Why are so many psychiatrists "so bad" at treating this? I've been bipolar for about 35 years, and it seems like the standard treatment regimen is "well, gee... let's try this drug and see what it does for you?"

"OK, Doc. What can I expect?"

shrug "It's different for everybody. Call me back if you experience thirst, or you're not thirsty. Let me know if you get hungry, or you're never hungry. Also, side effects might include manic episodes or bouts of depression. That'll be $150 for our session."

Are the drugs just that poorly understood, and, if so, why the hell should we ever trust them, since those of us with the problem seem to be a running laboratory?

EDIT: Thanks for the gold, kind stranger.

EDIT 2: I also want to point out that this is one large reason no one particularly trusts "you guys" in the mental health "profession." The implication of an Ask me anything is that you actually answer some of the tough questions, not ignore them. Whyever would someone trust any of you to give us brain altering chemicals if you don't answer questions about them?

from /u/justscottaustin

Trisha here - I am a psychiatrist working at a specialized center for mood disorders. In this center, I and my colleagues see many individuals with bipolar disorder who have been struggling for a long time to find the right treatment. With this experience, let me start off by saying that I 100% understand the frustration at the seemingly arbitrary nature of prescribing treatments for bipolar disorder.

There are many reasons why it can be difficult to find the right medication for an individual. One reason that I will focus on in this response is the current lack of ‘personalized medicine’ in psychiatry. We have many medications that have been studied for the treatment of bipolar disorder, and many that have shown efficacy. The problem is that these studies demonstrate efficacy by showing that a group of people who received the medication overall did better than a group of people who received placebo. These types of studies are essential to establish that a medication provides some benefit in treating symptoms. Unfortunately, these types of studies can’t tell us which particular individuals would benefit from this particular medication. I can estimate that, based on the studies, if I give medication X to 10 people, 6 people would benefit and 1 might experience side effects. However, I can’t estimate with any degree of certainty whether the individual sitting in front of me will be one of those six who might benefit, or the one who will experience side effects.

There are a number of ongoing studies looking at genetic and symptom profiles, and how this might help us with individual prediction of response and side effects. Unfortunately, though, we still have a ways to go in this area of research. We currently have treatment guidelines (like those from CANMAT) that ‘rank’ medications based on the efficacy they show in these types of group studies, the quality and quantity of studies that back them up, and the overall side effect burden. Taking a thorough clinical history, getting a detailed medication history, and combining that with recommendations from treatment guidelines is currently the best approach we have in deciding on treatment options. Sometimes using this approach we can fairly quickly find the best fit for the person, but unfortunately sometimes it is a much longer process.

Audience Approval (236)

Why are so many psychiatrists "so bad" at treating this? I've been bipolar for about 35 years, and it seems like the standard treatment regimen is "well, gee... let's try this drug and see what it does for you?"

"OK, Doc. What can I expect?"

shrug "It's different for everybody. Call me back if you experience thirst, or you're not thirsty. Let me know if you get hungry, or you're never hungry. Also, side effects might include manic episodes or bouts of depression. That'll be $150 for our session."

Are the drugs just that poorly understood, and, if so, why the hell should we ever trust them, since those of us with the problem seem to be a running laboratory?

EDIT: Thanks for the gold, kind stranger.

EDIT 2: I also want to point out that this is one large reason no one particularly trusts "you guys" in the mental health "profession." The implication of an Ask me anything is that you actually answer some of the tough questions, not ignore them. Whyever would someone trust any of you to give us brain altering chemicals if you don't answer questions about them?

from /u/justscottaustin

Hello! I'm a research assistant with CREST.BD who lives with bipolar disorder and has a degree in psych, so maybe I can give a perspective as someone who knows both the mental health system and people who work in it?

I think the thing is that a lot of these medications actually DO work for a lot of people, but they don't work for everyone. The process of finding the right medication can take years, because everyone's different. Scientists are still working on ways to analyse brain chemistry and match people up with the right medication, so for now it is just kind of trial and error. Which sucks for those of us who start to feel like guinea pigs being run on a wheel of medication. :/

Also, there are some crappy psychiatrists out there. That's just the unfortunate truth. Or just psychiatrists that you don't see eye to eye on. It honestly can be so exhausting to try to find the right person to help, but I really think it is worth it in the long term.

Personally, for me, JUST using medication never worked. I needed to get my lifestyle in balance, too. What balance looks like is different for everyone, but some of the resources that have helped me are CREST.BD's bdQoL.com tool, the iMoodJournal app, making my sleep schedule more consistent, and adjusting my caffeine depending on where my mood is. I hope that helps.

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Does anyone on the staff responding here actually have bipolar disorder? And if so, how has it influenced your path to where you are now?

We often don’t have people to look up to because there’s such a stigma that few people are open about it. I plan to be a physician, and it’s tough for a lot of us in higher level education (of course, it’s hard for all of us; I’m just speaking from my own experience) to handle so many things including coursework, clinical duties, exams, medical appointments, medication adjustments, sleep cycle disturbances, etc. Mark Vonnegut is the only openly bipolar physician that I’ve come across.

from /u/Doctahdoctah69

Steven Barnes here - I have bipolar disorder Type I, and talk about it openly both when teaching about psychiatric disorders and in general (as you can see...). Having bipolar disorder has had an immense impact on where I am and what I am doing (and probably vice versa). Some of those have been positive impacts, some negative. It continues to guide the choices I make in my career. For example, I am less tolerant of stressors than many around me, so I tend to avoid higher stress activities.

Audience Approval (289)

Does anyone on the staff responding here actually have bipolar disorder? And if so, how has it influenced your path to where you are now?

We often don’t have people to look up to because there’s such a stigma that few people are open about it. I plan to be a physician, and it’s tough for a lot of us in higher level education (of course, it’s hard for all of us; I’m just speaking from my own experience) to handle so many things including coursework, clinical duties, exams, medical appointments, medication adjustments, sleep cycle disturbances, etc. Mark Vonnegut is the only openly bipolar physician that I’ve come across.

from /u/Doctahdoctah69

Erin here. I know quite a few MDs who are living with bipolar disorder and are doing well in their careers (and the rest of their lives). Many of them have chosen not to disclose though. I think you’ll enjoy this video: https://www.outofdarkness.ca/post/physician-heal-thyself

Audience Approval (53)

Hi! I am stable on Lithium and find it to be a wonderful drug, but the sideffects for living out your life on meds for Bipolar sometimes worry me. Most of the drugs we use carry risks of serious healthcomplications.

Is there any new research in the works on less harmful medical treatments?

from /u/DungDew

Erin here - we’ve also seen several publications come out recently - some from our group at UBC in Vancouver - on the use of light therapy for bipolar disorder. For review, see:

Audience Approval (1)

Hi! I am stable on Lithium and find it to be a wonderful drug, but the sideffects for living out your life on meds for Bipolar sometimes worry me. Most of the drugs we use carry risks of serious healthcomplications.

Is there any new research in the works on less harmful medical treatments?

from /u/DungDew

Greg here: Very glad to hear that you are stable on lithium - it’s great to find a medication that works for the symptoms of bipolar disorder. I am not a medical doctor, and will defer to experts on medication, but have a couple of thoughts on this question (Dr Rob gives some tips about medication, in this post for example).

Concerns about medication are very common amongst people with bipolar disorder - you are definitely not alone! Just one reframe that might be useful - we would all prefer not to be taking any medications, but for many of us long term management of our symptoms (whether it be bipolar, diabetes, or blood pressure) outweighs concerns about the downsides. If this is not the case for you, then I would encourage you to discuss with your doctor. It’s always useful to raise queries and concerns with the prescriber. They will be able to give you good quality information about possible side effects and any risks associated with long-term use in your own personal case. For some up-to-date info on this important topic, see https://www.helpguide.org/articles/bipolar-disorder/bipolar-medication-guide.htm

One area of growing interest is chronobiological treatments for bipolar disorder - social rhythm therapy, light and dark therapy, melatonin agonists, etc. The International Society for Bipolar Disorders recently reviewed these treatments, and identified a number as being evidence-based, typically as adjuncts to medication. https://onlinelibrary.wiley.com/doi/full/10.1111/bdi.12847

Audience Approval (1)

Hi! I am stable on Lithium and find it to be a wonderful drug, but the sideffects for living out your life on meds for Bipolar sometimes worry me. Most of the drugs we use carry risks of serious healthcomplications.

Is there any new research in the works on less harmful medical treatments?

from /u/DungDew

Erin here - we’ve also seen several publications come out recently - some from our group at UBC in Vancouver - on the use of light therapy for bipolar disorder. For review, see:

Audience Approval (1)

Hi! I am stable on Lithium and find it to be a wonderful drug, but the sideffects for living out your life on meds for Bipolar sometimes worry me. Most of the drugs we use carry risks of serious healthcomplications.

Is there any new research in the works on less harmful medical treatments?

from /u/DungDew

Very glad to hear that you are stable on lithium - it’s great to find a medication that works for the symptoms of bipolar disorder. I am not a medical doctor, and will defer to experts on medication, but have a couple of thoughts on this question (Dr Rob gives some tips about medication, see question 19 for example).

Concerns about medication are very common amongst people with bipolar disorder - you are definitely not alone! Just one reframe that might be useful - we would all prefer not to be taking any medications, but for many of us long term management of our symptoms (whether it be bipolar, diabetes, or blood pressure) outweighs concerns about the downsides. If this is not the case for you, then I would encourage you to discuss with your doctor. It’s always useful to raise queries and concerns with the prescriber. They will be able to give you good quality information about possible side effects and any risks associated with long-term use in your own personal case. For some up-to-date info on this important topic, see https://www.helpguide.org/articles/bipolar-disorder/bipolar-medication-guide.htm

One area of growing interest is chronobiological treatments for bipolar disorder - social rhythm therapy, light and dark therapy, melatonin agonists, etc. The International Society for Bipolar Disorders recently reviewed these treatments, and identified a number as being evidence-based, typically as adjuncts to medication. https://onlinelibrary.wiley.com/doi/full/10.1111/bdi.12847

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If my diagnosis came from a drug induced mania (caused by an ssri) how likely is it that I will continue to have bipolar symptoms in my life?

from /u/1515NoName1515

Dr. Rob – What we have discovered over the past 20 years is that SSRIs kind of act like bipolar detectors, although we would never prescribe them that way. Individuals who rapidly switch into a manic, mixed, or hypomanic episode shortly after being prescribed SSRIs for depression are almost always experiencing a bipolar depression rather than major depressive disorder. The evidence has been so compelling that SSRI-induced mania is now a diagnostic criterion in the DSM. I would encourage you to maintain close follow-up with your physician to see what happens in your case.

Audience Approval (27)

Hello!

Any advice for those who’s psychotic manic episodes causes them to be angry and cruel to their loved ones or to just do hurtful things in general? I know these behaviors are so hard to understand from the outside but do you have any advice for self forgiveness and repairing relationships?

from /u/nori_34

Erin here. We do know that it’s common for symptoms of irritability/anger to be experienced by people with bipolar disorder. These symptoms can be extremely distressing for both the person themselves, and those who are at the receiving end of it. Here are some resources that you may find helpful:

- https://bipolarcaregivers.org/taking-care-of-yourself/maintaining-or-rebuilding-your-relationship-with-the-person

- - On bipolar anger: https://www.bphope.com/bipolar-stories-video-blog/video-bipolar-anger

Audience Approval (16)

After fighting for adequate treatment since October due to wait times, I was due to see a Bipolar specialist in April. Now this treatment is likely to be postponed or online due to the virus. Do you have any advice on managing bipolar (most likely type 2) in these turbulent times without treatment?

from /u/lazycarrotcake

Emma here - that is a really unfortunate situation, I’m so sorry to hear that you are experiencing so many challenges in getting support. If online treatment is offered, that would be better than nothing (and may be a way to get your foot in the door with a healthcare provider, rather than being put back on a waiting list). While research does show that medication is, for most people, a central part of their stay well strategy, there are many self-management tools that you can employ yourself. We have a website (www.bdwellness.com - unfortunately it has been down a bit lately, so check back later if it's not working) which lists evidence supported self-management strategies you can use to stay well, or to help recover from the impacts of a mood episode.

One of the most central things you can do to stay well (based on both clinical research and interviews from people who live well with bipolar disorder) is get adequate, regular sleep. We talk about “sleep hygiene” - that is, habits and environmental factors that support good sleep - on our website, but naturally some of those things are harder to do right now. Many people are experiencing higher levels of anxiety and changes to their routine that make it difficult to sleep well. CREST.BD is hosting a series of online chats to discuss ways to adapt your usual self-management strategies in these turbulent times - you can see the recording of the first one here: http://www.crestbd.ca/talkBD/ - we’re also polling on twitter to see if there are particular topics (like sleep) that you’d like to have us focus on for future events.

Audience Approval (8)

Is it at all possible for an individual, however unlikely (so I guess more "has it ever been recorded") to manage their bipolar disorder WITHOUT the use of stabilizing medications? As in to be of sound mind and will enough to recognise what is happening to them as it happens and almost functionally disconnect themselves from it (or some other form of self-management)? Or does the very fact that their mind is the thing being affected make these basically impossible?

Sorry if this is a naive sounding question guys, keep up the great work.

from /u/GeneralEi

Emma here – we know from interviews with people who are living well with bipolar disorder that one of the self-care strategies most central to staying well is having a treatment plan, which most typically involves some kind of mood stabilising medication. Having said that, a well-rounded self-management plan does not involve only medication – there are lots of changes you can implement to help improve your sleep, manage changes to your mood, and control the impacts of bipolar disorder on your life (see our website for tips: www.bdwellness.com - unfortunately it's down at the moment, but it should be online again later). If you don’t want to be on medication, it’s really important to not stop cold-turkey – have a conversation with a trusted healthcare provider about the pros and cons, and a plan for getting support early if things start to look wobbly (e.g., get a friend or family member involved, who knows your early warning signs of mood change well, and whose opinion you trust)

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Is it at all possible for an individual, however unlikely (so I guess more "has it ever been recorded") to manage their bipolar disorder WITHOUT the use of stabilizing medications? As in to be of sound mind and will enough to recognise what is happening to them as it happens and almost functionally disconnect themselves from it (or some other form of self-management)? Or does the very fact that their mind is the thing being affected make these basically impossible?

Sorry if this is a naive sounding question guys, keep up the great work.

from /u/GeneralEi

Erin here. I’ll add this qualitative study into the mix for this question: Managing bipolar moods without medication: a qualitative investigation.

https://www.ncbi.nlm.nih.gov/pubmed/25527994

Audience Approval (4)

How is it determined that one has bipolar, and not another mood or personality disorder that shares some of the symptoms?

What is a way that a good doctor diagnoses a person with bipolar?

from /u/Tremor_Sense

Trisha here - A thorough clinical assessment is the best way to get an accurate diagnosis. Some questions that a physician will try to answer through an assessment is whether the symptoms are ‘episodic’ (occurring during discrete periods of time and clearly representing a change from the person’s well self) or whether they are part of a stable pattern of interacting with the world and others (this indicating a personality disorder). Getting information from family or friends who know you well is very helpful. And not uncommonly, you and your physician will have to work together over a period of time before the diagnosis becomes clear.

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My wife has bipolar 2. When she has an episode, what can I do to help her the best during the episode?

Traditionally I make sure she doesn't hurt herself, and just stay with her till she gets through it.

from /u/Jalambi

Greg here: There are many things that partners can do to assist someone with bipolar disorder. Some of these things happen when the person is in an episode (like keeping them safe), but there are also things that can help outside episodes. Have a look here for more information https://bipolarcaregivers.org/ , and for a podcast about the relationship challenges of bipolar disorder, see https://www.abc.net.au/radio/programs/the-hook-up-podcast/bipolar/10940966 . Many therapists will invite partners into a session, to ‘officially invite’ them to become part of the management team. Partners can play an important role in observing for early signs of relapse, and (if the person with bipolar disorder agrees), prompting early intervention. It’s also important for the carer to look after themselves, and make sure that the challenges of bipolar disorder don’t come to overwhelm their own lives.

Audience Approval (2)

Bipolar 2 here! How are explosive episodes subdued? What is the way of treatment for someone stuck in that cycle of rage with what seems like no way out?

from /u/sadbuthaooy

Emma here - anger and irritability is a common experience during hypomania and mania, and unfortunately, coupled with impulsivity, many people end up saying or doing things they regret during a mood episode. To manage anger during mood episodes, many of the same techniques from anger management can be helpful: for example, using breathing exercises to calm down, or practicing expressing yourself assertively and not aggressively so you can share your feelings to others in a helpful way. If impulsivity is a particular challenge (feeling like you have no control over how you behave or the things you say when angry), it may be more helpful to identify your warning signs of an anger episode (for example, feeling particularly tense, feeling hot, clenching your fists) and knowing what is likely to trigger you (maybe particular things a spouse says, or people behaving rudely on the road) and removing yourself from the situation before it gets out of control. See more tips here: https://www.bphope.com/bipolar-anger-unravel-your-wrath/

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Thanks for doing this Ask me anything! I have BP2 and I’m currently medicated and the side effects affect my memory (not quite memory loss) so I feel frustrated over what seems like cognitive decline related to all of this. Is there anything that can be done about this or will there ever be progress you think relating to this?

from /u/tethra_

Ivan here - Hello - experiencing memory problems is not uncommon in people living with bipolar disorder. In fact, research is showing that is a common feature associated with the illness itself. In addition to that, it is possible that some memory problems could be related to side effects of some medications. However, the problems due to medication are likely to be less prominent than the problems due to bipolar disorder. To deal with potential side effects from medication, it would be important for you to discuss this with your doctor, and possible changes to your medications could be considered. Regarding cognitive problems related to bipolar disorder, there is currently a lot of interest in developing ways to treat memory and other cognitive problems associated with bipolar disorder, but we don’t have any proven, research established treatments available yet. There are some promising drug treatments that are still being studied, and there are some behavioural interventions (cognitive remediation) that also have the potential to provide some beneficial effects. To learn further about these issues I would recommend the links to the following resources:

- http://www.bdwellness.com/Quality-of-Life-Areas/Cognition
- https://www.isbd.org/Files/Admin/Cognition-Booklet(1).pdf.pdf)

Audience Approval (7)

Thank you all for doing this Ask me anything. I appreciate the professional work and contributions that all of you do to make this disorder more bearable and better understood for those inflicted and for their loved ones.

I would love to hear some insight from your experiences with how lamictal / lamortigine impacts patients, specifically pertaining to physical side effects.

Is there any strong evidence for the onset of tinnitus or visual complications from taking lamortegine as a regular medication? I've read about melanin-binding propetries of this medication, has this been observed to be a significant occurrence for patients over time?

Do any of you have any interesting observations on how lamortegine affects sleep (during euthymia or not)? As in, do patients have significant changes in sleep study results or self-reports before and after having taken lamictal for a therapeutic time period? If so, and if applicable, what do these data signify and how can this be reapplied to better understand ones psychiatric scenario?

Thank you very much.

from /u/00WELVAERT

Trisha here - from my own experience with patients, I have generally found lamotrigine to be quite well tolerated.

It is rare (about 1 in a 1000), but there is a risk of developing a severe skin reaction when starting lamotrigine. The risk is minimized if the lamotrigine dose is increased slowly.

