Explainer Link Copied 12.01.23

Everything You Ever Wanted to Know About Mood Stabilizers

No emotionless zombies here. BySam Brodsky

You know that mental health medications can help you manage the symptoms that make it hard to live your life. And if you’re dealing with a condition that impacts your mood in a big way (or know someone who does), you might’ve heard about meds called mood stabilizers.

For some, these can be game-changing. Take Brandon, 30, who has bipolar I. He previously told Wondermind that mood stabilizers help with the “impending sense of doom” he often experienced in the morning. Therapist Amanda Eldabh, LCSW, who has bipolar II, told Wondermind in that same story that her mood stabilizer (along with an antidepressant) is totally life-saving. 

But how does someone get prescribed mood stabilizers, and how do they know which one works for them? Truth is, your primary care provider or psychiatrist will ultimately be the one to help you figure out what prescription makes the most sense for your situation. In the meantime, here are the need-to-know basics about these mental health meds.

What are mood stabilizers, and how do they work?

Mood stabilizers basically do what the name implies: stabilize your mood. For people with bipolar disorders and schizoaffective disorder, or mental health conditions that cause dramatic mood swings, these meds keep those high highs (mania and hypomania) and low lows (depression) in check, says psychiatrist Samantha Saltz, MD. Mood stabilizers can treat other conditions that impact your mood too, like depression and generalized anxiety disorder, if other meds aren’t doing the job on their own, according to psychiatrist and psychotherapist Patrice Mann, MD, MPH. 

And there isn’t just one kind of mood stabilizer out there. Docs can prescribe one of the three main types depending on your age, symptoms, how your brain has responded to other meds, and whether you’re pregnant (or want to be soon), explains Dr. Saltz. For some, that means taking lithium, antipsychotics (like aripiprazole and quetiapine), or antiseizure or anticonvulsant medications (like valproic acid and lamotrigine), explains Dr. Mann. 

Each of these work in a different way. Lithium is an OG mood stabilizer first used to treat mania in the 1940s, according to the American Psychological Association (APA). Though it’s not totally clear how it works, it might have to do with something called cellular signaling, per the APA. 

Antipsychotics can double as mood stabilizers too (even if you don’t have psychosis) by stifling extra dopamine in the brain, Dr. Mann explains. Antiseizure meds are another type of mood stabilizer that “decrease hyperactivity in certain brain areas,” she adds.

Sometimes, doctors prescribe more than one type of mood stabilizer, Dr. Mann says. It really just depends on how you respond to the first prescription you try and if you’re still having symptoms, she explains.

Science aside, a lot of people (maybe you!) often think mood stabilizers work by turning people into emotionless zombies—which isn’t the case, says psychiatrist Aarti Jerath, MD. 

Cat, 31, thought that starting mood stabilizers would make her a “boring potato”…literally. “I thought creativity, bubbliness, and friendliness came hand in hand with what I now know can  be hypomania,” she previously told Wondermind. But she’s still able to tap into all of those parts of her personality. The meds just turn down the volume on her hypomania and depression symptoms. 

Obviously, if you’re used to having certain highs and lows, it’ll feel different and maybe even uncomfortable to live without those extremes, says Dr. Mann. That said, if you feel like something is really off, like you’re more apathetic than ever, you can talk to your doc about changing up your medication, she notes.

What are the side effects of mood stabilizers?

Like any medication, this type of pharmaceutical can, unfortunately, have drawbacks. For example, some antipsychotics can come with metabolic side effects like increases in blood sugar, weight, and cholesterol, says Dr. Mann. Antiseizure meds can make you tired and upset your stomach, while lithium is associated with shakiness and thyroid issues, notes Dr. Saltz. Certain antiseizure meds aren’t suggested during pregnancy since they can lead to birth defects, she says. Lithium has also been linked to risks during pregnancy, but recent research suggests that risk may be low and is something each person should discuss with their doctor.  That sounds like a lot, but it really varies from person to person and your doctor can keep a close eye on your blood work, weight, and blood pressure to make sure everything’s OK, says Dr. Mann. 

You might also be able to manage mood stabilizer side effects by being strategic about when you take it. “I have felt incredibly stable on this medication over the years, especially if I can time it right with food and taking them before bed,” says one 35-year-old woman who wanted to stay anonymous.

It’s also possible that you might not have any side effects, notes Dr. Jerath, who says she’s had patients on mood stabilizers like lithium, lamotrigine, and aripiprazole without any reactions. 

How long can you take mood stabilizers?

Some people stay on mood stabilizers for the long haul, says Dr. Saltz. And while others come off of them after several months or years, ultimately it depends on their diagnosis. For example, people with bipolar disorder are often on mood stabilizers for their whole lives, and someone with depression who’s using a mood stabilizer in addition to an antidepressant might get off of the mood stabilizer once their symptoms improve, says Dr. Jerath. 

