Bipolar4LifeSupport

An advertising company recently joked that people with bipolar disorder need not apply. Were they out of line?

FRIDAY, Jan. 13, 2012 — Agency experience. Formal design training. A knack for social media. These are some of the requirements listed on a recent Craigslist ad, posted by a San Francisco boutique advertising agency looking to hire a print and web designer. But there’s one applicant “must” that may make you do a double-take: Sanity.

Specifically, the ad indicates that “If you are a prima donna, bipolar, or require anger management, please go to a big agency where you can hide in the crowd.”

The San Francisco website SFist.com spotted the ad, acknowledging in an article that the agency Palmer Advertising likely meant the description to be “tongue in cheek.” The company has since taken down the original posting (here’s the revised job description) and apologized for their language. “This was a mistake on our end,” an employee wrote to Everyday Health in an email. “Sometimes, the creative department gets a little too creative … It is not a true representation and is truly taken out of context. I do not want to upset anyone.”

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Wisecracks and apologies aside, the description still begs the question: Why would anyone tease about bipolar disorder? Has the condition — which is characterized by potentially dramatic shifts in mood — become a joke?

Imagine that you are a talented designer looking for a new gig. You’ve got plenty of experience under your belt, your portfolio is pristine — and you also happen to have bipolar disorder. According to the National Institute of Mental Health (NIMH), nearly 3 percent of adults in the United States are affected by the mental health condition — that’s about 5.7 million Americans.

Would the job description discourage you from applying? Or if you did apply, would you feel the need to keep your condition a secret? SFist notes that discriminating against a candidate because of their mental health status is not only wrong, it’s illegal. According to the National Alliance on Mental Health (NAMI), the Americans With Disabilities Act “prohibits discrimination against people with disabilities in employment; state and local government activities; public accommodations; public transportation; telecommunications; and public services.” The act extends to people with “mental impairments.”

But the employees at Palmer Advertising aren’t the only ones out there who have, even if unintentionally, contributed to mental illness stigma — far from it. Last year, NBA star Brandon Jennings made headlines when he tweeted “I’m bipolar. (true story)” and then later claimed he was joking. An episode of the Nickelodeon show iCarly depicts the main character checking into a mental hospital and calling herself crazy … all because she kissed a boy she can’t stand.

NAMI notes that one in five Americans has some form of mental disorder — but nearly two-thirds of them live in silence and go without treatment, likely because of the stigma surrounding their condition. And the U.S. Office of the Surgeon General (OSG) has pointed out that mental illness stereotypes (such as that people with bipolar disorder are “crazy” or “wacko”) may be the biggest barrier to seeking help.

We applaud Palmer Advertising for taking down the ad and apologizing. Perhaps awareness about the debilitating effects of stigma will one day help prevent these kind of mishaps from happening in the first place.

What do you think? Was the agency out of line — or was it just a meaningless joke that no one should take offense to? Tell us in our comments section below.

Many people keep bipolar disorder a secret from their friends, love interests, co-workers, even family members. Follow this step-by-step guide to striking up this important conversation.

Filling someone in on your health history may not be your typical ice-breaker — and for people with bipolar disorder, sharing the diagnosis can be emotional and challenging.

But bipolar disorder is nothing to be ashamed of, and if you are proactive about starting the conversation, you will set a positive tone, whether you’re breaking the news to a family member, your boss, or a new love interest.

In fact, there are many reasons you should be open about bipolar disorder. “If patients carry their diagnosis around as a secret, it becomes a burden and they may feel even worried and alarmed that people are going to find out,” says psychiatrist Daniel Wilson, MD, chair of psychiatry at Creighton University in Omaha, Neb. Sharing can lighten your emotional load.

Other reasons to have the “bipolar chat” include:

Getting support. Just as when you have the flu, you will need the love and care of people around you during bipolar treatment and they, in turn, will appreciate knowing what’s going on with you.
Educating your loved ones. Finding a way to talk about bipolar disorder will allow you to inform the people in your life about your symptoms, as well as your bipolar treatment.
Identifying bipolar triggers and symptoms. People around a person with bipolar disorder are often the first to notice bipolar symptoms, particularly with mania. “Patients don’t always have the same degree of awareness of what’s happening,” says Dr. Wilson.
Breaking the News About Bipolar Disorder: An Eight-Step Guide

Once you decide that it’s time to tell others about your bipolar disorder, planning the conversation can be challenging. Use these step-by-step strategies:

Pick a calm moment. Too often, these conversations are forced by a crisis, says Wilson. “It’s better to have the conversation when the person is feeling well,” he says. That’s why you should share your diagnosis before another episode requires an immediate response. If you can choose the location, find a place where you feel comfortable and one that offers privacy for everyone involved.
Practice. It’s always a good idea to make a trial run with important conversations. Your therapist or a friend who already knows about your situation could be a good sounding board.
Fine-tune for your audience. Your exact words will be different if you are talking to a family member, a romantic partner, or a co-worker — so plan accordingly. For example, when you are talking to your boss, it might be helpful to bring along some of the highlights of your work history to show that you’ve been a productive employee over the years despite bipolar symptoms. If you are talking to a new love interest, it’s best to pick a time early in the relationship out of respect for your partner’s right to make choices about continuing to date you with full knowledge of your situation.
Be a teacher. There’s a good chance the person you are talking to doesn’t know much about bipolar disorder. Come prepared with helpful information. Bring pamphlets or contact information for a support group if you think that would help, or invite the person to meet with your counselor or doctor to fully understand your bipolar treatment.
Shut out stigma. You might be able to help your loved one better understand the implications of your diagnosis if you use a disease analogy. “I like to compare it to an overactive thyroid,” says Wilson. “Clearly you want to treat that condition.”
Make amends. If appropriate, you might want to acknowledge damage done by past behavior caused by bipolar symptoms. “Explaining that it wasn’t just a personal preference to behave in a particular way and that there is this medical aspect to it can be helpful,” says Wilson, adding that many patients feel guilt and shame over their actions and sincerely want to make amends. In some cases, both the disclosure of your diagnosis and acknowledging the impact of your choices might both be better handled in a letter.
Give them time. Some people are very open and flexible, but others — possibly family members with rigid ideas about family identity — can have a hard time digesting your news. “It’s often helpful to have a cooling-off period, letting people go their own way for a while,” says Wilson.
Accept their responses. Sharing your bipolar diagnosis may leave you feeling vulnerable and, unfortunately, not everyone will respond the way you wish they would. “I’ve had to advise patients to limit their contact with some family members for a while,” says Wilson. Talk to your therapist if you’re disappointed about the response that your disclosure received.
Keep in mind that what the person you are talking to does with the information you share is out of your control. “I’ve seen many cases of excellent, supportive work situations, and situations in which when people at work found out, they clearly tried to shuffle the person out of the job,” says Wilson.

To better help you manage this unpredictability, Wilson advises involving your counselor or therapist along the way, especially if your disclosure causes a major shake-up in your family dynamic or triggers denial or hostility.

The relationship between steroids and bipolar disorder isn’t well-established, but some doctors believe these anti-inflammatory medications can cause bipolar disorder symptoms.

Experts still aren’t sure of all the causes of bipolar disorder. But some medical professionals believe that one trigger can be the use of steroid medications.

Steroids, a class of medications that reduce inflammation in the body, are given for a variety of conditions, from asthma to arthritis. Certain people may find that these medications trigger a cycle of behavior typically associated with bipolar disorder, says Donald Freeman, MD, a psychiatrist in Beverly Hills, Calif.

“Someone can have asthma and need a course of steroids, and then have a big mood swing,” Dr. Freeman says. “It can either come in a phase of mania [overly excited behavior] followed by depression or depression followed by mania. But there’s always a low and a high.”

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However, Carrie Bearden, PhD, clinical neuropsychologist in the Department of Psychiatry and Biobehavioral Sciences at the University of California, Los Angeles, cautions: “There is certainly anecdotal evidence for steroid use triggering mood symptoms (either mania or depression), but [it has not been] empirically studied. ”

Jane Pauley’s Personal Account

In her 2004 autobiography, Skywriting: A Life Out of the Blue, television journalist Jane Pauley says she began experiencing symptoms of bipolar disorder after taking steroids for hives. The reason for such a reaction, Freeman says, is the stimulating effect that steroids have on the body. For example, difficulty falling asleep is a common side effect of prednisone, a frequently prescribed steroid.

The manner in which steroids are usually given — with a large dose up front to reduce the inflammation quickly — may also lend itself to triggering bipolar symptoms, Freeman says. “You get a big hit right away,” he explains. “That situation is set up to induce mood cycles.” People who take smaller steroid doses, such as those found in asthma inhalers, are less likely to experience bipolar behavior, he adds.