The tinnitus question is interesting. There is some (very preliminary) research looking at lamotrigine as a treatment for tinnitus. However, there are case reports of people starting lamotrigine for bipolar disorder or epilepsy who then develop tinnitus. Very recently, I had a patient who had to stop lamotrigine because he developed tinnitus within a few days of starting it. It resolved completely within a few days of stopping.

In my experience, most do not notice any effect on their sleep. Amongst those who do, they tend to find it sedating. However, I have had one patient who found it caused significant insomnia. I’m not sure if there are any studies looking at objective measures of sleep with long-term lamotrigine use.

Audience Approval (10)

Hello, I have a question about Covid 19. Do you think people with bipolar are finding it particularly difficult to cope? How could they mitigate this?

from /u/Wellman19

Erin here. Great question, thank you. We’re acutely aware of how anxiety-provoking these times are for everyone right now, and even more so for people with mental health challenges. Social distancing can be a particular challenge for people with bipolar disorder. So can loss of routine. We’re trying to help by creating an online series of events (delivered by Zoom and livestream) focused on managing bipolar disorder during the COVID-19 outbreak. You can watch the recording of the first one here: http://www.crestbd.ca/TalkBD/

Audience Approval (16)

I’m going into my third week of quarantine. I live alone + single And had a break down today (BP2). First break down since I was hospitalized last year.

I’m doing all the “right” things like body weights 3-4 times a week, running and yoga the other days. Super healthy diet and also make sure to go for a walk once a day. I have a great job that I love. Practice mindfulness, video chat with friends, etc..

My Pdoc was able to make a last minute appointment so I’m taking tomorrow off work for the appointment. But I have to be honest that if I’m like this after two weeks, I really don’t know how I’m going to survive 2, 3, 4, 5 months from now.

So what else can I do?

from /u/SammyGreen

Emma here - this is a really disruptive and stressful period, and the anxiety, disruption to routine, and isolation are throwing a wrench in many people’s self-management plans. It sounds like you are doing the best you can amidst some really challenging circumstances. CREST.BD is hosting a series of online chats to discuss ways to adapt your usual self-management strategies to respond to the additional challenges posed by the COVID-19 crisis - you can see the recording of the first one here: http://www.crestbd.ca/talkBD/ - one thing that came up repeatedly in our first session was the need to be extra compassionate and gentle with ourselves, in recognition that we are facing an extraordinary set of circumstances. We’re also polling on twitter to see if there are particular topics that you’d like to have us focus on for future events.

Audience Approval (6)

Bipolar disorder can obviously impact many interpersonal relationships.

What are some aspects regarding bipolar disorder you feel are misunderstood and how can someone looking to form an intimate relationship with someone who suffers from bipolar disorder create a stronger support network for their partner?

from /u/ServantOfPelor

Emma here - this is really considerate question, and something we have been hearing a lot from the community is that we need more resources to help people support their loved ones with bipolar disorder. One thing I have heard from people in my clinical practice is that it can be very invalidating to have their partner attribute any concerns or frustrations to bipolar disorder symptoms - if your partner is upset about something, it is important to hear out their perspective and try to see things from their point of view too. Try asking “how can I support you in this?” rather than “did you take your medication/have you told your doctor this”. Practicing open and honest communication and coming up with ‘ground rules’ for discussing sensitive situations (for example, when and how to bring up concerns about medication, substance use, or changes in mood) is a solid foundation. Make sure you are getting support for your own stress levels and mental health too.

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I’m going into my third week of quarantine. I live alone + single And had a break down today (BP2). First break down since I was hospitalized last year.

I’m doing all the “right” things like body weights 3-4 times a week, running and yoga the other days. Super healthy diet and also make sure to go for a walk once a day. I have a great job that I love. Practice mindfulness, video chat with friends, etc..

My Pdoc was able to make a last minute appointment so I’m taking tomorrow off work for the appointment. But I have to be honest that if I’m like this after two weeks, I really don’t know how I’m going to survive 2, 3, 4, 5 months from now.

So what else can I do?

from /u/SammyGreen

Dr. Rob – This all sounds excellent! It could just be the case that, because we all know find ourselves under extraordinary circumstances on account of the global pandemic, the stress of that is in excess of what you ordinarily encounter in the course of your life. Therefore, it is completely reasonable to consider the possibility of increasing medication dosages to buttress your individual coping strategies, with the understanding that this is a short-term strategy in the service of long-term stability. Obviously, it’s not for me to say what the shape of this would be, or if it is even the most rational approach, but it is worth putting on the table with your physician.

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I am a biological research academic pursuing a PhD, and I've been told by mentors and advisors that sharing that I'm bipolar (either casually or in my admissions application etc) with professional colleagues would be detrimental to my career trajectory. Any experience with this or thoughts on it?

from /u/Pravadeus

Hi Steve J here. My first response to your question is that it is definitely should not, here in the UK and as far as I am aware this is similar in North America it is illegal to discriminate against someone based on their mental health diagnosis. In Spectrum we have a range of people living with bipolar as peer and colleagues who are invaluable to our work. I am aware that despite legislation some individuals can discriminate more subtly and there who you decide to tell is often a personal decision taken by the individual in discussion with trusted friends/family. For the UK a consideration is that when bipolar is declared the employer is required to support reasonable adjustments to employment conditions to support that individual.

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I can't really figure out the distinction between just feeling good and having an hypomaniac episode.

I read the other answers but they sounded like "its a manic episode but smaller". How much smaller exactly?

If a patient experiences mood swings with energetic episodes that make his life easier, and this carries on for many years, how can he tell whether he has a mood disorder or just evolved to be a person that is more energetic?

Is BP2 really a separate disease, or is it just what we call people who don't fit other diseases because they sometimes feel great?

Honestly, if a psychiatrist asked me if I have hypomanic episodes, I wouldn't know the answer.

from /u/SirLobito

L here, living with BD - to build on Emma's answer, the "out of character" thing for me looks like... well, a lot of confidence, haha. I'm usually a pretty shy, unassuming person that lets other people speak. When I'm hypomanic, I become extremely eloquent and confident, and I start to feel like I can do no wrong. A lot of things definitely do feel easier. I also start to realllly believe in karma, and think things like, “If I steal this lipstick, the universe will balance it out!” Lol.

So yeah. At least in my experience, it feels more like a high than a good mood. Hope that helps!

Audience Approval (12)

I can't really figure out the distinction between just feeling good and having an hypomaniac episode.

I read the other answers but they sounded like "its a manic episode but smaller". How much smaller exactly?

If a patient experiences mood swings with energetic episodes that make his life easier, and this carries on for many years, how can he tell whether he has a mood disorder or just evolved to be a person that is more energetic?

Is BP2 really a separate disease, or is it just what we call people who don't fit other diseases because they sometimes feel great?

Honestly, if a psychiatrist asked me if I have hypomanic episodes, I wouldn't know the answer.

from /u/SirLobito

Emma here - we all experience ups and downs in our mood, so it is sometimes a challenge to draw a line and say “past this point is hypomania”. A key distinction is to what extent these energetic episodes are negatively impacting a person’s life and out of character.

Audience Approval (5)

Years ago I had a general practitioner put me on Prozac for anxiety, which you described earlier as the 'single most common mood state' attributable to bipolar.

Within a few weeks I had gone into full blown mania, and did and experienced things I will not go into here. Suffice it to say it remains the darkest period of my life.

A psychiatrist later told me that it was mistake to put me on a 'unipolar' medication for my condition. Is this an accurate statement? And what is to prevent GPs from making decisions like this in the future?

from /u/floydHowdy

Emma here - I’m sorry to hear this was your experience. Unfortunately many people with bipolar disorder are misdiagnosed as having unipolar depression, and for some people antidepressant medications can trigger manic episodes. As bipolar disorder is a much rarer presentation than unipolar depression or anxiety, and people tend to seek treatment for symptoms of depression rather than symptoms of hypomania/mania (which can be experienced as positive, or a welcome relief from depression), people may be misdiagnosed. Many organisations are hoping to reduce these experiences by promoting training for GPs about the importance of screening for bipolar disorder when someone presents with depression or other risk factors.

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I am a biological research academic pursuing a PhD, and I've been told by mentors and advisors that sharing that I'm bipolar (either casually or in my admissions application etc) with professional colleagues would be detrimental to my career trajectory. Any experience with this or thoughts on it?

from /u/Pravadeus

Erin here. It *shouldn’t be*, as Steve states, such discrimination is illegal in most countries. But that’s not to say that social and structural forms of stigma are not a thing. I know several academics who also live with bipolar disorder - some of them have chosen to disclose after they’ve made their way a bit in their careers. Or have selected to take a route of judicious disclosure (telling select people but not everyone). Deciding when, where or whether to disclose is a very personal decision.

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Hello! I was diagnosed bipolar II as a teen and have been on medicine ever since (12 years)

As an artist, I am constantly worrying that medication is blunting my emotional receptiveness and my motivation. This is especially true in cases like last night. I had forgotten my to take my pill yesterday (I ended up taking a half before bed to avoid headaches/vertigo today). But by the end of yesterday I was fairly emotional. I watched an episode of Better Call Saul that made me cry and it felt very good and inspiring to cry. Truth be told though, I wasn’t in a normal state— I was over emotional. That episode was good but not particularly intense.

Anyway, this makes me sometimes seek to lower my dosage or get off meds, but I can rarely handle the tumult of a medication change and my weekly moods are so different that my confidence in a change doesn’t last long.

I was wondering if there are suggestions for counteracting the “blunting” effect of meds through non-medical means?

from /u/BrockHeBe

Victoria here – I’m a playwright and actor and speak. So I know of the fears and concerns of which you speak. Three things come to mind.

  1. What I find is that when I wasn’t taking my meds, I wrote a lot more BUT what I wrote was crap. The quality and sustainability was extremely low. And my life was a mess. A study I know of (but haven’t been able to find since) showed that artists were more productive creatively on medication, because their moods didn’t disable them.

This is what I have found – I am more creative, and my creative projects are of better quality and I can sustain that over time.

  1. I needed to ensure I was on the right medication, the right dose and the right combination. I initially was on some that blunted my ’affect” – I felt like a walking piece of chalk. So I worked with my psychiatrist to find the best medicine with the lowest side effects and highest positive impact.

  2. When I feel those lulls in creativity – I go to those things that inspire awe and wonder in me as well as what makes me laugh. For me it’s watching animals, birds, their songs, nature, looking at the night sky and the stars, watching children play. Walking through a forest and looking at the colour. For laughter it’s watching reruns of Friends and Cute Emergency on Twitter.

Even if I only get a glimmer of “oooh” I know I am on the right track. I try to inject that on a daily basis even when I’m not in a low creative ebb – it seems to build inspiration inventory.

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Could a head injury or brain hemorrhage cause/worsen bipolar disorder order?

from /u/IronRT

Steven Barnes here - Traumatic brain injury (TBI) is associated with an increased likelihood of subsequently developing bipolar disorder (as well as many other psychiatric and neurological disorders). Even mild-TBI (formerly known as concussion) has that same association. I know of no research that indicates that it can worsen BD symptoms (but there are also no studies that I know of that address that question).

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why is mania persistantly taken far more seriously than depression? Depression was alienating me from my friends, negatively affecting my studies and causing me to self harm and even attempt suicide, when I or my family tried to get help with it I was brushed off as a typical teenager or a timewaster; when my family got me to go see a psychiatrist while manic I was on my way to a locked ward after about 20 minutes. The same story could be told by most of the manic depressives I've met. I was completely open about manic episodes and suicide attempts in earlier appointments, I was neither suicidal nor violent when sectioned.

from /u/MansfromDaVinci

Erin here. Actually, the research evidence points to exactly what you allude to - that it’s the depressive phases of bipolar disorder that account for the largest proportion of the disability associated with the condition. There are probably multiple answers to your question. One answer is that episodes of mania are often very frank - very obvious to everyone else - and they often come hand-in-hand with clear changes in peoples’ behaviour. So they’re easier to detect clinically. Symptoms of severe depression can be less obvious for people on the outside and more insidious in their onset (they can take longer to develop). I’d suggest trying to communicate with your family and treatment team (when you’re well, that’s the best time to advocate for yourself) about your perceptions of risk to yourself when you’re depressed.

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Can bipolar disorder be triggered by a trauma in a person who otherwise showed little to no signs of bipolar disorder? Also, beyond mild to severe mood swings, what are behavioral indicators of bipolar disorder?

from /u/Inbetweeker

Dr. Rob – We do know that there are a mix of genetic and environmental factors which lead to the onset of bipolar disorder, known as the “stress-diathesis hypothesis.” Beyond mood changes, indicators of mania include easy distractibility, increased propensity toward risk-taking which is outside of a person’s normal character, a tendency toward suddenly starting lots of new projects without bringing any of them to conclusion, rapid speech, and an uncontrollably busy mind full of ideas.

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Hi there and thanks for doing this Ask me anything. I was diagnosed with bipolar disorder but my symptoms began as part of an intense religious experience. In fact all of my episodes happened during periods in which I was undergoing a religious awakening of sorts. I’m curious, what is the connection between bipolar and religion according to all of you? Have you found other patients that have had religious experiences and then still hold on to those beliefs long after they are back to normal?

I often call my condition tripolar because not only is it affecting the two hemispheres in my brain but it affects a third aspect of my mind which connects me to the world beyond our own.

from /u/number1punjabi

Emma here - thanks for sharing your personal experiences with spirituality and bipolar disorder. Unfortunately this is not a well researched area, but the studies that have been done suggest that spirituality (including both organised religion and spirituality in the sense of connection to something greater than oneself) and mental health have a bi-directional relationship. That is to say, people’s experiences of bipolar disorder can influence their spiritual practices (for example, people may have intense spiritual experiences or beliefs during an episode of mania or psychosis), and spirituality can also influence mental health (in both positive and negative ways - it can be a source of coping and strength, but for some people it can be a source of stigma - so this is all dependent on your personal experiences). We know that for people with bipolar disorder, spirituality can be a core part of their quality of life - we have some information and resources about this on our website, www.bdwellness.com (which is unfortunately down right now, but hopefully tech support will have it back up soon!)

Because spirituality is so personal, it is hard to give a one size fits all answer to your question. It can be confusing to have had a spiritual experience during a mood episode, and can cause you to question the reality of that experience. Having said that, for many people these experiences can enrich their spiritual practice and feelings of connectedness even after a mood episode has passed. It is worth talking through your experiences with someone you trust, whether that’s a therapist or someone who shares your culture/belief systems, to help you process and figure out how you want to relate to those experiences.

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Hope I'm not too late.

Hi guys. I was diagnosed with bipolar around 7-8 years ago after what was described as a hypomania episode, supposedly triggered by an unwise prescription of Prozac.

I was on lithium for several years afterwards, however a couple of years ago I adjusted my medication to 30mg of mirtzapine, which helps me maintain my sleep pattern and, in turn, maintain a solid, healthy routine.

The thing is... Part of me thinks I may have been misdiagnosed. Although I have experienced maybe 2 or 3 more periods of increased activity and confidence, none of them quite matched the level of my first hypomanic episode. I wonder if actually my first episode was really just a few months of being an emotionally charged young male.

However, I also understand that "I was misdiagnosed" is a super common thought for someone entering a hypomanic episode. I rarely realise I'm experiencing these kind of episodes until they're over, and so I realise that I'm not exactly the most reliable person to be making such a statement.

My questions are,

Do misdiagnoses of bipolar happen often?

and,

What risks are there if I do have bipolar and continue to go on without using mood-stabilisers? Will I be able to avoid progression of symptoms, so long as I maintain a healthy lifestyle and continue with CBT?

Many thanks in advance for both your answer and your work.

from /u/Ultra-ChronicMonstah

Erin here. I’ll start by saying that we know that it takes 10 years on average for people to get a diagnosis of bipolar disorder. Getting a correct diagnosis of BD type II is often harder than BD type I (mania is more obvious and easy to detect than hypomania).

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I have bipolar and I am wondering if people like me ever get to a stable state? I’m in treatment but I still get pretty sizable peaks and valleys

from /u/EvoDevoBioBro

L here - I’m a CREST.BD research assistant with a BA in psych and have bipolar disorder. I'd say yes, it is possible! It might never be completely smooth sailing - a quote our team likes from a former research participant is that "bipolar disorder is like a ship always righting itself" - but it is possible to live well with bipolar disorder.

In addition to attending treatment, I've found that understanding yourself, and what you personally need, can go a long way in helping to treat bipolar disorder. "Self-management" is increasingly being researched and seen as important to living a good life with BD. The info from CRESTBD's bdwellness.com, and the quality of life tool at bdqol.com, helped me a lot with finding self-management strategies. And good old fashioned journalling helped, too. :)

Also, I’ve found that when it comes to applying therapeutic recommendations to my own life, there's a bit of trial and error involved. It’s a bit of an experiment to find out what works and what doesn't - we’re all different, after all. But with access to treatment, dedication to exploring the options, and a lot of patience and self-compassion, it is possible to get well! Hope that helps.

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What are the main differences between Bipolar Disorder and regular mood swings?

from /u/ZenzorAce

L here - I’m a CREST.BD research assistant with a BA in psych and live with BD. I think "mood swings" in the common vernacular refer to multiple changes in emotion, from happiness, to anger, to sadness, in the course of a short while. But within the field of psychology, a "mood" is defined as a feeling state that is longer-lasting than an emotion, and less specific. So when we refer to "moods" within bipolar disorder, that's what's (typically) meant: longer-lasting feeling states.

These moods, specifically, are depression and an "elevated mood" (mania in those with bipolar i; hypomania in those of us with bipolar ii). The subjective experience of these might vary by person, but the hallmarks of the mood states are analogously experienced across people with BD.

For me, one of the major differences between the bipolar mood states and the "normal" ones is how they influence my sense of self. When I'm hypomanic, I tend to think I'm magnetic and charismatic. When I'm depressed, it's like a radio station plays in my head, broadcasting all the reasons I'm a terrible person. It's very, very different from "normal" moods, which are generally pretty agnostic to whatever kind of person I am.

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I had a “manic episode” a few years ago and have been low ever since. Anti psychotics and SSRIs don’t seem to help much. I started growing psychedelic mushrooms as psychedelics have done wonders (maybe more than what is normal) for my mood in the past (the two or three times I tried). Do you have any info on wether micro dosing shrooms is a good idea?

Also, could my Crohn’s disease have any links to my bi-polar and mental health? As my gut tells me there are (pun not intended).

from /u/teejay89656

Emma here - the question of whether psychedelics can be used therapeutically is one that the research is starting to look at, but unfortunately there has not been enough work done in this area to be able to weigh in on the benefits and risks for bipolar disorder. I expect we will be seeing a lot more large scale studies on this topic in the future.

To address the second part of your question, the link between diet, digestive health and mood is one that is being explored by some colleagues of ours in Australia. I don’t have an answer to your question, but if you want to stay in the loop about new research on this topic, I recommend following the Food and Mood Centre: https://foodandmoodcentre.com.au/our-research/

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What do you think is the evolutionary purpose of bipolar ? Is it just a mistake, or being bipolar had a purpose in ancient humans ?

from /u/King_TG

Erin here. Most mental health conditions likely have a “purpose”, don’t you think? Seasonal Affective Disorder (SAD) keeps you close to your home, depressed, non-exploratory, but safer in the dark winter months. Anxiety conditions, OCD, autism spectrum - you can make a case for all of them conferring some advantages from an evolutionary and societal perspective. The people with bipolar disorder, specifically, can be among the brightest lights in our artistic and creative communities, the people who can think out of the box in terms of creative problem solving and innovation. Maybe one of the bigger problems we’re facing relates to “othering”. I’m sane, you’re psychologically ill. I’m of the dominant norm neurologically, you’re not.

