The In’s and Out’s…

or perhaps more appropriately, the ups and downs of Bipolar Disorder. You may be wondering; what is Bipolar? Well, it is a Psychiatric Mood Disorder also known as Manic-Depression. It manifests as extreme shifts in mood, energy levels and behavior and is caused by a defect in the part of the brain that regulates mood. Our mood becomes disconnected from our environment and circumstances.

People with bipolar don’t necessarily have more emotional swings than anyone else. We do, however, seem to take on a bit of an emotional rhythm that is specifically our own. Some may have more down periods, known as depression and others may have more up periods, called mania and a few of us have a mixed bag. We appear to be up but internally we are down.

The 5 states of Bipolar Disorder:

Mania, is the most extreme and dramatic of the bipolar symptoms. It can take weeks to develop. A person having a manic episode will exhibit elated, euphoric moods, irritability and grandiosity. This unrealistic sense of superiority is a bit aggressive and pro-active. We will be boastful, and unrealistically ambitious but our enthusiasm wanes rather quickly in most cases.

Cognitively we have a heightened concentration paired with accelerated thinking (that pesky little hamster spinning endlessly on it’s wheel) and this feeds that sense of grandiosity. I get a bit irritable with everyone and everything because I feel the entire world is moving way…to….sssssslllllloooooowwwww. Yep, that’s me; tripping the light fantastic at warp speed. This sense of the rest of the world moving at a snails pace is exacerbated by physical symptoms. A decreased need for sleep or food, increased energy and libido.

This heightened sense of well being, confidence, pleasant feelings and high mood grow more severe and downright unpleasant as time progresses and you run the very real risk of slipping into Psychosis which adds grandiose delusions and hallucinations to the mix. Behaviorally there is probably going to be some substance abuse, sexual promiscuity or overactivity, reckless behavior (driving to fast, picking fights, thrill seeking) and spending sprees.

  • side note: On rare occasions you can hit Super Mania. All of the above but on steroids. This was what put me in the hospital. I had gone to the doctor because I went to work one day and started crying and I cried for three days straight. I did give my doctor a heads up that I have a family history of bipolar (sibling) and was told that it was probably just a case of seasonal depression.I asked for a referral to another doctor that specialized in mood disorders, met with him, and once again gave my family history and was informed that it was indeed probably just seasonal depression. I was told that it is very rare for two siblings to both have bipolar. He put me on anti-depressants and I seemed to improve and then chemically induced chaos erupted. I learned at the hospital that with a family history of bipolar (rare or not) I should have been put on mood stabilizers first. Anti-depressants, if needed, could be administered later. It can also be attained by injury to certain areas of the brain, tumors, lesions, etc.

Next up on the spectrum is Hypomania. Hypomania is essentially Mania’s mini me. You still get the elated, euphoric moods coupled with grandiosity. The heightened concentration and accelerated thinking is still wrapped up nice and pretty with a bow of increased confidence but none of it is as severe as full-blown mania. Here is the downside. Hypomania is dangerous. If left unchecked it can lead to mania or even depression and most people really don’t think anything is wrong in this state. They are the life of the party, their A-game is rocking so why change anything. Why seek help and ruin a good thing? So, they don’t.

Next we have the strange and nefarious world of the Mixed State. The mixed state gives you all the frenzy and intensity of mania and all the negative thoughts and  suicidal tendencies that comes with deep depression. The Disney version of this is if Eeyore and Tigger had a love child. There is a lot of negative thought spirals, restlessness and excess energy, tension and pressure and it manifests with hostile, irritable, depressed moods, insomnia, anxiety, delusions and hallucinations, and you still get the heightened concentration and accelerated thinking driving this vicious cycle.

It is a nightmare. I have had a mixed state a time or two, which resulted in a fugue. A Fugue is where what is going on internally and in your surrounding environment are at such uncomfortable odds that you essentially black out or have a periods of dissociative amnesia. That heightened concentration gives you detailed recall of everything  with the dissociative fugue state you are not going to be able to recall anything, which doesn’t help your relationships at all in either case.

Finally, we have Depression and it is the polar opposite of mania. The mood symptoms exhibited during depression are Dysphoric (unease, anxiety, misery), depressed (unhappiness or despondency), grandiosity, guilt, anhedonia (can’t feel pleasure), Social withdrawal. They may have a Diurnal variant mood which means depressive in the morning but mood improves during the course of the day.

Cognitively, with depression you suffer from poor concentration, poor memory, indecision and slowed thinking, fatigue and suicidal thoughts. Physically you are prone to headaches, constipation, loss of interest in sex, sleep disturbances (insomnia or hypersomnia) and appetite disturbances (weight loss or gain). You can even have psychosis, in the form of delusions, hallucinations or catatonic states.

