WHAT IT IS
Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. Symptoms of bipolar disorder are severe. They are different from the normal ups and downs that everyone goes through from time to time. Bipolar disorder symptoms can result in damaged relationships, poor job or school performance, and even suicide. But bipolar disorder can be treated, and people with this illness can lead full and productive lives.
By Mayo Clinic Staff
Bipolar disorder is divided into several subtypes. Each has a different pattern of symptoms. Types of bipolar disorder include:
Bipolar I disorder. Mood swings with bipolar I cause significant difficulty in your job, school or relationships. Manic episodes can be severe and dangerous.
Bipolar II disorder. Bipolar II is less severe than bipolar I. You may have an elevated mood, irritability and some changes in your functioning, but generally you can carry on with your normal daily routine. Instead of full-blown mania, you have hypomania — a less severe form of mania. In bipolar II, periods of depression typically last longer than periods of hypomania.
Cyclothymic disorder. Cyclothymic disorder, also known as cyclothymia, is a mild form of bipolar disorder. With cyclothymia, hypomania and depression can be disruptive, but the highs and lows are not as severe as they are with other types of bipolar disorder.
The exact symptoms of bipolar disorder vary from person to person. For some people, depression causes the most problems; for other people, manic symptoms are the main concern. Symptoms of depression and symptoms of mania or hypomania may also occur together. This is known as a mixed episode.
Manic phase of bipolar disorder
Signs and symptoms of the manic or hypomanic phase of bipolar disorder can include:
Agitation or irritation
Increased physical activity
Spending sprees or unwise financial choices
Increased drive to perform or achieve goals
Increased sex drive
Decreased need for sleep
Careless or dangerous use of drugs or alcohol
Frequent absences from work or school
Delusions or a break from reality (psychosis)
Poor performance at work or school
Depressive phase of bipolar disorder
Signs and symptoms of the depressive phase of bipolar disorder can include:
Suicidal thoughts or behavior
Low appetite or increased appetite
Loss of interest in activities once considered enjoyable
Chronic pain without a known cause
Frequent absences from work or school
Poor performance at work or school
Other signs and symptoms of bipolar disorder
Signs and symptoms of bipolar disorder can also include:
Seasonal changes in mood. As with seasonal affective disorder (SAD), some people with bipolar disorder have moods that change with the seasons. Some people become manic or hypomanic in the spring or summer and then become depressed in the fall or winter. For other people, this cycle is reversed — they become depressed in the spring or summer and manic or hypomanic in the fall or winter.
Rapid cycling bipolar disorder. Some people with bipolar disorder have rapid mood shifts. This is defined as having four or more mood swings within a single year. However, in some people mood shifts occur much more quickly, sometimes within just hours.
Psychosis. Severe episodes of either mania or depression may result in psychosis, a detachment from reality. Symptoms of psychosis may include false but strongly held beliefs (delusions) and hearing or seeing things that aren't there (hallucinations).
Symptoms in children and adolescents
Instead of clear-cut depression and mania or hypomania, the most prominent signs of bipolar disorder in children and adolescents can include explosive temper, rapid mood shifts, reckless behavior and aggression. In some cases, these shifts occur within hours or less — for example, a child may have intense periods of giddiness and silliness, long bouts of crying and outbursts of explosive anger all in one day.
When to see a doctor
If you have any symptoms of depression or mania, see your doctor or mental health provider. Bipolar disorder doesn't get better on its own. Getting treatment from a mental health provider with experience in bipolar disorder can help you get your symptoms under control.
Many people with bipolar disorder don't get the treatment they need. Despite the mood extremes, people with bipolar disorder often don't recognize how much their emotional instability disrupts their lives and the lives of their loved ones. And if you're like some people with bipolar disorder, you may enjoy the feelings of euphoria and cycles of being more productive. However, this euphoria is always followed by an emotional crash that can leave you depressed, worn out — and perhaps in financial, legal or relationship trouble.
