Diagnosing Bipolar Disorder

Several people have approached me in various ways with concerns about whether or not they could have bipolar disorder. I cannot give much advice other than to suggest that they check the symptoms on a reputable website. If after further research they still believe that they may have bipolar disorder, I encourage them to make an appointment with a mental health professional to get an official diagnosis. It is best if you arrive at the consultation with an understanding of bipolar disorder in order to know what questions you should ask.

Using diagnostic criteria, it is difficult to accurately diagnose bipolar disorder (Statistic Brain, 2014). Individuals with bipolar disorder will be misdiagnosed at least 70% of the time (Depression and Bipolar SupportAlliance, n.d.). Individuals with the disorder can spend up to ten years coping with symptoms before getting an accurate diagnosis. Of those people, only 25% will receive a right diagnosis in less than three years.

In the medical setting, studies suggest that 10-25% of individuals diagnosed with unipolar depression may have bipolar disorder (Depression and Bipolar Support Alliance, n.d.). A higher incidence is found in the psychiatric setting. Due to the fact that patients are more likely to seek professional help during periods of bipolar depression, these individuals are often diagnosed with unipolar depression. Incorrect treatment for bipolar disorder can lead to drug therapy that can cause negative effects in people with bipolar disorder.  For example, antidepressants can worsen symptoms of bipolar disorder, possibly causing a manic episode. 

Mood disorders are classified into two separate categories, unipolar and bipolar disorders (University of Maryland Medical Center, n.d.). Although they are both considered to be mood disorders, they are different illnesses. It is necessary to have both depressive and manic phases in order to have bipolar disorder. Individuals who experience unipolar disorder exhibit depressive symptoms, but never experience the highs of mania. A person with bipolar disorder experiences mood swings between the lows of depression and the highs of mania with normal periods of mood in between. Bipolar disorder is divided into two main subtypes. Bipolar I is the most extreme type compared to Bipolar II which is less severe. 

(Hubpages, 2012)

People without bipolar disorder do not exhibit the exaggerated mood swings associated with the illness (National Alliance of Mental Illness, 2008). The moods of these individuals remain relatively stable within the normal range. People who have undiagnosed bipolar disorder may believe that they have occasional episodes of depression. They do not realize that the period of time when they are not exhibiting the symptoms of depression, there is the possibility that they may actually be experiencing the normal stage of mood between depression and mania or be in a manic stage. 

When I stepped into a psychiatrist office for a consultation, one of the first things that I mentioned to her was that I believed that I had bipolar disorder. She was able to ask me questions specific to the disorder to evaluate whether or not I was right. Some people tell me that because of my knowledge about the disorder and its symptoms I might have inadvertently given the doctor the answers that she wanted to hear, therefore, I received the diagnosis of bipolar disorder. In my case, I do not believe that is true.

Shedding Light on Bipolar Disorder

As I sit in my bedroom writing this blog, I am looking out my bedroom window. The sun is shining with all its glory from the sky above. Fall has arrived and I know that soon the dreary days of winter in the Pacific Northwest will bring overcast skies and an abundance of rain. The weather has a huge impact on my mood. 

Each year I expect to feel a bit of depression during the colder, darker months. The constant rain during these seasons in Western Washington makes it less appealing to spend time outside. I have less energy. I find that I am most comfortable snuggled in bed reading or watching movies. 

During the spring and summer months I wake up early. I get more things accomplished. Increased energy gives me more desire to spend time outside walking around in the sunshine. Our family takes part in more outdoor activities because of the warmer weather. 

My psychologist advises that I should get as much natural light as possible, especially during the months when there are less hours of sun available. He recommends that I wake up at the same time every morning. He also suggests that getting regular doses of light earlier in the day is better in order to take advantage of the limited amount of sunlight during fall and winter. Even when it is overcast, spending time outdoors is still beneficial.

Depressive symptoms in individuals with bipolar disorder can be predicted by looking at a calendar (Daily Health Report, 2011). When the weather shifts from days filled with light into days with longer periods of darkness, depression may occur. Seasonal affective disorder (SAD) happens during the fall and winter months. Seasonal depression is more common in the northern region of the world.

The change of the seasons from winter to spring can influence moods of people in the opposite direction (Pendulum.org, 2005). With the introduction of more sunshine, a person experiences an increase of energy and elevation of mood. The behavior of individuals with bipolar disorder may change to mania. The upswing of moods may lead to high-risk behavior. A higher rate of suicide may occur as the mood shifts upward. It is theorized that the increase of energy may allow someone with bipolar disorder to have the mental strength to put their suicidal thoughts into action.

I realize that people with mood disorders are not the only ones that experience changes in mood during the transition of the seasons. In my case, I have to pay attention to how the weather affects me because it plays a large role in my behavior. Individuals with bipolar disorder can have more extreme mood shifts, therefore, making them more susceptible for erratic behavior.

