Hi, everybody. Welcome to a live Q&A session about bipolar disorder. This broadcast is brought to you by the good people at Healthline.com. My name is Dr. Rob Dobrenski and I'm a licensed psychologist here in New York City. I'm a consultant for Healthline. I'm also the mental health expert with Yahoo! Health.
I also had my first book published back in June. It's called Crazy: Notes On and Off the Couch. What I'm going to do here is I'm trying to give you the best information possible about bipolar disorder. I have some questions that have already been submitted and others should be coming in live, and I'm going to answer as many as I can in the time that we have.
Remember, though, this is not a substitute for medical treatment and really should be used for informational purposes only. You hear that all the time with broadcasts about medical stuff, but I think it's particularly important in psychology because there's just so much variability between people. There are exceptions to almost every rule. So please consider what you hear from me today as simply guidelines to help you make good choices going forward.
Alright, so let's get into it. There are a couple of questions I want to do first because it's come in multiple times and I think it will put us all on the same page.
Question: What are the major symptoms of bipolar disorder?
Answer: A lot of people might know this, but there’s usually a big mistake in this. Usually, when people think of bipolar we think of really, really high and really, really low, but I tell people you don't want to think…especially about the high periods we talk about, you don't want to think elevated. You want to think more expansive.
Most people think, "Oh, during the manic phases I should feel really, really, good," which is true sometimes, but a lot of people feel very, very irritated or they feel really, really excited about things and people will question them because they seem a little bit off. And then they'll feel frustrated that people are not on board with their plan. So everything really seems to be kind of just bigger than it would normally be. It's not always just good.
Usually, you see those things last at least once a week. Some of the common features would be: decreased sleep, racing thoughts, really fast speech, a lot of distractibility. And sometimes you'll see risky behaviors – people spending money outside their means, engaging in risky sexual behaviors, things like that.
Now, remember, self-diagnosis is a very, very risky endeavor because those symptoms in and of themselves don't necessarily make for bipolar. Various medical conditions, issues with using substances and other psychological conditions could be causing these symptoms, so you always want to consult with a mental health professional if you think you might be in this ballpark.
Question: What's the difference between being manic depressive and bipolar?
Answer: Good question. There actually is no difference. We've just changed the terms. Sometime – I think it was in the '90s – we basically just switched the term manic depressive and replaced it with bipolar. You hear people still use manic depressive, but it's an old term. It's kind of like we don't called multiple personality disorder that anymore. Now, they call it dissociative identity. So it's the same thing. It's just that manic depressive is an antiquated term.
Question: What's the difference between bipolar I and bipolar II and are there other types of bipolar?
Answer: Bipolar I is considered kind of the classic standard. Now, I'm going to try to show you using a graph of my finger here. Usually, when we think of Bipolar, we think of it as something with ups and downs. This is your baseline, so it something that goes like this.
Bipolar II is just considered a more mild form of that, so the ups are not necessarily way up here. They're more like right around here. The depressive pieces tend to be the same in both. There's also a third type called psychothymia, which is like a mini version of both. It's usually not nearly as debilitating. It's got the highs. It's got the lows and most people can usually detect it, but it's usually not nearly as extreme.
Question: I was diagnosed five years ago when I was in a very high manic phase and I've not had one since. Is it possible to be bipolar and only have had one manic episode in your life?
Answer: Absolutely, and this is one of the controversies and one of the problems with what we know about bipolar disorder. You can have one single episode and you will essentially be labeled as bipolar disorder, basically, throughout your whole life. Now, that doesn't mean that there won't be others later. This person went five years. I hear of people going 10-15 years without another episode. So it is possible.
Now, you even hear sometimes psychiatrists now saying that anything that even resembles a manic episode will sometimes be labeled as bipolar, which is really risky because it's kind of a heavy term. It scares a lot of people and while it may be true, usually, you're looking at the more common situations where people have multiple manic episodes, but not always. You can have one episode and that's enough.
Question: I have a child that I placed for adoption years before being diagnosed with bipolar disorder. Should I let the adoptive parents know about my diagnosis? Should I include how I came to be diagnosed?
Answer: Well, this is an interesting question because, basically, it ties into bipolar disorder and genetics. Depending on the study that you look at, you can see a genetic connection in many as low as 4% up to as much as 24% in first-degree biological relatives.
This is kind of an ethical question. I think probably the best answer would be to contact the adoption agency and just ask what their policy is with finding out new information about a biological parent's mental health or physical health.
That's a wide variability. A study of only 4% connection and as high as 24% – a lot of variability there. There's clearly some genetic connection. We don't know, at this point, exactly what it is.
