Forums » Smalltalk » AMA: Living with bipolar disorder

Bipolar disorder (also called manic depression) is a mental illness in which someone experiences alternating mood episodes. They experience both depression and mania, to varying degrees. I have Bipolar I, which means that I experience at least one depressive episode and one full blown manic episode per year. Typically though, it's closer to four because I am rapid cycling. I tend to run more manic than depressed.

I was diagnosed six years ago and am currently on disability because of this diagnosis. I've been in and out of the hospital and been through several different medications. Presently, my disorder is managed fairly well, but I also still experience disruptive mood episodes. Ask me anything!

What was your experience like during diagnosis? What was the biggest symptom that helped you get the diagnosis and in turn the help you needed?

Getting the diagnosis was pretty surreal! I'd been experiencing depression earlier in the year, so at the advice of a psychiatrist, I went on an SSRI (for those who don't know, this is a common type of antidepressant). The medication made me so manic that I didn't know what day it was, I could barely speak, and all I could really do was cry when I did.

What ended up happening was my regular therapist, who'd been tracking my symptoms, finally encouraged me to go to the hospital. I walked in, checked myself in, and was put on a stretcher in a hallway while I was placed on something called "bed search." This is when the emergency department calls other hospitals to try and find you a bed in a psych ward. It can take a very long time, and I was in the ER in that hallway for about twelve hours before I was finally admitted to that hospital's ward.

I expected it would be a quick 24 hour stay, but it ended up being 10 days. The whole thing felt really strange, like it was happening to somebody else, which I attribute to my adjusting to my new medications. There's also the stigma of "whoa, I'm in a psych ward" combined with the anxiety of re-entry into the regular world where you lose that 24 hour support structure. It was pretty intense!

Having had experience with someone with Bipolar Disorder, I hope you are able to keep yourself as well as you can.

My question(s) are how this diagnosis affected your relationships with other people in your life? And how supportive have the people in your life been to you with both the diagnosis, and with your episodes?

Do you feel there are any key features that can be used to help differentiate between Bipolar Disorder and other disorders or such that can look similar? For example, there have been times I've wondered things like, "Do I have some form of Bipolar, or is this just the mix of ADHD and 'regular' Depression?"

So I have bipolar disorder IRL as well as a few other disorders and I wanted to ask a few questions that I'm too afraid to ask my doctor about.
WHAT IS BIPOLAR DISORDER?
WHAT ARE THE SYMPTOMS OF BIPOLAR DISORDER?
HOW IS BIPOLAR DISORDER DIAGNOSED?
HOW IS BIPOLAR DISORDER TREATED?
WHAT IS THE DIFFERENCE BETWEEN DEPRESSION AND BIPOLAR DISORDER?
What is bipolar disorder?
Is there more than one type of bipolar disorder?
What causes bipolar disorder to develop?
What are some common bipolar disorder symptoms?
Is BPD dangerous?
Will I have to be hospitalized for BPD during a manic or depressive episode?
Is normal life possible when living with BPD?
What are the symptoms of Bipolar Disorder?
What’s the difference between Bipolar I and Bipolar II?
Can Bipolar Disorder be Cured?
What are the risks of Bipolar Disorder?
Will I have to take medication for Bipolar Disorder?

I'm sorry that you had such a stressful experience with a loved one living with unmanaged bipolar disorder. It can be very devastating to the people around us if we're not taking proper care of ourselves.

As for my relationships, unfortunately many of them have suffered because of my diagnosis. Though I wasn't diagnosed until the age of 26, I can trace my cycles as far back as 12 years old, and they greatly impacted the ways in which I interact with the world. The biggest issue I've had is manic hyperfixation. I would get manic, fall deeply in love with someone, do everything I could to be the perfect partner, and then crash hard a few months later when I bottomed out into depression. Suddenly, my partner was dealing with me fully isolating and falling out of love. This was a recurring theme in my romantic relationships, and it wasn't until I got fairly properly medicated that I could recognize the pattern.

Once I became aware of this, though, I was able to realize that I'm actually on the aromantic spectrum, and I generally only feel romantic love when I'm manic (with some exceptions - I'm demiromantic). Being better medicated, I've only felt romantic feelings a couple of times in the past five years. Being self-aware has helped me to avoid more doomed relationships.