Regardless of how long you take them, you might not be on the same exact mood stabilizer forever. For instance, if you need to be hospitalized for a manic episode, your doctors might put you on a higher dose or a different type for a couple of months to see how it impacts your mood, says Dr. Mann.  

Depending on the medication and your symptoms, you may need to take them for weeks or months to see the full effects, so try to level set your expectations before you get discouraged, says Dr. Mann.

The bottom line: Mood stabilizers are a solid way to manage any mental health condition that causes extreme highs and lows. With the help of a doctor, you can find the one that makes the most sense for you and start feeling better soon.

The post Everything You Ever Wanted to Know About Mood Stabilizers appeared first on Wondermind.

Stories Link Copied 05.26.23

11 Things People With Bipolar Disorder Want You to Know

No, meds won’t make you a “boring potato.” BySam Brodsky

Heads up: This article mentions the topic of suicide and self-harm if you want to skip it. 

Amber, 27, notices that some people shy away from getting to know her when they find out she has bipolar disorder. Some have even called her “crazy” when she’s reached out for help, she says. And she’s not the only one noticing the stigma. Three in five people with a mood disorder like bipolar said they get treated differently once others hear about their diagnosis, according to a National Alliance on Mental Illness (NAMI) survey from 2021.

Despite the progress society has made in raising awareness of mental health issues, there’s still a lot of shame attached to bipolar disorder. Amber sees this stigma when the media mainly paints people like her as being erratic 24/7 and only really features them in “crisis mode,” she says. Brandon, 30, sees it when he posts videos about his bipolar disorder and people leave massive generalizations in the comment sections. And Tara, 41, saw it when a former boss told her never to disclose her diagnosis in the office. Ever. This just shows that the less you understand the condition, the easier it is for you to make assumptions about how a person with bipolar thinks, feels, or acts. 

What it all comes down to is that bipolar disorder is often an “invisible disability, and people don’t understand what they can’t see,” says Brandon. This is why Christina, 34, who spent years advocating for herself before she got a diagnosis, says more awareness is crucial. Setting the record straight about what bipolar disorder is (and isn’t) and calling out harmful stereotypes can get people to be a bit more empathetic and understanding when they find out somebody has the disorder, Christina notes. 

So, some bipolar 101 to start: Bipolar disorder means someone has significant shifts in energy and mood that can interfere with their everyday life. To break it down even further, there are three main types. In bipolar I, someone experiences episodes of uber elevated, energetic, and/or irritable mood (aka mania), plus the lows of depression and sometimes milder elevated mood episodes (aka hypomania). In bipolar II, they have depressive episodes and hypomania. With cyclothymia, a person deals with less intense and shorter hypomania and depression symptoms that don’t quite fit a bipolar II diagnosis, and it lasts for at least two years, per the American Psychological Association.

People with bipolar disorder can also have mixed episodes where they have a combo of both manic and depressive symptoms, like feeling hopeless and sad but also very energized, according to the National Institute of Mental Health (NIMH).

Even if you do  know all this info, you might still consciously or subconsciously have some preconceived notions about people with bipolar disorder. To help chip away at the stigma, we spoke to people with a range of experiences living with the condition. Here’s what they want those not  living with it—or those who were just diagnosed and have a million and one questions—to remember.

1. Bipolar disorder is not the same thing as having mood swings. 

“It’s normal for everybody to feel sad, to feel anxious, to feel hyper, to feel happy, to feel elated,”  says therapist Amanda Eldabh, LCSW, who also happens to have bipolar II. It’s only when those changes in mood last for days, weeks, or more and impact how you function in daily life that they could fall into bipolar disorder territory, she clarifies. 

“I know guys whose ex-girlfriends had extreme reactions, tempers, or were unreasonable, and they labeled them as bipolar,” recalls Tara, who has bipolar I. “While we do experience extreme moods, it’s not typically a sudden change. We experience moods that can be extremely high or low … [and] may last days or weeks. It’s very different from someone getting angry or reacting in an extreme [way].”

Amber, who also has bipolar I, wants to clear up this misconception too. “These episodes are more than just a feeling. They impact behaviors and thought-processing. In manic episodes, I become rageful and convince myself that other people are conspiring against me,” she shares. “It seems like people are talking to me in a foreign language, my speech becomes illogical and rapid, and I have trouble sleeping.”

When Amber is depressed, she says she feels like she can’t breathe. “I convince myself that everyone would be better off without me, especially when dealing with the repercussions of my manic episodes,” she adds.

2. Bipolar disorder is treatable. 

Thinking that bipolar disorder can’t be treated just adds to the stigma that it’s this dreadful “life sentence,” says Eldabh. It can be treated with a combo of meds and psychotherapy, plus lifestyle changes (like a consistent routine and fam/friend support), per the NIMH. 

