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Bipolar patients want to know “Am I okay to drive?” Learn about the issues surrounding driving and bipolar disorder.

As an adult bipolar patient, one of the most significant lifestyle issues you take up with your doctor will likely involve driving, including questions like, “Am I okay to drive when I’m manic? What about when I’m depressed? What if I’m only mildly manic or mildly depressed?”

The answers to these questions are not clear-cut from the viewpoint of your doctor or even the law. Although there are specific state laws governing driving and some medical conditions like epilepsy, most states are hesitant to legislate driving and such a complicated, variable condition as bipolar disorder.

“Very disorganized, symptomatic people often continue to drive through their illnesses and have a perfect driving record,” says Paul S. Appelbaum, MD, director of the division of law, ethics and psychiatry in the department of psychiatry at Columbia University and a member of the American Psychiatric Association’s Council on Psychiatry and Law. “Alternately, there are a lot of people out there on the road with no psychiatric disorder whatsoever who are terrible drivers. There is not a good correlation between symptoms and driving ability, which makes it hard sitting in an office to know how good a driver is.”

Driving and Bipolar Disorder: Unique Circumstances

Whether you should drive most likely will come down to an open, honest discussion: with your doctor, who can only offer his educated opinion, and with your family members and loved ones, who can help convey to your care team the individual circumstances surrounding your bipolar disorder.

Those circumstances may include:

• The severity of your manic and depressive episodes. While manic episodes are legendary for causing reckless, aggressive driving within the bipolar population, depressive episodes, especially if you are suicidal, can also be problematic.
• The medications you are taking and whether they are stabilized. If you are just starting or changing your medications, particularly those known to have sedating effects, your doctor will most likely suggest you stop driving for a period of time to adjust to the changes in your body.
• Your driving record. Your doctor may want to know if you have a good driving record with plenty of previous driving experience or a previous record of poor driving.
• Your history of substance abuse, particularly while driving.Between 50 and 60 percent of patients with bipolar disorder will at some point in their lifetime struggle with substance abuse and addictionissues.

Your doctor will more than likely help you and your family come up with a variety of options on managing your driving needs. It may be that your moods are not so extreme and your driving routine doesn’t need to change at all. It may be that your moods are especially severe and that you should always have someone else drive you where you need to go. It may be that your depressive episodes are not that dangerous, but your manic episodes put you at risk, which is often the case with bipolar disorder.

The possibilities and varieties of options are endless, requiring your entire care team to be on board, perhaps most especially your family and loved ones.

Driving and Bipolar Disorder: Your Doctor’s Role

“The person in the manic episode 99 percent of the time will not have the insight to say, ‘Gosh, I’m manic — I shouldn’t drive.’ They will be thinking, ‘Gosh, nothing is wrong with me. I’m all-powerful — I’m amazed my car doesn’t fly,’” says Melvin G. McInnis, MD, director of psychiatry programs at the University of Michigan Depression Center in Ann Arbor. “It really becomes up to the family member to provide the guidance, counsel, and insight into the situation, to say, ‘Charlie, I’m taking the keys. You’re not driving.’”

Keep in mind that your doctor can only offer advice. While your partner or parent may choose to stop you from driving, your doctor is not in the position to take such action.

In some states, doctors are required by law to report to that state’s department of motor vehicles the names of patients who, because of their disorders or treatments, are “driving-impaired,” which can mean different things, depending on the state. In other states, doctors are required by law to report the names of those patients who have been advised not to drive, but continue to do so. However, statutes and laws vary widely.

Meanwhile, the American Psychiatric Association’s position paper, “The Role of the Psychiatrist in Assessing Driving Ability,” says that the doctor should talk about a patient’s ability to drive only “when appropriate.”

The onus is on you and your family members to be proactive on this important and potentially life-threatening activity, to offer honest information, to seek out experienced counsel, and to be courageous enough to ask your doctor the very important question: “Is there a reason I should not drive?”

“If the family is concerned,” says Dr. McInnis, “it’s up to them to have a chat with the doctor and to see what’s going on.”

Fluctuating hormones during menopause can worsen bipolar symptoms. Find out how to cope.

If you are a woman with bipolar disorder, you may experience a double whammy during a profound time in your life — menopause.

Bipolar Disorder and Menopause: The Estrogen Effect

“Unfortunately, menopause can exacerbate bipolar disorder,” says Ahsan Y. Khan, MD, professor in the department of psychiatry and behavioral sciences at the University of Kansas School of Medicine-Wichita and director of Via Christi Psychiatric Outpatient Clinic, also in Wichita. “You can be irritable and dysphoric [anxious] at the same time. And then here come hormones into play. They compound the problem.”

