Bipolar Disorder – The Facts

Bipolar Disorder.  The Facts.

Bipolar disorder is a mental illness. It is both severely debilitating and serious. Figures estimate that as low as 1% and as high as 5% of the total population have the disorder. The disorder is classified as a mood disorder. This means that it has an effect on the moods of a person. It is however, much more complex than that. Bipolar disorder affects the entire being of a person.  So, to explain, here are the facts.

1. Bipolar disorder is recognized by the DSM-V (the diagnostic and statistics manual – edition 5), all Psychiatrists and all medical universities in the world. It was previously known as “manic depression”, a term that is outdated and should no longer be used.
2. Bipolar disorder is categorized in Bipolar1, Bipolar2, Bipolar NOS (not otherwise specified) and Cyclothymia
3. Bipolar 1 means depression with mania.
4. Bipolar 2 means depression with hypo-mania (less intense mania)
5. Bipolar NOS is when the normal criteria of bipolar 1 and 2 are not applicable.
6. Cyclothymia means a disorder with mood changes but not as intense as with bipolar.
7. Bipolar disorder has 6 states. These are not types of bipolar although they are often confused as such.
8. The first state is depression. This is not normal depression or the “blues”.  It is a clinical state of depression that is just as intense as Major depression and often it can be worse. All bipolars have depression.
9. The second state is mania or hypo-mania. This is a state of elevated mood, increase in energy, disrupted or fast thought patterns; increase is speech speed, irresponsible behavior, hyper-sexuality (increase in libido), sensitivity to loud noises – especially sharp ones, sensitivity to light, and increase in functionality, increase in body temperature, blurred vision, headaches as well as numerous other symptoms. Not all of these symptoms are always present in a specific person. A person may have from a few to numerous of these symptoms.  All bipolar have mania or hypo-mania. If they don’t they don’t have bipolar. Mania is the defining feature of bipolar and not depression. If only depression occurs the person has Major depression only. Bipolar 2 is not less severe than bipolar 1 because it has hypo-mania, the depression and other symptoms are just as severe. There is no current diagnosis of unipolar mania although it is reported.
10. The third state is stability. This is a state where the person experiences stability like a person without bipolar would experience. This does not mean the person is healed from bipolar; they are just in that state at that moment. Not all bipolars experience stability. 
11. The fourth state is rapid cycling. Rapid cycling is when the moods between depression and mania alternates in short period of time. To be diagnosed as rapid cycling a person needs at least four episodes of mania in one year. Rapid cycling can be much faster, within in weeks or even days. Ultradian rapid cycling can also occur where the person cycles between moods within hours or in extreme cases even minutes. Not all bipolars rapid cycle but most do.
12. The fifth state of bipolar is mixed states. This is a state where both mania and depression is present at the same time. This means that both mania and depression can manifest itself in a very confusing state.  It is very difficult to explain how you can feel good and bad at the same time.  Not all bipolars experience mixed states.
13. The final and most serious state of bipolar is psychosis. Psychosis has nothing to do with legal insanity. It is a state that the person is in due to the illness, usually during intense mania. Psychosis means a loss of reality. The person may hear voices and have visual hallucinations. Thought patterns are severely impaired or interrupted. A person with psychosis has to be hospitalized to prevent any actions that can lead to harm caused to them or other people. Psychosis cannot be treated with therapy; it can only be treated with medication.  Not all bipolars experience psychosis. 

Accountability.

People with bipolar disorder remain accountable for their actions. There are however two exceptions. Intense mania bordering on psychosis and psychosis. In extreme mania a person remains accountable; however, there is a fine line that can be broken.  If the mania is fed with alcohol, with irresponsible behavior and with narcotics the person could go into a state where they no longer know what they are doing.  In psychosis a person is not accountable for his or her actions. It is also the only state of bipolar accepted in Law as a state on no-accountability. It is however very difficult to prove and very few cases are successful.

Diagnosis.