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Is it normal for people with Bipolar to also feel very uncomfortable in their body? Recently I’ve felt very uncomfortable but I don’t know if that’s a side effect of Bipolar or something else I have to worry about.

from /u/ImJustTired__

Emma here - this is tough to answer because I’m not 100% certain what you mean by feeling uncomfortable in your body. You may be talking about a type of dissociation, which is a feeling some people get where they feel disconnected or detached from your body. There isn’t a lot of research on how common this is in bipolar disorder, however, bipolar disorder and dissociation share a common risk factor (childhood trauma). If this is happening for you, I encourage you to check in and process that experience with a therapist to explore what might be going on for you. There are many effective psychological strategies, such as grounding and mindfulness, that can be helpful for people who experience those uncomfortable body feelings. I hope that answered your question.

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I always thought that I was a little off, I chalked it up to me just being a little different than other people. I always felt a little bit like an outcast, the odd one out, not like other people. Now that I'm older (27) these feelings have amplified. I can feel that there is something that just isn't right.

I have major depression that has gone on for years without any change, massive unpredictable mood swings that can happen several times a day. Anything from feeling suicidal and talking to myself about how I'm going to do it to feeling well, I guess manic. Music is a trigger for my brand of 'mania' I guess. Where I can just be sitting down weeping and planning my suicide and then I'll turn on music and dance and sing for hours at a time and then suddenly all joy will leave me and I'll return to my suicidal thoughts as fast as you can snap your fingers. I have big dreams and aspirations but feel like there's nothing I can do about it. Sometimes doing ANYTHING can be so draining. I have issues with addiction; food, sex, alcohol, drugs so I try to stay sober as much as possible. Massive issues with sleeping. Most times I'll just wake up at 4 or 5 am for no reason at all and cannot return to sleep. This includes if I get woken up by my dog or a random noise at night even after a couple of hours sleeping I cannot go back to bed. Sometimes this doesn't seem to bother me at all and other times it feels like I'm dying from fatigue. I have trouble with relationships because I feel so different. Sometimes I can be incredibly extroverted, life of the party type, no issues with being the center of attention or public speaking. I'll be telling jokes, stories, having fun and then suddenly a certain type of anxiety wells up inside of me and I can't even make eye contact with people and then I'll try to find a reason to leave. This really sucks when it comes to the few friends that I do have because they've known me long enough to see this happen to me and I feel like they blame themselves even though I've explained it to them. I cannot focus on anything for too long, distracted easily. I have a really crazy attention to detail and then poof, its gone. Sometimes in the middle of a conversation I'll completely forget everything that I was saying and it's really frustrating and embarrassing, especially at work. Sometimes I can be incredibly sympathetic towards people and then it's like a switch gets flipped and I couldn't care less about anything. This has really hurt my relationship with my girlfriends. Sometimes I can be really sweet and caring and then... nothing. It doesn't feel like it's a choice though, it just is what it is and I'm aware of it but in the moment I feel so overwhelmed and like there's nothing that I can do about but watch. I can be really condescending sometimes on accident and very blunt. Sometimes it feels like I can articulate myself extremely well and then out of nowhere it's like I can barely talk and I can start stuttering. It's like there are two sides of me that are constantly battling with one another. The extroverted super charming funny nice part of me and then the darker introvert overwhelmed by anxiety without empathy and filled with anger. For the longest time I've felt like I'm broken and completely worthless/hopeless. But then I can get these insane surges of hope and ability that just fizzles away. I'm extremely sensitive to any chemical change in my body; nicotine, caffeine, foods, and drugs or alcohol can cause me to have these crazy mood swings or sometimes I can just start shaking. I've been hospitalized multiple times for my suicidal tendencies. And a new thing has been panic attacks. I thought I was just having seizures for awhile until I heard someone else describe what they feel like for them. I've never been diagnosed with anything except depression and ADD and ADHD.

Can someone please help me? I need help

from /u/MrJesus321

Greg here: Thanks for sharing some of your challenges so clearly. It sounds like you would benefit from a comprehensive biopsychosocial assessment. I’m biased because I work primarily with bipolar disorder but some of the experiences you’re describing have a ‘bipolar’ flavour to them, particularly the changes in extraversion/activity, and the chronic problems with sleep and fatigue. Anxiety and addictions are also common amongst people with bipolar disorder.

Ultimately, what matters is not the diagnosis but getting the best treatment - I only mention the ‘bipolar’ flavour to some of the issues because it might suggest some different treatment options. I’m assuming and hoping that you are in regular contact with a mental health professional who could either conduct the assessment themselves, or direct you to someone who can do this?

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I have a question in regards to bipolar and suicide (sorry if that's a difficult subject for some folks). I've heard many different things about the two, that women survive attempts more than men etc. I'm wondering what are some of statistics on suicide and bipolar? I ask because I want to eliminate any confusion of misinformation about the topic especially due to how highly stigmatized the subject is. (Thanks for doing this! This helpful for me as someone with bipolar two and PTSD.)

from /u/dangerpanther

Erin here. Talking about suicide risk openly is vital - bipolar disorder can be lethal. One well-regarded summary of the statistics here comes from the International Society for Bipolar Disorders - this is an open-access paper: https://www.ncbi.nlm.nih.gov/pubmed/26175498

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While researching Type 2, I noticed a large amount of adults had been misdiagnosed with depression/anxiety. Their bipolar diagnosis wasn’t until they were in their early-mid 30s. Why is this a common situation?

from /u/DisFlavored

Emma here - it is unfortunately pretty common for people with bipolar disorder not to get an accurate diagnosis until later in life. This happens for a few reasons - bipolar disorder is a rarer condition than depression, so clinicians may be less attentive to the possibility of a BD diagnosis. This is particularly the case with BD-II, as people experience milder symptoms of mania, and may not experience these as a problem (in fact, hypomania may seem like a welcome relief after a period of depression!) People tend to seek help when they are feeling depressed, and not mention periods of elevation. That is why it is important for doctors to ask screening questions about experiences of mania to improve detection rates.

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My father has bipolar and is currently not taking his meds since he does not take his diagnosis seriously. It is very frustrating and his behaviour gets destructive. I am seriously considering cutting him off from my life unless he is taking his meds. Is this route pointless? Are there better approaches vs. this ultimatum?

from /u/ann_w_

Fiona here: This sounds really tricky and very frustrating for you. The fact that you haven’t cut him out of your life already, implies there are some aspects of this relationship you value. Without knowing what you have already tried, it’s difficult to advise on this. Have you been able to tell him how you feel, and exactly what it is that he does that frustrates you, and why? If you can frame this as concern for him, as well as for your relationship, its more likely he will listen to you. It might be better to focus on the behaviour rather than making it about the diagnosis if he is not keen on this label. Similarly, taking medication is a very personal decision – have you been able to talk with him about what the pros and cons are for him about taking medication? Does he have other strategies he uses to manage his bipolar experiences? If it is possible to have these discussions at time when you are both calm and not when you are feeling angry and frustrated you might get a better sense of what his concerns about medication are, and he might get a better sense of how his behaviour impacts on you. From here it might be easier to agree a way forward that you can both sign up to. Its challenging and you may feel you have tried all this already – in which case you may just need to back for a while until you feel ready to give it another go. You don’t need to decide to cut his off for ever (it’s a long time!), and things may change. But you may feel you need to take a break to look after yourself. Good luck!

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Recently I’ve wondered if I was misdiagnosed. Bipolar vs Cyclothymia?

from /u/gladysk

Emma here - cyclothymia is considered a bipolar spectrum disorder. Symptoms are not as extreme as a full blown episode of mania or depression, but people with cyclothymia experience a much greater chronicity of symptoms (most of the type for a 2 year period). As cyclothymia is rare, there is little research about treatments that may be specifically effective for it, but pharmacological, psychosocial and self-management techniques used for bipolar disorder are likely to be helpful.

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Med student here.

Is there anything you find yourself wishing the physicians around you (who don't specialize in bipolar disorder) would read?

(Within reason. Last thing I need right now is another textbook...)

from /u/ranstopolis

Erin here. We’ll come back to you I imagine, with a reading list we’re fond of (what’s the one book or paper you’ve read that most steered your career CREST.BD team members? Was of most use to you clinically?). But in the meantime, I’ll give you the words of the youth with bipolar disorder we worked with in Canada for two years:

“You are not alone”

And from our Community Advisory Group” for research: “Health, quality of life and recovery are possible”

I strongly believe that the most powerful message we can give as clinicians is an antidote to what your patients find on the web when they google ‘bipolar disorder’ :-)

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Is there any research linking extreme moods/bipolar disorder to menstrual dysfunction/amenorrhea in women?

from /u/Polyg1rl

Emma here - there is some research about the effects of the menstrual cycle on mood symptoms in bipolar disorder (for some women, their symptoms worsen in the premenstrual phase). I was curious about your question, as I haven’t seen much discussion about the other possible relationship (bipolar disorder, or medications used to treat bipolar disorder, causing menstrual dysfunction). I found very little scientific studies on this topic. What I did find was some large scale population studies suggesting that women with polycystic ovary syndrome (which can cause menstrual dysfunction) may have a higher risk of mental health difficulties in general, including bipolar disorder: https://academic.oup.com/jcem/article/103/6/2116/4964634 The article I found suggested it is very difficult to tease out exactly how PCOS influences mental health (it may be due to hormones, obesity, or the distress associated with having PCOS). Unfortunately it seems like there isn’t a conclusive answer to your question just yet.

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Does having really good meta-cognition equate to being considered a person with high functioning BD?

from /u/weakforjawlines

Ivan here - Having good metacognition, or good awareness and insight into your own cognitive functioning, is probably a feature that would help you adapt well and to function better overall. In other words, being aware of your cognitive strengths and limitations likely translates to engaging in behaviours that are more likely to be rewarding and meaningful, and in staying away from behaviours or situations that are more maladaptive or lead to bad outcomes. Having said that, it is important to keep in mind that metacognition is but one dimension of human behaviour that can influence overall functioning in bipolar disorder, and that there are other dimensions that can also be important (mood symptoms, coping style, cognitive functioning, substance use, etc.)

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why aren't there 2 world bipolar days? held at opposite ends of the Earth and on opposite days of the year

from /u/thatguyblah

Greg here: Hahaha!

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I have bipolar disorder and here's my only question - what the fuck?

from /u/AnalystOfData

Erin here. I don’t live with bipolar disorder, but that’s pretty much the first question on my mind most mornings these day :-(

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Is there a reason why some psychaitrists won't diagnose someone with bipolar disorder until they reach a certain age? I was told I couldn't be accurately disgnosed with it until I was in my 20s and even then, my psychaitrist at the time still just wanted to say "mood disorder, unspecified" on any paperwork.

Also. What are the main differences between Bipolar I and Bipolar II?

from /u/Rise-of-the-Aquarius

Trisha here - Pediatric bipolar disorder (a diagnosis of bipolar disorder in an individual below the age of 18) is a contentious issue in psychiatry. Some researchers and clinicians maintain that bipolar disorder is in fact very rare in children and adolescents, and that disruptive behaviors that are due to other causes (such as attention-deficit/hyperactivity disorder, problems in the young person’s environment, anxiety) are mistakenly attributed to bipolar disorder. There are studies indicating that a young person with a ‘disruptive mood’ - repeated temper outbursts, irritability and aggression - is more likely to be diagnosed with a (non-bipolar) depression and anxiety, rather than bipolar disorder, as an adult. So the argument from this side is that behaviors that might appear ‘manic’ and lead to a bipolar diagnosis in a young person is most often a manifestation of other environmental or mental health issues. Other researchers and clinicians, however, do feel that bipolar disorder in children and adolescents is real and requires immediate identification and treatment.

Whichever side of this debate you favor (and there are arguments for both), it is true that it is much less common for children or young teenagers to present with the ‘typical’ symptoms of bipolar disorder that allow for a clear diagnosis. For example, current diagnostic criteria requires that a person have mood episodes of a certain duration in order to diagnose a bipolar disorder. It is much less common for children/adolescents to have such clear cut mood episodes compared to adults. So some psychiatrists, even if they suspect that the young person may have a bipolar disorder, may prefer to just treat the symptoms that are there without making a formal diagnosis, and see how things evolve as the individual ages. Generally, the ‘typical’ symptoms of bipolar disorder become clearer as an individual enters their twenties.

For the bipolar I versus bipolar II question: these are the two main subtypes of bipolar disorder. To diagnose bipolar I disorder, the individual must have had a ‘manic’ episode. A manic episode is a period of at least 7 days where the person shows clearly abnormal energy and an abnormally happy or irritable mood, along with other symptoms such as impulsivity, not needing as much sleep, being more talkative. These symptoms may have been to the point where the person required hospitalization, developed psychotic symptoms (for example, hearing voices or becoming delusional about their abilities), or the symptoms caused a great deal of difficulty (for example, being impulsive to spending your entire life savings). Most people with bipolar I will also experience depressive episodes.

People with bipolar II experience ‘hypomanic’, rather than ‘manic’, episodes. Hypomanic episodes are characterized by similar symptoms to manic episodes, but they are generally milder and do not cause as much difficulty for the person. Individuals with bipolar II do experience depression.

It is important to note that even though hypomanic episodes are milder than manic episodes, bipolar II disorder is NOT just a milder form of bipolar I disorder. Individuals with bipolar II can experience an equal degree of difficulty overall as those with bipolar I, mostly due to long-term depressive symptoms. So both are important to recognize and treat.

Hope that is helpful!

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What is the biggest misconception that still gets to you?

from /u/Malicious_Hero

Steven Barnes here: As a person living with bipolar disorder, the misunderstanding I would most like to see done away with is the notion that persons with bipolar disorder are violent/dangerous. The opposite is true: Individuals with bipolar disorder (and just about any other mental illness) are more likely to be the victims of violent crime than the perpetrators.

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Hey so I was recently diagnosed with BPD, I was supposed to be going to therapy before everything closed in the UK and have been left in limbo with it a little bit.

I find myself becoming insanely anxious over next to nothing and it can lead to me being extremely controlling in a relationship or showing stalker like symptoms. I dont follow through with 95% of my insane thoughts but I couldn't even talk to my ex about them out of fear that she'll think I'm Ted Bundy in disguise.

In the past I have done things like pull up my gf for liking a picture on social media or ask her to change a revealing dress, I then snap out of it soon after and realise how much an ass I was. Are these symptoms typical of people experiencing hypo mania? And do you have any advice on how to handle it?

Apologies if this doesn't fit the thread I just don't have anyone to ask currently

from /u/spliffwizard

Greg here: I am assuming that BPD means ‘borderline personality disorder’ (apologies if I’ve got this wrong!). Borderline personality disorder and bipolar disorder are not the same thing, but they do have features in common, such as irritability, rapid and extreme shifts in mood, and impulsivity. In fact, many people’s diagnosis changes from one to the other. Whatever ‘label’ describes your circumstances, there are a few things that might be helpful.

Thank you for being so open about your current challenges. Couple of suggestions from me: (1) while you wait for therapy to start, check out some online supports and treatments. In Australia, we have this site https://au.reachout.com/articles/support-services-for-personality-disorders . If you can’t logon to that site, I’m sure there’ll be similar things in whatever country you’re in. (2) In terms of your ‘insane’ and ‘controlling’ thoughts, it sounds like after the fact they seem irrational to you, but that is understandably hard to work through in the moment when you’re upset. A couple of ideas: First, is there anyone in your community you could trust with sharing these thoughts? Past girlfriends may not be the best, it might be someone who’s a bit more removed from you? A family member perhaps. Someone sensible. Second, if you think there’s any chance that you might act on controlling or harm-related thoughts (towards others or yourself), you should consider contacting emergency or crisis services in your country. See https://unsuicide.org/https://unsuicide.org/ (3) Both borderline personality disorder and bipolar disorder are associated with problems regulating emotions. For many people, these problems with emotion regulation can appear in their close relationships. So yes, we do sometimes see irritable and controlling behaviours in the hypomania and mania of bipolar disorder. Sounds like you may also benefit from a thorough psychological or psychiatric assessment, so you are clear about the best ‘label’ to describe your current challenges?

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What effect do abusive (emotionally) parents, or other family members, have on a bipolar person?

I have a friend who's bipolar, depressed, and has very bad anxiety issues. She no longers wants to leave her bed and is suicidal. She lives with her parents but they won't let her out of the house unless they are with her. She's an adult but is still treated this way. She stopped out of college and doesn't have a job. It's hard to write this. She sees a psychiatrist but her condition continues to worsen.

from /u/MoreShenanigans

Emma here - thank you for being so concerned about your friend. Yes, childhood trauma (including emotional abuse) can increase the risk of developing bipolar disorder, and as an ongoing stressful event, can make people’s mental health and mood state worse. Having said that, strong social networks are a protective factor, so the fact that you care for your friend, even if you feel helpless at times, is an invaluable source of support. If you have current concerns about your friend’s safety, please consider contacting emergency or crisis services in your country. See https://unsuicide.org/https://unsuicide.org/ Take care.

Audience Approval (1)

Are manic attacks directly correlated to Bipolar Disorder? Is it possible to experience them without having a disease? Thank you!

from /u/yellowblue1

Emma here - some symptoms of mania can occur in other mental health conditions (for example, schizoaffective disorder) or seem similar to other conditions (e.g., borderline personality disorder). They can also be triggered by physical health conditions or substance use.

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Hi, my sister was diagnosed at 40, after a manic episode (her first) requiring hospitalization. She's finally with a phyciatrist and but doesn't really remember the month around her hospitalization.

At what point do we start talking about it and stop pretending it didn't happen?

from /u/RoganIsMyDawg

Emma here - it’s quite common for people to not remember what happened during manic episodes. The intensity of manic symptoms (particularly if coupled with substance use, or a traumatic hospital admission) can impact people’s ability to process and store memories. This naturally makes it quite challenging for family members, who may have been distressed to see their loved one acting out of character, or hurt by their actions. It’s also common for people to feel defensive, embarrassed, or confused when faced with things they don’t remember - particularly if emotions are running high when discussing the event. It can be helpful to have these discussions with a neutral third party (your sister’s psychiatrist may be able to help link you in to someone who can ensure these conversations are productive and fair to everyone involved).

Audience Approval (1)

How do I support my best friend who is most definitely suffering from some sort of bipolar disorder?

I love her dearly, but she'll go from happy as can be to screaming at me that I'm, seemingly without warning. It's frightening at times and she'll occasionally become violent towards me.

How do I make her feel safe?

How do I try to deescalate things when she becomes angry?

from /u/ATLL2112

Emma here - this sounds like a really stressful situation. It is lovely that you care so deeply for your friend and want to support her, but at the same time it is important for you to stay safe. Are there times when things are less emotionally heightened, where it might be safer to express your concerns, and ask what kind of support your friend needs? A gentle offer to help your friend attend a doctor’s appointment for emotional support, for example, might be better received when things are calm. If your friend behaves violently, you shouldn’t have to handle that alone - please seek assistance from crisis supports in your country: https://unsuicide.org/ You are not a bad friend for drawing boundaries around the kinds of behaviour you can tolerate, and for setting limits around the type of care you offer.