Question: Can the highs and lows that are characteristic of bipolar disorder happen quickly, as in many times throughout the day, or is it only classified by long periods of highs and lows?
Answer: This question might be referring to what some people know about, which is called rapid cycling, where people go through multiple manic and depressive episodes but, you really – in those cases – you really think more about not multiple times a day. You're thinking about multiple times per year. What this person is talking about could be…and this will tie into the next question that is coming in – the difference between bipolar disorder and borderline personality disorder because there are some similarities. Usually, people who are cycling that much throughout the day, it's usually not bipolar.
Borderline personality disorder, which many people have heard of, is different than bipolar in the sense that it's not considered a symptom disorder. It's considered a personality disorder. That doesn't mean a flaw in character, but it means a way of viewing the world that tends to be just really maladaptive. So what happens is you see people kind of shoot up in a very happy phase and come down very quickly multiple times throughout the day. So they’re considered very transient mood states and those people are considered very labile. So what the person is referring to here, my guess is that's not going to be bipolar, but, as always, you don't want to diagnose that yourself.
Question: Is there any clear way to know whether one has bipolar or borderline personality disorder?
Answer: A mental health professional can give you a diagnosis, but there are no X-rays or CT Scans or any sort of lab findings that can clearly differentiate those two. Keep that in mind, as well.
Question: Is bipolar a disability?
Answer: Bipolar can be a disability. Those things usually are decided by state government agencies regarding what's a disability and what isn't. Bipolar can be an extremely crippling disability. It can impact everything – work, relationships. We're going to get into some questions about that, as well. So depending on how severe it is, absolutely. Some people are able to get financial compensation for being disabled due to bipolar. It's usually decided, though, by multiple mental health professionals when they figure that out.
Question: What medications work best for bipolar?
Answer: Really tough question. Now, I'm a psychologist. I'm not a psychiatrist, so I'm not doing any prescription-writing myself, but I think anyone who would come on here would really want to shy away from this question because, as I said right at the beginning, there is so much individual variability.
When it comes to medicine, most people say that Lithium is kind of the gold standard. Most medicines are measured against that, but there is no such thing, really, in any mental health area, where one medicine is just the best, period.
You are going to have to look at individuals and what works for them. That includes age, family history because some medicines tend to work well in families. Side effect profiles, which impact some people more so than others and some are more important to other people. Some medicines have side effects that are sexual and that's really important to some people. Some have issues regarding weight gain and that really important to other people.
So you never want to get caught into the sea of just what's best. You want to talk to you doctor and a lot of questions have come in about, "I'm taking blank, blank and blank and it's not working. What do I do? Is there another option?" There are almost always other options, but in something like bipolar or anything related to mental health, you have to be your own advocate and you really have to talk to your doctor in a proactive way. You have to say, "This is not working." You can't simply just go with what they say. Now, that's not to say they don't know what they're doing, but I always tell people that if you don't think you're getting all the options, I always say, "Ask the doctor.” “What else have you prescribed for people in this spot,” or “Are there any other options that you can possibly think of?" Engage in as much dialogue as you can with your doctor and if you're not getting the results, keep asking for alternatives.
Question: When is it a good idea to reveal your diagnosis to people around you, if ever, such as employers, new friends and family?
Answer: There's going to be a lot of variability on this, too. I wrote a post for Yahoo! Health recently on depression in the workplace and who should you tell, and who should you not tell. When I mentioned talking to co-workers, I said it might be worthwhile sharing, but don't treat your co-workers as a support group.
I think a lot of people feel a lot better when they actually share what's going on with them and you may be surprised. There may be people in the office who also have mental health issues and that can be really, really helpful, but the workplace is really for work. If you're talking to your boss, I think the big thing is just remember who that person is. That person has the company's interests at heart first.
I also stress to people that if they're going to talk about having some sort of psychological or psychiatric issues with their boss, you always want to make sure to always highlight the point that you're addressing it and that it's not going to impact your work, as much as possible.
What I've seen with a lot people is when they just kind of say there's something wrong, immediately the superiors often start looking for flaws in their work. That doesn't mean that bosses are uncaring or I'm not trying to imply that for everyone, but I think it's a really good idea to get the idea forward that I'm addressing it. It's not just that I have this illness and I'm a victim. I'm doing something about it.
When it comes to family and friends, this ties into another question about someone was saying, "People just don't get it. They don't understand it. How do you talk to someone who doesn't have bipolar?" Mental health, in many ways, is kind of like religion and politics – people are going to believe what they want. I always tell people there are plenty of research articles on bipolar that you can find, but it's not your job if you really can't convince someone that you've got a mental illness. That's ultimately going to be their problem.
