Bipolar Blog

Under Construction - We’re currently working on a three-part post on this topic to answer the following three questions:

1. What are my options for treating bipolar depression?

2. Is my antidepressant making me manic?

3. How effective are antidepressants alone in treating bipolar depression?

Stay tuned.

In a recent article in Westchester Magazine entitled “I’m Bipolar. He’s Bipolar. You’re Bipolar,” Carol Hall ponders the following: “Sometimes it may seem as if everyone is bipolar. Is this a real condition – or just a fashionable diagnosis?”

Although this question is likely to ruffle the feathers of anyone who’s had to deal with the often brutal reality of bipolar disorder, Hall explores this issue in detail and presents answers from various perspectives, including insights from both experts in the field (including myself) and patients who live with the disorder. (Visitors to the Bipolar Blog are already aware of what I see as the potential problems posed by over-diagnosing bipolar in children, as I discuss in “Bipolar Disorder Overdiagnosed in Children?“)

“Dr. Biederman’s stance is we diagnose young, so we can fix it early,” says Dr. Candida Fink, a New Rochelle-based child and adolescent psychiatrist. “But there are a lot of pre-pubertal children who are being diagnosed without presenting the full range of symptoms. People have gotten into labeling these kids ‘bipolar’ when many of them are not.” Dr. Gallager of Westchester Medical Center reports that his emergency room is seeing roughly the same percentage of bipolar adults but “about fifty percent more kids.”

From “I’m Bipolar. He’s Bipolar. You’re Bipolar,” by Carol Hall, first published in Westchester Magazine

The article does an excellent job of highlighting many of the factors that may be contributing to the rapid rise in the bipolar diagnosis over the past decade (a 40-fold increase in children and adolescents, and a two-fold increase in adults). Here are some of the most likely contributing factors (many, but not all, of these are mentioned in Hall’s article):

• A greater awareness of bipolar disorder among doctors. The idea here is that many doctors simply did not recognize bipolar in the past, so they diagnosed it less.
• A greater awareness of (and perhaps a greater acceptance of) bipolar disorder among consumers allows more people who really need help to feel more comfortable seeking it rather than just trying to deal with it on their own.
• In the past, doctors often missed the bipolar diagnosis – patients often present with depressive episodes before full blown mania, so without careful diagnostic sleuthing, many people with bipolar were being diagnosed as depressed.
• The professional criteria for diagnosing bipolar disorder have expanded with the publication of the 1994 edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The addition of the Bipolar Disorder Not Otherwise Specified category opened up a much larger range of mood regulation difficulties to being diagnosed as a bipolar variant.
• The highly influential 1994 article published by Joseph Biederman, MD from Massachusetts General Hospital formally introduced the idea that young children could have bipolar disorder and described many (1 out of 60) of his sickest patients with this label. Prior to the publication of this article, bipolar disorder was thought not to occur in pre-adolescent children.
• Diagnosing children with mental illness has become more acceptable.
• Diagnosing older people with mental illnesses has become more acceptable.
• The proliferation of pharmaceuticals to treat both depression and mania have encouraged more doctors to make the diagnosis.
• Health insurance companies tend to pressure doctors to work quickly, encouraging quick diagnostic labels and the quickest possible intervention. This often leads to medication rather than taking more time for a comprehensive assessment and recommending more complex and comprehensive treatment interventions that would include various types of therapy and supports in addition to medication. Reimbursement for non-medication interventions has typically been much more restricted than for “medical” treatments.
• While it is just a speculation, it seems quite possible that as more and more anti-depressants (especially SSRI or Selective Serotonin Reuptake Inhibitor) are prescribed for treating depression, amphetamines (such as Adderall and Ritalin) are prescribed for treating ADHD, and other stimulants (including caffeine, nicotine, weight-loss drugs, and energy drinks) are used for various purposes, we’re seeing more emotional and behavioral side effects that can include agitation or sleep disturbances or even classically manic symptoms that may result in a premature bipolar diagnosis.

Wisely and appropriately, Hall is careful to point out that her report discusses trends, and that any question of whether bipolar disorder is over-diagnosed does not presume that bipolar is a phony diagnosis or that people (including children and adolescents) diagnosed with bipolar disorder have something else entirely. Her article contains reports from patients and parents who battle this devastating illness on a daily basis and who require medications and therapy to level out their mood fluctuations.

Her conclusion that bipolar disorder’s “newfound fame is helping its victims” is right on target. For those with this disorder, heightened awareness and improved understanding by the public – that this is an illness and not just “an excuse” or a moral failing – can only be positive. Shining a light on this most painful of illnesses is the only way to ensure that patients will be more able to seek help comfortably, and professionals will be more likely to make the diagnosis and provide help to those who are suffering.

Overall, I think this article is very well done, and I think you should certainly check it out.