On the friendships front, I have an incredible support network of people who have been with me through several cycles and know what to expect. For my part, I do my best to do things like check in before I unload about my symptoms and feelings ("Are you okay if I talk about x?") and communicate clearly. I also try very hard to rely on resources such as my therapist, crisis hotlines, and the hospital as necessary so that I'm not laying the burden heavily on the people I love. I won't say that friendships haven't suffered, but in many cases, it was a situation where someone else's diagnosis/neurodivergence was clashing poorly with mine. Even then, I don't have this issue with any of my offline friends. It seems largely reserved for the internet.

The people in my life are pretty excellent, and though it's taken me a few years, I've reached a point where I'm able to maintain healthy relationships. I still slip because, well, my symptoms are extremely intense, and nobody is perfect. I make a sincere effort, though, and the people who've stuck with me appreciate it.

Is bipolar disorder something that you had symptoms of even as a child even though you weren't diagnosed?

It's funny you mention ADHD specifically because I have often wondered if I also have that diagnosis due to comorbid (overlapping) symptoms, but there are some pretty key differences that my care team has pointed out to me. First and foremost, many, many mental illnesses can come with extreme executive dysfunction, which I'm sure you know is a prime feature of ADHD. The biggest difference in how I experience it, though, is that when I'm totally baseline (not in a mood episode) - which doesn't happen often - my executive dysfunction totally clears up. I'm sure that's not the case for everyone, but that is my personal experience.

Additionally, manic episodes are more than just hyperfixation. I can't speak for everyone's experiences, but in my case, my manic episodes are very pronounced. I experience racing thoughts, insomnia, impulsivity, recklessness, irritability, and at times dissociation and psychosis. One of the important defining factors of diagnosing a manic episode is how long it lasts. It's not fleeting like a mood swing, but something that lasts anywhere from a few weeks to several months. My shorter episodes usually run about 3-4 weeks, and my longest was closer to 6 months.

I am going to attempt to answer your questions, but I absolutely need to preface this with the fact that nothing I say is a substitute for medical advice. You should definitely talk to your doctor about these questions and concerns. I know it can be scary, but they know the illness much better than I do, as well as your personal medical history, and they can offer much better insight!



Bipolar disorder (formerly called manic-depressive illness or manic depression) is a mental disorder that causes unusual shifts in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks.

There are three kinds of bipolar disorder that are all defined by alternating highs and lows that generally last at least a week. Even though people refer to these as "mood swings," it's important to note that bipolar mood episodes do not shift quickly and are typically both gradual and sustained. You won't go from manic to depressed over the course of a single day, generally (although I have Bipolar I and have definitely experienced "mixed" episodes before, so it's not unheard of).

Here are the different types of bipolar disorder:

• Bipolar I Disorder — defined by manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depressive symptoms and manic symptoms at the same time) are also possible. When people think of bipolar disorder, this is the type that most often comes to mind.
  
• Bipolar II Disorder — defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes that are typical of Bipolar I Disorder. Hypomanic episodes are typically shorter and less intense than a full-blown manic episode. You may experience an elevated mood, a rush of energy and sleeplessness, impulsivity, etc. but not to the degree that you might experience psychosis as is possible with full-blown mania.
  
• Cyclothymic Disorder (also called Cyclothymia)— defined by periods of hypomanic symptoms as well as periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.

People with bipolar disorder experience periods of unusually intense emotion, changes in sleep patterns and activity levels, and uncharacteristic behaviors—often without recognizing their likely harmful or undesirable effects. These distinct periods are called “mood episodes.” Mood episodes are very different from the moods and behaviors that are typical for the person. During an episode, the symptoms last every day for most of the day. Episodes may also last for longer periods, such as several days or weeks, or even months.

Please note that these are not complete lists of symptoms, but rather a "greatest hits" highlight of the most common ones.