That said, treatment will look different for each person. For Eldabh, it’s a mood stabilizer and an antidepressant (that she says are lifesaving), along with regular meditation and mindfulness. For Brandon, who has bipolar I, mood stabilizers help him not  wake up with this “impending sense of doom.” Also, the antipsychotic he’s on helps with the paranoia that everyone was judging him, which makes doing things outside of his apartment so much easier, he says.

For Cat, 31, who was told by psychiatrists that she either has cyclothymia or bipolar II, treatment looks like therapy and a mood stabilizer. Exercise and journaling help her overall mental health, and she goes to support groups to hear from people with similar symptoms as a reminder she’s not alone. 

3. No two people will experience bipolar disorder in the exact same way. 

Maybe you’re generalizing what you think you know about bipolar disorder based on one interaction you’ve had with a cousin, friend, or co-worker. To avoid stereotyping, it’s good to know different people experience bipolar disorder differently, says Christina.

For example, Eldabh and Christina both have bipolar II. When Eldabh is hypomanic, she says she’ll get impulsive. Sometimes that means spending too much money, being hypersexual, or going on a random road trip without much thought. Christina says she’ll have a bunch of flowing ideas (she’ll write a full essay or tons of jokes for a new stand-up routine), she’ll have extra energy, and she’ll call or text people more than usual.

4. Mania isn’t necessarily a fun experience. 

Amber says people always assume that mania is euphoric, and while it can be for some who have bipolar disorder, it’s not fun or a good time, in her opinion. When she’s in manic episodes, “it feels as if I’m screaming on the inside but can’t control my actions and what I say on the outside,” she says. These episodes are exhausting for her—but she can’t sleep—and they can sometimes lead to self-harm. She also can experience delusions (a sign of psychosis) where she’ll speak super illogically and think people are targeting her.

Similarly, Brandon says that, for him, there’s really no positive aspect to mania even if the extreme confidence he felt was a nice change. In his first manic episode—which happened during the Covid pandemic—he had this elaborate delusion that people wanted to hurt him because he was figuring out his family members were criminals. So mania was really scary, and he ended up in the hospital for mental health treatment.

5. And hypomania isn’t just being in a good mood. 

Christina was first diagnosed with depression when she was 14, and it wasn’t until her mid-20s that she had periods of high energy and euphoria that she later realized were hypomania from bipolar II. But even when she told psychiatrists about her symptoms, it took years for a doctor to listen her and confirm the diagnosis she’d already suspected. One psychiatrist even said he thought she was just in a good mood because life was good (WTF!). 

Equating hypomania to a “just a good mood” (whether you’re a mental health professional or not) is simplifying a symptom that, for some people, can mess with a normal sleep schedule and cause impulsive behavior. Brandon says his bouts of hypomania—which happen a couple times a year and don’t include delusions—feel similar to mania in that he’s much more impulsive than usual (even if he does  feel more in control of those impulses when he’s hypomanic as opposed to manic).

6. Bipolar disorder doesn’t make people dangerous.

Sometimes Brandon will see comments on his videos about bipolar disorder from people who say their loved ones have verbally lashed out at them, and they’ll continue on to claim that every person with the disorder is like this. “It’s sad because they obviously went through something really traumatic with someone with bipolar disorder, but the issue, obviously, is that it’s such a blanket statement,” Brandon notes.

Saying that all people with bipolar disorder will lash out perpetuates the stereotype that those with the disorder—especially those with severe forms of mania—are violent. In reality, just because someone with bipolar disorder can be irritable during manic episodes, doesn’t mean they will become violent, says clinical social worker Kirsten Bolton, LICSW, who works with patients who have bipolar disorder or psychotic disorders in one of McLean Hospital’s residential treatment programs. Plus, someone with bipolar disorder is way more likely to be a victim of violence than a perpetrator of violence, she adds.

7. People with bipolar disorder aren’t always manic or depressed.

Christina was nervous colleagues would think she was “unstable” once they found out that she had bipolar II and that it might cloud their judgment about what she could bring to the table as an employee. “I was worried people would think, Oh my gosh, who knows what version we’re gonna get today at the office? ” she says.

But it’s not like Christina is either hypomanic or depressed all day, every day. Her mood is at a stable baseline the vast majority of the time thanks to the medication she’s on, she says. As Tara explains it: It’s not like a yo-yo. It’s more like a rollercoaster where she has extreme moods broken up by periods where she feels like herself. 

This baseline or stable mood is called euthymia, says Sarah Sperry, PhD, assistant professor of psychiatry at the University of Michigan and an associate director in the university’s Heinz C. Prechter Bipolar Research Program. Even without medication, people with bipolar disorder still experience a baseline mood and aren’t just constantly fluctuating between manic and depressive symptoms, she says. Plus, it’s important to note that not every big emotion experienced is due to someone’s bipolar disorder—everyone has big feelings and they aren’t necessarily a symptom just because you live with bipolar disorder.  