Audience Approval (2)

What are the key symptom differences between bipolar and manic depression?

from /u/Valgal86

Fi here- Bipolar disorder is the current term for what used to be called manic depression. It was thought that people were misunderstanding manic depression to mean severe depression, rather than a description of the two poles of extreme mood ie mania and depression. Bipolar Disorder has 2 main forms: Bipolar I – which is used to describe people who have had at least one episode of full mania; Bipolar II disorder – which is used to describe people who had at least one episode of depression and one episode of hypomania, but not had an episode of full mania. Hypomania is characterised by the same features as mania, but at a less severe level, for shorter duration and without causing as much impairment in social or occupational functioning.

Audience Approval (1)

Do people with bipolar, that are undiagnosed understand what is happening to them? It seems obvious to everyone around them, but is it so obvious to themselves?

from /u/BoomToeShot

Greg here: Before people are diagnosed with bipolar disorder, they often don’t understand why their activity, moods and motivations change so markedly from time to time.

They may think that they have problems with depression, and not ‘notice’ that the elevated mood states are also an abnormal state. Consequently, people are often relieved when they finally receive a diagnosis of bipolar disorder - it helps them understand what’s been happening in their moods, actions and motivations.

Once diagnosed, people with bipolar disorder can slide into an episode of hypomania or mania, and lose sight of the fact that they are experiencing symptoms of bipolar disorder. They might think that they’re excited about a new relationship or career opportunity. Clinicians describe this as ‘impaired insight’, referring to the fact that the person has lost insight into the fact that they have a disorder that can explain these experiences. When they are moving into a depressive episode, or actually depressed, people with bipolar disorder are often much more aware that they are suffering from a mental disorder.

Audience Approval (1)

How long can depressive episodes last? Can it be that the "low" periods last months/weeks longer than the happy ones?

from /u/doggomemes77

Greg here: Yes, the depressive episodes of bipolar disorder typically last longer than the elevated episodes, and can continue for months unfortunately. The depressions of bipolar disorder are one of the biggest problems that people with bipolar disorder face.

Audience Approval (1)

How are tests able to accurately diagnose people with bipolar disorder? Every test I've seen online seems pretty easy to answer in the positive or the negative. I feel that if I went in to get a diagnosis it'd be fairly easy to sway the results of any exam.

from /u/r00t1

Erin here. When you talk about tests I presume you’re talking about different types of self-report assessment scales… The short answer to your question is that self-report assessments for symptoms of depression are fairly reliable. Self-report tests for symptoms of hypomania are not as useful on the whole. You wouldn’t diagnose someone with bipolar disorder on the basis of just self-report assessments though - they should be part of a psychiatric or clinical assessment, but you need a detailed diagnostic interview to settle on a diagnosis. Cheers.

Audience Approval (2)

I have a lot of symptoms of bipolar disorder but my doctor wont hear it and dismisses everything. How can i get diagnosed and get treatment?

from /u/jfk116

Hi Steve J here. As you are probably aware a diagnosis of bipolar requires a full structured clinical assessment. If you are unhappy with your current doctor’s approach to your diagnosis you might want to consider a second opinion from a different qualified clinician.

Audience Approval (1)

”ask us anything” okay. Favorite fruit, and why?

from /u/QuiXotiC-RO

Steven Barnes here - Passion fruit. Because it tastes so good in POG.

Audience Approval (5)

My mother was diagnosed in her 60's. Is this something she's always had or can it pop up that late normally? I was obviously out of the house by this time, and we weren't close enough to talk about it

from /u/SwimminAss

Hi Steve J here. Bipolar appears to begin most commonly in late adolescence/early adulthood but there is a secondary peak in older adults. It is therefore possible for it to appear as a new diagnosis in some in their 60’s.

Audience Approval (1)

Is there a consensus on whether bipolar 2 leads to irreversible cognitive decline or impairment, and if so, is there a good way to reverse it?

from /u/nogord

Trisha here, I recently wrote “Does bipolar disorder damage the brain?” here: www.crestbd.ca/bipolar-brain-damage/

Audience Approval (1)

Hi, as someone who was recently diagnosed with bipolar disorder, I was wondering what actually triggers it. I know that you can have genetic predispositions to it but what if that's not the case. Where does it start?

from /u/Rubyrosee

Hi Steve J here. There is evidence that prolonged experiences of psychological and social stress during childhood can be linked to hypersensitivity to stress as the person becomes an adult which can be linked to more severe disturbances of mood. Traumatic childhood experiences are also linked to more severe course of bipolar including more substance use issues and being more likely to experience hallucinations and delusions (https://www.sciencedirect.com/science/article/abs/pii/S0022395604001530).

Audience Approval (3)

What do you recommend for a bipolar person who can't get medicine to try to stabilize themselves?

from /u/wailingblue

Hi Steve J here. Medication is typically the first line intervention for people with bipolar to stabilise mood and I am not sure from the question why this might not be an option. Whether or not medication is being used for this purpose, psychological research supports the additional things people can do for themselves. Developing a stable activity including reasonably regular work, sleep, recreation and meal times can be very useful in helping to stabilise mood patterns. This can be challenging to do alone so often it can be helpful to work with a psychologist or other mental health professional to achieve this. Here are links to some self help books covering a range of ways to manage mood.

https://www.amazon.co.uk/Overcoming-Mood-Swings-behavioural-techniques-ebook/dp/B003GUBILQ

https://www.amazon.co.uk/Bipolar-Disorder-Survival-Guide-Third-ebook/dp/B07FY5W22Y/ref=sr_1_4?dchild=1&keywords=bipolar&qid=1585637486&s=digital-text&sr=1-4

Audience Approval (1)

Hello,

I have a question regarding my SO. She recently (~5 months ago) started weening off her medication she’s been taking for 12 years or so. She was diagnosed bipolar as a teenager. She doesn’t believe she is actually bipolar and there might be truth to that, but I don’t know. A therapist recently told her she had BPD because of her fits. This therapist was a pretty quick with the “you need me sales pitch” though and was meh. I’m not here to ask about her diagnosis, but how common are misdiagnoses?

She’s weening off the meds because the side effects became debilitating. One of the generic companies for this medication actually ended up killing some people with bad batches recently. I’m totally for her getting off it but she has been a different person. How do these drugs change your personality and how do they affect the way someone loves? How can I differentiate between someone’s withdrawals and who they really are without medication?

from /u/triremecream

Hi Steve J. MIND the UK’s largest mental health charity have information on issues linked to coming off medication here https://www.mind.org.uk/information-support/drugs-and-treatments/medication/coming-off-medication/. As they suggest it is important to not do this suddenly, to discuss with your doctor and be aware that symptoms can worsen as a result over following few months https://europepmc.org/article/med/11862280

Audience Approval (2)

Where and how can one get a SPECT scan for confirmation without funds or inaurance?

from /u/thatsmeegirl

Dr Rob - At present, the diagnosis of bipolar remains clinical. A number of investigators around the world use functional brain imaging, which includes fMRI, PET, and SPECT, to hunt for brain-based biomarkers of the disorder. My own focus has been SPECT. At present, those biomarkers, from the SPECT perspective, remain elusive. Therefore, clinically, SPECT can't really confirm or disconfirm a diagnosis of bipolar disorder. What it can do is suggest previously overlooked problems, such as traumatic brain injury, or dementia. To get a scan without funds, see if a university near you is performing research in aspects of bipolar disorder using functional brain imaging, and you might be eligible to become a research volunteer.

Audience Approval (1)

What is the youngest a person can be diagnosed with Bipolar?

from /u/Rocksta87

Hi Steve J here. In the UK clinical practice is guided by the NHS National Institute for Health and Care Excellence (NICE) Clinical Guidelines. The NICE clinical guideline for bipolar focuses on people from 13 upwards as the committee was concerned about the appropriateness of labelling younger people with this diagnosis especially as much earlier diagnosis is often not predictive of presenting with bipolar as an adult https://www.nice.org.uk/guidance/cg185.

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I was misdiagnosed and treated for depression for 18 long miserable years. When I was 34 yrs old I was diagnosed with bipolar 2, a diagnosis that changed my life for the better. I have an 11 yr old daughter who has anxiety and some difficulty falling asleep. What can I do as a parent to help her now to possibly prevent a bipolar diagnosis in the future? I do not want my child to end up like me. It is my worst fear.

from /u/bourbon78

Hi Steve J here. Although it is true that rates of bipolar are higher in first degree relatives of someone with bipolar than the general population, the majority of such relatives still do not develop it. Furthermore, risk may be further reduced in children who have had a relatively stable childhood, avoided significant trauma and have better friend and family relationships https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-017-0106-4. Many parents with bipolar are anxious about their children developing this and we are currently researching ways of offering parenting support on line which seems promising for both parent and child https://www.ncbi.nlm.nih.gov/pubmed/28512921.

Audience Approval (1)

How could normal non-expert people can tell approximately if a person they know has bipolar disorder?

And if a normal person suspects a relative/friend of his has bipolar disorder, how can he gently tell that person to get tested for it?

from /u/TheOmerAngi

Hi Steve J here. If someone suspects that they have bipolar then sites such as Bipolar UK https://www.bipolaruk.org/frequently-asked-questions have useful information including a mood self rating form. However self diagnosis is not a good idea as reliable diagnosis requires a formal clinical interview, so any self-rating scores should only be used to indicate whether it would be sensible to discuss the possibility of bipolar with your clinician. If you think someone you care about might have bipolar it might be more fruitful focus on what is causing them distress and what help professional or otherwise they might want with this, rather than focus on diagnosis straight away.

Audience Approval (1)

Something I'm really curious about would be, Have we discovered the cause(s) of Bipolar and related Pyschiatric disorders or do we have a grasp on what we think may contribute? Is it organic or genetic or environmental in nature? And does the current thinking on cause change frequently as in other difficult medical questions and how can experts take what we know or what we think we know about the causes and use that to develop treatments or mitigation strategys in the future?

from /u/MikeAbbsV

Hi Steve J here. There are a number of factors considered to be linked to bipolar be there is no definitive evidence on cause as yet. Bipolar tends to run in families and so family and twin studies have been taken as evidence for a role for genes. However the extent of the role genes play and their clinical significance for the individual person is a complex question which has not been resolved. Social factors including adversity and trauma are linked to bipolar as are psychological factors such as self-esteem, drive and how people think about their mood experiences. Learning from people with lived experience of bipolar is a crucial element in thinking how to develop better interventions and support in relation to bipolar.

Audience Approval (3)

Please explain the difference between Bipolar and BPD? Why does medication work for one and not the other?

from /u/Vyviel

Hi Steve J here. BPD and bipolar do seem to share similarities around mood instability. However the experience of mania and associated psychotic symptoms is much more characteristic of bipolar. Furthermore, long term patterns of difficulties with interpersonal relationships, including fear of abandonment, is a key part of the BPD picture.

Audience Approval (1)

I’m in a committed, long term relationship with a girl that had her bipolar disorder onset and get diagnosed in college. She is stable with medication, but I know she hates being dependent on it and still experiences occasional intense lows. In that time, we have discovered one very reliable “out” that will allow her to calm down and (typically because they happen at night) go to sleep. It is using marijuana. However, she hates being dependent on things and in the moment will often refuse to use it out of a sense of fear of dependency or something. I have learned not to push her one way or the other, but I always let her know that I am there for her and will help her with whatever she needs if she asks. My question is, has there been any study on the effects of treating episodes with marijuana? Are there any risks? Any known potential for dependency? Is there any research I can show her that would help ease her fears of it? It is almost miraculous how consistently it helps when she finds the will to use it. She doesn’t require a large amount, but she is able to regain control of her emotions so much faster, within a few minutes typically. I am worried my perspective is skewed by my love for her and desire to comfort her in those moments. Please, any advice is appreciated. I just want to help her in any way I can.

from /u/gogreengineer

Is it possible to cure bipolar disorders? Up until now I have NEVER seen people getting better but htat might be my perspective and experiences.

from /u/ZARAeyewear
Audience Approval (1)

Hey, I'm bipolar II and have been for a couple of years. I have a couple of questions. 1. What is your opinion in psychedelics and bipolar? 2. Is there a link between bipolar and creativeness?

from /u/SsnufflesS

Hi Steve J here. There is a significant literature on relationships between bipolar and creativity. Greg Murray (on this Ask me anything), Sheri Johnson and colleagues have published two excellent reviews on this topic highlighting higher rates of creativity in bipolar particularly in those with milder forms of bipolar and relatives and discussing the clinical implications of this (https://www.ncbi.nlm.nih.gov/pubmed/20579791 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3409646/)

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Do you think psychedelics will become a legitimate treatment for mental illness? Or do you think the stigma surrounding them will prevent them from being further studied.

from /u/grtrevor

Erin here. Yes, I do, and this shift towards building evidence in this area is already occurring. Trials of psilocybin for major depression are underway, studies of ayahuasca for PTSD, LSD for smoking cessation and alcohol dependence… There’s not a pile of published evidence yet (https://www.ncbi.nlm.nih.gov/pubmed/31931272 or https://www.ncbi.nlm.nih.gov/pubmed/30102078) but watch this space. As I’ve mentioned elsewhere in this Ask me anything, see the Multidisciplinary Association for Psychedelic Studies (MAPS). Well-designed studies (longitudinal) are needed and from my perspective they should include qualitative methods along with quantitative. Participant safety in such studies needs to be as protected as possible - we don’t yet know what the impacts can be fully for people who are vulnerable to psychosis. And we need more psychotherapists to specialize in supporting people who are choosing to go this route and to help with psychological integration. The non-fiction book I most enjoyed reading last year was ‘How to Change Your Mind’ by Michael Pollan, have you read it?

Audience Approval (2)

Hey, I'm bipolar II and have been for a couple of years. I have a couple of questions. 1. What is your opinion in psychedelics and bipolar? 2. Is there a link between bipolar and creativeness?

from /u/SsnufflesS

Erin here. Adding to this, we’ve just finished recruitment to a study with Sheri Johnson looking at lab-based assessments of creativity in people with bipolar disorder (see this blog) and launched a new project in Hong Kong with team member Dr. Samson Tse (see this blog).

Audience Approval (1)

Hey, I'm bipolar II and have been for a couple of years. I have a couple of questions. 1. What is your opinion in psychedelics and bipolar? 2. Is there a link between bipolar and creativeness?

from /u/SsnufflesS

Erin here. I’m very interested in the potential role of psychedelic-assisted therapies as healing tools for people with mental health challenges. I don’t have much expertise in this area, but I do know that many mental health problems are rooted in deep-seated trauma, and I’m intrigued by the narratives I read about people findings ways of breaking through the blockages left in the wake of trauma through psychedelic therapies.

There’s very little research yet looking at psychedelic therapies in bipolar disorder specifically – mostly case studies. But some exciting research is happening internationally (see the Multidisciplinary Association for Psychedelic Studies, MAPS). Well-designed studies are needed and from my perspective they should include qualitative methods along with quantitative. Participant safety in such studies needs to be as protected as possible. And we need more psychotherapists to specialize in supporting people who are choosing to go this route and to help with psychological integration.

Audience Approval (1)

Hi! How do you address your family when they don’t believe that you are bipolar and are always trying to normalize your symptoms being like, well, maybe it’s PMS, maybe it’s because you’re a Gemini? How do you educate those who fail to fundamentally understand the disease? Most of the information/literature about BP usually is about BP1, so my BP2 diagnosis makes my family doubt that I actually am bipolar. My family doesn’t understand how terribly difficult it is, and always tell me to relax and like, watch a movie or do yoga. I feel like I always have to try and justify/explain what is me and what is BP.

from /u/bravelittletoaster6

Hi Steve J here. That sounds really hard. Dr David Miklowitz has done a lot of work on family focused therapy for bipolar disorder designed to help parents and children through sharing information about bipolar in a constructive environment and providing support with family communication and problems solving challenges https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5922774/ . It might be worth talking with your clinician about options to access support of this type locally.

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I recently learned that my friend (high schooler) suffers from bipolar disorder. What are the best ways to help them?

from /u/jaxieboy

Hi Steve J here. Thanks for your question about your friend. Probably the most important thing is to carry on relating to your friend as you used to. Often people living with bipolar experience more subtle forms of stigma in which friends or loved ones respond to them in a different way because of their diagnosis. As with any friendship if your friend wants help or support in relation to feedback on his/her moods/behaviour then helping with that would be great, but not if they have not asked. Another key support factor is being tolerant of your friend presenting in different ways at different times as a result of their mood issues.

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I was diagnosed with major depressive disorder, but I find that I experience many mood fluctuations in which I spend days, weeks, to months on a time feeling invincible and then wanting to kill myself. I don't know if it is seasonal depression, or a relapse of my depressive symptoms, or potentially manic depression? What would be your psychological take on this?

from /u/Magnus_Carter0

Erin here. I would recommend that you see a psychiatrist to get another assessment. And in preparation for that, you could consider doing a daily mood diary so you have some ‘data’ on your mood over time to take into that appointment. There are also online tools to help. Check out MoodFx (developed by our team member Dr. Ray Lam at UBC, it’s designed for people with depression, not bipolar disorder though) or we like the apps Dalio and emoods.

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I've got a question why the fuck shouldn't I kill myself rather than face more decades of torture with this disease?

from /u/Any1ButYouRoman

Fiona here: I am sorry to hear you are in so much pain right now. When things are really difficult it’s sometimes hard to imagine a time when they will be different – but everything changes. You have clearly suffered a lot with bipolar in the past, but it does not mean it will always be this way in the future. For some people, bipolar experiences improve with age, others find effective treatments that work for them, and others find ways to live a meaningful life whilst managing symptoms. It’s really important that you find someone to talk to right now who can help you. I would recommend going to visit your GP as soon as possible and explaining how you feel. If you feel you need immediate help then go to your local A&E department, call 911, or ring the NSP Lifeline 1-800-273-8255 for someone to talk to. Unsuicide.org also contains an extensive directory for crisis texting services.

Audience Approval (1)

Can Bipolar Disorder occur at any age? I wasn’t diagnosed until age 52. Prior to that had been treated for depression. Wondering if the diagnosis is right. Thanks.

from /u/JRTmom

Hi Steve J here. Bipolar disorder is commonly diagnosed in late adolescence and early adulthood. The other common peak for it being first diagnosed is in adults over 50. So it is certainly possible to have a correct diagnosis over 50. The key issue for diagnosis at any age is that it is based on the cardinal symptoms for bipolar as indicated in DSM-5 (https://www.psycom.net/bipolar-definition-dsm-5/)

Audience Approval (1)

I've been on several different types of medication and in therapy since I was 22 (I'm 34), and I've been doing maintenance ECT every week or two for almost a year and a half. I intend to request ketamine treatment when this pandemic is over. Nothing seems to be "fixing" my mood swings. I still have major depression episodes, complete with SI, and high manias with money issues, unrealistic thinking patterns, and problems with all kinds of relationships and interactions. Is bipolar disorder curable with the right types/amounts of meds and treatments? Or is it just something that I will be in constant flux with? I guess I'm wondering if I will ever find a happy medium mood?

from /u/hotfoffeemomma

Erin here. I’m so impressed with your perseverance and dedication. Bipolar disorder isn’t curable per se - for most people it’s a lifelong condition. But saying it can’t be cured isn’t the same as saying that you can’t get to a place where you’re experiencing a minimal number of mood episodes, mood stability, recovery and good quality of life. Please don’t lose hope. For some tips on excessive spending when manic, please see the finances section of our Bipolar Wellness Centre: http://www.bdwellness.com/Quality-of-Life-Areas/Money Also, we’ve started a regular series of online events focused on bipolar disorder during COVID-19 - please join us for some support, tips and tools if that would be helpful for you currently: http://www.crestbd.ca/talkBD/ - thanks for reaching out.