Although doctors don’t completely understand the complex biochemistry behind the reaction, clinical research consistently suggests that a significant number of women with bipolar disorder are more sensitive to hormonal shifts during menopause and the powerful changes going on in the body. At menopause in particular, they report more depressive episodes than women without bipolar disorder, at least partly because of a normal menopausal decrease in the powerful hormone estrogen.

The connection between estrogen and mood disorder is not completely clear. What researchers do know is:

• High levels of estrogen tend to have a “brightening effect” on mood, while low levels promote a dampening of mood.
• Estrogen will decrease during menopause and the five- to 10-year period before menopause, known as perimenopause.
• A drop in estrogen can have particular consequences for the bipolar patient, doubling susceptibility to depressive episodes.

Bipolar Disorder and Menopause: Not Everyone Gets an Increase in Symptoms

Does this mean all women with bipolar disorder will experience a return ofdepression and complications of mood as estrogen levels decrease during menopause? Not necessarily.

While psychiatrists consistently field an increase in depressive reports during their bipolar patients’ menopausal years, research suggests that a high percentage of, but not all, women experience an escalation of depressive symptoms during menopause.

By the time you’re in your mid-30s, your doctor should begin checking your hormone levels to make sure menopausal hormone fluctuations are not overlooked as a contributing factor to your mood issues.

“If there is a worsening of symptoms without any other change in life, I would ask my patient if they are going through menopause,” says Dr. Khan. “I would ask them to contact their primary care doctor to look at hormone levels.”

Khan recalls the case of a 51-year-old bipolar patient who was being unsuccessfully treated for a sudden increase in mood symptoms. It wasn’t until her doctors measured her hormone levels that they realized she was in menopause. As soon as she started on hormone replacement, her symptoms dramatically decreased, says Khan.

Bipolar Disorder and Menopause: Options for Treatment

If your doctor finds a hormonal imbalance, he or she may suggest one or both of these options:

• Hormone replacement therapy (HRT). If your symptoms don’t improve after adjusting the dosage of or otherwise make changes in your current regimen of bipolar medications, HRT might be beneficial. However, HRT must be considered carefully because it increases the risk of heart disease, stroke, and blood clots. Some women are advised against HRT because of existing health conditions that may be worsened by it.
• Talk therapy. Speaking with a qualified therapist may help. Some women may need or want to talk about pessimistic thoughts, about their life, and about the fact that they can no longer bear children, says Khan.

Sometimes the problem gets worse with treatment before it gets better. Synthetic estrogen, for example, has been known to increase stimulation and anxiety in some women — exactly what you don’t want. A lower dose or another hormone combination might work better. This may take time and patience to discover.

Indeed, just as there is no one way to combat bipolar disorder and just as it takes time to find the right combination of medications, so it is for managing your menopausal symptoms. Your care team is there to help.

Taking good care of yourself is perhaps the most important part of successfully managing bipolar disorder.

As important as your medications and therapy sessions are, what you do to care for yourself on a day-to-day basis is just as important in managing bipolar disorderand preventing episodes.

Bipolar Disorder: Adopting Healthy Habits

Getting plenty of sleep and having a regular sleep schedule is a good start to taking care of yourself and managing bipolar disorder, says Adele C. Viguera, MD, a psychiatrist and the associate director of the perinatal and reproductive psychiatry program at the Cleveland Clinic in Ohio.

Eating a healthy diet with nutritious foods, as well as eating on a regular schedule to prevent getting too hungry, are also important self-care steps for people with bipolar disorder, Dr. Viguera adds.

It’s really important to watch what you eat, she says, because a lot of these medicines can promote weight gain. “So you really want to pay attention to nutrition.”

She also recommends taking omega-3 fatty acids and other nutritional supplements and vitamins along with — not instead of — medications.

Bipolar Disorder: More Healthy Tips

Other healthy habits to manage bipolar disorder symptoms include:

• Know what triggers your bipolar symptoms, and learn how to avoid them.
• Keep a diary of your mood swings, symptoms, and triggers.
• Devise a strategy to deal with symptoms when they start to arise.
• Join a support group for people with bipolar disorder.
• Get plenty of regular exercise.
• Find a hobby, sport, or game that you enjoy.
• Limit or avoid caffeine, alcohol, and sugary foods.
• Continue your therapy and counseling visits as long as your doctor recommends them.
• Give yourself some relaxation time.

Bipolar Disorder: Choosing the Right Doctor

You’ll need a close, ongoing relationship with your doctor, so it’s important to find the right fit — and someone who can truly help you.