8. You can have bipolar disorder and be in healthy partnerships.

Cat felt like it would be impossible to keep up a healthy love life since she hadn’t seen any positive examples of that in the media. “I have seen our society sexualize bipolar disorder with phrases and memes, saying things like, ‘People with bipolar disorder are great for one night stands but not girlfriend/boyfriend/partner material ’cause they’re always gonna be crazy,’” Cat explains. 

As she learned about her own diagnosis and continued to live with her condition, she realized that wasn’t true. She reports that she’s been in a happy, monogamous relationship for two and a half years now, and she says it’s important to know that bipolar disorder does not disqualify you from having meaningful bonds. 

9. Bipolar II isn’t necessarily less severe than bipolar I. 

Eldabh says a lot of people think because she has bipolar II (and not bipolar I) and she’s successful as a mental health professional that she doesn’t struggle—and that’s not fair to assume. For her, bipolar II can be debilitating. For example, she attempted suicide during a hypomanic episode in the past.

Not to mention, depressive episodes in bipolar II can actually be longer and come on more often than depression in bipolar I, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). For Eldabh, her depressive episodes can be intense and sometimes manifest as intense guilt and regret for things she did during a hypomanic episode, which can lead to suicidal thoughts.

10. Bipolar disorder meds don’t turn you into a zombie.

At first, Cat fell into the trap of thinking she would be emotionless once she started mood stabilizers to level out her extreme highs and lows. “I thought medication would make me a boring potato because I thought creativity, bubbliness, and friendliness came hand in hand with what I now know can  be hypomania,” she says. But Cat found out that she can be joyful, bubbly, and excited even when she’s not hypomanic.

We’re happy to report that Cat is NOT a boring potato. Her periods of hypomania and depression aren’t as long or intense because of her meds, and she still taps into her creative side as an artist, she says. Facts: Cat painted a giant canvas of a whale while jamming out to Rihanna after the last Super Bowl, and she continues to do makeup gigs for film and photoshoots.  

Bottom line: It’s a major misconception that all mental health meds will flatten your emotions. Sure, that might be the case for some people depending on what they’re taking—Nick, 36, who has bipolar II, says he thinks his combo of meds was partially to blame for his “stifled” emotions—but that’s not something that’ll 100% happen.

11. And getting off medication isn’t really the goal for most people with bipolar disorder. 

Since there’s such a stigma around mental health meds in general, Brandon says people always assume he wants to stop taking them as soon as possible. But, turns out, he’s finally found stability after 20 years, so he’s for sure staying on them, he says. “I’m under the impression that I will be on medicine the rest of my life, and I’ve accepted that,” he adds.

It’s true that a lot of people with bipolar disorder take medication to help prevent future mood episodes and reduce symptoms in between episodes—so the majority of those living with the disorder will stay on meds, explains Dr. Sperry. But some people can decrease their meds or go off of them depending on their circumstances, she says.

Thanks to medication, help from mental health professionals, and social support, Amber says she’s living a fulfilling life. “Bipolar disorder may be an obstacle you have to live with, but it does not need to define where you will go and who you want to be,” she assures.

The post 11 Things People With Bipolar Disorder Want You to Know appeared first on Wondermind.

Explainer Link Copied 01.26.23

What Actually Causes Bipolar Disorder?

Get ready for a lot of gray area. BySam Brodsky

When you find out that you have bipolar disorder—or any mental health condition, for that matter—it’s not unreasonable to wonder, Why is this happening to me?  A diagnosis from a professional is cool and all, but if you don’t understand why  you are the way you are, the symptoms of a mental illness might seem even harder to deal with. So, what causes bipolar disorder anyway?

Let’s start with what we do know: Bipolar disorder is characterized by significant shifts in energy and mood that can interfere with your life. There are a few different types of bipolar disorder that you can be diagnosed with, depending on your symptoms. A bipolar I diagnosis means you’ve experienced mania (an elevated, restless, and oftentimes impulsive mood state) and usually features depressive episodes too. A bipolar II diagnosis means you’ve experienced both depressive episodes and hypomania (a milder form of mania). There’s also cyclothymia, which happens when people have ongoing hypomanic and depressive symptoms that never quite reach bipolar II level.

We know you want a clear-cut answer here, but experts say there’s no one cause of bipolar disorder. Instead, research suggests that multiple factors—like your genes and things in your upbringing—can come together to cause it. Plus, the equation for what actually causes bipolar disorder in one person isn’t going to be identical to someone else’s, says Sarah Sperry, PhD, assistant professor of psychiatry at the University of Michigan and an associate director in the university’s Heinz C. Prechter Bipolar Research Program.

