In the general public, many have probably heard of Bipolar Disorder but may not have much info beyond that. “Bipolar” is now looked at as a spectrum with varying degrees of symptoms. When I meet with a new client it is not uncommon that they have met with a psychiatrist who has used the diagnostic term bipolar. People can find this upsetting and frightening because they can’t readily make sense of it. The spectrum addresses the fact that different people can have varying degrees of “bipolarity.”
Let’s talk for a minute about the concept of diagnosis. Labelling a condition can be scary. What does this mean for my future? Will my children be susceptible to this? In my mind, diagnosis has two primary uses.
1) Understanding what you might be experiencing in a way that is useful and understanding that you are not alone and 2)using the diagnostic process to inform treatment options. It is a tool, not your identity.
First things first. Bipolar 1 is associated with cycling episodes of mania and depression. Mania is distinguished by some or all of the following: better than normal mood, rapid speech, very reduced sleep, racing thoughts, high energy, grandiosity. People in the midst of a manic episode may exhibit overspending behaviors, hyper sexuality, impulsive decisions, inflated sense of one’s capabilities. Bipolar 1 manic episodes may require hospitalization or intense out patient treatment. Bipolar disorder may interfere with one’s ability to work. There is often a family history of others who have been diagnosed BP1. A person may seek treatment when depressed or during or after a manic episode.
So let’s move to BP2. More often than not, people with this diagnosis will seek help when they are depressed. Psychiatrists and therapists may look for evidence of past episodes of hypomania. These would be periods with many of the same descriptors but with less intensity and duration. Periods of feeling better than good, sleep disruption, rapid speech, and increased confidence. The current guideline for hypomania is 4 days but there is controversy about the accuracy of this. The hallmarks of depression of BP2 include low energy, increased sleep and increased appetite. The person may have had a number of periods of depression with onset of depression before age 25.
Some folks may seek treatment in part because they have tried a number of antidepressants with less than stellar results. They may report that the antidepressants didn’t help that much, made them feel worse, or stopped working.
Having a thorough diagnostic eval can help you consider if you are on the bipolar spectrum and what treatment might be appropriate.
I am a fan of James Phelps latest book, Bipolar, Not so Much as a good resource and advocacy tool.
Complicating factors exist in the treatment of bipolar spectrum disorders. There is a psychiatrist in my community who is especially well educated in the Bipolar Spectrum and treatment protocols. Other professionals in the community not up to date with the Spectrum view, at times, accuse him of “over diagnosing Bipolar.” Many primary care doctors and psychiatrists begin with a non specific diagnosis of classic depression or unipolar depression and treat with antidepressants. When those are not effective they may increase the dose, try other or multiple antidepressants. As with many other medical conditions, it is helpful to be informed and to choose carefully who you decide to work with. The shortage of psychiatrists in general and of psychiatrists taking new patients can make this a challenge. And it can be expensive as many psychiatrists don’t accept private insurance. One option is seeing a psychiatrist for an evaluation/second opinion. They may be able to provide differential diagnosis and recommend treatment that can be followed up by a primary care doctor.