Bipolar Support Groups.com blog

What Is It?

Sometimes called manic depression, bipolar disorder causes extreme shifts in mood. People who have it may spend weeks feeling like they’re on top of the world before plunging into a deep depression. The length of each high and low varies greatly from person to person.

What the Depression Phase Is Like

Without treatment, a person with bipolar disorder may have intense episodes of depression. Symptoms include sadness, anxiety, loss of energy, hopelessness, and trouble concentrating. They may lose interest in activities that they used to enjoy. It’s also common to gain or lose weight, sleep too much or too little, and even think about suicide.

When Someone Is Manic

During this phase, people feel super-charged and think they can do anything. Their self-esteem soars out of control and it’s hard for them to sit still. They talk more, are easily distracted, their thoughts race, and they don’t sleep enough. It often leads to reckless behavior, such as spending sprees, cheating, fast driving, and substance abuse. Three or more of these symptoms nearly every day for a week accompanied by feelings of intense excitement may signal a manic episode.

Bipolar I vs. Bipolar II

People with bipolar I disorder have manic phases for at least a week. Many also have separate depression phases, too.

Those with bipolar ll have bouts of major depression, but instead of full manic episodes, they have low-grade hypomanic swings that are less intense and may  last less than a week. They may seem fine, even like the “life of the party,” though family and friends notice their mood changes.

What’s a “Mixed Episode”?

When people with bipolar disorder have  depression and mania symptoms at the same time, or very close together, this is called a manic or depressive episode with mixed features.  This can lead to unpredictable behavior,  such as taking dangerous risks when feeling hopeless and suicidal but energized and agitated.  Mood episodes involving mixed features may be somewhat more common in women and in people who develop bipolar disorder at a young age.

What Are the Causes?

Doctors don’t know exactly what causes bipolar disorder. Current theories hold that the disorder may result from a combination of genetic and other biological – as well as environmental- factors. Scientists think that brain circuits involve din the regulation of mood, energy, thinking, and biological rhythms may function abnormally in people with bipolar disorder, resulting in the mood and other changes associated with the illness.

Who Is at Risk?

Men and women both get bipolar disorder. In most cases, symptoms usually start in people who are 15-30 years old. More rarely,  it can begin in childhood. The condition can sometimes run in families, but not everyone in a family may have it.

How It Affects Daily Life

When it’s not under control, bipolar disorder can cause problems in many areas of life, including your job, relationships, sleep, health, and money. It can lead to risky behavior. It can be stressful for the people who care about you and aren’t sure how to help or may not understand what’s going on.

Risky Behavior

Many people with bipolar disorder have trouble with drugs or alcohol. They may drink or abuse drugs to ease the uncomfortable symptoms of their mood swings. Substance misuse also may be prone to occur as part of the recklessness and pleasure-seeking associated with mania.

Suicidal Thinking

People with bipolar disorder are 10-20 times more likely to commit suicide than others. Warning signs include talking about suicide, putting their affairs in order, and doing very risky things. If you know someone who may be at risk, call one of these hotlines: 800-SUICIDE (800-784-2433) and 800-273-TALK (800-273-8255). If the person has a plan to commit suicide, call 911 or help them get to an  emergency room immediately.

How Doctors Diagnose It

A key step is to rule out other possible causes of extreme mood swings, including other conditions or side effects of some medicines. Your doctor will give you a checkup and ask you questions. You may get lab tests, too. A psychiatrist usually makes the diagnosis after carefully considering all of these things. She may also talk to people who know you well to find out if your mood and behavior have had major changes.

Which Medicines Treat It?

There are several types of prescription drugs for bipolar disorder. They include mood stabilizers that prevent  episodes of ups and downs, as well as antidepressants and antipsychotic drugs. When they aren’t in a manic or depressive phase, people usually take maintenance medications to avoid a relapse.

Talk Therapy for Bipolar Disorder

Counseling can help people stay on medication and manage their lives. Cognitive behavioral therapy focuses on changing thoughts and behaviors that accompany mood swings. Interpersonal therapy aims to ease the strain bipolar disorder puts on personal relationships. Social rhythm therapy helps people develop and maintain daily routines.