You have to be okay with saying, "This is the facts. I know what the facts are and I'm going to be okay with it.” Your family and friends, hopefully, they're there as a good support system. For those who aren't, people will often go to see a therapist in addition to working with a doctor. That ties into another question that's coming in.
Question: What talk therapies are effective for bipolar and can people be treated for bipolar without medication?
Answer: Let's do the second one first. Generally speaking, medicine is the way to go with bipolar disorder. We don't have a lot of evidence that therapy helps for bipolar at least in a direct way of decreasing mania or improving mood, especially when it's that severe for bipolar. Medicine is usually the option. Most doctors are likely to encourage you to stay on it as long as possible, if not for life.
The therapies usually come in to help people identify patterns in terms of what things might trigger manic or depressive episodes, to provide support and education and also to help families. Someone asked, "How can my husband and I cope with his bipolar diagnosis?" I would say to see a therapist for those things or join a support group.
There are people who have been there or people who understand and the professionals, generally, are really good at just helping people get a structure and build their life around the bipolar idea. The thing is, when people here that they're bipolar, they immediately just start to think their whole life is going to come falling apart, which doesn't have to be the case, but it does have to be treated actively and I think you should be consulting with a therapist as to how it does impact relationships and things like that.
Question: Is there a relationship between bipolar disorder and dementia?
Answer: I'm not aware of much related to that. I believe I've seen one study that showed a decrease in dementia for people who had bipolar who took Lithium, but I think that was just a singular study and I think that's just a brand new area that's opening up. Dementia is kind of a pretty hot topic right now, so they're probably going to link that to bipolar at some point to see if there is any connection. Right now, though, there's really not all that much in that area.
Question: I suffer from some of the symptoms of bipolar disorder, but they're not as intense as described on different web sites. Is this still bipolar? Do you think I should visit a mental health professional?
Answer: I'm not sure. It could be bipolar. It sounds like with that very, very limited information, it smacks a little bit of maybe bipolar II or psychothymia, which I mentioned at the beginning of the Q&A. There's no way to know for sure without consulting. I always encourage people if finances are not an issue, if your insurance will cover it. I don't think it's ever a bad idea to consult with a mental health professional on something like this. It's really just your time. There could be finances involved or your co-pay, if your insurance covers it, but visiting a mental health professional is not a life-long commitment. It's a consultation. You use the information to make good choices going forward.
I think people see it as a little bit too…they make it bigger than it actually is. If I go to see someone that means I'm extremely mentally ill or that I'm committing to something huge. It's really not. Some people just go to a single session or two just to kind of get the information. That's fine. That's not a problem at all. So if you have the means and the time, it's certainly worth exploring because if there is something there, again, you want to treat it as aggressively as possible.
Question: How is it possible for someone to counsel a person with a mental disorder like bipolar if they themselves haven't had the condition and can't truly understand what goes on in the head of the patient?
Answer: This is a great question. The reality is no one – that’s mental health professional or not – can truly get in your head whether they've had the disorder…even if they've had the disorder. They don't know what it's like for you. We, as professionals, are trained to know the symptoms and know the best possible treatments. That's all we know. We can't understand, "Oh yeah, we've been there." Even someone who's in a support group, their experience is going to be a little bit different than yours. The good news is that the medicines and mental health as a whole, has a pretty good track record for a lot of this stuff, whether they've had the condition or not.
I talk about this in my book. A lot of the mental health professionals that you see do have their own stuff going on and you'll probably never know about it. My theory is, I've always said, "We're all crazy." That's why the name of my book is called Crazy, but not in the [PH 17:29] majorital way. I just think everybody's got stuff. Some of it's more severe, but the mental health professionals who are good, they know how to ask the right questions. They don't need to necessarily have had that diagnosis to be able to do it.
Question: Everyone talks about the highs of bipolar as something really great, but I get mostly irritable. Am I some strange exception?
Answer: Going back to what I said earlier, no, you certainly are not the exception. In fact, in many ways, I think this is becoming the norm. Especially because people tend to see these people on these highs and ask a lot of questions because they just sense something is up. It usually makes those people very irritable. Again, you want to think expansive mood. Don't just focus on the highs in such a good way.
Is it true that people get very, very productive during those times? Sure. That happens a lot, although, what you will see and a lot of people don't talk about is that sometimes people will have almost like an ADHD quality to it, where they'll start a lot of things, but don't necessarily finish a lot. So they'll be productive in starting stuff, but you're not going to see nearly as many of these completed projects as movies and TV people will lead us to believe.
Question: When are most people diagnosed with bipolar disorder?