Basically, researchers know bipolar disorder can be passed down in families, is correlated with certain childhood environments, and could be caused by something happening in people’s brains, but they’re still narrowing down exactly how  those things can come together to produce this mental health condition, explains Po Wang, MD, Stanford University clinical professor of psychiatry and former director of the university’s Bipolar Disorders Clinic. 

So answers aren’t 100% set in stone (because…science!), but continuing to dive into these theories will help mental health professionals fine-tune treatment for people like you or your loved ones who have bipolar disorder. Very cool and very necessary!

Ahead, you’ll find some risk factors that can up your chances of developing bipolar disorder. Though you won’t be able to say for certain why you or someone you know has bipolar disorder, it’s helpful to understand what parts might play a role. 

Family history

Though genes alone won’t determine if you have bipolar disorder, this mental health condition often runs in families, according to the National Institute of Mental Health (NIMH). It might seem like common sense, but you share more genes with your immediate fam members, so the handy dandy genetic coding that puts you more at risk for bipolar disorder is often passed down through those people (think: parents), Dr. Wang says.

For example, if your mom or dad has bipolar disorder, you have a 5-10% risk of being diagnosed with it, whereas the risk for the general population is about 1%, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). No one knows the exact genes that dictate your bipolar risk, but we do know that there are hundreds of genes that can come together to cause that risk, Dr. Sperry notes. 

Childhood trauma

Research suggests that experiencing trauma growing up can also add to your risk of developing bipolar disorder, particularly earlier on in life, according to the DSM-5-TR. FYI, that trauma can include things like violence and sexual trauma, but it can also look like extreme neglect where you don’t have enough food or a stable support system at home, says Dr. Sperry.  

Not to sound like a broken record, but it’s not clear why exactly childhood trauma can trigger bipolar disorder, Dr. Sperry says. One theory is that trauma may reduce the brain’s ability to adapt and change on the fly (aka its neuroplasticity), and without adequate ability to adapt to challenges, people could be more vulnerable to mental health issues, including bipolar disorder, she says.

Plus, facing childhood trauma can cause a supercharged fight or flight response when stressful life events happen in the future, Dr. Sperry adds. That stress response could lead you to cope by turning to substances (think: alcohol, cannabis, and stimulants) that might actually add more fuel to the fire, she explains. Just so you know, if you’re already at risk for developing bipolar disorder, it’s possible that substance use can set off manic symptoms for the first time, according to the DSM-5-TR.

On that note, some of the research that Dr. Sperry is working on right now has her diving into the idea that these substances further mess with your circadian rhythm, or your body’s internal clock that helps you know when to sleep, which may up your bipolar risk and can trigger mood episodes like mania, she says. It’s all ~connected~.

Neurological differences

Research suggests that brains of people with bipolar disorder work differently in some ways than those without bipolar disorder, according to the NIMH. Studies show some type of dysfunction in parts of the brain that deal with emotions like your amygdala and your anterior cingulate, Dr. Wang says. It’s unclear why or if it’s something that can outright cause bipolar disorder versus something that’s happening because of the bipolar disorder, but researchers are digging into it, he adds.  

There’s more: Just like putting gas in your car and running on fuel, the brain (specifically the mitochondria in the brain) burns through different molecules to give your body energy, Dr. Sperry explains. Research suggests that there’s something off with how the mitochondria produce energy in people who have bipolar disorder, she says. During a manic episode, people seem super energized and restless, so some experts believe this reflects that the brain is producing too much energy, and the opposite goes for when you’re depressed, she explains.

The bottom line: A number of things can come together to cause a person’s bipolar disorder, and research is ongoing (because, again, science!). The great news is that bipolar disorder is treatable regardless of the type, and you can read more about that here. The Depression and Bipolar Support Alliance also has info on risk factors and where to find support, if you’re interested. 

The post What Actually Causes Bipolar Disorder? appeared first on Wondermind.

Essay Link Copied 09.16.22

Let’s Talk About Dating With Bipolar Disorder

I’ve weathered enough storms and come to understand myself and this condition so much better. ByBrielle Diskin

Dating, like any noble pursuit, is best approached with honesty and bravery. But as someone who lives with bipolar disorder, ashamed of the mechanics of my mind, sometimes I find it’s easier to avoid honesty and hide in the shadows of shame—at least for now.

ICYMI, bipolar disorder causes dramatic shifts in a person’s mood (see: mania and depression), energy, and ability to function. There are a few different types of bipolar disorders, depending on the severity of your symptoms as well as how often and how long they come up. With bipolar II, the type that I have, a person goes through patterns of hypomania (a milder form of mania) and depression. 

I was diagnosed in 2014, when I was 17, after my family and I grew concerned with how I behaved and my frequent outbursts, mood swings, racing thoughts, and recklessness. Now, at 25, after years of cycling through doctors and doses, I am finally in a comfortable place with my treatment.