What You Can Do

Everyday habits can’t cure bipolar disorder. But it helps to make sure you get enough sleep, eat regular meals, and exercise. Avoid alcohol and recreational drugs, since they can make symptoms worse. If you have bipolar disorder, you should learn what your “red flags” are — signs that the condition is active — and have a plan for what to do if that happens, so you get help ASAP.

Electroconvulsive Therapy (ECT)

This treatment, done while you are “asleep” under general anesthesia, can rapidly improve mood symptoms of  bipolar disorder. It uses an electric current to cause a seizure in the brain. It’s one of the fastest ways to ease severe symptoms. ECT is often a safe and effective treatment option for severe mood episodes when medications have not led to meaningful symptom improvement. It’s a safe and highly effective treatment.

Let People In

If you have bipolar disorder, you may want to consider telling the people you are closest to, like your partner or your immediate family, so they can help you manage the condition. Try to explain how it affects you and what you need. With their support, you may feel more connected and motivated to stick with your treatment plan.

Concerned About Someone?

Many people with bipolar disorder don’t realize they have a problem or avoid getting help. If you think a friend or family member may have it, you may want to encourage them to talk with a doctor or mental health expert who can look into what’s going on and start them toward treatment. Be sensitive to their feelings, and remember that it takes an expert to diagnose it. But if it is bipolar disorder, or another mental illness, treatment can help.

A bipolar disorder diagnosis can have a big effect on your job and career. In a survey of people with depression and bipolar disorderconducted by the Depression and Bipolar Support Alliance, 88% said their condition affected their ability to work.

But don’t be alarmed. A diagnosis of bipolar disorder doesn’t necessarily mean that you can’t keep your job. Plenty of people withbipolar disorder work and live normal lives.

Should I Tell my Boss About my Bipolar Disorder?

You don’t have to talk to your boss or coworkers about your bipolar disorder. Your health is your business. But if your condition has been affecting your performance at work, being open may be a good idea. Your boss and coworkers may have noticed the changes in your behavior. If you explain what’s going on, they may be more sympathetic and helpful than you expect.

Making Changes in Your Job

Some people with bipolar disorder find their current job just isn’t a good fit. Maybe it’s too stressful or the schedule is too inflexible. Maybe it doesn’t let them get enough sleep, or involves shift work that could worsen their condition. If you think your job is hurting your health, it’s time to make some changes. Here are some things to consider:

• Decide what you really need from your job. Do you need to reduce your responsibilities? Do you need extra breaks during the day toreduce stress? Would you rather work independently or in a group? Do you need to work shorter hours or take time off? Or do you need a different job altogether?
• Make decisions carefully. People with bipolar disorder are prone to acting impulsively. Think through the effects of quitting your job — both for yourself and possibly for your family. Talk over your feelings with your family, therapist, or health care provider.
• Look into financial assistance. If you do need to take time off because of your bipolar disorder, see if your employer has disabilityinsurance, or look into Social Security Disability Insurance, which will provide some income while you recover. You can also look into the Family and Medical Leave Act. Ask your doctor or therapist for advice.
• Go slowly. Returning to work after you’ve taken time off can be stressful. Think about starting in a part-time position, at least until you’re confident that your bipolar disorder has stabilized. Some people find that volunteer work is a good way to get back into the swing of things.

WebMD Medical Reference

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Reviewed by Joseph Goldberg, MD on October 27, 2014

© 2014 WebMD, LLC. All rights reserved.

Depression should be talked about with the same candor as say, diabetes. But we have quite a ways to go in recognizing what it looks like – and stripping away the shame attached to mental health conditions, says Rory Brosius.

Brosius is deputy director of Joining Forces, an initiative launched in 2011 by first lady Michelle Obama and Jill Biden, wife of Vice President Joe Biden, to help military personnel transition to civilian life. Brosius’ mission is to promote wellness in that population and beyond — service members, veterans and civilians.

She’s broadening that conversation through Campaign to Change Direction, an initiative begun last spring that hopes to change the culture of mental health in the U.S. The campaign helps raise awareness of five key signs of emotional suffering.