Audience Approval (1)

What are the thoughts and stigmas against someone with Bipolar Disorder and how can we change the perspective of others?

from /u/rianne_banzuela

Erin here. Thanks for your question. Mental illness stigma is an unfortunate, yet pernicious, reality. It’s important to know that stigma can occur (and be tackled at) at three primary levels:

  1. Self (or internalised) stigma
  2. Social stigma
  3. Structural stigma

Stigma related to bipolar disorder is a core research area in our team, here are a couple of links to papers we’ve produced about how stigma can be experienced by people with the condition:

‘It’s something that I manage but it is not who I am’: reflections on internalized stigma in individuals with bipolar disorder

Stigma Shrinks My Bubble: A Qualitative Study of Understandings and Experiences of Stigma and Bipolar Disorder

My favourite scholar speaking to structural stigma is Dr. Jamie Livingston - here’s one report he wrote for the Mental Health Commission of Canada.

Audience Approval (1)

is it possible to say that everybody is bipolar to some degree?

names of mental disorders have changed a lot over time. what are some old fashioned words for bipolar and what do you think the new trendy word could be?

from /u/wadi23

Erin here. Mood fluctuations -- throughout the day, between the seasons -- are normal for the majority of us. What differs in people with bipolar disorder is the intensity of their mood fluctuations (as well as changes in things like energy and activity levels), and, critically, the degree of negative impact that their mood episodes have on their lives.

Bipolar disorder used to be called manic-depression. Many people say that this older term actually captures the experience of bipolar disorder better. “Bipolar” disorder implies that people are always at one of two poles. They’re not. Mania can be laced with depression. Depression can be laced with anxiety-laden energy. IDK that the diagnostic term will change in your or my lifetime though :-)

Audience Approval (1)

Do you need to be struggling with sleep issues to have bipolar 2? I have been doubting my diagnosis since day 1 because while I do have highs and lows my sleep remains the same. I work night shifts so I often go to sleep around 3am every night, some nights I’m able to stay up till 7 no problem and other times I fall asleep quickly before or near 3/4am. During hypomania, I can sleep a solid 5 hours but will often wake up a lot after that and then go back to sleep because I’m almost always tired upon waking, sometimes I can roll out of bed and will feel the energetic wave and sometimes I don’t leave my bed till 1/2. When I am feeling extremely creative and excited about projects I don’t WANT to go to bed and i won’t sleep, making me feel sick and weak the next day..I am extremely sensitive to stimulants and I definitely have all the other symptoms but the sleep thing isn’t a symptom for me, would that mean no bipolar?

from /u/foolproofapricot

Greg here: Sleep problems are very common in bipolar disorder, and are often linked to the episodes (more sleep or insomnia with depressive episodes, decreased need for sleep or insomnia with hypomania and mania). But not having problems with sleep does not rule out bipolar disorder as the best explanation of your mood and energy changes. If you have doubts about your diagnosis, it’s really important to share these doubts with your mental health professional. Everyone’s experience of a disorder is different - ultimately it’s about getting the best treatment or management plan, and often that involves checking the diagnosis

Audience Approval (1)

What’s the most accurate way to first self-diagnose? I could easily negative self-talk myself into many different mental illnesses. My pragmatic, scientific side wants to find some peace with a proper diagnosis. I once asked a therapist about how can a person determine if fluctuations in mood and life outlook is a normal and natural response to traumatic events or indicative of BP. I couldn’t get a definitive answer.

from /u/MsTponderwoman

Fiona here: Fluctuations in mood and life outlook is definitely normal - and when traumatic events happen, these fluctuations are understandably more intense. When these fluctuations become extreme to the point where they are having prolonged and significant impact on your life, either because your mood is very low and you are unable to continue with day to day activities, or you feel very revved up and maybe finding it difficult to sleep, then it can be useful to seek help. A diagnosis may help you to find the peace you are seeking, but this may only happen if the diagnosis comes with a working model to help you understand your experiences, and therapies to help you manage these moods. The diagnosis is made on the basis of the experiences you. It doesn’t in itself tell you much about why these are happening or how to manage them. It might be worth checking out some self help resources such as

https://www.amazon.co.uk/Overcoming-Mood-Swings-behavioural-techniques-ebook/dp/B003GUBILQ

https://www.amazon.co.uk/Bipolar-Disorder-Survival-Guide-Third-ebook/dp/B07FY5W22Y/ref=sr_1_4?dchild=1&keywords=bipolar&qid=1585637486&s=digital-text&sr=1-4

Audience Approval (1)

Is it normal to think that you’re not bipolar anymore even though you are diagnosed with it but you sometimes feel like you’re misdiagnosed?

from /u/cutebladder

Fiona here: Yes - the pattern of bipolar mood swings can vary a lot over a lifetime. Some people can be diagnosed on the basis of one manic episode and never have another episode again. They may or may not be in contact with any mental health services. For other people, they may have a pattern of repeated episodes throughout their lifetime, and generally are in contact with mental health support. There is a continuum between the two. So it’s highly possible that you did meet criteria for bipolar at one point in time, but you no longer experience extreme moods. If you have been receiving psychological support then maybe some of the strategies you have learnt have worked for you, or if you are taking medication, this may be what is keeping you stable. It is important that you don’t suddenly stop using any of the strategies that could be keeping you well. If you are concerned that you were misdiagnosed, and you want this to be changed, then you could seek a second opinion by contacting a qualified professional.

Audience Approval (1)

I've had a close friend and also partner who were bipolar. One was type 1, the other type 2. Both were very selfish emotionally and cited their bipolar as an excuse whenever confronted about it.

Are these two individuals unique or is this common among people with bipolar? Putting their own needs first due to emotional regulation issues.

Thanks! Hope you have time to respond

from /u/Banterscc

Fiona here: There is nothing inherent in having bipolar that would make a person more selfish than anyone else in the population, and I have met many people with bipolar who are incredibly selfless and astonish me in how well they manage the difficulties they face, whilst also being incredibly supportive of those around them. However, when we are feeling low in mood, or a bit high, then its natural for us all to become a bit more wrapped up in our own lives, and more internally focussed. This makes it more difficult to be fully available to others. Think of the last time you were feeling any strong emotion and try and remember how overwhelming this felt? You also mention that they put their own needs first due to emotion regulation issues. It is often the case that when people have had their lives devastated by an extreme mood episode then they realise they have to take extra care to make sure this doesn’t happen again. This may look selfish – but often it’s an important survival strategy that keeps them well. Understanding what your friends have been through and why they prioritise their needs in this way can help. Talking about your own needs too and trying to find a way to support each other is important to maintain these relationships.

Audience Approval (1)

This might be a silly question, but do you think we’ll ever be able to cure bipolar and/or depression? Like literally cure

Thanks!

from /u/pxiogy

Fiona here: This is not a silly question – but actually a really interesting one. Our moods are on a continuum and having mood changes in response to life events is an important part of being human. For some people, such as those diagnosed with bipolar, these mood swings can be very extreme and psychologically very painful. Finding ways to manage the extremes is important, and there are already some psychological and pharmacological things that help with this for some people.

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I have a question, I was prescribed a medication by my doctor a few years ago for bipolar depression / manic depression and it helps. but sometimes it almost seems to make it worse. is there anything else I can do, to help? aka diet, regular exercise, meditation. or should I go back and try a new medicine?

from /u/altiodds21

Fiona here: There are lots of different medications that can help with bipolar and if you are not sure if the one you are currently taking is working for you, then I would go back and discuss this with your doctor. Its really important not to stop any medication suddenly and without discussing this with the doctor first. There are also lots of other things you can do to help manage your mood. The key is to learn to understand your mood. What triggers mood changes for you? What are the early signs of your mood changing? ….and having a range of strategies to hand to manage these early signs of mood escalation. These might include the things you mention – including exercise and meditation. Other strategies might include regular sleep and social routines, building supportive networks, learning when to take time out etc.

You could check out some of the self help suggestions outlined in the MIND UK charity fact sheets https://www.mind.org.uk/information-support/types-of-mental-health-problems/bipolar-disorder/self-care/#collapse00547 .

If you want to buy some books, these might be helpful too

https://www.amazon.co.uk/Overcoming-Mood-Swings-behavioural-techniques-ebook/dp/B003GUBILQ

https://www.amazon.co.uk/Bipolar-Disorder-Survival-Guide-Third-ebook/dp/B07FY5W22Y/ref=sr_1_4?dchild=1&keywords=bipolar&qid=1585637486&s=digital-text&sr=1-4

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How does the weather/season affect Bipolar Disorders?

from /u/Amildcaseofutopia

Fiona here: Changes in the seasons, and in weather effect all our moods – but there is now quite a lot of evidence to show that this effect is particularly strong for people with bipolar experiences. A review in 2014 reported in Journal of Affective disorders looked at all the studies which had investigated the relationship between seasons and mood episodes, and found that there were seasonal peaks for different bipolar mood episodes that were replicated around the world. Specifically, manic episodes seem to peak primarily during spring / summer, depressive episodes in early winter, and mixed episodes early spring or mid /late summer. However, there is individual variation within this so it's important to work out what the pattern might be for you.

Why there is a link between seasons and bipolar is less clear but is currently being researched. In simple terms, changes in the amount of light we are exposed to and the length of daylight period, influences how much of various neurotransmitters we secrete, which in turn influences our internal clocks which drive the rhythm of our sleep-wake cycles, diet, thermoregulation, hormonal secretion, and metabolism - all of which are thought to play a role in bipolar mood variation. The impact of seasonal factors can be managed by close attention to stabilising these circadian and social rhythms in our lives. This might involve trying to develop very regular sleep, eating socialising patterns, and using supports such as light boxes, which some people find helpful in winter time.

If you want a very scientific and detailed review of this area you could try this paper – https://www.tandfonline.com/doi/full/10.1080/07420528.2018.1487975?casa_token=BFgV-7r9tBEAAAAA%3AKmvo9Lm6TOCt-XrN-hJfe3DQjjwyi4aK-VCYIKLi3n99wJdA90qO7RFQCBgv2MhjRKBov5Wbqcx2A2E

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I read somewhere about a link between bipolar disorder and a behavior of kids and teens of thinking too much of themselves (not sure the exact terms here). Do you know of this study / correlation?

from /u/steak_tartare

Emma here - one symptom of mania, a type of mood episode that can occur in bipolar disorder, is called ‘grandiosity’. A clinician might pick up on this if someone is presenting with an unrealistic sense of superiority - boasting they are smarter/luckier/more attractive/more powerful than others, criticising or dismissing others, or thinking of oneself and not others when planning a course of action. One meta-analysis (a study that combines data from other studies) found that this occurs in 57% of pediatric bipolar disorder cases: https://www.ncbi.nlm.nih.gov/pubmed/26748678 It was a common symptom, but not as common as some features like increased energy or irritability.

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Is it possible to be in remission indefinitely, with the right medication and lifestyle modifications? Asking for a friend (j/k, asking for myself- 12 years in now).

from /u/breadprincess

Greg here: Yes :-) Some people, for example, have a great response to lithium, and it holds them indefinitely

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How do you know you should get help through medication or therapy or both? Is it the doctor that decides? I have a hard time talking to Doctors without getting too nervous to get my actual point across.

from /u/Perception_Is_Funny

Greg here: Many people find it difficult to express themselves with the doctor. Couple of tips for this: work out your questions in advance, write them down, and then read them out in the room. You can ask the doctor if it’s ok (you do need to ask) if you can record their answer on your phone (with Voice Memo or the like), so you can listen back later. Alternatively, you can bring a friend to the appointment. Make sure you brief the friend in advance about what you would like them to do in the appointment - do you want them to ask questions, or just be a support for you to ask questions.

For the average person with bipolar disorder, best practice treatment involves the combination of medications and psychological therapy. Many people only receive medications because psychological therapy can be hard to access in some areas.

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I was told by a psychiatrist that the intensity of symptoms of Bipolar Disorder usually improve with age. First question: Is that because someone with Bipolar Disorder understands its symptoms and how to react to them as they age? Second question: Are there are any studies of parents with BD?

from /u/universally

Erin here. I’ll add to this that bipolar disorder can get easier to manage with age if the person has access to the right treatments and supports for them. Evidence also suggests that the more episodes of depression and mania a person experiences over their lifetime, the harder the toll can be for them (in terms of physical health, and everyday functioning).

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I was told by a psychiatrist that the intensity of symptoms of Bipolar Disorder usually improve with age. First question: Is that because someone with Bipolar Disorder understands its symptoms and how to react to them as they age? Second question: Are there are any studies of parents with BD?

from /u/universally

Fiona here: BD can certainly improve with age – and for exactly the reasons that you cite. Understanding what triggers our mood changes, learning to recognise early signs of changes of mood changes, and how we can manage these to prevent mood escalation can all help to prevent the risk of future episodes. The key is to learn to spot really really early signs of depression or mania and to learn what helps prevent these escalating.

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It seems like bipolar is being diagnosed more and more since hypomania is becoming more widely recognized. Do you think this increase in diagnoses is accurate or is it in danger of being overdiagnosed?

from /u/ktaylor27

Fiona here: There has been an increase in bipolar disorder diagnoses, particularly in children and teenagers. This is much more prevalent in some countries e.g. the US than others e.g. the UK. Whether this reflects over-diagnosis or not depends on your point of view – and your social context. The upside of diagnoses are they can offer people a label which they can then use to find information to make sense of their experiences and can allow them access to help which may not otherwise be available (especially in the US). The downsides are this label can be stigmatising and can lead to a sense that this is something out of your control and may be lead to a sense of helplessness and reliance on medical treatments to manage mood. In the UK, diagnosis per se is not a requirement to access help for mental health difficulties, and so may be less often used, particularly for young adults and children, for whom mood difficulties are also an inherent part of growing up.

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My mother has bipolar type 1. Is there any advice you can give me to help her get through some of her patches of depression, especially in a time like this where she’s encouraged to isolate?

from /u/Or1gin91

Greg here: For self-help advice around managing depression, check out http://www.bdwellness.com/Quality-of-Life-Areas/Mood. With bipolar I, I presume your mother is also on medication for her bipolar disorder, and so it might be useful to encourage her to have more regular appointments with her doctor when she is experiencing significant depression.

We know that people with bipolar disorder benefit from the combination of medication and psychological therapy. If your mother has never had one of the evidence-based psychological therapies for bipolar disorder, it would be worth her while giving one a try - there is evidence that they can help ward off bipolar depressions.

One particular challenge at this time, when many people are in isolation due to COVID-19, is to maintain our daily routines. Without daily routines, people’s mood can suffer. For tips about maintaining daily routines while in social isolation, see https://www.psychiatrictimes.com/article/covid-19-pandemic-and-emotional-wellbeing-tips-healthy-routines-and-rhythms-during

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Is it possible to have BP2 with massive depressive episodes but the hypermania episodes, although out of character, aren't negatively affecting their life?

from /u/Fjsbanqlpqoanyes

Erin here. Totally. In fact, many of the people I’ve worked with don’t haven’t viewed their hypomanic episodes historically as pathological. That’s one of the reasons that BD type II gets misdiagnosed so often as major depression.

Audience Approval (1)

Seems strange there'd be a world bipolar day. I thought days were generally positive/expressing admiration?

Also what authoritative body decides to make something a day?

from /u/tightirl1

Erin here. Is it strange though? There’s a World Poverty Day, a World Diabetes Day, a World Rare Diseases Day... World Bipolar Day is held every year on March 30th, as a worldwide awareness initiative of the International Society of BD (ISBD) in conjunction with the Asian Network of Bipolar Disorder (ANBD) and the International Bipolar Foundation (IBPF). It’s a day for connection, outreach and coming together in solidarity around the goal of increasing awareness, acceptance and funding for bipolar disorder. And it has all of us here talking about how to help increase awareness and support people with bipolar disorder via this Ask me anything, and dispelling some myths, so I’m in for it :-)

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Is there any understanding of why modern humans have this disorder, the earliest historical reference to it, genetic and /or evolutionary root cause/ infusion point of it ( e.g. we now know the genes linked to nicotine addiction were passed on to us by Neanderthals.)? Said that, is it a genetically passed condition?

Is this disorder any way linked to modern day fast, consumerist & stressful rat-race life? Does taking it slow and leading a simplistic life style help in some way?

What is the underlying biological/neurological trigger(s) of the bipolar mood swings? What causes brain to switch the mode? Does brain scans of bipolar people indicate any distinct delta patterns as against the normal ones?

Thanks in advance.

from /u/mshiray

Erin here, answer to your first part - most mental health conditions likely have a “purpose”, don’t you think? Seasonal Affective Disorder (SAD) keeps you close to your home, depressed, non-exploratory, but safer in the dark winter months. Anxiety conditions, OCD, autism spectrum - you can make a case for all of them conferring some advantages from an evolutionary and societal perspective. The people with bipolar disorder, specifically, can be among the brightest lights in our artistic and creative communities, the people who can think out of the box in terms of creative problem solving and innovation. Maybe one of the bigger problems we’re facing relates to “othering”. I’m sane, you’re psychologically ill. I’m of the dominant norm neurologically, you’re not.

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Did I miss you guys ???:(

from /u/irvings18

Not yet... but please be patient with us, we will try to get to as many questions as possible :)

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What are the biggest differences between borderline personality disorder and bipolar disorder? As I’ve been diagnosed with both depending on the psychiatrist.

from /u/banana902

Emma here. BPD and bipolar disorder diagnoses share some symptoms in common, such as mood instability and impulsivity, and a person can be diagnosed with both at the same time. We tend to see mood changes happen on a more frequent basis in BPD (hour by hour), whereas mood changes in bipolar disorder tend to be more sustained (lasting for days at a time). In bipolar disorder, you are also more likely to experience racing thoughts, an increase in goal-directed activity, elation/euphoria, and a decreased need for sleep.

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As someone with Bipolar I, I’m not freaked out, but I’ve seen ‘studies’ that claim life expectancy is shorter, not only because the rates of suicide, but other factors as well.

What are your takes on this? Validity? More on what those other, ambiguous factors are?

from /u/i_gnarly

Erin here. This data is true, life expectancy in people with bipolar disorder is - at a group level - shorter. But there’s a really important caveat here, which is that much of this data comes from studies which have looked at cohorts of patients who have experienced multiple episodes of depression/mania, or had long periods of being diagnosed with major depression. As we’ve said elsewhere in this Ask me anything, it often takes about 10 years before people get the ‘right’ diagnosis of bipolar disorder, and the right treatments and care. The other part of this picture that’s under-emphasized is about the power of self-management strategies for health and wellbeing. Attention to diet, exercise, sleep, social support - these are all somewhat modifiable and can make a *huge* difference to health outcomes. See our Bipolar Wellness Centre for more information. Thanks for the question!