Bipolar is diagnosed by a Psychiatrist. A general practitioner can also diagnose the disorder but it is not advisable to be treated by a GP for bipolar. A psychiatric nurse, psychologist, priest, pastor, friend, online test can not diagnose a person as bipolar. They can give a referral to a psychiatrist.  It can take many years to correctly diagnose the disorder.  People are often incorrectly diagnosed as Major depressive disorder, PTSD, Borderline personality disorder as well as numerous others. The sooner a person is correctly diagnosed the better the changes of proper treatment.

Prognosis

Bipolar disorder has no cure. People can be in remission for many years and then experience an episode, often much worse than before.  With treatment however the possibility does exist that the person can live a full and happy life. Untreated bipolar has a very poor outcome, usually resulting in permanent hospitalization due to extreme actions during mania, prison sentences due to criminal behavour and drug abuse and ultimately death due to suicide. Bipolar disorder may not be left untreated.

Causes.

There is nor consensus on the cause of bipolar. The studies show evidence ranging from instability in neuro transmitters to a difference in brain structure, especially in the hippocampus to genetics.

Co-morbidity.

A co-morbidity is where two or more disorders are present at the same time.  A huge number of people with bipolar also have another disorder. The most commonly reported are PTSD, addiction, ADHD, DID, OCD and borderline personality disorder. Major depression and bipolar cannot be co-morbidities as MDD is unipolar and has no mania. Fybromyalgia is also reported in bipolar, the reason is not clear.

Addiction.

Many people with bipolar end up with addiction. This usually does not start with addiction but with what is called self medication. The person is not correctly diagnosed or the medication does not work so they drink or use drugs to feel better. Caffeine addiction or abuse is also common as caffeine can induce mania. People with bipolar disorder should not use narcotics or alcohol. It can cause toxic psychosis, worsen depression, increase mania and lead to psychosis. Energy drinks should not be taken at all by people with bipolar.

Eating disorders

Eating disorders are often reported due to food as comfort. Weight increase with medication should not be confused with an eating disorder. The increase is then due to medication.

Suicide and suicidal ideation.

Bipolar has one of the highest successful suicide rates in the world. Some studies put the numbers as high as 25%. This is alarming as it means that one quarter of people with bipolar will lose their lives due to suicide. The number of attempts is much higher. Suicidal ideation is not suicide or an attempt. This is were the person constantly thinks and even plans suicide but they never do anything about it. Sadly this causes a “cry wolf” situation where people later on don’t take the person seriously anymore. Sadly many people do then attempt and lose their lives because no one thought they were serious.

Personal hygiene.

As with other mental illnesses people with bipolar sometimes (not all and not always) have difficulty with person hygiene. The reasons can vary from not enough energy to simply not seeing the point. It is very important to understand that the person is not a “dirty person” it just means it is a manifestation of the illness.

Medication.

Medication forms the basis of bipolar treatment. Usually a mood stabilizer like Lithium is prescribed. Many mood medication incidentally is actually ant-seizure medications. This does not mean people with bipolar get seizures, they don’t. If they do it is incidental and part of another illness. An anti-depressant can also be added. This is however done with extreme caution as anti-depressants are known to increase mania and suicidal ideation. In cases of psychosis an anti-psychotic can also be prescribed. A range of other medication can also be added, from sleep medication to anti-anxiety medication.  To state that medication is the answer is incorrect. It only forms that basis. Many people do not respond well to medication. Some are even medication resistant. In such cases more invasive treatment such as electro convulsive treatment (ECT) are an option. Many people with bipolar give up on medication because it does not work fast enough or it does not cure them. It is very important to remember there is no cure for bipolar and it can take up to four weeks for the correct levels to be reached in the blood. Also there are thousands of options. If one medication or combination does not work another should be given.

The biggest drawback to medication and the number one reason people stop drinking it is toxicity in the liver and organs with long term use and then also side effects. Psychiatric medication is not over the counter aspirin. The medications are highly regulated and scheduled. Some bipolar medications are so strong and have such powerful effects that they are sold on the black market as “drugs”

The decision to live with or with medication is a deeply personal one. It is chosing the lesser between two evils. Side effects range from dry mouth, frequent urination, vivid and upsetting dreams, impotence, sexual dysfunction, itching, weight gain to very serious side effects such as tardive dyskenesia (involuntary spasms in the face and extremities – a condition that can become permanent).