“We’ve treated mental health somehow different than our physical health, but it’s part of our holistic wellness,” says Brosius, a social worker by training and the wife of Matthew Brosius, a Marine who is re-entering civilian life.

WebMD talked to Brosius, 33, about the campaign and the work she’s doing to promote psychological wellness, both among service personnel and their families and the general public.

Q. What are the 5 signs that someone may be suffering from a mental health issue?

A. The key part is educating people on these five signs: personality change, withdrawal, agitation, poor self-care, and hopelessness. They’re signs somebody may be suffering. If you see them, you can reach out and help them. Because there is support that is available.

Q: What are some misperceptions people have about mental illness?

A: There are quite a few, like, people with mental illness are violent or somehow unpredictable, when the reality is that people with mental illness are 10 times likelier to be victims of a violent crime. We have stereotypical ideas of what it means to live with a mental health issue. Another one is that people assume they don’t know anyone with mental illness, but 1 in 5 American adults has dealt with a mental health issue in their life. You look around a room, someone’s dealing with it, someone’s in recovery. You may not notice it.

Q: If the signs of mental illness are subtle, how do you make ordinary people aware of them?

A: It’s not so easy to detect because it’s something we don’t talk about. [But] there are things you notice that indicate that somebody’s in pain. Forty years ago people didn’t know how to recognize a heart attack; through education we learned how to read the signs. This is a sticky and hard issue for people to talk about …it will take time, but we’ve seen the same thing with heart disease and stroke and breast cancer — it’s a matter of education.

Q: What is the best way to support someone with mental health issues?

A: There are great ways to support somebody suffering, just by being empathetic, being a good friend, listening, you can learn a lot about mental health. There are great resources –mentalhealth.gov, National Alliance for Mental Health – their whole mission is to teach people what to look for. In the age of the internet and Google, we have the ability to access that information at our fingertips. But really, just being there. Maybe the person would like you to go to an appointment with them or spend time with you.

Q: Is there a different approach we might take with a service member than with a civilian?

A: In the same way you’d listen to a civilian, you would do with a service member. One benefit in that population is we have specialized resources geared to service members and their families. There is support for military personnel and their families, peer-to-peer services, warm handoff programs to service members transitioning to civilian life. There are distinct benefits to being a service member.

Q: You have written that mental health is a human issue, not a military issue. Can you elaborate?

One in 5 American adults has experienced a mental health issue. In the military, people are suffering from mental health issues just like across the population. PTSD [post traumatic stress disorder] is a signature illness, but that shouldn’t be the only issue we’re discussing. By focusing too much on specific populations we could pigeonhole people. We should be talking about this as a broader cultural perspective, about Americans going through this.

Q: What is a signature wound?

A: The signature wounds of Iraq and Afghanistan are traumatic brain injury (TBI) and post- traumatic stress disorder. There’s been a lot of focused research and work in these areas because this is what we’ve seen in our service people.

You do see TBI in other places – in our professional sporting teams you see severe concussions, and the NFL, DoD (Department of Defense) and the VA (Department of Veterans Affairs) have worked together and shared research. We see PTSD in children who’ve survived child abuse, crime victims, people who’ve been in car accidents. PTSD has made its name in the news because of the military population, but it happens in the civilian population, too.

Q: What can average people do to support the mission?

A: The reason we love Campaign to Change Direction is that it’s so simple: People can take the pledge. Go to changedirection.org. Help us spread the message through social media. It’s my goal that people see shame fall away from mental health and think about it like when you go to the dentist.  How’s your brain doing today?

Bipolar disorder may be hard to identify in children and adolescents for several reasons, including a lack of age-appropriate diagnostic guidelines and symptoms different than those commonly seen in adults with the disorder. However, findings from two studies by NIMH-funded researchers, published in the October issue of the Archives of General Psychiatry, may help scientists to better understand bipolar disorder in youth.