Answer: Trying to remember my history here. The average age, I believe, for bipolar is about 20. Although, it really can occur at various points throughout the lifespan. You can see it in the 50s and 60s. Usually, though, over 40, doctors start to think about other things like maybe substance use, medical issues, maybe a sped up thyroid. So 20 is the average. Over 40, you start considering other things, but it's not something that everybody is completely free of at a certain point.
Question: A lot of the questions, again, are asking about the coping aspect within families and things like that.
Answer: The best thing that anybody can do is to have as much open communication about it within a close-knit family and have all the information possible. So that usually means medical intervention, psychological intervention. Sometimes it's a support group.
I have a lot of husbands and wives come into my practice where they have a partner who is bipolar and a lot of it is really helping to understand when the symptoms come on, any of the patterns. Couples who get together as a team on this stuff tend to do better than people who work on it in isolation. So it's really important that you have all of the information at your disposal. So that includes things like this, but also attending those appointments and getting as much support as possible.
Bipolar doesn't need to be this debilitating thing that everybody talks about. It doesn't need to be as scary. It can be very, very crippling and very, very painful, but the people who are really working hard on it live much fuller lives than those who don't. So you never want to get into the spot of living in ignorance. Take advantage of all the resources that are available to you.
I think that about covers it. I just want to give one more scan, make sure there’s nothing that I didn’t get into or touched on with the other things. There’s more questions coming in. Let me take a look here.
My chat seems to have stopped. I’m going to ask the producer if she could email me some a few of those questions, so I can answer those.
Answer: For people who are doing self-help, which is just doing things on your own, there's a great resource. It's by a group called TherapyWorks. They produce really, really good hands-on self-help manuals for anxiety and for panic. There's one called How to Handle Your Anxiety and Worry and one called How to Handle Your Anxiety and Panic. Both of those are excellent manuals.
What they usually talk about…for panic, there's a lot of good research on things like diaphragmatic breathing, which you can look up, as well as cognitive behavioral therapy for both anxiety and panic. There are good self-help books for that. You also might want to consider consulting a professional specifically for anxiety and panic because those two conditions have a much better track record in terms of therapy than therapy does for bipolar disorder.
Question: Since I have bipolar, will my children have it?
Answer: Like I had said in the beginning, there are studies that show first degree relatives are only talking about a 4% chance up to as high as 24%. Those are smaller numbers, but they are not…there's no guarantee there. There's clearly a genetic component, but I don’t think people should be making the assumption that because they have bipolar, their children will, too. The best thing you can do is make sure your bipolar is being treated, so that you're giving your kids the best of you. People who are leaving their bipolar disorder untreated usually get themselves into a bad spot where it impacts everything they do, including their parenting.
Question: I have an adult child. I feel she has signs of bipolar. How can I get her to seek help if she is unwilling?
Answer: Unfortunately, if you've got someone who's unwilling and is an adult, there's not much you can do. What I've said to a lot of people who have had this problem is that you want to try to point out to the person what they're missing and how it's impacting them, whether it's their relationships, whether it's their job, whether it's their schooling, whether it's their recreation. Most people who show signs of bipolar are experiencing something that is not in their best interests. It's your job to kind of point that out.
Some people and I'll often make the analogy that it's like a substance abuse. Some people will need to hit rock bottom before they'll do anything about it. They need to come to that conclusion on their own. All you can do is point them in the right direction and really encourage them to see what they're missing, but we can't, unless someone is imminently suicidal or a danger to somebody else, we can't force treatment on them. That's the way the system is set up.
Question: How can I tell if I'm in a mixed episode? I try to track my moods, but I don’t know that I can tell what a mixed episode is
Answer: There are actually two ways that people look at mixed episodes. Some people will consider a mixed episode that they go high and then they go low, and those are discreet periods. This is why a therapist can be really, really helpful because people who are tracking their moods, they often can't necessarily see what other people see in terms of their behaviors.
A therapist is really good at helping people to really figure out where the discreet moments are. Now, other mixed episodes, people sort of describe a combination of the expansive stuff that I was referring to, but also feeling really down.
It's hard to tell, just with this question, how to really flush that out. I think if you are keeping track of your moods, if you're not seeing a therapist, you want to start. You want to bring that information in. A lot of people will keep track of…even throughout the day they'll rate their moods and they'll look for patterns, but my guess is if you can't tell and it's not standing out, you're probably missing something in terms of your behaviors or things that other people can't see. So you want to seek some help for that, as well.
That just about covers it, I think, for us. I want to thank you so much for coming out for the Q&A. If you want to come back to review any of the information, there's going to be a recorded version of this right on this URL starting later at the end of this week. I hope the information…
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