Before I was diagnosed with bipolar disorder, I took the advice to get more sunshine during the winter months for granted. I considered it to be a general guideline for everyone. Now that I know that it is crucial for me to get enough light in order to regulate my moods, I am more apt to follow the advice.

Asking for Help

A couple of days ago I wrote a blog about how I wanted to commit suicide. Over the past two days I had some time to think about my feelings. I also had a chance to speak to my psychiatrist. He saw me the day that I had the urge to take my life and I also had a follow-up appointment with him the next morning.

Since then I have had time to reflect on the situation. Yes, I know that suicide is a permanent solution to a temporary problem, but in the moment of despair, you are not thinking clearly enough to consider the ramifications of death. Killing yourself seems like the only option. The only problem is that while I was considering suicide, I was not in a desperate state. Instead, the thought of suicide crept into my mind out of nowhere. I had the details worked out in my mind: What, when, where, and how I was going to do it. Yet I did not have a reason why.

At the time that I wrote my original post, I thought that it was necessary to get my feelings published. I wanted to post a snapshot of that particular moment in time. I wanted to share my raw emotions. Obviously, since I am writing this blog post, I did not kill myself. 

Due to the fact that I did not make an actual attempt, I have had second thoughts about my decision to make my suicidal feelings public. After a few hours passed I wrote on facebook. "Sometimes, I wish that I would have kept my mouth shut and suffered in silence." A good friend reminded me about the reason why I started writing my blog. I wanted to inform others about bipolar disorder. I think we are making an impact. People have said that we have taught them things that would never have considered. Others have said that they can relate to our words. We have been told that we are brave for sharing our experiences. My psychiatrist said that our blogs could save someone's life. That is all very flattering. 

My psychiatrist and I discussed putting together a safety plan for the next time I have suicidal thoughts. I was told that I needed to post it in different areas of my home to remind myself of what I need to do. If I follow the plan, hopefully, I will have changed my mind about ending my life before I got to the end of the list. I have to fill out the plan with detailed information. I need to fill in the list with actions, names, phone numbers, and locations. What am I going to do to make myself feel better? Who am I going to talk to if I still feel suicidal? If the first two things do not work out, where else do I go for help? 

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Safety Plan

1.   Comforting Actions

Watch a movie

Write a blog

Take a walk

2.   People To Reach Out To

Friends

Family

Neighbors

3.   Crisis

Find places to go

      (visit a friend, public place, or store)

Call a crisis hotline

Call 911

Go to the emergency room before attempting suicide
      (call an ambulance or walk if necessary)

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I go back to my psychiatrist in a month. By then I need to have my list ready for review. It will also give us a chance to follow up on my suicidal feelings.

Tomorrow I see my psychologist. Honestly, I don't know what I am going to say. "The other day I wanted to kill myself...I changed my mind...I am fine now." He probably won't accept that explanation.

Help!

I am experiencing a major setback today. I have been feeling down for the last few days and have not been able to shake it off. I have always had dark thoughts running through the back of my mind as long as I can remember. I usually have the ability pull myself out of these dark places, but not today. It pains me to admit this to the world, but I feel the need to be honest. Bipolar disorder is serious business. Although our blog posts are positive most of the time, there are times when the ugly parts of it have to be highlighted.

Right now, I am suicidal. My husband stayed home from work today to keep an eye on me. Like I said previously, in the past I have been able to push these thoughts away. I'd think, "Where did that crazy thought come from?" I would talk some sense into myself and move on like nothing had happened. This time it is different. I actually planned my demise in precise detail. Not good. With the exception of my teenage years, I haven't done that before.

Before I admitted to my husband that I was having suicidal thoughts, I asked him to lock up my meds before he left for work. Overdose. I was going to wait until all the kids where off to school. He was going to leave for work but I told him that I needed him to stay home with me today. I needed someone to keep me from doing something that I know is irrational.

I have been irritable, moody, and all I have wanted to do for the past few weeks is sleep all day. My children started school earlier this month. I graduated with an associate degree from my local community college in the spring. I have alone time. No kids running around the house. No more tight schedules of homework, studying, projects, and exams in college. Now I have too much time to think. Without those distractions, I have more time to hear the voices of the ugly monsters inside me. I try not to listen to what they say. It is hard.

My husband called my doctors' office. I have not done anything to myself yet. I don't think I need someone to bring me to the emergency room. Until the office calls back after talking with my psychiatrist and psychologist, I am just waiting. As of now, I am concentrating on life one minute at a time. I am breathing trying to stay calm and hold back my tears. I am fighting the urge to have a mental breakdown.