Audience Approval (3)

Can marijuana use (to stimulate/increase appetite) be detrimental for someone with Bipolar 2?

from /u/icecream16

What are non western (e.g Far Eastern) perspectives on bipolar as a psychiatric condition? - do they still use a medical model to assess and treat? - are rates of associated symptoms lower?

from /u/AaronJP1

Jill here- this is a really interesting question, thank you! There is extensive literature from transcultural psychiatry and anthropology on how mental illnesses are experienced and understood differently across cultures. For example, cultures with traditions of animism, like in Vietnam, often understand mental illness in spiritual terms, whether it be related to spirit possession or communication from ancestors.

Unfortunately, there is less in the literature about bipolar disorder cross-culturally compared with unipolar depression and other diagnoses. This is likely because bipolar disorder is really underdiagnosed in many settings, especially countries with fewer resources. It is often misdiagnosed as schizophrenia or major depressive disorder and therefore pinpointing specific cultural narratives related to it may be challenging. This points to a bigger global challenge of lack of diagnosis and access to evidence-based care for people with severe mental illness in many parts of the world.

Regarding how assessment and treatment takes place, typically, bipolar disorder would be assessed using IDC-10 or DSM-5 criteria and treated according to international guidelines by psychiatrists (with collaboration from primary care when possible).. This of course depends on availability of treatment, including availability of medications and psychosocial supports. Unfortunately these are often unavailable in low resource settings. We also realize though, that treating mental illness appropriately needs to take into local cultural understandings of mental health (which Arthur Klienman calls “explanatory models”). In a best practice scenario, these would be integrated into evidence-based care to provide the most appropriate and acceptable treatment. There are of course many ways that people seek care for illness that doesn’t fall within traditional biomedical models, including visiting spiritual healers, religious sites, traditional medicine, etc.

More and more research is taking place to improve access to and availability of culturally appropriate and evidence-based care across the world. There is a major gap especially for care for people with severe (vs. “common”) mental disorders so there’s lots of work left to be done!

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My brother is bipolar and will often spend a lot of money on a project that the rest of my family knows he will never fully commit to. What is the best way to try to steer him away from wasting his money and time?

from /u/themostevilcupcake

Erin here. There is still relatively little research specifically examining financial problems in people with bipolar disorder. Impulsive spending, however, is a fairly frequent occurrence during episodes of hypomania or mania. One Australian study, for example, found that over 70% of patients with bipolar disorder type II reporting spending large amounts of money when hypomanic. Consequences of over-spending included (no surprise), financial difficulties. But the research participants also described increased interpersonal conflict with family members and partners as a result of overspending, as well as feelings of guilt and remorse. Another small research study looked at the relationship over time between financial difficulties and mental health in people with bipolar disorder. Study results suggested that the relationship between financial problems and mental health problems is a two-way street: mental health problems may increase risk of problems like compulsive buying, whereas worries about finances, can exacerbate poor mental health. Other research suggests that financial management skills may be lower in people with bipolar disorder compared to people in the general population, and that this may be related to higher levels of impulsivity. We provide a list of resources for financial management on our Bipolar Wellness Centre and produced this video. One pragmatic tip someone with bipolar disorder told one once was that they freeze their credit cards when they’re becoming manic :-) All the best.

Audience Approval (1)

Is there any link between excessive Marijuana usage and bipolar disorder? Can marijuana be a trigger for mania?

from /u/fukuokaswitch

I am a third-year medical student interested in psychiatry. What are the risks of patients who are bipolar using CBD oil’s or marijuana? I know it doubles the risk of developing psychotic disorders, but how does it effect bipolar patients?

from /u/patagoniadreaming

How redundant do you think the purist biomedical model of mental health is? Also how careful are you to avoid pathologising understandable distress and fostering dependency on drugs?

from /u/Definitive-pie

Erin here. A1. Highly redundant. The name of our team is the Collaborative RESearch Team to study PSYCHOSOCIAL issues in Bipolar Disorder (CREST.BD). We formed 15 years ago partly because we thought there wasn’t sufficient focus on psychosocial issues in bipolar disorder, nor inclusion of people with lived experience in research. We’ve blogged recently on how our research tries to be inclusive of people who don’t align with a medical model. But we do work within biopsychosocial model and many of our team members lead or participate in research into pharmacological treatments for bipolar disorder as well as psychosocial.

A2. The psychotropic medications recommended for bipolar disorder treatment don’t cause dependency or addiction.

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Hi, I believe I may be bipolar (I was told I was as a child but haven't taken medication in 9 years). I would like to know which type of doctor I can go to in order to determine if I am and what I can do to deal with it as an adult, and what I can expect to happen during the first visit?

from /u/m149307

Erin here. The answer to this question depends on where you live and what kind of treatment system you have access to (and let’s face it, in some countries, what kind of treatment you can afford). Typically, your first port of call would be your general practitioner or primary healthcare provider - you would likely need them to make a referral anyway to get a more specialized evaluation, which would come from a psychiatrist. They should do a diagnostic interview with you, and might get you to do some measurement-based scales (like a depression rating scale for example).You can start to prepare yourself now by beginning to measure your mood with a daily mood diary. The more data you have about yourself going into an assessment, the better IMHO.

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How can you tell the difference between bipolar disorder and borderline personality disorder?

from /u/cimmerianmuse

Emma here. BPD and bipolar disorder diagnoses share some symptoms in common, such as mood instability and impulsivity, and a person can be diagnosed with both at the same time. We tend to see mood changes happen on a more frequent basis in BPD (hour by hour), whereas mood changes in bipolar disorder tend to be more sustained (lasting for days at a time). In bipolar disorder, you are also more likely to experience racing thoughts, an increase in goal-directed activity, elation/euphoria, and a decreased need for sleep.

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Is there any merit to not eating carbs early in the day? Someone told me that I should stay away from them and eat more protein to help keep my mood stable but I havent found much to back that up

from /u/CSGOWasp

Dr. Rob, Victoria, and Emma answered this question about carbs earlier :)
https://www.reddit.com/r/I am a/comments/frv7op/we_are_bipolar_disorder_experts_and_scientists/fly52yv/

Audience Approval (1)

How can you tell the difference between bipolar and other disorders (say BPD)?

from /u/stare_at_the_sun

Emma here. BPD and bipolar disorder diagnoses share some symptoms in common, such as mood instability and impulsivity, and a person can be diagnosed with both at the same time. We tend to see mood changes happen on a more frequent basis in BPD (hour by hour), whereas mood changes in bipolar disorder tend to be more sustained (lasting for days at a time). In bipolar disorder, you are also more likely to experience racing thoughts, an increase in goal-directed activity, elation/euphoria, and a decreased need for sleep.

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Have you read books by psychiatrist Thomas Szasz?

from /u/MichaelTen

Erin here, yup :-)

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Is there a doctor that works for the NHS please? I would like to know something about my Bipolar diagnosis that only someone from Britain can answer.

from /u/titwankthethird

Panelists Dr. Steven Jones and Dr. Fiona Lobban from the Spectrum Centre for Mental Health Research at Lancaster will be joining us on this Ask me anything later :)

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How many of you actually are bipolar? How accurate are peoples view of bipolar without it?

from /u/chattywww

Victoria here - Good question. There are four of us who have lived experience or are experts by experience so to speak: myself, Ryan, Steven Barnes and Stephanie. My personal experience is that researchers and clinicians here are really in tune with how bipolar disorder is and what can help. From my experience they all highly value the contribution those of us who live with the disorder can make. I work in partnership with many of them. I don’t know if that’s typically the norm, but CREST.BD research team is based on always working with people with bipolar disorder on research and throughout the process. Erin can speak more to it.

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I just wanted to thank you for doing this Q/A around Bipolarism. I struggled for a long with mine until I finally got serious about making drastic lifestyle changes to get better. I am, however, concerned about its progression as I grow older. I was dealing with rapid cycling and also struggling with the side effects of traditional medicine (Lithium, Lamictal, and Abilify).

My question is what have you seen regarding new treatments. I saw something about a process called Transcranial Magnetic Stimulation and am not quite sure I fully understand it. Could you please speak to what you know? Also, I would just like to know what are your views on other treatments I might not have heard of?

from /u/CentSavior

Erin here. Thank you for the positive feedback. We have a leading expert on TMS here at UBC in Vancouver, I’ll pass your question over to them and get back to you.

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I was diagnosed as bipolar 2 over 7 years ago. However I am sure that it is borderline personality disorder becuase of the types of relational problems I suffer from. I mentioned this to a nurse but they dismissed me. How do I get them to take me seriously? And also what are the main differences between bipolar and bpd?

from /u/Ephesians314

Emma here - I’m sorry to hear that you weren’t taken seriously by your healthcare team. It can be helpful to have a friend or family member you trust to attend appointments to help advocate for you. If you don’t have a support person in your life, depending on where you live sometimes peer workers can help advocate for you.

BPD and bipolar disorder diagnoses share some symptoms in common, such as mood instability and impulsivity, and a person can be diagnosed with both at the same time. We tend to see mood changes happen on a more frequent basis in BPD (hour by hour), whereas mood changes in bipolar disorder tend to be more sustained (lasting for days at a time). In bipolar disorder, you are also more likely to experience racing thoughts, an increase in goal-directed activity, elation/euphoria, and a decreased need for sleep.

Audience Approval (3)

Can you address the common conception that bipolar is only circulating between two extremes?

from /u/someguynamedaaron

Emma here - there is a common misconception that bipolar disorder always involves rapid, extreme shifts in mood. While this is one (rare) form of bipolar disorder, there are many other possible presentations. Some people experience what are called ‘mixed’ episodes, where they have symptoms of mania and depression at the same time. Although the defining feature of bipolar disorder is symptoms of mania, people with bipolar disorder spend a much greater amount of time experiencing depression. Long term studies have shown that people with bipolar type one spend 9% of the time experiencing manic symptoms, but 32% of the time experiencing depression. Other people may go long periods of time without experiencing symptoms at all.

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I know this sounds stupid but what is bipolar disorder and how does it affect a person?

from /u/asteroidsteam

Erin here, this is not a stupid question :-), I responded to a similar question here: https://www.reddit.com/r/I am a/comments/frv7op/we_are_bipolar_disorder_experts_and_scientists/fm507tu/

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How hard to live with this disorder? How Does it affect someone’s lifestyle?

from /u/FeetusDeletusThot

Erin here. Depends, depends, depends. In many ways, I think it can be easier to manage for people who get the “right” diagnosis of bipolar disorder early in their life, rather than the norm, which is often about 10 years. Then, you can learn about self-management strategies that are particularly useful for this specific condition (e.g., sleep, routine, strategies to use when your mood is escalating). The question about lifestyle is a two-way street. If you’re going to thrive with bipolar disorder, then you’re typically going to have to modify your lifestyle to some degree. Left unattended, your bipolar disorder can have a huge impact on your lifestyle. Self-management of bipolar disorder I hear can be incredibly boring, and huge hard work - stick to a sleep schedule, get regular exercise, watch your diet, prioritize your social relationships, avoid too much substance use. But then many people say that those efforts are worth it.

Audience Approval (1)

has there been any research into a link between BP and environmental pollution??

from /u/fuckyoubipolar

Erin here. Yes, some research has been done in this area. I found these articles:

https://www.ncbi.nlm.nih.gov/pubmed/31430279

https://www.ncbi.nlm.nih.gov/pubmed/31850801

Audience Approval (6)

What are the best ways to help someone with bipolar disorder who struggles with anger?

from /u/SinfullySinatra

Emma here - anger and irritability is a common experience during hypomania and mania, and unfortunately, coupled with impulsivity, many people end up saying or doing things they regret during a mood episode. To manage anger during mood episodes, many of the same techniques from anger management can be helpful: for example, using breathing exercises to calm down, or practicing expressing yourself assertively and not aggressively so you can share your feelings to others in a helpful way. If impulsivity is a particular challenge (feeling like you have no control over how you behave or the things you say when angry), it may be more helpful to identify your warning signs of an anger episode (for example, feeling particularly tense, feeling hot, clenching your fists) and knowing what is likely to trigger you (maybe particular things a spouse says, or people behaving rudely on the road) and removing yourself from the situation before it gets out of control. See more tips here: https://www.bphope.com/bipolar-anger-unravel-your-wrath/

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How can I avoid pushing my bipolar friend into dangerous mania when we're hanging out doing stuff?

from /u/sirblastalot

Emma here - it’s really considerate of you to ask this. I recommend talking to your friend about what they do to stay well to see how you can include them in activities without interfering in their self management plans. For example, daytime catchups might be better for someone who is working hard to get the right amount of sleep (something that is really important for staying well with bipolar disorder). You can also be supportive if your friend is trying to avoid substances that make their symptoms worse by socialising without alcohol or other recreational drugs. Having an active and supportive social life is really important to quality of life, so thank you for helping your friend in this way.

Audience Approval (1)

Did you guys see the new episode of DAVE on FX? What’d ya think?

from /u/samuraiabel

Emma here - I haven’t, but I’m adding it to the TV recommendations from this thread along with Ozark. Cheers for the tip! DONE

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Hi, I know I’m late to this, but 2 part question:

1, have you seen ozarks season 3?

2, and if so, how wel does the bipolar character Ben portray bipolar people?

I don’t know much about it I just want to know how accurate that depiction of the disorder is?

Edit: my apologies, disorder, not disease

from /u/Tisorok

Erin here, pretty soon I’m going to log out of this Ask me anything and go treat myself to a binge of Ozark Season 3. Until then, I can’t comment, I’m afraid :-)

Audience Approval (1)

How do you know if you're bipolar? Is it just mood swings or.?

from /u/my_stories_

Ivan here - Sometimes there can be a fine line between whether one’s symptoms represent a diagnosed illness such as bipolar disorder, or whether symptoms reflect an extension of the typical human experience. Based on current thinking and diagnostic instruments such as the DSM-5, the distinction between these lies in the extent to which the symptoms interfere with one’s daily functioning. Thus, if symptoms are problematic and interfere in a substantial way with daily functioning, then the symptoms are more likely to be viewed as part of an illness like bipolar disorder. If symptoms are not problematic or interfere with daily life, then they may be viewed as “just mood swings.”

Audience Approval (1)

Have you guys had a chance to see the portrayal of a bi-polar character in the new season of Ozark? Would be interested in your thoughts on how bi-polar disorder is treated in media ingeneral.

from /u/I_Am_Dynamite6317

Emma here - I’ve seen this mentioned a few times in this Ask me anything so I think I will have to give it a watch. I answered a similar question earlier today - short answer, I think media representation is getting much better, but we still have a ways to go. I think a CREST.BD film/book club might be called for in future.

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Wow. This is timely. My sister is bipolar. She used to beat me up as a kid. Has wild mood swings and is obnoxious. She loves to poke at people to start fights. What can an outside person expect from someone with bipolar in terms of responsibility for their own toxic behaviors? I understand it can be difficult to medicate but at what point can a person with bipolar be held accountable for their disease? As a family member, am I unloving because I can’t be around her when she seems to target me with her aggression? She is spiteful, and angry, then ecstatic and over the top. I can’t deal with her.

from /u/coswoofster

L here - I’m a research assistant with CREST.BD and have bipolar disorder.

I don't think you're unloving because you can't be around her when her behaviour is painful to you. As other responses have stated, it's very, very important for loved ones of those with BD to take care of themselves.

As for the accountability question... well, it's an interesting one. I don't think there is any answer written in stone there. Because this is so personal and specific to you and your relationships, it might be worth talking to a counsellor about.

Personally, I consider myself accountable for attempting to manage my bipolar disorder: taking medication, attending treatment when needed, and using self-management strategies. I don't blame myself for, say, being in a depression, when I'm in a depression, but I do take responsibility for trying not to fall into a depression. That said, if any actions I'd taken were harmful to someone else, whether or not I was in a mood state, I would apologize. Hope that helps.

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Thanks for doing this! Two of my best friends are Bipolar - so I’m wondering how I (or anyone) can be the best friend possible for them?

from /u/SAC_10

Hello! It’s so kind of you to consider how to best support your friends. Victoria and Steve J’s answers on this post might provide some guidance for this. Emma’s response here and Rob’s here might help as well. Take care!

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Have you guys had a chance to see the portrayal of a bi-polar character in the new season of Ozark? Would be interested in your thoughts on how bi-polar disorder is treated in media ingeneral.

from /u/I_Am_Dynamite6317

Emma here - I’ve seen this mentioned a few times in this Ask me anything so I think I will have to give it a watch. I answered a similar question earlier today - short answer, I think media representation is getting much better, but we still have a ways to go. I think a CREST.BD film/book club might be called for in future.

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Hi! Thanks for doing this. I suspect I have bi polar but haven’t been evaluated yet. But my mom has BPD, and due to the acronyms being very similar, I’ve had them confused for a time.

What is the most efficient way to differentiate the two? And is it possible to have both?

from /u/Genevieve-Victoria

Emma here - you are right that the acronyms get tricky to follow there (and BPD is sometimes used interchangeably for both borderline personality disorder and bipolar disorder). These diagnoses share some symptoms in common, such as mood instability and impulsivity, and a person can be diagnosed with both at the same time. We tend to see mood changes happen on a more frequent basis in BPD (hour by hour), whereas mood changes in bipolar disorder tend to be more sustained (lasting for days at a time). In bipolar disorder, you are also more likely to experience racing thoughts, an increase in goal-directed activity, elation/euphoria, and a decreased need for sleep. A good healthcare provider will work with you to carefully explore your experiences and history, and evaluate what kind of diagnosis/treatment plan is most appropriate.

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What is your take on lithium and cognitive side effects, dulling, and snubbing passion? The consensus of patients says it is there, but many papers and doctors claim it is not?

And what would you think of having doctors take some of these meds to see what they are asking us to live with? I saw one article from a doctor who did this with Seroquel and only lasted 2 or 3 days and changed how readily he perscribes it.

from /u/bt_85

Ivan here. The research on the effects of lithium do suggest that there may be some effects of lithium on cognition, although for the most part they are fairly modest. Much of this conclusion comes from studies that use objective cognitive tests such as paper and pencil or computerized tasks. However, we must recognize that these conclusions are based on averages from studies investigating many people with bipolar disorder. It is very likely that across different individuals, the side effect profiles from lithium may vary, and some people may be more affected than others. Decisions about taking medications should always be made in conjunction with your doctor, taking account both the side effect profiles (e.g. cognition) as well as the potential benefits (mood symptoms). I think we also need to look at other limitations in the research in this area. For example, even though the effects of lithium on cognitive testing on average may be small, it may still be possible that some individuals may be affected in ways that are more difficult to measure, quantify, or study (for example, dulling, snubbing passion). Finally, I find your proposal to have doctors try drugs that they are prescribing to be interesting. However, there too, I suspect that different doctors would have different experiences to the same drug as well. Hopefully we can get better answers to these questions as we continue to understand how these drugs work.

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What are the major differences between Bipolar I and II?

from /u/Lousing_My_Mind

Emma here - A healthcare provider diagnoses bipolar disorder type one when someone has had at least one period of mania in their life (although most people who have experienced mania also experience periods of depression). A diagnosis of bipolar disorder type two is given when a person has experienced times of depression as well as hypomania (a type of mania that is less extreme, but still out of character). People with Bipolar II tend to experience more periods of depression, so even though they do not experience full-blown mania this condition can be just as distressing and impactful on quality of life.

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A silly question, but do I need to consult with an expert to be able to tell if I have Bipolar disorder? Also, is it a yes or no thing, or more like a spectrum?

from /u/hldsnfrgr

Hello! Yes, you will need to consult with an expert to do so - some context about that can be gained from this response and this response from Steve J.