On a first date, you wouldn’t know I live with bipolar disorder.

That’s because bipolar disorder is often an invisible disability even though it can also be a debilitating one. Instead, you’d just see that I have a fulfilling full-time job, financial independence, and an active social life. I work out, eat well, and I even have a morning routine that involves yoga, journaling, and ~hot lemon water.~ It’s annoyingly That Girl, I know. But you also wouldn’t know because, ever since my last breakup, I haven’t told anyone I’ve dated that I have bipolar disorder.

Before then, I proudly wore my diagnosis on my sleeve. To me, it felt like a personality trait that made me unique. In sharing, I felt like I was breaking down stereotypes and defying the stigma-riddled feeling that it was some shameful secret. But after a series of relationships where my condition was often used to dismiss my feelings and oversexualize me, it became clear just how damaging the stigma around bipolar disorder still is. 

When I fall in love, or merely develop a crush, I melt into that person.

I give them everything and save little for myself. Turns out, some aspects of falling in love could actually trigger mania for some people with bipolar disorder, says David Miklowitz, PhD, a professor of psychiatry at the University of California, Los Angeles. That can mostly be chalked up to changes in your routine that can be both delightful and disruptive.

I’m sure most people can relate to this on some level—when you’re in that fun and exciting stage of a new relationship, your routines get thrown out the window in favor of impromptu dates and late-night phone calls. But for people with bipolar disorder, routines and regularity can be pretty crucial to managing the condition, explains Dr. Miklowitz. That’s especially true for your sleep schedules since sleep disturbances can worsen symptoms of bipolar disorder for some people. For me, the start of a relationship can bring on overthinking and under-sleeping, both of which make it harder for me to balance my moods.

From personal experience, I can confirm that relationships of all kinds can affect—and be affected by—a mental health condition like bipolar disorder. So, maybe it’s not surprising that my last serious relationship was a disaster. I ended up disclosing my diagnosis the first time we spoke. Taken over by the whole I’m-not-like-other-girls thing and thinking he’d decide I was some sexy enigma, it just slipped out. As soon as I heard myself say it, I felt like I probably should have given that disclosure more thought. I figured it was something people don’t casually come out with, but I was still following that defiant feeling that makes me feel powerful. Immediately, he revealed his own mental health struggles, and it gave me a sense of relief. I thought, Wow, here’s someone who could understand.

Dating someone with bipolar disorder means being there for both manic and depressive episodes.

Shortly after we made our relationship official, things started getting serious. Falling in love triggered a new hypomanic state for me, which, at first, he seemed to love. (My exes all have.) It’s exciting and euphoric to be with someone who is so elated about life, ready for spontaneous day trips, to party every weekend, to cook restaurant-level five-course dinners, and spend hours sharing my thoughts on everything from French new wave films to Beyoncé lyrics. He called me the most positive, bright person he’d ever met and expressed his gratitude for the burst of light I’d been for him. 

Then there were the physical aspects of our relationship. While it was never explicitly said, I felt like sharing my bipolar diagnosis enabled a narrative he created about me. One of an energetic, manic, “mysterious” type of girl. (It’s a stereotype I’ve heard before. I even once had a therapist  tell me that bipolar women were the sexiest.) 

This recurring narrative made me feel like an object. Then the relationship got dark, and I got quiet. When I tried to share what I was going through or when my sex drive left during those unavoidable depression periods, he seemed angry, disappointed, and made me feel like I was betraying that initial “down for whatever” persona he first fell in love with. No matter what, it always felt like my diagnosis was being used against me and was to blame for everything that went wrong. Now I realize that whether or not you live with a mental health condition, a partner should accept all of you, even the “less fun” parts, and listen when you confide in them.

The manic and depressive states can make it hard for people like me to feel grounded and trust their own emotions in an intimate relationship, says therapist Melanie Shapiro, LCSW. And this tracks. There was a time, particularly in that   relationship, where I thought being attached to someone would solve all my problems. I thought relationships made you whole and meant you were happy. But this thinking diluted my gut feeling that things weren’t going well, and I wasn’t comfortable with speaking up when I did have an urge to. Part of that came from being scared to be alone, afraid of how being single would force me to be alone with myself and deal with a mental illness that I still didn’t understand.

And then there’s the worst fear people have disclosing a diagnosis: that we’ll be labeled “crazy.” Yeah, that happened too. I trembled with shame and embarrassment, and it reinforced the feeling that I’d always be judged because of this condition. From then on, I decided to stop telling casual dates and acquaintances about my diagnosis until I felt absolutely sure I could trust them.

Today, I’m trying to feel OK with telling new potential partners.