If you're reluctant to seek treatment, confide in a friend or loved one, a health care professional, a faith leader or someone else you trust. They may be able to help you take the first steps to successful treatment.
If you have suicidal thoughts
Suicidal thoughts and behavior are common among people with bipolar disorder. If you or someone you know is having suicidal thoughts, get help right away. Here are some steps you can take:
Contact a family member or friend.
Seek help from your doctor, a mental health provider or other health care professional.
Call a suicide hot line number — in the United States, you can reach the toll-free, 24-hour hot line of the National Suicide Prevention Lifeline at 800-273-8255 to talk to a trained counselor.
Contact a minister, spiritual leader or someone in your faith community.
When to get emergency help
If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately. If you have a loved one who has harmed himself or herself, or is seriously considering doing so, make sure someone stays with that person. Take him or her to the hospital or call for emergency help.
WHAT NOT TO SAY AND WHAT TO SAY
If your loved one has been diagnosed with bipolar disorder, you may be in shock and may not know what to say. It’s important to choose your words carefully, because what you communicate can either support your loved one and encourage him to seek treatment or make him feel even worse about himself and his diagnosis, discouraging him from getting the help he needs.
Bipolar Disorder: The Nine Worst Things to Say
You may have been surprised by your loved one’s diagnosis and his behavior may be very frustrating, but no matter what he does (or doesn’t do) and how upset you get, do your best to avoid saying the following:
This is your fault.
You’re not trying.
Everyone has bad times.
You’ll be okay — there’s no need to worry.
You’ll never be in a serious romantic relationship.
What's the matter with you?
I can’t help you.
You don’t have to take your moods out on me — I’m getting so tired of this.
The truth is that bipolar disorder is a genetic medical illness — and it is treatable. Your loved one may cycle between being depressed with very little energy to being hyperactive or “manic.” This is all part of the illness and he can’t help it. It’s important that you be supportive, without nagging him. It will also help you if you know what to expect and how to spot when your loved one is not doing well or has stopped taking his medication.
Not finding someone to love romantically is something your loved one may be concerned about, so be careful not to reinforce that idea, even in frustration, especially since it’s not true. “There are plenty of people with these illnesses that get married. It just means that they have to do their best to get the condition under control,” says Jeffrey Rakofsky, MD, a psychiatrist at the Emory University Bipolar Disorders Clinic in Atlanta.
Bipolar Disorder: The Eight Best Things to Say
What should you say to be supportive and help your loved one to do his best to manage the condition without being too pushy? Some of the best words of encouragement include:
This is a medical illness and it is not your fault.
I am here. We'll make it through this together.
You and your life are important to me.
You’re not alone.
Tell me how I can help.
I might not know how you feel, but I’m here to support you.
Whenever you feel like giving up, tell yourself to hold on for another minute, hour, day — whatever you feel you can do.
Your illness doesn't define who you are. You are still you, with hopes and dreams you can attain.
Kristin Finn, author of Bipolar and Pregnant, a mental health advocate and member of the speaker’s bureau of the Depression and Bipolar Support Alliance, was diagnosed with bipolar disorder 30 years ago and is the mother of a 17-year-old daughter with bipolar disorder. Finn stresses that as important as it is to know what to say, it is also important to know when not to say anything. Finn says when her daughter’s mood changes suddenly, the best thing she can do is give her daughter space and not ask “What’s wrong?” or “Is it something I did?” She adds, “Remember it’s not about you. You’ve got to let the person experience what they are experiencing.”
Finn also recommends suggesting a support group to your loved one or finding books about the condition that may help him realize that he is not alone and that lots of people live with bipolar disorder every day.
Dr. Rakofsky adds another important point to remind your loved one of: “People with bipolar disorder are often very creative [and] talented. We have people like Vincent Van Gogh and other artists and actors out there that speak to that.”
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