I believe that many people with depression suffer in silence. That makes it difficult for the outside world to find the answers as to why someone would choose to end their life. They may feel that they never saw the signs; to them, it may appear as if the individual committed suicide for no apparent reason. I don't know what is wrong with me...I just know that there is something wrong and I have to do something about it.

One in five people with bipolar disorder commit suicide. I need to take my feelings seriously. I do not want to be a statistic.

Link to Update

Do I Stay or Do I Go?

It's been a little over a year since my wife Jane has received her diagnosis of bipolar disorder. I know that my insight into her disorder and her compliance with treatment has improved our relationship. Even though things are better we still struggle. We have come a long way but it is still a work in progress.

In trying to understand this illness I have spent a great deal of time interacting with online support groups for people with a bipolar partner. Every case of bipolar disorder is different. I can relate to many of the problems that other people are facing within the bipolar support community. I have read many comments from angry and frustrated people. This is because their partner usually made poor decisions that caused damage to their relationship. In my opinion, the people who struggle the most are those who have not researched the disorder. They do not truly understand what they are dealing with.

I have seen many people on online support groups advise others to end a relationship. While I can sympathize with their frustration, it seems to me that many people think that because the person they are with has a mental health issue and they do not like their behavior, they have a valid reason to leave. This idea really bothers me. Would it be fair to leave a person because they had cancer or another physical illness? Just because you cannot see a mental disorder, does it make it different than a physical one? I believe the decision to leave someone just because they are ill is wrong; whether it be mental or physical. 

There are things that be can be done to make life less stressful for people who are involved in a bipolar relationship. When Jane is in a bad mood I try to avoid pushing her buttons but there are times where I fail miserably. Even with medication, her bipolar attitude will show up in a conversation. She will say things that are very hurtful. I try to set my feelings aside and choose to not take offense to what she says to me.

There are many challenges within any relationship. When you are fighting with someone who has a mental illness, you are dealing with the symptoms of the disorder, not the individual. When I get frustrated with my wife, I have to remind myself that she did not choose to have bipolar disorder and I should not blame her for it. While being a supportive is partner is important, I feel that there are specific behaviors that are non-negotiable. Regardless of whether or not a mental illness is present, in situations where a partner is violent, abusive, or unfaithful it is not acceptable. The person involved with someone who displays these behaviors need to set their boundaries. If their partner refuses to change, they should leave the relationship.

In my opinion, positive changes in the relationship will not happen until the person with bipolar disorder is stable. This is attained by adherence to medication and therapy. If these circumstances are not met things will not change. You are fighting a losing battle.

I Hate Myself

I hate myself. I hate that I need to rely on medication in order to be "just like everyone else". I hate the fact that there is a "new" me, that I have to be "normal".  Most of all, I hate that I have bipolar disorder and I have to control it.

I had an appointment with my psychologist yesterday. He made mention that with all I have going on in my life; I look as if I am "pulled together". What I didn’t tell him is that behind the closed doors of my mind, I am not as in control as I look on the outside. I struggle. I long for the feelings and behaviors associated with the manic aspect of bipolar disorder.

I miss the feeling of euphoria found in the simplest of pleasures. I loved the feeling of the breeze against my body. I would throw my arms in the air, spread my fingers as far as they could, and twirl around in delight. With my eyes closed, I would lean my head back, my face pointing toward the sky, and feel the glorious warmth of the sun on my body. I would inhale the fresh air and smell the fragrance of the flowers. Although I know that my experiences with such things were exaggerated, to me they were invigorating.

I used to be impulsive. I would say what I wanted. People who knew me would chalk it up to my personality. To me, my comments were mind blowing revelations. To others, it was probably crazy talk. It did not matter.

Grandiosity; that one word evokes excitement for me. There were times when I thought I could do anything. Be anything. The world was mine. I believed that I had the ability to achieve anything I wanted, I couldn’t be held back. I would follow my wildest aspirations. I could soar to the brightest star. I felt invincible. Nothing could go wrong. Nothing could stop me, not even reality.

Others allowed themselves to be held back by conventional wisdom, I had the ability to think beyond the limitations placed by the world. I was innovative. I would come up with ideas that I perceived to be brilliant. I had the innate power to accomplish tasks that no one in their right mind would attempt. I did not have time to sleep. My drive was strong. I had to reach my goal at any cost; even if the cost was my sanity.

On the surface, my transition between bipolar madness and a life of normalcy is running smoothly. Behind the external façade, I am broken up inside. I miss the manic part of me. At times it feels like life is not worth living. The loss of the “gifts” that I am forced to leave behind tears me up inside. It was an important part of me.

Inside, I am trying to prevent the “crazy” in me from breaking through. I pretend to be fine with having a diagnosis of bipolar disorder. It takes every ounce of my being to stay composed so that everyone will think that I am coping with having my illness in a positive manner. I pretend to be fine. I can’t deny that I am only doing it because it is the right thing to do; I am expected to be responsible.