David Axelson, M.D., of University of Pittsburgh, and colleagues found that three different classifications of bipolar disorder among youth—bipolar I, bipolar II, and bipolar disorder not otherwise specified (BP-NOS)—represent varying levels of impairment on a continuum, with elevated mood as a common feature of the bipolar spectrum illness in youth. Elevated mood was present in about 92 percent of youth diagnosed as having bipolar I disorder, as well as nearly 82 percent of those with BP-NOS. Youth with bipolar II disorder showed less functional impairment and were less likely to be hospitalized than those with bipolar I disorder, and also had higher rates of co-occurring anxiety disorders than those with either bipolar I or BP-NOS. According to the researchers, this is the first study to systematically assess and compare children and adolescents with these different types of bipolar disorder.

In another study, Barbara Geller, M.D., and colleagues at Washington University showed that prepubertal and early adolescent-onset bipolar I disorder appears to be the same illness as adult-onset bipolar I disorder. Previous studies have shown differences in symptom severity, frequency of cycling between manic and depressive episodes, and other aspects that raised questions as to whether bipolar disorder in youth was the same illness as in adults. Dr. Geller also demonstrated that bipolar disorder is significantly more prevalent in relatives of such affected youth, compared with relatives of youth with attention-deficit/hyperactivity disorder (ADHD) or healthy youth. In addition, the prevalence of bipolar disorder in relatives was significantly greater if relatives had co-occurring disorders, such as ADHD, oppositional defiant disorder, or conduct disorder, and for parents the age of onset of bipolar disorder was significantly younger if he or she also had ADHD. The prevalence of major depression was not significantly different between relatives of youth with bipolar disorder and ADHD, although in both of these groups the prevalence was significantly greater than that found in relatives of healthy youth.

Axelson D, Birmaher B, Strober M, Gill MK, Valeri S, Chiappetta L, Ryan N, Leonard H, Hunt J, Iyengar S, Bridge J, Keller M.Phenomenology of children and adolescents with bipolar spectrum disorders . Arch Gen Psychiatry. 2006 Oct;63(10):1139-48.

Geller B, Tillman R, Bolhofner K, Zimerman B, Strauss NA, Kaufmann P. Controlled, blindly rated, direct-interview family study of a prepubertal and early-adolescent bipolar I disorder phenotype: morbid risk, age at onset, and comorbidity . Arch Gen Psychiatry. 2006 Oct;63(10):1130-8.

Bipolar disorder costs twice as much in lost productivity as major depressive disorder, a study funded by the National Institutes of Health’s (NIH) National Institute of Mental Health (NIMH) has found. Each U.S. worker with bipolar disorder averaged 65.5 lost workdays in a year, compared to 27.2 for major depression. Even though majordepression is more than six times as prevalent, bipolar disorder costs the U.S. workplace nearly half as much — a disproportionately high $14.1 billion annually. Researchers traced the higher toll mostly to bipolar disorder’s more severe depressive episodes rather than to its agitated manic periods. The study by Drs. Ronald Kessler, Philip Wang, Harvard University, and colleagues, is among two on mood disorders in the workplace published in the September 2006 issue of the American Journal of Psychiatry.

Their study is the first to distinguish the impact of depressive episodes due to bipolar disorder from those due to major depressive disorder on the workplace. It is based on one-year data from 3378 employed respondents to the National Co-morbidity Survey Replication, a nationally representative household survey of 9,282 U.S. adults, conducted in 2001-2003.

The researchers measured the persistence of the disorders by asking respondents how many days during the past year they experienced an episode of mood disorder. They judged the severity based on symptoms during a worst month. Lost work days due to absence or poor functioning on the job, combined with salary data, yielded an estimate of lost productivity due to the disorders.

Poor functioning while at work accounted for more lost days than absenteeism. Although only about 1 percent of workers have bipolar disorder in a year, compared to 6.4 percent with major depression, the researchers projected that bipolar disorder accounts for 96.2 million lost workdays and $14.1 billion in lost salary-equivalent productivity, compared to 225 million workdays and $36.6 billion for major depression annually in the United States.

