatment by a licensed professional.