Those with a family history of the disease are particularly susceptible, Freeman says. “Identical-twin studies have been done, and it’s been found that when one twin has manic depression, the likelihood of other twin having manic depression is much higher than if it was just random,” Freeman says. “We know there is a genetic component.”

Alternatives to Steroids

This relationship between steroids and bipolar symptoms can make for a sticky situation in patients who have a family history of the disease or who have been diagnosed with bipolar disorder. However, people who are already being treated for bipolar disorder with mood-stabilizing medications may not see significant mood swings from steroid use — the medicine can often mitigate the steroid’s effects.

If steroids are needed for a relatively minor condition — say, a case of poison ivy — then it might be wise to ask your doctor about non-steroid treatment alternatives. “You can use calamine lotion and suffer through itching for 10 days, [and] maybe try some antihistamines,” Freeman says.

In more serious situations, like brain swelling due to a car accident or other trauma, your doctor may prescribe steroids in spite of your predisposition to bipolar disorder. “That’s a life-threatening situation that would require steroid treatment,” Freeman says.

If you do choose to use steroids, it’s important to stay in close contact with your health care provider about any unusual feelings you may be having. Be honest about any highs and lows you’re experiencing. This will help your doctor determine whether medication, and what kind, is needed to treat your symptoms.

Also known as cyclothymic disorder, the condition is different from other types of bipolar disorder.

Cyclothymia is a milder form of bipolar disorder, sometimes referred to as cyclothymic disorder.

Both cyclothymia and bipolar disorder are characterized by extreme mood swings, from the highs of mania to the lows of depression, with short periods of neutral time in between.

The difference lies in the intensity: People with bipolar disorder will experience major depression and clinically diagnosed mania, while patients with cyclothymia experience low-grade depression and mild mania.

With cyclothymia “it may seem like you’re just going through a string of good days and a string of bad days,” says psychiatrist Kathleen Franco, MD, of the Cleveland Clinic Lerner College of Medicine in Ohio.

“But the mood shifts keep going, and there’s little neutral time in between.”

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Cyclothymia Symptoms

Besides cycling between the two mood extremes, the other criteria that will determine a diagnosis of cyclothymia include:

You’ve experienced these mood swings for at least two years.
At least once in the two-year period, you have significant distress or social impairment.
Your symptom-free intervals last no more than three months.
Your symptoms don’t meet the requirements of any other bipolar disorder.
Cyclothymia vs. Bipolar Disorder: What’s the Difference?

Only a doctor can accurately make the clinical distinction between cyclothymia and bipolar disorder.

But generally speaking, the symptoms of a major bipolar depression include dramatic disturbances in

Symptoms can be long-lasting and dramatically reduce quality of life.

The same symptoms may be present in a cyclothymic depression, but they’re less severe (though they can have a significant impact on quality of life and social functioning).

The symptoms may last no more than two weeks, and they may cause less of a disruption in your daily routine.
The true mania of bipolar disorder, essentially the opposite of major depression, can likewise be debilitating.

It may be accompanied by feelings of euphoria and indestructibility — a sense of being “on top of the world” — that can include reckless behaviors such as driving too fast or abusing drugs or alcohol.

The manic person may go a day or two without sleeping. He may talk rapidly, moving from topic to topic without making much sense.

The hypomania seen with cyclothymia is less dramatic and not as long-lasting. Your symptoms may be so mild as to seem normal — mild sleeplessness, for example, or chattiness and increased energy.

While some people living with cyclothymia are happy to go without treatment, it may be important for others to recognize and monitor the condition, because one-third to one-half of people with cyclothymic disorder go on to develop full-blown bipolar disorder.

This escalation is especially prevalent if bipolar disorders run in the family.

Although preventive treatment hasn’t been identified yet, there is some hope among researchers that early treatment for cyclothymia may prevent full-blown bipolar disorder from developing.

Cyclothymia Treatment

There’s no cure for cyclothymia.

Medicines usually prescribed for bipolar disorder, such as mood stabilizers, don’t always work on cyclothymia.

More often, treatment for cyclothymia involves talk therapy with a trusted psychologist who can help patients recognize the triggers that may increase the severity and frequency of their mood swings.
For example, mood shifts can be triggered by lack of sleep, alcohol consumption, or traveling through many time zones.

Light therapy can also help treat cyclothymia.

In time and with the help of a trusted support team — beginning with your doctor — you can learn to manage your moods and your response to them, and live a life less disrupted by cyclothymia.

Last Updated: 7/1/2016