*Most people with Bipolar Disorder never develop all the above symptoms of the illness. It is the pattern of presence or absence of symptoms over time that allows for diagnosis. it is also difficult to diagnose due to the fact that symptoms not only are individualized but they can “mimic” or types of mental illness, most commonly schizophrenia.

The most common types of Bipolar Disorder are: Bipolar Type 1 and Bipolar Type 2 and the easiest way to tell them apart is how they are diagnosed. Type 1 means that you have a history of all the states (mania – major depression) and type 2 you have a history of hypomania-major depression but haven’t had a manic episode. I have Type 1 and my sister has Type 2.

Both men and women can have Bipolar Disorder, most men tend to have manic episodes and women most commonly have depressive but I am female and have mixed or manic episodes and I have been in the hospital with male patients that suffered from major depressive episodes. Women are, however, 3 times more likely to rapid cycle than men. Rapid Cycling is when you have four or more manic, hypomanic, or depressive episodes in any 12 month period, both Type 1 and Type 2 can rapid cycle.

So, what causes Bipolar Disorder? In my case, as well as my sister’s, Genetics is at play. Short and to the point; it runs in my family. Environmental stressors triggered episodes in our case. The good news for those of you that have a family history of Bipolar Disorder, just because you have a genetic predisposition doesn’t mean that you will develop it. You need those environmental stressors to act as a catalyst.

the other possibility at play is Brain Chemistry. Noradrenaline, Serotonin and Dopamine may all contribute to Bipolar Disorder, either because your brain is misfiring and circuits are allowing too much or too little of these chemicals into your system or they are causing things to go wonky. MRI studies have shown that patients with Bipolar Disorder have a smaller prefrontal cortex than patients without. Your prefrontal cortex is what helps you problem solve and make decisions.

Bipolar Disorder can not be cured but it can be treated. The most common way of treatment is of course, medications and there is a very long list that seems to grow by the minute. Other treatments are electroconvulsion therapy, psychiatric therapy, herbal supplements and a strong support system. There are also more alternative methods that really haven’t caught on as quickly in the psychiatric community but I personally find them to be more conducive to managing my symptoms long term.

Picture: View from the Hospital Therapy Room. Sharpie (marker) Pointillism by Pamela (red, yellow and blue sharpie markers used)


6 Comments Add yours

  1. dianemoments says:

    Thanks so much for your insight . Despite being very articulate , I struggle to express the difference between normal moods and bipolar moods at times. Bipolar feels more like a mental and physical state than a mood state at times. Depression: flat, empty , black as opposed to sad or upset, mania : wired, racey, everyone else is moving too slow as you say, elated like I’m on drugs .. mixed . Just ugh. I appreciate anyone who seems to express the same things

    Liked by 1 person

    1. Pamela says:

      Thank you dianemoments, I agree it is incredibly hard to explain to someone that doesn’t have bipolar and explaining has been a very real issue as I have been writing, sometimes more than others…I have brain fog days that frustrate me.

      Liked by 2 people

  2. Thank you for “voicing” what my brain cannot. Bipolar I have found can be a hugely destructive disorder…to my own life and those around me. It frustrates me no end, often I wish I could just be “normal”. Have a normal relationship, normal responses to life occurrences.
    I have learned from my own research that antidepressants are singularly the worst thing you can take if you have bipolar. They will exacerbate every “mood swing”, chemically entirely the wrong solution.
    I have found that stopping all medication has helped me cope better. I was walking around like a zombie. Zero energy, dead to the world. I have started using cbd paste which helps through very bad days…my own form of “fighting” my own mind. I do things to help unplug my brain. Sometimes I don’t succeed and when I’m the greatest threat to myself or society, I have a habit of locking myself away, until the worst has passed. These can be bad times. Weird as that sounds. I love reading your insightful blogs. Really helpful and sharing them with my friends help them understand me. Thank you for sharing.

    Liked by 2 people

    1. Pamela says:

      Thank You Karen, I sometimes feel as though I am pushing it with what I share but there really is no way to sugar-coat it and have other’s understand. I agree about the medication. I hated it and I just kept remembering the alternatives that they taught us at Chelsea Hospital and so far, so good. Good luck to you along your journey and thanks again for reading and sharing. Sincerely, Pamela

      Liked by 1 person

  3. Oh yes, there was a time when I was so embarrassed to admit to anyone that I was bipolar but it is so misdiagnosed and misunderstood, now I shout it out to the world, hoping to spread awareness 🙂

    Liked by 2 people

    1. Pamela says:

      Thank you for spreading awareness. I think the more it is understood perhaps the easier it will be for people that are bipolar to be diagnosed and get the help they need help.

      Liked by 1 person

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