“Finding a doctor who has some expertise in treating bipolar disorder is important,” says Viguera. “I would encourage the patient to see someone who sees a lot of those patients — those docs have a lot of experience.”

And your relationship with your doctor isn’t just between the two of you — your family plays an important role in your treatment, too. “Get family members involved — bring them to the appointments,” Viguera stresses.

It’s also important to establish up-front the friends and family members who can be contacted if your doctor has questions or needs help. Your loved ones should also be encouraged to reach out to your doctor if they notice strange behavior or symptoms of a bipolar episode.

Bipolar Disorder: Take Your Medications

Staying compliant with your medication is very important — even if it’s a challenge. Medication is “a cornerstone of treatment,” says Viguera. So instead of skipping pills, come up with tricks to make it easier to remember to take them, or talk to your doctor about an alternative dosage.

“It’s hard to take a medication three times a day, so there are creative ways where you can try to bunch medications together if you can,” Viguera says. She suggests linking them to a daily habit like eating a meal or brushing your teeth.

If you experience side effects like drowsiness or just can’t squeeze all those pills into a day, ask your doctor if you can take them at a different time of day or reduce the number of pills you need each day. Your doctor wants you to keep taking your medications, so he’ll be willing to work with you to help you successfully manage your bipolar disorder.

Keeping tabs on your symptoms of mania and depression can help stop a bipolar episode before it starts. A good way to track those mood swings is in a mood diary.

Subtle changes in your personality might not seem like a big deal to you, but they can be an important warning sign when it comes to predicting an episode of bipolar disorder.

Do you find that you’re more excitable, more carefree with your money, more likely to start staying up late or binging on junk food before an episode of mania? Before a bout of depression, do you start sleeping too much or staying home instead of going out with friends? Whatever the warning signs of a bipolar episode are for you, tracking your mood swings in a diary can help you pinpoint when an episode is likely to occur.

“A mood diary is incredibly helpful, and I always encourage people with bipolar disorder to use one,” says Adele C. Viguera, MD, a psychiatrist and the director of women’s mental health at the Cleveland Clinic in Ohio. “It’s hard when you’re with your doctor to remember what it was like over the last month.”

Dr. Viguera says that a mood diary can help both you and your doctor manage bipolar disorder. “On a day-to-day basis, you’re in tune with how you’re doing, and you can take better care of yourself,” she says.

How a Mood Diary Can Help

Since taking care of yourself is top priority, every little thing that you can do helps. Keeping a bipolar mood diary can actually help you maintain healthy habits and ward off a bipolar episode. “When having another episode is constantly in your awareness, you’re less likely to do things that are self-destructive,” Viguera says.

A mood diary can also help you make better choices, Viguera says. You can identify bipolar episodes earlier, which allows for earlier treatment. You can use the diary as a way to talk to your doctor, so the two of you can figure out what’s going on and what you can do about it, she says.

Tracking Mood Swings

Viguera suggests that keeping a calendar to note how you’re feeling on a particular day is a good start. She says to devise a simple rating system of your symptoms for a particular day. For example, a “1” can denote a good day, while a “5” may indicate a bad day. As those ratings accumulate, it can show patterns of your symptoms that may help determine what’s causing them.

“There are some calendars that are devised just for people with bipolar disorder, where you can chart if you’re on the upside or the downside,” she says. “Then, your doctor will have a pattern of how you’ve been doing and can look at the course of your symptoms over time.” Online mood trackers are also available.

Bipolar Symptoms: What to Write Down

To get started keeping your diary of bipolar symptoms and mood swings, Viguera offers these ideas to help you figure out what to track and record:

• Your sleep patterns, whether too much or not enough
• Your anxiety levels
• Your mood
• Changes in your diet, including different foods and how much you eat
• Changes in menstruation for women
• Relationships and changes or problems in them
• Stressors like a move, a new job, or a new baby

Any of these changes can indicate an alteration in your mental health, and major stressors may be behind them. Tracking these symptoms can make it easier for you and your doctor to piece together the clues that may suggest when a bipolar episode is on the horizon.

Some people with bipolar disorder who experience episodes of mania can also have psychotic symptoms like delusions and paranoia.

People with bipolar disorder may have many different symptoms, including depression, joy, hypersexuality, and even psychotic symptoms like delusions or paranoia. These are all symptoms of one condition — not separate conditions that a person has to deal with.

Bipolar disorder makes the mind swing between different thoughts and emotions, so it’s difficult to know what to expect. But if medication and therapy can manage bipolar disorder, psychotic symptoms stay under control, too.