Medication should always be taken with the guidance of a Psychiatrist. Changing dosages on your own is very irresponsible as is skipping medication. Going completely “cold turkey” is extremely dangerous and has been know to result in death.

Therapy.

The most beneficial and successful treatment of bipolar is with therapy. This can take the form of many types of therapy, from regular psychotherapy, to dialectic behavioral therapy to cognitive therapies. Therapy should preferably be provided by a clinical psychologist and not a normal counselor. The reason is bipolar is too complex to be treated without enough knowledge. Priest and pastors can assist with support but they cannot provide therapy for bipolar. More harm than good will be done. They are not qualified to treat a serious medical condition no matter what their beliefs are. Psychiatric nurses can also assist but they cannot treat bipolar in the same manner.

Alternative treatment.

Alternative treatments of bipolar can be beneficial. Aromatherapy, massage, neuropathy etc can assist. However, it is extremely important to remember these therapies are complimentary and cannot replace medical treatment. The practitioners of these therapies are not qualified to treat bipolar. It is as simple as that.

Cannabis and bipolar.

Medical cannabis (it is just cannabis not matter how people word it) is more and more used in the treatment of illnesses. It is especially effective in the treatment of pain. However, myself as an individual and my support group does not support the use of cannabis for bipolar. The reason is simple and plain. Cannabis does over time worsen depression. It does induce mania and it is extremely dangerous in psychosis. The benefit of the little relief a person gets from the depression is not nearly enough to outweigh the danger of psychosis. Harvard medical school published a paper backed by research that clearly disproves all the “benefits” Furthermore cannabis can increase the risk of addiction and the use of more serious narcotics.

Health and nutrition.

Optimum nutrition and a good exercise regime is hugely beneficial for bipolar. Not only does it assist with both depression and mania, it assists with social functioning and weight gain due to medication.

Relationships.

People with bipolar often have a list of failed love and other relationships. The reason is the complexity of the disorder. It is also difficult to have one bipolar partner and one that is not. One person being depressed and one stable can cause issues. People with bipolar often yearn for friends and an understanding partner. Often when they are given this their disorder also improves.

Stigma

A great deal of stigma is still attached to bipolar and mental illness in general. Such people as seen as criminals, insane, irresponsible and lazy. The latest celebrity breakdown or school shooting is attributed to bipolar. Words like crazy, nuts etc are used. This is not only irresponsible but it is the same as referring to someone as the N word or a faggot. It is degrading and people should be banned from using the words at all.

Bipolars

Some of the most awesome people I have the pleasure in knowing have bipolar. I have made friends all over the world and I am proud to call them my friends. They are witty, intelligent, creative people with hope in their eyes. I have also seen on the other pole people that are so ill they can barely see through their own eyes. I understand them both as I have been them both.

Bipolars Supporting Bipolars.

BSB was founded almost six years ago by Zara Hilton and Herman H Le Roux. The group was started with only five members. Today it is the largest and busiest bipolar support group on Facebook and one of the largest bipolar networks in the world. From assistance and advice is given to action in emergencies such as suicide attempts. Many lives have been saved. The group is spam, troll, advertising and drama free and is kept light and full of humour. A wide range of topics are discussed, from bipolar to non bipolar related.

Conclusion.

Bipolar disorder is a serious illness.  This does not mean that the sufferer cannot live a full and happy life. There is however work involved. Taking a pill and waiting for better days will not solve your problem. Constant evaluation, adjustment, a stable environment, a healthy lifestyle, active community connections, a support animal, self worth with a job or studies and a caring partner goes a long way towards a happy bipolar person.

We are the polar riders. Give us a chance; you might just like what you see.

For bipolar, depression, borderline and addiction support please join this group.

https://www.facebook.com/groups/BSB.Group/

© Herman H Le Roux. Feel free to share.

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