But I know that I need some security before I do. “For people who struggle with mental illness, it’s always better to share when you feel comfortable and ready,” says Shapiro. Still, I know that if I wait too long, a partner could find out about my diagnosis before I’m ready if they spot my medication or inevitably witness me having an episode, lying on the bathroom floor with the lights off for hours, ghosting them for days at a time, or talking obsessively and overthinking.

Of course, there’s no one-size-fits-all answer to how disclosure conversations should go, Dr. Miklowtiz says. That would be too easy, right? But I’ve recently found power in starting to disclose my diagnosis to new friends again. At first, it was terrifying. I worried that no one would look at me the same ever again. Sometimes I get the “Oh, that makes sense” response. That used to tick me off, but now I find a certain satisfaction and freedom in people knowing where my head is at. I do exhibit bipolar symptoms, and it feels better when loved ones know why. It also opens the door for sharing what I’m going through and building a larger support system. 

The idea of opening up again is scary. And I won’t lie: It has held me back and made me reluctant to date. But I’m a romantic who doesn’t want to live my life in the shadows, afraid. I’m ready to step out and be brave with the knowledge that some people might not be worthy. Not everyone will be open-minded, but I feel more prepared now to deal with whatever reaction I get. I’ve weathered enough storms and come to understand myself and this condition so much better. In fact, I’m starting to feel like disclosing doesn’t scare me as much as giving into the stigma does. 

The post Let’s Talk About Dating With Bipolar Disorder appeared first on Wondermind.

Explainer Link Copied 09.16.22

What’s the Difference Between Mania and Hypomania?

The same—but different! BySam Brodsky

Chances are you’ve heard of mania, a mood state that can make people feel next-level energized or pretty damn irritable. Whether you have bipolar disorder or randomly heard someone mention a “hypomanic episode” in passing, you might be curious about what that means exactly—and how it’s different from straight up mania.

But first, here’s what they have in common: Both mania and hypomania are episodes of elevated or irritable mood where people could have racing thoughts, be super talkative, avoid sleeping, feel restless, and have inflated self-esteem, according to the American Psychological Association (APA). They’re also both symptoms of bipolar disorder and other mental health conditions. 

People going through a manic or hypomanic episode may feel uber productive and do impulsive or overly ambitious things, like staying up all night to repaint their bedroom, says Kirsten Bolton, LICSW, a clinical social worker for McLean Hospital. Plus, they might take some serious risks, like randomly spending a ton of money they definitely can’t afford to.

All that said, there are some BIG differences between the two symptoms. Here’s what makes mania and hypomania different, who’s at risk for those symptoms, how they’re treated, and more.

How to tell the difference between hypomania and mania

TL;DR: Hypomania is usually milder than mania, according to the APA. That’s partly because untreated hypomanic episodes are typically shorter than untreated manic episodes, explains Po Wang, MD, Stanford University clinical professor of psychiatry and former director of the university’s Bipolar Disorders Clinic. A hypomanic episode lasts at least four days and a manic one lasts at least a week, per the Diagnostic And Statistical Manual Of Mental Disorders (DSM-5-TR). 

On top of that, a hypomanic episode isn’t severe enough to majorly interfere with a person’s social or work life or land them in the emergency room like a severe manic episode can, according to the DSM-5-TR.

Unlike hypomania, severe manic episodes can cause some people to experience psychosis, where they lose touch with reality in the form of hallucinations or delusions. The latter could manifest as grandiose delusions, Bolton explains, like thinking they can win the Grammys even though they can’t hold a tune (sorry). Outside of this, they might make strong connections between themself and the universe, like seeing a Vermont license plate and interpreting that as a message that they should drop everything and drive there ASAP. 

Who actually experiences hypomanic and manic episodes

There are three main types of bipolar disorder, and knowing whether you’ve experienced mania or hypomania (or both) can help experts point you to the right diagnosis. Mania is a key feature in a bipolar I disorder diagnosis (though you can still experience hypomanic episodes in bipolar I), whereas hypomania is a feature of bipolar II disorder. (FWIW, even though hypomania is a less severe form of mania, bipolar II is not a less severe form of bipolar disorder, according to the DSM-5-TR.) 

People with schizoaffective disorder can also experience a hypomanic or manic episode, explains Dr. Wang. It’s worth mentioning, too, that substances like cannabis, cocaine, steroids, and methamphetamines can sometimes trigger mania and hypomania in the general population as well as in those diagnosed with or predisposed to conditions like bipolar disorder, explains Dr. Wang.

What’s more, medical conditions that impact the part of the brain that regulates emotions and impulses may also cause hypomanic or manic symptoms, says director of Yale School of Medicine’s Mood Disorders Research Program Hilary Blumberg, MD, professor of psychiatry and psychiatric neuroscience. These can include multiple sclerosis, brain trauma, stroke, and more, according to the DSM-5-TR.