In another response, Emma described the hallmark mood states of bipolar disorder, and how it exists as a spectrum.

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Is Bipolar Disorder a spectrum? Is there such a thing as sub-clinical bipolar?

from /u/Relevant_Monstrosity
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What should you do if you think your friend is unmedicated and bipolar?

from /u/TheMasterCharles

Hello! Steve J’s answer on this post might provide some guidance for this.

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What are your opinions on Marijuana and Bipolar Disorder?

from /u/beets_bears_bubblegm

Victoria here - Great question! I live with bipolar disorder, anxiety and psychosis. I can’t cite exact studies - I’ll let my colleagues do that. But from what I know smoking pot can make you more vulnerable to bipolar disorder if you have a family history of it. My opinion is that it’s not worth the risk - especially if you have a history of psychosis.

For myself - I don’t and can’t smoke it. The few times I did, I went into mild to moderate psychoses. It is something I know increases the chances of triggering a mood swing or psychosis for me. I stay away from it.

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Why is bipolar considered a single disorder?

It contains a variety of symptoms, many of which can exist without overlapping, and there is not a standard treatment that works for everyone.

from /u/doesanybodyreallyno

Emma here - this is a challenging and controversial topic! You are correct that two people could receive the same diagnosis of bipolar disorder type two, and have very different symptom presentations and experiences of treatment. There is also the question of how we can separate out normal fluctuations in mood from the more extreme mood states that receive a bipolar diagnosis. The short answer is that there is research being done to consider how we can implement a dimensional approach to diagnosis, research, and treatment. Genetic and neurobiological research is helping us to consider what features underpin categorical diagnoses. Our current research about what works is largely organised around these categorical systems, so any move away from this will require a large change in practice, that needs to be implemented slowly as more research is conducted. Taxonomies like the DSM and ICD are continual works in progress that evolve over time.

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I have a buddy with bipolar disorder, who is not only untreated but also complicates things by being a heavy drinker. He will drink all night long, then around 3am the crazy train gets rolling and he posts suicide notes online, cuts himself, one time he even shot himself (by accident).

He basically gets these manic episodes (the crazy train) and crashes. This is when the really bad shit happens.

What can i tell him to calm him the fuck down, stop drinking and get him to go to bed?

from /u/00_sieben

Erin here. I’m sorry to hear about the struggles your friend is still having :-( People with bipolar disorder are three times as likely as those without bipolar disorder to drink too much alcohol, and seven times as likely to struggle with substance misuse. This is worrisome as research has shown that the combination of bipolar disorder and substance misuse can lead to greatly reduced quality of life and a poor expectation of future health. Substance use and mood symptoms are closely connected: substance use can cause mood symptoms and mood symptoms can cause substance use. There are some resources and tools tailored towards problem drinking available at our Bipolar Wellness Centre.

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Hi im Schizoaffective and hope this allowed as you know the condition is mixed with Bipolar.

I'm not sure this applies to the bipolar state but im looking for any help with 'Negatives' mostly Anhedonia and Avolition.

I hear there are some promising results with Ketamine treatment but this not available on the NHS and costs quite a bit so was wondering is this a good thing to try? Before I ask my pdoc to refer me (if they will) and any other treatment you are aware of?

The Negs are killing any possibility of leading a "normal life" and im only hanging on for the odd manic state to get me though the year (yes its awesome as destructive as it is)

Currently, taking Abilify Depot. Thank you for your time. Mods can remove is this inappropriate

from /u/Madcotto

Fiona here: I can understand why a manic state that you describe as “awesome” might seem attractive, especially if you have been experiencing anhedonia and avolition. It is a stark contrast. However, you also describe manic states as destructive, and oscillating between these states must cause some difficulties. It could be that focusing on finding things that can give you more subtle feelings of contentment, or satisfaction and exploring what that feels like might be something for you to explore. This may never feel like the highs of mania, but may offer something much more sustainable, ultimately satisfying, and less destructive. Experimenting with things like music, art, exercise, being in nature, and noticing very subtle changes in how they make you feel, might help you see when there is variation in your ability to enjoy things, and / or motivation. You can then slowly build on these small changes by understanding what really brings you joy. Cognitive Behavioural Therapy and Skills Based Interventions (such as occupational and vocational therapies) also have some evidence to support effectiveness in improving negative symptoms – you could ask your doctor about accessing these? The efficacy of ketamine in improving outcomes in severe depression and bipolar continues to be investigated and it is not generally available yet but can be accessed in some areas at a cost. Any previous experiences of psychosis may make your doctor concerned about prescribing ketamine, but its definitely worth exploring with him /her.

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I’ve read a tonne of very positive “it’s treatable, lots of people with BP lead productive lives, just a matter of finding the right treatment” type comments from your team.

That’s not my experience. I know one successful person with bipolar, out of the many bipolar people I’ve met through hospital stays, group therapy, people I’ve met socially. Not all of them have survived the disorder.

Personally, since diagnosis in 2015 I have lost some of my cognitive abilities, my business, my physical health, my strength, custody of my child, my creativity, my positive self image, all of my hobbies & sports & passions... I could keep going, the list of things that have changed for the worse is pretty long.

I’ve been hospitalised 6 times, the last hospitalisation lasted 4 months. I’ve tried lithium (constant since diagnosis), olanzapine, rispiridone, seroquel, abilify, topirimate, lamictal... whatever was prescribed by my pdoc, I’ve tried it. I’ve never messed around with my meds, never skipped my therapy. I even did 18 months of intensive DBT in case some of my mood irregularities were due to BPD.

I can categorically say that my life post diagnosis is a sad husk of what my life used to be. My diplomacy has improved, I don’t have to apologise for not filtering as often. That’s about the only positive I can think of. My depressive episodes are more frequent & severe, my near constant hypomania - what I used to think of as my confident high achieving go get ‘em energetic self, is completely gone. Mania was pretty rare, I think, or at least I’m only aware of one definite manic episode - the one before diagnosis.

Am I statistically just unlucky not to be happy or productive by now, even when stable, or is the positive spin just spin? I honestly feel worse about my lack of functionality when everything I’ve read from you guys has suggested that maybe I just haven’t tried hard enough to find the right treatment because lots of other people are doing just great.

from /u/labile_erratic

Ivan here - Thank you for sharing your story. It is very clear that you have experienced many challenges and losses since the time of your diagnosis, and I appreciate your courage in expressing your thoughts. I think stories like yours are important because they remind us that bipolar disorder can have a profound impact on one’s functioning, self-concept, and quality of life. Your story also illustrates that different individuals can be impacted in different ways, and provides us a “dose of reality” about how the illness can affect some. While it is true that many people with bipolar disorder can and are finding meaning and direction while trying to live and cope with a lifelong illness, others experience more difficulties for a variety of reasons - perhaps their symptoms are more severe or problematic, they respond less well to treatments, they live in more stressful situations, they have fewer resources, they have fewer psychosocial supports, etc. Regardless of what the illness may have taken away from you, I hope that rather than trying to recover the past you can continue to move forward and find some hope, meaning, and accomplishment. I encourage you to continue to seek support from friends, peers, and clinicians who understand what you have been through and who are truly on your side. Even though you may have barriers that most don’t have to contend with, hopefully you can find new ways to contribute positively to those around you and to yourself, or to uncover passions that may have been obstructed in the past. Given what you have gone through and what you have expressed above, you sound like an insightful and resilient type - perhaps there is a way that you can harness these strengths to help others who may be struggling or facing similar experiences as yours. I wish you the best and thanks again for sharing your experiences and thoughts.

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Do any of you wonderful researchers know anyone who is doing work on sleep and bipolar disorder (and is maybe looking for a grad student next year?)

from /u/weakforjawlines

Emma here - we know lots of people doing interesting work in this area. It’s a bit hard to say without knowing where you are located - I recommend having a comb through the twitter accounts followed by myself (@morton_emm), Erin Michalak (@erin_michalak), and CREST.BD (@crest_bd) to see if there is anyone doing work on a topic you are interested in and reaching out from there. Good luck!

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I have heard that bipolar disorder is higher among individuals with a pre-disposition or inclination to the creative arts, such as composition, painting, writing, and other similar activities - is there any scientific data to support that? What are the reasons if not, that people hold that view?

from /u/brodymulligan

Emma here - there is a lot of research on the link between bipolar disorder and creativity - generally, the literature supports that people with bipolar disorder (and their siblings) are overrepresented in creative professions. One of the most seminal books on this topic was written by Dr Kay Redfield Jamison, a psychologist and researcher with personal experience of bipolar disorder. Creativity can be a significant strength for people with bipolar disorder, but this is not to suggest that getting treated for bipolar disorder will stop a person from being creative. In fact, the symptoms of bipolar disorder can stop people from expressing their creativity: mania can make people feel highly energetic and productive, but they may rush ideas or put less care into their work than usual, leaving them unsatisfied with the works that they come up with during this period. Periods of depression can leave people without any energy to create.

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what are some examples of what people experience during a phase of mania?

from /u/sleepyboi08

Emma here - Mania (and to a lesser extent, hypomania) might involve feeling unusually sped up, extremely positive and excited, sometimes extremely touchy and irritable, for a distinct period of time. You might be feeling full of energy with lots of plans, experimenting with new things, be the life of the party, chatty, and wise-cracking, but in a way that’s really out of character. Those plans might not be things you would usually consider or well-thought out - things like spending too much money, saying things that upset others, or taking risks. People can feel like they are more attractive/powerful/interesting or intelligent than others, and often feel like they don’t need to sleep much or at all.

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I had a doctor, just a regular family doc, tell me I’m bipolar when I came to him with symptoms of depression and anxiety. He said since I had both depression and anxiety, that was bi polar, put me in some heavy meds, sent me on my way. I just didn’t feel like that was the right course of action especially after looking into bipolar disorder more upon arriving home. I took the meds for about a month and felt no different, eventually I saw someone else and they gave me Lexipro. Which I’d been on before. It’s made a tremendous difference. So, sorry for the long winded question, but does depression + anxiety = bipolar?

from /u/macabrejaguar

Emma here - the defining feature of bipolar disorder is having experienced symptoms of mania or hypomania. Mania (and to a lesser extent, hypomania) might involve feeling unusually sped up, extremely positive and excited, sometimes extremely touchy and irritable, for a distinct period of time. You might be feeling full of energy with lots of plans, experimenting with new things, be the life of the party, chatty, and wise-cracking, but in a way that’s out of character. Those plans might not be things you would usually consider or well-thought out - things like spending too much money, saying things that upset others, or taking risks. People often feel like they don’t need to sleep much, if at all. Obviously, we can’t comment on whether your diagnosis is right for you, but it is always okay to seek a second medical opinion if you have concerns about the diagnosis your primary doc landed on.

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What's the best kind of medication for this now? Is lithium no longer a good one? My father has this and it has gotten worse over the years. He's 76 and on a cornucopia of medication. Lithium, Seroquel, clenozapan (tho he never takes that one as he wets himself when he does). His highs seem to always come on evert few months and his lows don't last that long before he jumps back up again. His recent spout I think was caused because he started drinking hard liquor heavily. He has quit alcohol for a few years but that didn't seem to matter. I worry also about his cognitive ability as his reasoning skills seem to be disappearing completely. He just wants to be left to his own devices and watch his music video on you tube (the same video over and over and he talks to the singer as if she was a real person. He even bought her an expensive ring with her name engraved on it, it's just wacky. ). He's in the hospital being treated right now as they admitted him due to a blow up we had. I suppose my question is.... How can we help him when he seems so hard set on disregarding anything we do for him?

from /u/goose_of_trees

Emma here - this sounds like a really challenging situation, I can only imagine how stressful and frustrating it must be to try to help but feel like that is not landing with your father. I am not a medical doctor, so I can’t comment on that side of treatment, however a few of our other experts have chimed in about lithium throughout this thread. There is some research to suggest that as people have more mood episodes, their illness becomes more severe, and the threshold for triggering another mood episode becomes more sensitive. However, given your father’s age and history of alcohol use, there is also a possibility of other medical conditions influencing his behaviour and mental state. Given that he is currently in hospital, you may bring your concerns to his doctor to see if they would consider a neuropsychological evaluation.

It is vitally important for you to also get support for your own mental health and stress levels in this challenging time. Care for the carer is very important - depending on where you live, the hospital your father is in likely has a carer support program and resources they can link you in with. Some hospitals will also offer family meetings to come up with a plan for helping your father while taking care of your own needs.

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Are features such as auditory hallucinations, mild visual hallucinations, and delusions regarding reality exclusive to BP1? I was diagnosed with BP2 but I've had auditory and visual hallucinations for as long as I can remember, sometimes during an episode, sometimes when I'm "normal". I also get delusions where I think I'm not human and the people around me aren't real and I get very scared. I've read that these kinds of symptoms are exclusive to BP1, so I just feel confused about having these symptoms.

from /u/Mellamellamella

Emma here - I’m sorry to hear you’ve been having those distressing experiences, it sounds quite frightening. Auditory and visual hallucinations are not exclusive to mania: they can also occur during a depressive period, may be triggered by substance use, or may be a response to trauma. Talking through these experiences with your healthcare provider might give them useful information about whether your diagnosis and treatment plan is appropriate. It might also help them to link you in with additional supports around these experiences, as they sound quite upsetting.

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I'm bipolar 2 but I'm basically completely stable when eating a ketogenic diet. Why aren't we funding this?

from /u/nonFuncBrain

Emma here - the link between diet and mood, including the possible therapeutic benefits of the ketogenic diet, is one that is being explored by some colleagues of ours in Australia. I recommend following the Food and Mood Centre for updates: https://foodandmoodcentre.com.au/our-research/

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I have bipolar disorder and my mood symptoms are in remission. However, I still struggle a lot with impulsivity (shopping and eating). I'm on Vyvanse for ADHD but it doesn't help all that much, so my prescriber is trying Lamictal on top of my regular mood stabilizer. Are there any other treatments I can try and is it uncommon for people to have lasting damage to their self-control even without a current mood episode?

from /u/meradorm

Emma here - there are some behavioural strategies that people who live with bipolar disorder can try to limit the negative impacts of impulsive shopping - our website has some tips: http://www.bdwellness.com/Quality-of-Life-Areas/Money We don’t have specific resources about impulsive eating, but similar principles apply: managing things that trigger impulse eating, using relaxation, distraction or mindfulness to ‘ride out’ the urge. If you can speak to a counsellor or psychologist, they may help you explore precisely what is triggering these behaviours. They may be linked to impulsivity, but there are sometimes other psychological needs that people meet by eating or shopping excessively. It is important to get a handle on the underlying cause to know what kinds of self-management strategies will be most effective.

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I know I’m really late to this party, but given that this generous team are in different time zones, maybe someone will be able to address this question:

The diagnostic symptoms of bipolar and (C)PTSD have so much overlap; do you think there is misdiagnosing happening as a result? Is there something that cleanly differentiates the two diagnostically?

Thank you.

from /u/lisanik

Emma here - some of the symptoms of bipolar disorder (irritability, impulsivity, unstable moods) can overlap with other presentations, including those presentations that some clinicians and researchers are beginning to consider as a trauma response (cPTSD). We do know that some symptoms appear to be particularly cardinal, or key, to bipolar disorder. In particular, disruptions to sleep (reduced need to sleep) is highly indicative of BD, and mood changes tend to be of longer duration (a period of days) in BD relative to other conditions characterised by emotional shifts.

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Are people vwe miss diagnosed as bipolar after a suspected mania phase? If so how can make sure if the diagnosis is proper or not?

from /u/NACHOS_4_ALL

Emma here - as with all mental health conditions, there is a possibility for people to be given the wrong diagnosis. Unfortunately, as we don’t have laboratory tests for mental health conditions, healthcare providers need to make a diagnosis based on the information available at the time. Sometimes mania, particularly if it occurs with psychotic symptoms, may be indicative of other schizophrenia spectrum disorders. We have also mentioned a few times in this thread that some symptoms of bipolar disorder (impulsivity, irritability, rapid and extreme emotional changes) are similar to symptoms of borderline personality disorder. The best way to ensure a diagnosis is correct is to continue to discuss your past and current symptoms with your healthcare provider to make sure they have all of the information needed to make the best possible judgement. It’s always okay to ask for a second psychiatric opinion if you are feeling uncertain.

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I’ve heard that BP is a progressive disease. How often does BP2 turn into BP1? Are there ways to prevent it?

from /u/dogonlynose623

Trisha here - Fully agree with Dr. Rob! With regards to the bipolar II to bipolar I question, long-term studies indicate that somewhere between 5-15% of individuals diagnosed with bipolar II end up having their diagnoses altered to bipolar I. So most people diagnosed with bipolar II will not develop or be re-diagnosed with bipolar I.

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I didn't find anyone asking, so I'll give it a try. Do you know if it's true that carbohydrates possibly worsen this disorder? Is there a diet correlation or causation?

from /u/hyrian

Emma here - the link between diet and mood is one that is being explored by some colleagues of ours in Australia. I don’t have an answer to your question, but if you want to stay in the loop about new research on this topic, I recommend following the Food and Mood Centre: https://foodandmoodcentre.com.au/our-research/

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Hi there, I have been living with Bipolar 2 disorder for majority of my life but was not diagnosed until i was in my late 20's. That being said, i have enjoyed a life in the military as a medic (being released from duty due to my diagnosis) and i am also a Paramedic. During these times, i feel an obligation to help, as it is of the utmost importance to me that i take care of my peers, especially if i have the skill set to do so. However, the shift work has become a growing concern as it directly impacts my sleep schedule (which is imperative to my medication administration ie lithium 1200 mg and quetiapine 300mg). Not only this, lack of sleep has behaved like a trigger to my hypo manic and manic tendencies in the past. I am incredibly high functioning and capable of working under high stress scenarios, but do you have any advice to offer someone in my situation? Is it advised against that i return to work as a paramedic during the outbreak? Thanks again in advance!!

from /u/XDDF

Emma here - I really admire the strength of your convictions and desire to help others. Having said that, it is sensible to work through any possible risks to your own health during this time. We know that shift work can be particularly destabilisng for people with bipolar disorder, as good, regular sleep is critical for staying well. Given your past experiences with poor sleep leading to mania, it would be particularly important to review the pros and cons of doing shift work with a trusted healthcare provider or friend/family member. One thing to consider is that your usual supports may not be available at this time if your mood was to worsen: psychiatrists are in some cases being redeployed to provide support for physical health in areas significantly impacted by the outbreak, and some community mental health services are not able to provide face-to-face support. There may also be risks to your health if you were hospitalised. It’s a tricky situation so best to work through this decision with someone who knows your health well. It is worth considering if there are other ways for you to live out that value of helping others, such as volunteering to help out elderly or immunocompromised neighbours who can’t get out and about.

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I hope yall are doin well today. Is there anything a person can do who is witnessing a complete stranger start having an episode of anxiety or extreme mood switch? Is there a way to do it without making things worse? Thank you all for trying to help people.

from /u/foxiphy

Emma here - thank you for your question and for your care towards others. General principles around supporting a person experiencing a mental health crisis are to be supportive, calm, non-judgemental, and try to help that person access professional help. Mental Health First Aid training sessions are open to the public, and are sometimes run through workplaces: https://mhfa.com.au/. I found these very helpful in giving me skills to step in if I had concerns for someone before I did my psychology training.