Psychotic symptoms occur most often during manic episodes, says Adele C. Viguera, MD, a psychiatrist and the associate director of the perinatal and reproductive psychiatry program at the Cleveland Clinic in Ohio. But people can also experience psychotic symptoms during episodes of depression.

Typically, “patients are hospitalized if they have psychotic symptoms,” says Dr. Viguera. They may have “grandiose delusions — think they’re Christ or they have powers. Or, that they have a special connection with the universe and they can feel people’s pain.”

“You see that typically in mania,” says Viguera, but “people can be so depressed that they can be psychotically depressed. It happens [more] frequently with mania [than with] depression.” People may seem like they are out of touch with reality — and are in danger of hurting themselves.

Treating Psychotic Symptoms

Viguera says people experiencing psychosis immediately receive antipsychotic medications and a mood stabilizer. “Generally it’s for the acute period of time — once they’re better from that acute episode, we’ll generally take them off of that,” says Viguera, although some of those medications may also be used as a maintenance treatment.

Examples of antipsychotics include olanzapine (Zyprexa) — usually given along with an antidepressant medication — quetiapine (Seroquel), and risperidone (Risperdal). Mood stabilizers include lithium and the anticonvulsant divalproex sodium (Depakote).

The antipsychotics and mood stabilizers will stop the psychosis and keep it from coming back, Viguera says. Therapy, besides the medications, is effective in managing psychotic symptoms and bipolar disorder.

People with bipolar disorder are “not chronically psychotic,” Viguera says. Regular follow-ups with a doctor are important for managing psychotic symptoms and bipolar disorder itself, so that any recurring episodes can be spotted and stopped quickly.

Psychosis: How Family and Caregivers Can Help

Bipolar disorder is a disease that requires a long-term commitment to wellness, compliance to treatment, and monitoring. You don’t take a pill and it just goes away. While symptoms can be well-managed, it’s important to keep an eye on them to see if bipolar disorder symptoms start popping up again.

“It’s a kind of illness that needs constant vigilance and a good working relationship with your doctor,” says Viguera. “Patients with bipolar disorder definitely benefit from close follow-up, even if they’re well.”

And caregivers, friends, and family members can be a huge help in keeping a loved one with bipolar disorder on track. Reminding your loved one about taking his medications, making sure appointments (including counseling sessions) are kept, and encouraging healthy habits are all important tasks for caregivers and friends.

Bipolar disorder isn’t something that can or should be managed alone. The individual with bipolar disorder needs help to stay on track, and to spot symptoms that he might not be able to notice. Family can be a huge help in monitoring symptoms, and letting the doctor know of any changes or suspicious signs of an impending episode. The earlier signs are caught, the better the opportunity to prevent an episode and keep symptoms under control.

Hypersexuality, or increased sex drive, is a common manic symptom of people with bipolar disorder.

Bipolar disorder is a mood disorder that can be characterized by drastic mood swings — between feeling elated, energetic, and risky to feeling sad and disinterested. These drastic swings are called episodes of mania and depression, and they are the classic signs of bipolar disorder. Not everyone has these drastic swings; some people with bipolar disorder swing back and forth between depressive and somewhat elated states.

But when someone with bipolar disorder is having a manic episode, risky, reckless sexual behaviors and significantly increased sex drive are quite common. Hypersexual behavior is often a warning sign of a manic episode, but keeping bipolar disorder managed with medication and therapy can stop hypersexuality.

Some people with bipolar disorder may show a greater interest in sex and sexually risky behaviors than is otherwise normal for them.

Related: Bipolar Disorder and Gender

Bipolar Disorder: What Hypersexuality Means

“In general it’s a symptom of hypomania or mania — it goes with that particular mood episode,” says Adele C. Viguera, MD, a psychiatrist and associate director of the perinatal and reproductive psychiatry program at the Cleveland Clinic in Ohio.

Mania is one of the two main episodes that someone with bipolar disorder may experience; hypomania is just a milder form of mania. “Hypersexuality can be one of the characteristic symptoms for that,” says Dr. Viguera. Other symptoms include:

• Spending an excessive amount of money
• Not sleeping
• Having trouble concentrating
• Speaking quickly and in a scattered manner

Bipolar Disorder: Focus on Sex

There isn’t a clear-cut definition or criteria for being hypersexual, but for a person with bipolar disorder, it means being more focused on sex and risky sexual behaviors than they normally are. What’s significant is that there is a change or difference from normal behaviors.

