When Mariah Carey recently opened up about living with bipolar disorder, it put the spotlight on a well-known but often misunderstood mental health condition. Unfortunately, like several other conditions — like ADD and OCD — bipolar has become cultural shorthand for a person who changes moods quickly, but in reality, the condition is much more than that.
So what exactly is bipolar disorder and how does it affect people? We spoke with some psychiatrists to find out. None of the experts we interviewed are treating Carey, nor have they treated her in the past, but were able to provide general information on the condition.
In short, bipolar disorder — formerly known as manic-depressive disorder — is a condition in which the mood changes from manic highs to depressive lows, Dr. Dion Metzger, a psychiatrist tells SheKnows. She says that some cases can be very severe, and people can have suicidal thoughts, impulsive behavior and frequent conflict in relationships.
According to Dr. Steve Levine, board-certified psychiatrist and founder and CEO of Actify Neurotherapies, the two “poles” — mania and depression — are typically distinct from each other (though it is possible to have “mixed states”) and represent a specific period of time in which emotion and behavior are markedly outside a person’s baseline state and interfere with social or occupational function.
Following a mood swing, the new state can last anywhere from a few days to a few weeks or even months, Dr. Fran Walfish, a Beverly Hills family and relationship psychotherapist, author of The Self-Aware Parent, regular expert child psychologist on The Doctors (CBS TV) and costar of Sex Box (We TV), tells SheKnows.
“A manic episode is characterized by euphoria (extreme happiness), hyperactivity, risky behaviors, restlessness, little need for sleep, racing thoughts and trouble concentrating, which may lead to rapid speech,” Walfish explains. “A depressive episode is characterized by extreme sadness, a lack of energy or interest in things, an inability to enjoy normally pleasurable activities and feelings of helplessness and hopelessness. On average, someone with bipolar disorder may have up to three years of normal mood between episodes of mania or depression.”
Bipolar disorder is recurrent: More than 90 percent of those who have a single manic episode will have additional ones in the future, Walfish says, adding that around 70 percent of manic episodes in bipolar disorder occur immediately before or after a depressive episode.
The symptoms that come ahead of a diagnosis of bipolar disorder depend on the type of episode the person experienced. For example, during a manic episode, a person may experience a decreased need for sleep (up for days at a time), distractibility, impulsive behavior (like hypersexuality or excessive spending of money) and extremely high self-esteem, Metzger explains. Symptoms of depressive episodes are the opposite, consisting of feelings of hopelessness, excessive guilt, poor motivation, low energy and sometimes suicidal thoughts, she adds.
In order to be diagnosed with bipolar disorder, a person must have had at least one episode of mania or hypomania (lower-level mania) during their lifetime as well as one or more depressive episodes, Levine explains.
“During severe manic or depressed episodes, some people with bipolar disorder may have symptoms that overwhelm their ability to deal with everyday life and even reality,” Walfish says. “This inability to distinguish reality from unreality results in psychotic symptoms such as hearing voices, paranoia, visual hallucinations and false beliefs of special powers or identity. They may have distressing periods of great sadness alternating with euphoric optimism (a “natural high”) and/or rage that is not typical of the person during periods of wellness.”
These abrupt mood shifts are problematic because they interfere with reason, logic and perception to such a drastic degree that those affected may be unaware of the need for help, Walfish says, adding that if left untreated, bipolar disorder can seriously affect nearly every aspect of a person’s life.
Typically, a depressive episode occurs before a manic episode, Walfish adds, and many patients are initially treated for major depression. Then, the first recognized sign of bipolar disorder is a subsequent manic episode.
“Once a manic episode occurs, it becomes clearer that the person is suffering from an illness characterized by alternating moods,” Walfish says. “Because of this difficulty with diagnosis, family history of similar illness or episodes is particularly important. People who first seek treatment as a result of a depressed episode may continue to be treated as someone with unipolar depression until a manic episode develops. Ironically, treating depressed bipolar patients with antidepressants can trigger a manic episode in some patients.”
There are two types of bipolar disorder: bipolar I and II. The primary difference between the two is the severity of the manic episodes caused by each type, Walfish says. While the depressive episodes are similar in both types, people with bipolar I experience more severe manic episodes than those with bipolar II. (Carey was diagnosed with bipolar II.)
“People who suffer with bipolar II are also less likely to have as [many] difficulties in other areas of life (work, marriage, etc.) because their symptoms aren’t as severe,” Metzger explains. “Nonetheless, they should still seek treatment to improve the mood swings.”
Most people living with bipolar disorder require a variety of treatments, including medication and talk therapy, Levine says. The medication typically includes mood stabilizers, which work to treat the manic highs and depressive lows for the patient to achieve a more stable mood, Metzger explains.
“The mainstays of medication treatment are mood-stabilizers such as lithium, but other medications may be necessary periodically to treat depressive episodes, psychotic symptoms, insomnia or anxiety,” Levine says.
Talk therapies can also be a very important component of treatment — vital to the person accepting their illness, being willing to engage in treatment, being educated about self-care and creating strategies to evaluate manic and depressive thought patterns, Levine says. “Along with all of this, maintaining consistent patterns, particularly sleep schedule, as well as healthy diet, exercise, meaningful activity and nurturing a support network are both protective and therapeutic,” he adds.
Because bipolar disorder can be very serious, it is important to encourage those who may be living with the condition to seek treatment and to get help yourself if you think you’re experiencing it yourself.
If you’re looking for resources for helping a friend or loved one or trying to get information about treatment for yourself, you can turn to the National Suicide Prevention Lifeline by calling them at 1-800-273-8255.
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