I hate that I have to lose the attributes that I have always loved. I hate what I am forced to become; something I am not. I hate myself. 

Unlocking My Subconscious

I have known that I have bipolar disorder for over a year. Until recently, the only mental health professional I have seen is my psychiatrist. He deals with my medication, not therapy. He has been suggesting that I see a therapist for some time now. 

I struggled with myself. I stalled my efforts with starting therapy because I didn't think that I had many issues to resolve. I believed that I was fine, I did not need to talk to a professional. 

I thought I worked out most of my past experiences in my head; therefore, therapy was set on the back burner. I usually mind-f*ck any negative aspect of my life at the time it is happening, push it into the back recesses of my mind, and move on. I do not deal with my problems; I avoid them by trying not to think about it. Out of sight, out of mind.

I recently decided that it was finally time for therapy. In contrast to seeing a psychiatrist, my visits to the psychologist has been more difficult. Thus far, I have only seen him a few times. Sitting in his office digging deep into my soul is hard work. The problems that I thought were no longer bothering me were brought back into the forefront. An avalanche of repressed feelings fell upon me. Even though I would have loved to unearth my memories with an excavator, I understand that I cannot deal with a lifetime of problems in only a few visits. I will have to dig my way out a shovelful at time. 

I felt vulnerable in front of the doctor. My thoughts turned into a choked-up jumble of words as I tried to express them. I could barely speak as tears flowed down my face during our appointment. All the things from my past that have been festering in my subconscious mind flew out of my mouth. The doctor did not have the time to say much because my longstanding illness of diarrhea of the mouth took over. I spilled my guts. I asked and answered my own questions. The short breaths between my scattered phrases were the only times that the doctor had time to get a word in edgewise. To my dismay, he would inquire specifically about the most distressing aspects of my life. I do not know how he could decipher my most important issues during my incessant rambling. How could he sit there calmly while I was sitting in a puddle of my own tears mumbling incoherently?

Therapy is exhausting! I didn't realize that it would be so hard. When will the healing begin? When will I stop picking at my emotional wounds? When will my scars fade to where I barely notice them at all? And the most important question of all, when will I stop paying someone to make me cry? 

One day I will have the ability to walk out of his office with a smile on my face and not have to go to the bathroom to compose myself before walking out of the building.

Treatment Gone Wrong

In the spring of 2013 I went to see a psychologist. At my first appointment I told him why I was there. We talked about my life, my job, and my family. The stress in my life was due to Jane's mood and personality changes while taking the stop-smoking medication Chantix. At the time we did not know that Jane had bipolar disorder. Chantix put her into a major hypermanic phase that changed her behavior. Towards the end of my appointment he told me that my stress level was too way too high and he was worried it was killing me. It is a scary thing to hear your counselor tell you that during your first visit.

Before I left my psychologist's office he told me he felt I could use some antidepressants and anti-anxiety medications to help me get through things. I was really shocked that he would suggest I take any kind of medications.I had come to that appointment looking for support and advice. I wanted to get help and learn how to cope with my problems. His solution was to offer me pills. He also asked if I needed a break from life and needed some time away. I thought the idea a vacation sounded nice. He followed up by telling me, "There are some anonymous inpatient facilities here in Western Washington." WTF?

I reminded him the psychologist that I had been in drug and alcohol recovery for over twenty years. I know I am not a good candidate for taking mind altering drugs. I was afraid that if I had access to those medications it would affect my ability to good make decisions. I really did not want to notify my employer about being on those kinds of medications. Being able to operate equipment and drive a vehicle is part of my job. I thanked him for his offer, but declined meds.

I knew that getting on medication would not fix the problems in my life. I believe it would make things worse. That is why I told the psychologist that I was the last person that should be taking those medications. I came out of the visit feeling mixed emotions. It felt good to talk to a professional about my wife and our problems. I feel that he wanted to treat my situational depression and anxiety. I only saw him three more times and I can honestly say it was not helpful.

Jane and I went to the next two appointments together. I hoped that allowing her to come along would help. At the end of every appointment we left his office in worse shape than before we went we went in. She only came with me for two of my four appointments. At each visit he was very blunt towards her, he peppered Jane with questions and pulled her triggers. We would leave the appointments and find another spot to continue arguing. Going to see this psychologist together was more harmful to our relationship than if we had not gone.

I do not consider myself a person that normally suffers from depression or anxiety. As difficult as things were back then, I hoped that as soon as Jane pulled herself together, that our situation would improve. I might have needed that medication if Jane did not get her diagnosis or follow her treatment plan. Today we are doing good and are in a better place in our lives and relationship.