About three-fourths of bipolar respondents had experienced depressive episodes over the past year, with about 63 percent also having agitated manic or hypomanic episodes. The bipolar-associated depressive episodes were much more persistent — affecting 134-164 days — compared to only 98 days for major depression. The bipolar-associated depressive episodes were also more severe. All measures of lost work performance were consistently higher among workers with bipolar disorder who had major depressive episodes than those who reported only manic or hypomanic episodes. The latter workers’ lost performance was on a par with workers who had major depressive disorder.

“Major depressive episodes due to bipolar disorder are sometimes incorrectly treated as major depressive disorder,” noted Wang. “Since antidepressants can trigger the onset of mania, workplace programs should first rule out the possibility that a depressive episode may be due to bipolar disorder.”

Future effectiveness trials could gauge the return on investment for employers offering coordinated evaluations and treatment for both mood disorders, he said.

Also participating in the study were: Dr. Kathleen Merikangas, NIMH; Dr. Minnie Ames and Robert Jin, Harvard University; Dr. Howard Birnbaum, Paul Greenberg, Analysis Group Inc.; Dr. Robert Hirschfeld, University of Texas; Dr. Hagop Akiskal, University of California San Diego.

The National Institute on Drug Abuse (NIDA), Substance Abuse and Mental Health Services Administration (SAMHSA), Robert Wood Johnson Foundation and John W. Alden Trust provided supplemental funding.

In a related NIMH-funded study in the same issue of the American Journal of Psychiatry, Drs. Debra Lerner, David Adler, and colleagues, Tufts University School of Medicine and Tufts-New England Medical Center, found that many aspects of job performance are impaired by depression and that the effects linger even after symptoms have improved.

The researchers tracked the job performance and productivity of 286 employed patients with depression and dysthymia, 93 with rheumatoid arthritis and 193 healthy controls recruited from primary care physician practices for 18 months. While job performance improved as depression symptoms waned, even “clinically improved” depressed patients performed worse than healthy controls on mental, interpersonal, time management, output and physical tasks. The arthritis patients showed greater impairment, compared to healthy controls, only for physical job demands.

Noting that 44 percent of the depressed patients were already taking antidepressants when they began the study and still met clinical criteria for depression — and that job performance continued to suffer despite some clinical improvement — the researchers recommended that the goal of depression treatment should be remission. They also suggest that health professionals pay more attention to recovery of work function and that workplace supports be developed, perhaps through employee assistance programs and worksite occupational health clinics, to help depressed patients better manage job demands.

Also participating in the study were: Dr. William Rogers, Dr. Hong Chang, Leueen Lapitsky, Tufts-New England Medical Center; Dr. Thomas McLaughlin, University of Massachusetts Medical School.

The Tufts-New England Medical Center General Clinical Research Center is funded by the NIH’s National Center for Research Resources.

The National Institute of Mental Health (NIMH) mission is to reduce the burden of mental and behavioral disorders through research on mind, brain, and behavior. More information is available at the NIMH website,http://www.nimh.nih.gov.

The National Institute on Drug Abuse is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports more than 85 percent of the world’s research on the health aspects of drug abuse and addiction. The Institute carries out a large variety of programs to ensure the rapid dissemination of research information and its implementation in policy and practice. Fact sheets on the health effects of drugs of abuse and information on NIDA research and other activities can be found on the NIDA home page athttp://www.drugabuse.gov .

NCRR provides laboratory scientists and clinical researchers with the environments and tools they need to understand, detect, treat, and prevent a wide range of diseases. With this support, scientists make biomedical discoveries, translate these findings to animal-based studies, and then apply them to patient-oriented research. Ultimately, these advances result in cures and treatments for both common and rare diseases. NCRR also connects researchers with one another, and with patients and communities across the nation. These connections bring together innovative research teams and the power of shared resources, multiplying the opportunities to improve human health. For more information, visithttp://www.nih.gov/about/almanac/archive/2003/organization/NCRR.htm .

The National Institutes of Health (NIH) – The Nation’s Medical Research Agency – includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov .

About the National Institute of Mental Health (NIMH): The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure. For more information, visit the NIMH website.

July 3, 2006 • Science Update