Mania symptoms:

• Feeling very “up,” “high,” elated, or irritable or touchy
  
• Feeling “jumpy” or “wired”
  
• Having a decreased need for sleep, or a generally elevated energy level
  
• Loss of appetite
  
• Racing thoughts and at times rapid speech (sometimes I run out of breath while speaking when manic)
  
• Feelings of grandiosity and importance, such as feeling invulnerable, or even godlike (in more extreme manic episodes)
  
• Doing risky things that show poor judgment, such as eat and drink excessively, spend or give away a lot of money, or have reckless sex

Depression symptoms:

• Feeling very sad, “down,” empty, worried, or hopeless
  
• Feeling slowed down or restless
  
• Having trouble falling asleep, waking up too early, or sleep too much (I sleep 12-16 hours when depressed after staying up all night)
  
• Increased appetite and weight gain (the opposite is also true - I tend to have no appetite when depressed)
  
• Talking very slowly, feeling like they have nothing to say, forgetting a lot
  
• Difficulty concentrating and completing tasks
  
• Having little interest in almost all activities, a decreased or absent sex drive, or an inability to experience pleasure
  
• Feeling hopeless or worthless, thinking about death or suicide

There are a few steps for getting a diagnosis:

• Physical exam -- Your doctor may do a physical exam and lab tests to identify any medical problems that could be causing your symptoms.
  
• Psychiatric assessment -- Your doctor may refer you to a psychiatrist, who will talk to you about your thoughts, feelings and behavior patterns. You may also fill out a psychological self-assessment or questionnaire. With your permission, family members or close friends may be asked to provide information about your symptoms. Other factors may contribute to your evaluation, such as other mental illnesses that could be causing your symptoms. In my case, I attempted to get a diagnosis in college, but was unable to because I was going through grief and trauma at the time.
  
• Mood charting -- You may be asked to keep a daily record of your moods, sleep patterns or other factors that could help with diagnosis and finding the right treatment. This is typically done over several weeks to a few months depending on how long your symptoms last. In my case, my mood episodes are quite long.
  
• Criteria for bipolar disorder -- Your psychiatrist will compare your symptoms with the criteria for bipolar and related disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. The DSM is essentially the overarching guidebook for diagnosing mental illnesses.

In most cases, it's treated with a combination of talk therapy and medication. I see a therapist weekly, and I have medication evaluations at least once a month to see if we need to do any adjustments. Because bipolar disorder is a lifelong diagnosis, consistent maintenance is necessary to keep your quality of life up and avoid a higher level of care such as hospitalization. Your care team will work with you to outline a treatment plan.

A patient with a unipolar depression diagnosis does not experience hypomanic or manic episodes.

Science is still on the fence about this one, but there is indication that genetics factors into it, along with stress and trauma. In my case, my biological father as well as my maternal aunts all have bipolar disorder, AND I experienced severe, prolonged stress and trauma as a child.

I'm going to be pedantic here for a moment, but BPD stands for Borderline Personality Disorder, which is a completely different diagnosis and is not a mood disorder. Bipolar disorder is abbreviated as BD.

As for "dangerous," I feel like that's very subjective. A person with bipolar disorder isn't inherently dangerous by virtue of having the illness, but they may engage in risky behaviors that can make them a danger to themselves or others. That's true of many other diagnoses, however, and not unique to bipolar disorder. Patients with consistent care and treatment are able to live perfectly safe and "normal" lives in many cases.

Most people with bipolar disorder will never be hospitalized. A higher level of care is generally reserved for situations wherein the patient is incapable of caring for themselves, or they are a danger to themselves or others. In my case, I've been hospitalized about 7 times over the course of the past 6 years, but my case is fairly extreme and pervasive.

Currently, there is no known cure for bipolar disorder, and it is considered a lifelong diagnosis.

That's a decision for you to make with the advice of your doctor.

I can track distinct mood episodes as far back as about 12 years old, but prior to that, I experienced pronounced depression and PTSD as a child. It usually manifests and is diagnosed as early as adolescence, and it's not typically diagnosed in children due to the fact that mood episodes are so hard to track -- plus many factors can be causing a child to experience mood shifts.

In a perfect world, I would have received my diagnosis around 16, but my family had a strong stigma about mental illness and was not supportive of my attempts to receive treatment at the time.

I feel like I have bipolar disorder and I've been thinking and studying the things I do for a while now, and I feel like it just makes sense... however, people insist that my fluctuating emotions are because I'm a teenager and now I don't really know what to believe.

Unfortunately, it's very difficult to diagnose bipolar disorder in adolescents due to the fact that their brains are still developing. It's not impossible, though! I would recommend tracking your symptoms - journaling is a great idea - and bringing them to the attention of your therapist. If you don't have one, I'd suggest talking to your parents about finding one so they can help you navigate your potential mental illness. It's a very important layer of support that would be helpful for any adolescent, even if you don't end up having a bipolar diagnosis.

I wish you the best of luck and hope you're able to get some answers soon!