People with bipolar disorder experiencing hypersexuality may:

• Have multiple sex partners
• Think about sex constantly
• Have one-night stands
• Be more interested in pornography
• Notice a difference in their sexual behaviors
• Engage in other reckless behaviors like driving too fast or gambling

Bipolar Disorder: Managing Hypersexuality

Hypersexuality with bipolar disorder isn’t a separate condition or problem that needs its own treatment — it’s a symptom of bipolar disorder. Once the bipolar disorder is successfully treated and mood swings and symptoms are under control, those hypersexual feelings will dissipate.

“You treat the disease, not the symptom,” says Viguera. Once the disease is under control, people with bipolar disorder often react differently to sex and their past behaviors.

“You often see a lot of regret for the past behavior because they put themselves in very bad situations,” says Viguera. “When they’re well, they reflect back on that and there can be a lot of regret and remorse. It’s just another clue that shows you that that was not their normal state.”

Related: Making Good Choices With Bipolar Disorder

Bipolar Disorder Treatments

Bipolar disorder is usually treated with:

• Mood-stabilizing medications
• Antipsychotic medications
• Antidepressants
• Cognitive-behavioral therapy
• Other forms of therapy and counseling that may include family members
• Electroconvulsive therapy (ECT); also called “shock therapy” because small electrical waves are used

The right combination of these various therapies can reduce or eliminate bipolar mood changes between mania and depression, and symptoms of hypersexuality will no longer be a problem.

But those symptoms of hypersexuality may be a big red flag for some people with bipolar disorder that they are slipping into a manic episode. When they start to notice themselves thinking more about sex or engaging in promiscuous behavior, it’s time to notify the doctor that symptoms are starting.

Learn about the differences between these two easily confused disorders.

Bipolar disorder and borderline personality disorder (BPD) are both mental illnesses that involve extreme mood swings. Since many BPD and bipolar symptoms overlap, these conditions are often mistaken for each other. But bipolar disorder and BPD are different illnesses, each with their own symptoms and treatments.

How BPD Differs From Bipolar Disorder

Both bipolar disorder and BPD can interfere with relationships, work or school, and the ability to lead a productive life.

In bipolar disorder, which is also called manic depression, a person experiences severe mood swings, resulting in the dramatic emotional highs of mania and the profound lows of severe depression. In BPD, on the other hand, people have both unstable moods and problems with self-image that specifically affect their ability to form healthy relationships. People with personality disorders such as BPD are often not aware that their behavior is abnormal, but their disordered personality makes it difficult for them to deal with other people.

“BPD is based around interpersonal relationships and self-image, versus bipolar disorder, which is manic highs and lows,” says Julie Walther Scheibel, MEd, a therapist based in St. Louis, Mo.

Like bipolar disorder, BPD does lead to mood swings. Unlike bipolar disorder, in which a manic or depressive episode typically lasts for at least a week, a BPD-associated mood swing usually runs its course in a few hours or up to a day.

Although more people are familiar with bipolar disorder, BPD is actually more common. It affects 2 percent of the adult population. Young women are at highest risk of developing BPD.

Symptoms of BPD include:

• Episodes of anger, depression, and anxiety
• Aggressive behavior
• Self-harm
• Drug or alcohol abuse
• Binge eating or spending
• Frequent changes in life goals
• Poor self-esteem
• Feelings of emptiness
• Fear of being alone
• Intense, but unstable relationships
• Suicide threats or suicide attempts
• Impulsiveness
• Manipulative behavior

Bipolar disorder symptoms, on the other hand, include episodic, dramatic shifts from an overly elated mood to severe depression. During manic periods, people with bipolar disorder experience excessive energy, insomnia, irritability, racing thoughts, and difficulty concentrating. While depressed episodes lead to intense sadness, inability to enjoy activities, and suicidal thoughts.

Like those with BPD, people with bipolar disorder often engage in impulsive behavior, but they don’t tend to view their relationships in the same damaging ways as people with BPD. In BPD, people often manipulate others due to distrust and a profound fear of rejection.

Since BPD often occurs along with other psychiatric illnesses, it is not unusual for a person to have both BPD and bipolar disorder.

Treatment for Bipolar Disorder vs. BPD

Treatment for bipolar disorder involves the long-term use of mood stabilizing medications. Bipolar treatment may also involve psychotherapy, which can educate a person with bipolar disorder on how to recognize an impending manic or depressive period so it can be dealt with before it becomes a full-blown episode.

Whereas the mainstay of bipolar disorder treatment is medication, treatment for BPD typically centers around psychotherapy, either group or individual therapy. Anti-depressant medications may also be prescribed, depending on the individual’s specific symptoms.

Both bipolar disorder and BPD are serious mental illnesses that should be managed by a mental health professional.