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These are multiple questions, but I hope it is visible that I'm after only one important issue, though I'm having difficulties pinpointing it. So, these questions should be construed as multiple attempts to get at one and the same thing. Background: am both suffering from "bipolar 2" since 15 years, as well as educated on the subject (MSc in Psychology, doing PhD at the moment)

How confident are you in the current psychiatric diagnostic system? How close do you think the analogy between physical and mental illnesses is? If an "illness" is something the health care system should be responsible for, then (of course) bipolar disorder is an illness. But I'm talking about the conceptual level. In a hundred years, do you think the diagnosis "bipolar disorder" will still exist?

from /u/I_B_V

Erin here. Adding to this I would hope too that in a 100 years we have advanced our thinking - and our “treatment” or care systems - towards a position where we acknowledge and embrace that not everyone sees bipolar disorder as a pathological illness. Several studies (mostly qualitative) have shown that some people perceive that their bipolar disorder as advantageous, believe that it comes with positives (e.g., enhanced creativity). Of course, many also people view it as a potentially lethal condition that they would eradicate entirely given the chance. But surely an advanced and mature healthcare system (society??) should provide support for people with diverse world and “illness” views? There, that’s just me opening up a hornets nest :-)

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Let’s say you have the opportunity to treat someone for bipolar 2 in early adolescence. What would a best case scenario look like for treatment? Would it be weekly talk therapy and drugs? A partial hospitalization program? Therapy integrated with school? What ideas seem best to you for early intervention?

from /u/Derringler337

Emma here – best case scenario for early treatment does differ depending on the individual. Accurate diagnosis will be the foundation of effective treatment – as has been commented a few times here, bipolar disorder is very rare in childhood, and becomes progressively more common into late adolescence and adulthood. Treatment may range from things that are likely to be helpful regardless of the specific diagnosis (and not harmful if the problem experienced by the young person is in fact something other than bipolar disorder) – things like sleep hygiene, talk therapy, skills training to ensure a young person’s social and educational developmental trajectory are not disrupted. More intensive intervention strategies, such as medication and in extreme cases hospitalization, would be considered depending on how distressing and impairing a young person’s symptoms are.

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Do any of you guys have bipolar disorder?

from /u/thiccus-diccus

Yes! On this panel, Victoria, Stephanie, Steven Barnes, and Ryan live with bipolar disorder. :)

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Is bi polar disorder related to high conflict personality disorder?

from /u/PrettyinPink75

Dr. Rob – While individuals in the grip of the mood episode, particularly in irritable mania, can be quite conflict prone, personality usually completely reverts to normal in between mood episodes.

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Have there been any recent news on the link between culture and bipolar I disorder, psychosis and command hallucinations? I've read research stating that people who experience command hallucinations in Asian countries. The voices are more includes to be playful versus harmful in places like America. I always found it difficult to grow up with a diagnosed bipolar I mother of Indian background living in America and more trying to navigate care for her.

from /u/shivadadestroya

Jill here- culture certainly plays an important role in the experience of symptoms, including hallucintations. In your own research you may have learned that people living in Asian societies more often hear voices of family members while in North America they may be more commonly associated with strangers and perceived as threatening. We’re learning more and more about the relationship between cultural and mental health, and the need to provide care that is informed by a deep cultural understanding. Despite this, it can be difficult to access care that adequately addresses the connection between culture and mental illness experience. Depending on your location, I suggest looking for cross-cultural psychiatry programs or clinics, or therapists that take a cross-cultural approach. This may be helpful in navigating care for your mother and finding options that take into account these diverse types of experiences.

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Hi, thanks for doing this!

I have two questions.

1) How closely related are bipolar disorder and clinical depression?

2) How likely is it that one inherits bipolar disorder from their parents?

from /u/Jordzy2j

Ivan here!

  1. Bipolar disorder and depression can look very similar, especially because most people with either of these diagnoses experience symptoms of depression. However, what distinguishes bipolar disorder (BD) from clinical depression is that people with BD at some point also experience either a manic episode, a mixed manic/depressed episode, or a hypomanic episode. The treatments for these conditions can also have some overlap, but treatment decisions should always be determined by your doctor.
  2. If you develop bipolar disorder and one of your (biological) parents have the diagnosis, it is very likely that you inherited the illness from your parents.
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So I'm BP1 and I've been hosting a show on the matter for a couple days now. I've been hypomaniac a bit and decided to have my med shot in advance today ( Abilify Maintena ) is there any tricks to try controlling a hypomanic episode appart from like , reading and rushing to my doctor like I did , what's your best advice ?

Regards, Royal.

from /u/Royal_Vengeance

Emma here - seeing your doctor when you notice your mood changing is a great start. Knowing yourself well enough to detect when you are experiencing early warning signs is a powerful skill to have. Apart from getting on the right medication for you, we also know that getting adequate, regular sleep is a central stay-well strategy. See our website www.bdwellness.com for some tips. Avoiding substances that lower your inhibitions or disrupt your sleep (such as alcohol) is also key.

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Hi, thanks for doing this. I have two questions:

  1. What is the biological indicator of bipolar disorder? I have been to many psychiatrists and diagnosed as bipolar and ADHD based on how I answered a few questions and some stories I told, but I have never had a physical brain scan or blood test of any kind. Is there a scientific, biological way to demonstrate the presence of bipolar disorder? Can we see an expression of irregular brain chemistry, or something? Or is the definition more flexible than that? Sorry I don't know the best way to phrase that question.
  2. I have heard that bipolar disorder & schizophrenia can be brought on (but not caused) by recreational/street drug use. Do you know of any link to "synthetic cannabinoids"? I ask because I smoked a brand called "space" (not Spice or K2) a few times and tripped out of my mind, and I think that was a huge factor in my mental decline, some 11 years ago.

Happily, mostly, managed with 250mg of Lamictal for 4 years now :-)

-thanks!

from /u/Missinglemon

Trisha here - Glad to hear you have been doing well :) Finding a biomarker (something we can objectively measure either through brain imaging or taking blood samples) to diagnose bipolar disorder is something of a ‘holy grail’. It is currently a huge area of research, but at this time there is no biomarker which is reliable, accurate or specific enough to be put in use clinically. The only way we can accurately diagnose bipolar disorder (or ADHD) is through a detailed clinical interview. Any substance use has the potential to destabilize symptoms, it’s generally recommended to avoid substances if you have been diagnosed with bipolar disorder.

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Hi there! Bipolar 1 and had a quick one:

I have found DBT to be one of the most useful modalities I've ever experienced. Literally life changing. Have you had any interaction with Marsha Linehan, and would you say you have a favorite or most proven modality?

from /u/TeenyTinyTeratoma

Emma here - I’ve run some groups using DBT exercises and have found them very useful for supporting emotion regulation and social skills. I’m glad to hear you had such a positive experience of it! Research on psychological therapies for bipolar disorder has focused on psychoeducation (teaching people about the condition and behavioural strategies to stay well), interpersonal and social rhythm therapy (supporting good sleep and stability of daily rhythms, as well as reducing stressful social interactions), family focused therapy (which aims to reduce stressful interactions in the family that exacerbate bipolar disorder), and cognitive behaviour therapy (which aims to change unhelpful thought patterns that might make depression or mania worse). These are the therapies with the most support for bipolar disorder, but there are some emerging treatments that research is starting to look at, like mindfulness and acceptance and commitment therapy. These therapies might be particularly helpful in bipolar disorder as they can change how people relate to experiences they don’t have control over, while redirecting their energy to things that they value and give their life meaning. Personally, in my therapeutic practice I like to weave self-compassion into any treatment plan. It is easy to be self-critical about getting self-management ‘right’, and personalise responsibility for any changes to your symptoms. Self-compassion can help people use these other strategies in a way that is kind to themselves and realistic for their circumstances. There are some good exercises here: https://self-compassion.org/category/exercises/

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How do I politely explain to people that bipolar disorder is not the same as being hypocritical or inconsistent or “flip-flopping?”

from /u/KateWG

Emma here - how frustrating! Unfortunately, misconceptions that bipolar disorder is being ambivalent, or extreme, or even multiple personalities still persist. They aren’t helped by people still saying things like “the weather is so bipolar today”. In some cases, people genuinely aren’t aware of what bipolar disorder is, in which case some gentle education (by linking them to non-stigmatising articles, or even suggesting they watch a show with an accurate and realistic depiction of bipolar disorder) might help them realise they are not the same thing. In some cases, however, these kinds of attitudes reflect stigma or prejudice towards mental health conditions. In those cases, education and social contact might help change people’s minds, but do be aware of your own limits in having these kinds of conversations. Know when trying to change someone’s mind is doing more harm to your own mental health and stress limits, and when to walk away from the conversation if needed.

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How do you care for a loved one who is bipolar? How do you make sure you’re helping them without “enabling” them if that makes sense?

from /u/cracksilog

Stéphanie here: This is such a great question. Your loved one is lucky to have someone who cares. I suggest you ask them this question. Give them some time to think about it and have a discussion – you both will learn something, and it might help your relationship in the future. Each person and circumstances are different, so the answer is unique. Here are some elements of answer that can help (myself living with bipolar disorder). Most importantly, protect your own health, for the short and long term. Seeking resources for you as a carer should be a priority for you (ex. family associations). Unfortunately, carers are at a higher risk of developing anxiety or depression. Self-management techniques are good for diagnosed people, but also for carers. Second, keep believing that your loved one has the strength to eventually cope with BD, if not immediately. Share hope with them, as hope is essential for your loved one to seek help when needed. Third, learn about the resources and illness (ex. peer support, group supports) and try to share that information with your loved one and encourage them to seek help (knowledge is one of the pillars to self-management). Finally, it might be appropriate to establish in advance an “intervention plan” in case of a manic or depressive episode, and to clarify what role your loved one would like you to play.

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I know that this question was already answered but I’d like a deep-down explanation on how to support someone close to you that has BD?Thanks guys!

from /u/DrasticPegasus

Erin here. There are some great resources provided by our team member Dr. Lesley Berk in Australia via https://bipolarcaregivers.org/ - you can download a detailed guide for caregivers there.

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In your opinion, does childhood bipolar disorder exists even though there isn’t a diagnosis for it in the DSM?

from /u/monsteronmars

Emma here - although there isn’t a specific diagnosis for childhood bipolar disorder in the DSM, it does describe how some symptoms present in childhood (for example, that irritable mood may be more common than sad mood in children). It is challenging to diagnose bipolar disorder in children, as some symptoms overlap with other disorders such as ADHD, unipolar depression, or behaviour/conduct problems. This has made it challenging for research to get accurate prevalence rates. While this has been a controversial topic, there is enough research to suggest that childhood bipolar disorder can occur (although it is very rare, and much less common than ADHD and depression).

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How common is it for bipolar to be misdiagnosed as depression? Currently my diagnosis is major depressive disorder as primarily I feel extremely low, but I also feel like my mood can shift rather erratically. I ask because I have family history of bipolar and wonder if I could have been misdiagnosed. What are some key things to look out for that might help me know?

from /u/TheMindSlayer

Trisha here - unfortunately, many individuals with bipolar disorder go many years before receiving an accurate diagnosis.

Certainly, having a family history of bipolar disorder (especially in a close relative such as parent, sibling or child) can increase a person’s risk of having bipolar disorder. It's also not uncommon for someone with bipolar disorder to primarily struggle with depression.

I would suggest reviewing your symptoms with your physician. You’ll want to focus on how long these mood shifts last, what your physical energy feels like during these times, and what other symptoms come along with them (feeling decreased need for sleep, more impulsive, talking more). It can also be very helpful to track your mood over a month or so, so you can better see the patterns.

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I am currently diagnosed with MDD, but I suspect I may be bipolar. Def not bipolar 1 but possibly 2/other specified/cyclothymia. My mental heath professional is unsure. How can I know if I’ve got it?

from /u/LatrellSprewell88

Hi Steve J here. If someone suspects that they have bipolar then sites such as Bipolar UK https://www.bipolaruk.org/frequently-asked-questions have useful information including a mood self rating form. However self diagnosis is not a good idea as reliable diagnosis requires a formal clinical interview, so any self-rating scores should only be used to indicate whether it would be sensible to discuss the possibility of bipolar with your clinician.

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These are multiple questions, but I hope it is visible that I'm after only one important issue, though I'm having difficulties pinpointing it. So, these questions should be construed as multiple attempts to get at one and the same thing. Background: am both suffering from "bipolar 2" since 15 years, as well as educated on the subject (MSc in Psychology, doing PhD at the moment)

How confident are you in the current psychiatric diagnostic system? How close do you think the analogy between physical and mental illnesses is? If an "illness" is something the health care system should be responsible for, then (of course) bipolar disorder is an illness. But I'm talking about the conceptual level. In a hundred years, do you think the diagnosis "bipolar disorder" will still exist?

from /u/I_B_V

Ivan here - On the one hand, it is pretty clear that most psychiatric disorders (including bipolar disorder) are indeed bona fide complex illnesses that are due to some underlying physical/biological cause (with contribution of environmental factors) that unfortunately, are not well understood. For this reason, we still principally have to rely on clinical symptoms to diagnose these illnesses. This is in contrast to other areas of medicine (e.g. cancer, diabetes, etc.) where disorders can be diagnosed much more readily based on physical signs, lab tests, and other biomarkers. In a sense, this makes the diagnosis of psychiatric illnesses a bit less precise and more challenging. With further understanding about the biological/brain basis of psychiatric illnesses, the hope is that in the future we will be able to rely more on these objective, biomarkers to make the diagnosis. Hopefully these biomarkers will also allow us to better direct treatments. From that point of view, I think the diagnosis of bipolar disorder may still exist in 100 years, but our methods for diagnosing it will be different.

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How could normal non-expert people can tell approximately if a person they know has bipolar disorder?

And if a normal person suspects a relative/friend of his has bipolar disorder, how can he gently tell that person to get tested for it?

from /u/TheOmerAngi

Victoria here - Take a look at Julie Fast’s FaceBook group The Stable Table ( https://www.facebook.com/groups/StableTable/ ) She is an expert in helping family and friends who have a loved one with bipolar disorder or schizoaffective disorder. In the group and also in her book Loving Someone With Bipolar Disorder she talks about the Bipolar Conversation and the Bipolar Loop and how to get out of it. She’s an excellent resource.

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Are you guys still focusing on the gut bacteria causing mental health issues? any new information around that? I always felt that research is promising.

from /u/redeyejedi86

Steven Barnes here, thanks for the question. We discussed this earlier here: https://www.reddit.com/r/I am a/comments/frv7op/we_are_bipolar_disorder_experts_and_scientists/fly0jb2/

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Got a presentation tomorrow morning about Childhood Bipolar Disorder. Any special cases, crazy facts, or just any extra tips?

If you do answer, how do I cite a reddit post?

from /u/YokosBigman

Erin here. I’d suggest that you visit this group at Sunnybrook for youth-specific facts and resources. They’re also active on Twitter today.

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Not sure if you’re still answering questions, but my mother is bipolar. She has plenty of triggers, but I’ve always wondered if some people go manic around the same time. She experiences large lapses, but when she does go manic it’s typically in May. Is this timing theory consistent for other patients?

from /u/0816516

Greg here: Many people with bipolar disorder show a seasonal pattern to their episodes, and the increased daylength of spring is one of the common triggers of a manic episode (I’m presuming you’re in the northern hemisphere - if you’re in the southern hemisphere, May is late autumn, and some people do also experience manias at that time of year, it’s just not so common).

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Is it possible to cure bipolar disorders? Up until now I have NEVER seen people getting better but htat might be my perspective and experiences.

from /u/ZARAeyewear

Steven Barnes here, I talked about this in last year’s Ask me anything too: https://www.reddit.com/r/I am a/comments/b6zhfx/we_are_a_psychology_teacher_with_bipolar_disorder/ejoitto/

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Can a person diagnosed bipolar live a normal life? Sometimes you see celebrities (like Stephen Fry) come out as having the disorder. What are some things in terms of treatment or representation you would like to see that would make you more hopeful about the quality of a person's life?

from /u/sloppyminutes

Dr. Rob – Speaking of Stephen Fry, he hosted an excellent documentary, The Secret Life of The Manic-Depressive, right around the point where he was grappling with whether or not to go on lithium. He interviewed a number of Hollywood celebrities who chose to be open about their own mood difficulties, including Carrie Fisher (of Star Wars fame) and they all spoke quite frankly about their successes and difficulties. The short answer is, yes, many people with bipolar disorder can and do live normal lives. Check out that documentary, and you may find it encouraging. Do note that, even though Stephen Fry chose not to go on lithium at that period in his life, he did later decide to start taking mood stabilizers and seeing a psychiatrist, leading to him creating another documentary, The Not So Secret Life of The Manic-Depressive: 10 Years On. You might find these enjoyable.

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Hello, i think i am kind of a modest case... dont even know if i count as bipolar. I am kinda successful, on the brink of getting junior prof. Still i do not feel happy about it. In contrast i kinda suffer from imposter syndrom. I force my self to do real great things but then when they done, instead of taking a pause i just get depressed until my next maniac behavior starts. I feel it is kinda good for my employer, but for myself... i dont know. I mean i have other issues. Look like 12, never get complimented (just in terms of work)... kinda sad. I mean i think it sounds dumb, but are there any tricks how to self manipulate to get rid of either bein a maniac due to feeling like an imposter or to actually enjoy when i did something great and not get depressed?

from /u/Dooooon

Dr. Rob – I guess my first question would be, have you ever discussed these difficulties with a physician or therapist? That is where I would start if I were in your shoes. If that seems too intimidating, ask a close friend or family member for some honest feedback, because I can assure you, the people in your life have almost certainly noticed. The good news is, if this is a mood disorder, there are effective treatments which can greatly improve your quality of life. Even junior professors deserve mood stability!

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It seems like bipolar is being diagnosed more and more since hypomania is becoming more widely recognized. Do you think this increase in diagnoses is accurate or is it in danger of being overdiagnosed?

from /u/ktaylor27

Erin here, Steven Barnes and I also talked about this topic in last year’s Ask me anything :-) https://www.reddit.com/r/I am a/comments/b6zhfx/we\_are\_a\_psychology\_teacher\_with\_bipolar\_disorder/ejo70r0/

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Has there been any research involving bipolar disorder betting caused by a concussion?

from /u/fake_chow_a_djs_mom

Erin here. There’s a reasonable database looking at the relationship between traumatic brain injury and a range of mental health conditions, including bipolar disorder. Here’s a link to an open access review paper (a meta-analysis): https://www.ncbi.nlm.nih.gov/pubmed/26315003 Research in this area is difficult though - really, longitudinal work is required t o fully understand the relationship between onset of BD and previous TBI, but much of the prior work has been cross-sectional or retrospective (and assessment of TBI retroactively is not very reliable).

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Are you different people or all the same person?

from /u/BuddahsThumb

We are a team! :)

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Have you ever considered the possibility that Bipolar is not an actual disorder, just some people have tendencies to the extreme of a medium that we all call emotion?

Bipolar does not seem unnatural at all, just mood swings that normal people have. By that definition isn't everyone technically "Bipolar" ?

from /u/iAffinity

Greg here: Many people would agree with you- many people think bipolar disorder is nothing more than the extreme end of normal variation in mood and activation. But if you are at the extreme end of some continuum or spectrum, you may have a problem that requires attention. That’s why we call ‘bipolar disorder’ a disorder - the mood swings are so extreme that they cause the person a problem, and warrant some treatment.

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