Madness, by Marya Hornbacher, is one of the few personal accounts of bipolar disorder I’ve read that covers the escalating unfolding of the disorder from such an early age (4 years old) to the present. The book covers just about every aspect of the struggle with bipolar disorder – early failures to diagnose it, misdiagnosis, clueless and competent psychiatrists and therapists, stressors, triggers, the tendency to self-medicate, hospitalizations, hyper-sexuality, the terrible side effects of many of the medications used to treat depression and mania, bipolar and career, alcoholism, self-mutilation, relationship dynamics, lack of insight (not realizing when a manic episode is settling in), and the highly productive and invigorating hypomanias that often convince those with bipolar disorder that nothing’s wrong. Her narrative functions almost like a textbook case study of bipolar disorder. Read the rest of this entry »

Whether you’ve been recently diagnosed with bipolar disorder or have been dealing with it for a long time, it’s likely that nobody has taken the time to sit you down and explain what you can and should be doing to help yourself. We’ve put together this Top 10 list to bring you up to speed on bipolar self-help strategies that really work: Read the rest of this entry »

By Joe 

In a previous post, “Should I Go or Should I Stay?” I discuss the dilemma that many people face when living with someone who has bipolar disorder.

Lately, I’ve been thinking about relationship dynamics and how these dynamics can trigger confrontations. I’m one of those people, for example, who really needs to please others. I’ll clean the house, cook dinner, do several loads of laundry, plant flowers, take my partner out to dinner, and so forth, just to see her happy. Read the rest of this entry »

In Part I of this series, I highlighted the challenge of returning to work with bipolar disorder and provided some practical advice on how to smooth the transition back to work after experiencing a major mood episode. In this second part of the series, I provide some more in-depth information and recommendations on obtaining additional assistance with your back-to-work efforts:

• Bipolar can get worse or better: Don’t add even more stress to your situation by assuming that your condition is progressive and will get worse—this isn’t universally the case. With the right treatment and some good fortune, situations can and often do improve.
• Brains change: We sometimes have the idea that adult brains have stopped developing and changing—but that is not true. The brain changes throughout life—with or without Bipolar Disorder. But this of course means that medication needs and symptoms can all change over time as well.
• Stay in touch with your doctor: Returning to work can expose you to additional stressors and triggers, which can lead to more frequent or severe episodes, but medication can make a big difference. During the transition, your doctor may need to monitor the situation more closely and be prepared to make necessary adjustments to your meds. If the doc isn’t willing to consider changes, consider getting another opinion.
• Stay in touch with your therapist: If you have a therapist on your treatment team, he or she will be an important resource for you right now. Digging through the problems that are going on related to work and generating some solutions to those problems—running the gamut from things you can change to changing work situations and if so to what kind of alternative work—is an important part of the ongoing management of bipolar disorder.
• Consult a vocational therapist: Even if you already have a general therapist working for you, consult a vocational therapist who specializes in helping people deal with work-related issues and accommodations. Most states have some form of vocational training and rehabilitation services. You may need to be receiving services from your state Department of Mental Health or through Social Security Disability to qualify. Disability income, health care, and other supports should be available to people with mental illness in all states, but it is managed differently in different places.If you prefer private resources, you could consider working with a private vocational counselor. Vocational counselors may be accessible through a local or community college.

Tip: As an added bonus, obtaining vocational therapy can actually make it easier to obtain disability benefits later if you are unable to work. It proves that “you’ve tried everything,” and may even provide you with an additional advocate (your vocational therapist) who can testify that yes, you have tried everything.

• Get more help from NAMI: The National Alliance on Mental Illness is an advocacy organization and they may have a local chapter in your area; you can search for local chapters at State/Local NAMI. Connecting with people there may help you to access services in your local area.

Remember to try to tackle this in small pieces—one task at a time—it won’t all get fixed at once—but as long as you are talking to people and reaching out you are still in the game.

This is the first part of a two- or perhaps three-part series on how to smooth the transition back to work after a severe mood episode.

Many people with bipolar disorder are able to successfully return to work once they’re on an effective treatment regimen, which typically includes one or more medications. In Bipolar Disorder For Dummies, however, we recommend that you avoid stressors and mood triggers – and returning to work, especially a demanding job, can be loaded with stressors and triggers. In this article, we offer some suggestions on how to ease the transition back to work. Read the rest of this entry »

Recently on Yahoo! Answers, a member posted a question asking whether bipolar disorder can be misdiagnosed as depression. This is an excellent question, and it made me think that we should post something on this important issue.

The answer is yes; bipolar disorder can be and often is misdiagnosed as depression. This could be a very dangerous misdiagnosis, because many of the medications prescribed to treat depression can trigger mania in those who have a genetic predisposition to bipolar disorder. In other words, you could go into your doctor’s office depressed and as a result of the anti-depressants experience a manic episode.

Read the rest of this entry »

In the previous post entitled “Is Your Current Bipolar Medication/Therapy Working?” we recommended filling out a form prior to your doctor’s visit to provide detailed information on the effectiveness and possible side effects of your current treatment plan. I think this form is a great tool, and I would love to have patients bring me something this detailed, but if the form seems a little overwhelming, you may prefer a simpler approach - keeping a daily mood calendar. Read the rest of this entry »

Whenever you have a change in medications or therapies, your moods will improve, worsen, or stay about the same. Documenting how you feel can be a valuable tool in helping you team up with your doctor and therapist to obtain the right combination of medications and therapy. Use the following form to record the most recent change in your treatment plan and in how you feel since the change. (Or download the form as a Word Document.) Read the rest of this entry »