Bipolar Disorder: Managing the Balancing Act

Bipolar disorder symptoms include dramatic shifts in mood and the ability to function. Successful bipolar disorder treatment requires a careful course of medication, psychotherapy, and discipline to stay on track–and avoid an emotional crash.

Most teens spend their time discussing their latest crush with friends, studying for college admission tests, and taking driver’s education. Not Robin Molliner. When the 26-year-old California native was 16, she was busy trying to talk car dealers into selling her a new ride — even though she didn’t have a dime to her name — and staging a two-week walkout from her high school chemistry class because she wasn’t “happy with the level of the teaching.”

But what seemed like normally high levels of energy and ambition were just the beginning of the full-blown mania that quickly followed.

“I wanted to have sex with anything, I didn’t care who or what,” she recalls. “I felt like my mom was trying to hurt me, and I had feelings of being a prophet.”

At the time, “I would go from moments of being totally happy, bubbly, and having fun to moments when pain from every point in life would come exploding out and I would lose control,” she says.

The Lowdown

As a result of these symptoms and the depression that followed, Molliner was diagnosed with bipolar disorder. Affecting more than 2 million American adults, this illness brings dramatic shifts in mood, energy, and ability to function.

Just about everyone has ups and downs from time to time, but for people like Molliner, these changes can be severe. Moods range from ecstatic or irritable to sad and hopeless — often with extended periods of normalcy in between. Manic episodes may mean increased energy, euphoria, and an unrealistic belief in one’s abilities. People with bipolar disorder may go on lavish spending sprees. They may also have hallucinations (such as hearing voices) and delusional thoughts, as Molliner did about her mother.

Onset typically occurs in late adolescence, as it did with Molliner, or early adulthood. But some people develop symptoms later in life and still others start showing them during childhood. The illness affects children and teens differently from the way it affects adults, according to results from the Course and Outcome of Bipolar Illness in Youth (COBY) research program. The very young develop symptoms that last longer and swing more swiftly from hyperactivity and recklessness to lethargy and depression, the study showed.

While the exact cause of bipolar disorder is not known, most researchers say that it is the result of a chemical imbalance in certain parts of the brain. And some evidence suggests that individuals may have a genetic predisposition to the illness. More than two-thirds of people with bipolar disorder have at least one close relative with the disorder or with unipolar major depression. True to form, Molliner has two uncles and a grandfather with the disorder.

Medicating Mania

Bipolar disorder can’t be cured but is typically treated with medication, psychotherapy, and lifestyle changes. Doctors often treat the mania symptoms with one set of drugs, and use other drugs to treat the depression. Maintenance treatment with a mood stabilizer such as lithium or an anticonvulsant drug can substantially reduce the number and severity of episodes for most people, but this can be a tough pill to swallow.

Why? Because many people with bipolar disorder struggle with the idea of staying on their medication for life. Some even enjoy the initial phases of the manic stage, while others feel fine and don’t want to deal with the side effects of the medications, which can include weight gain and sexual problems.

Having been on lithium for 10 years, Molliner says, “I didn’t have that choice [about treatment], because I was 16 at the time of diagnosis. [But] the peak of the mania and the deepest end of the depression were so scary and big that I never wanted to experience them again. In the manic stage, I was totally out of control in my own mind and body, and that is the scariest experience ever,” she recalls. “And the depression felt like death.

“The biggest issue with the lithium for me was that it triggered [the skin condition] psoriasis, and I developed a slight hand tremor. But there were no sexual side effects,” she says. Weight gain was an issue, though. “For the first six years [of treatment] I could not lose weight for the life of me, but finally my body adjusted.”

Balancing Act

One of the concerns voiced by those with bipolar disorder is that medication will wipe out their ability to feel joy and express creativity. Like many artistic types, Maurice Bernard, the Emmy Award-winning actor who for 13 years has played General Hospital’s tempestuous mobster, Sonny Corinthos, at first feared that going on lithium would affect his productivity — and his livelihood.

“If you’re an actor, people think if you take medication for bipolar disorder you won’t be able to creatively do the work,” Bernard tells WebMD. His track record refutes this notion. He received the Emmy for Outstanding Lead Actor in a Daytime Drama Series in 2003 and was also nominated in 1996, 1997, 2004, and again in 2005.

After a series of personal events ranging from being misdiagnosed with a brain virus and being told he had six months to live, Bernard was diagnosed with bipolar disorder at age 22. And even though he knows full well that going off the lithium could result in hospitalization, Bernard says that he flirts with the idea every day.
“I don’t want to take them lately,” he says of the pills he has been on for more than a dozen years. “I don’t have any side effects from the medication — I just don’t feel like taking pills anymore. But the main thing is, I know what the consequences are. It’s pretty simple: When I haven’t taken my pills, I have a breakdown. So I am not stupid.”

The ‘Learning Curve’

Bernard, who also serves as a spokesman for the National Mental Health Association (NMHA), admits that there has been a learning curve. “I did go off for one year and had a breakdown, and then I went off for two and a half years and I had a breakdown,” he says. The last time he stopped taking his medication, he threatened to kill his wife, Paula, and ended up in a psychiatric facility.

Regardless of the downsides, the mania can be compelling. “I felt like God was talking through me at one point, and I bought lavish gifts for my girlfriend [now wife],” Bernard recounts. “It’s the feeling of being high and feeling like you are the messiah.” In an upcoming story on General Hospital, his character Sonny — who also has bipolar disorder — will traverse the manic stage of the illness.

“You feel like you are on top of the world and nothing can stop you. And then, of course, the real problem is having to deal with the crash,” says Bernard.

“I understand that patients who feel elated [also] feel wonderful … it’s like being on cocaine and can be extremely attractive and very seductive,” says Joseph Calabrese, MD, a professor of psychiatry at Case Western Reserve and director of the Mood Disorders Center at the University Hospitals of Cleveland, Ohio. “There is one problem,” he adds. “One hundred percent of people have a depression after a high.

“There are short periods of productivity on the way up, but once the highs get more severe, they are less productive,” Calabrese says. And “once you are ill, you have to be able to stay on your medication for life, since in most instances when medications are stopped, people will relapse.”

“It’s a human phenomenon,” agrees Gary Sachs, MD, an associate professor of psychiatry at Harvard Medical School and director of the Bipolar Mood Disorder Program at Massachusetts General Hospital, both in Boston. “There is a willingness to take a treatment when you’re acutely ill, but then when symptoms are no longer [obvious], it’s hard to get your arms around the idea of taking a drug forever when you are not perceiving any benefit.”

Just as with Bernard, “as patients experience more and more relapses, the wisdom to take medication becomes clearer,” says Sachs. Some people, he adds, may get the message after three lapses — and for others it can take 13.

James E. Rosenberg, MD, director of neuropsychiatry at the Sports Concussion Institute at Centinela Freeman Hospital in Marina del Rey, Calif., says that people with bipolar disorder think, “‘I am going to finally write the great symphony or make some brilliant discovery.’ But in the long term, people with untreated mania may find they no longer have family, are HIV positive from engaging in risky, thrill-seeking activities, are in jail, or are bankrupt. There are horrible consequences that affect the rest of your life.”

For Molliner, the repercussions were mainly social. “I lost my identity as a 16-year-old adolescent girl. I didn’t take final exams [the year] I got diagnosed because I was being treated, and everybody I went to high school with knew why, and the shame that went with that was the biggest repercussion,” she says. “I felt like I didn’t fit in and never would.”

More Than Pills

In addition to medication, there is also family support, counseling, and keeping regular routines to help people with bipolar disorder live with the condition. Molliner has been successfully living with bipolar disorder for 10 years, but that’s not to say she does not feel the onset of symptoms and moods from time to time. “I know I need [help] when I sense symptoms coming on in my sleep. I let the people in my life know that I sense it coming on. In doing that, I feel empowered,” she says. Exercise helps, too.

Molliner’s family has been a huge source of support over the years. “They didn’t throw it in my face,” she says. “Initially they were like, ‘Have you taken your lithium?’ ‘Are you having a manic episode?’ or ‘Are you having depression?’ — which was not helpful,” she recalls. “What was useful for them to say was: ‘You are feeling happy, that’s OK,'” she says. “They learned to be supportive of me having emotional experiences without it being an episode.”

Bernard agrees that support from his family has been crucial in his recovery. “Since taking my medications and starting on General Hospital, I have accomplished a great deal in acting and in my life. My life is as perfect as can be,” he says. “I still go through moods and whatnot; but in general, if you get treatment for bipolar disorder, stay on your medications. You can live an incredible life. That’s the bottom line.”

The same holds true for Molliner. The Berkeley graduate is now earning her master’s degree in psychology at Phillips Graduate Institute in Los Angeles. “I am developing programs for people recently diagnosed with bipolar disorder that incorporate art therapy, relapse prevention, and building medication compliance.” She says she wants to become the therapist that she never had.

“We work on self-esteem and identity through group therapy and relapse prevention through education about symptoms that come on before an episode, as well as coping mechanisms,” Molliner says. “You can’t get rid of bipolar, but you can choose how to live with it.”

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