How hypomania and mania are treated

The best thing to do during a manic or hypomanic episode is to seek out support from a mental health professional. They can get to the root of the issue and prescribe the right treatment or medication, like mood stabilizers or antipsychotics. That said, if you or someone you’re looking out for has stopped eating or drinking or are getting into dangerous situations during a manic episode, it could be worth seeking help at a hospital or treatment center right away, says Bolton. 

Meds and therapy aside, Dr. Blumberg and her team at Yale are studying how regulating sleep and daily routines can help mitigate symptoms of bipolar disorder, like mania and hypomania. Dr. Blumberg says this can be an effective treatment option in addition to others like meds and psychotherapy. So, with that in mind, it could be helpful to encourage people dealing with this symptom to get more sleep and/or narrow down all the projects they want to take on, says Dr. Wang.

FYI, after mania plays out, people may have regrets about their behavior, and it’s common to have “varying degrees of lethargy and depressed mood,” says Bolton. That makes sense considering studies suggest 60% of manic episodes happen right before a major depressive one, according to the DSM-5-TR. Same goes for hypomania: Depression almost always follows a hypomanic episode, Dr. Wang says. But, by managing hypomanic or manic episodes with a solid support system and potentially some medication, it’s possible to minimize the impact of those low periods, says Dr. Wang.

The post What’s the Difference Between Mania and Hypomania? appeared first on Wondermind.

Explainer Link Copied 09.14.22

Here’s What Bipolar Disorder Actually Is (and Isn’t)

It's not the same as being moody. ByColleen Stinchcombe

Having ups and downs in mood is a part of life. But for some people, the extremes of these changes in mood are so severe that they may hardly recognize their thinking afterward. For people with bipolar disorder, feeling “up” may cause them to make dangerous decisions or experience hallucinations. And when they’re down, it may feel impossible to get out of bed.

Chances are, you know or will know somebody with bipolar disorder—some 4.4% of the United States will experience the condition in their lifetimes, according to the National Institute of Mental Health. But that doesn’t stop misinformation from spreading. Stereotypes about bipolar disorder include that people with the condition are unreliable or violent or that their behavior is a choice. That isn’t true, but stigma continues to be a major barrier for people seeking treatment for mood disorders, according to a 2021 survey from National Alliance on Mental Illness (NAMI).

So, let’s clear up what bipolar disorder actually is, who it affects, and how to be there for yourself or others who live with it. 

One quick thing before we dive into the details: Mental health is complex and everyone has a unique experience, so don’t go diagnosing yourself just because you read a few articles on the internet (though, we do appreciate you stopping by to learn a few things). If this resonates with you, consider it a jumping-off point in your journey to getting care. OK, let’s get into it…

What is bipolar disorder?

Bipolar disorder, sometimes called manic-depressive disorder, causes significant shifts in someone’s mood and energy level. Most people think of bipolar disorder as swings between extreme depressive lows and manic highs, but some forms of the condition can be more subtle, according to Francis Mondimore, MD, associate professor of psychiatry and behavioral sciences at Johns Hopkins School of Medicine and author of Bipolar Disorder: A Guide for Patients and Families. Yep, there are actually three main types of bipolar disorder: bipolar I disorder, bipolar II disorder, and cyclothymic disorder. 

With bipolar I disorder, people experience manic episodes and sometimes also depressive episodes. Let’s talk about mania first. Mania isn’t just like a caffeine rush. In a manic episode, you might feel especially wired, elated, or even irritable, with little interest in sleeping or eating. “People have more energy than they know what to do with,” Dr. Mondimore says. They might think faster and speak faster or start to have really grandiose ideas. “They can develop abnormal thinking, such that they believe that they’re on a special mission from God or that they’ve been appointed prophet, that they’re going to win the presidential election or find a cure for cancer in their kitchen.” 

By definition, bipolar I manic episodes last at least a week (with symptoms going on most or all of the day) or the mania becomes severe enough that emergency hospital treatment is needed, according to the National Institute of Mental Health (NIMH).

Now let’s talk about those depressive moods, which typically last two weeks or longer and can be so severe that even small decisions feel overwhelming. Some people may even experience mania and depression at the same time. “This can be a very dangerous mood because it’s a time when people have all of this excess energy but feel very hopeless, so can trigger people into suicidal behavior,” Dr. Mondimore says.

Bipolar II disorder doesn’t have the intense manic episodes you see with bipolar I disorder. Instead, they experience depressive episodes and hypomania, which is a less extreme version of mania. During hypomania, someone might feel especially “up” and productive but more impulsive and reckless with things like their spending or their sexual behaviors. Though there’s still a change in mood and activity levels, it’s a bit less noticeable and there are generally fewer consequences than a manic episode, explains Dr. Mondimore. Later, after the hypomanic episode has passed, people often feel surprised by their actions. “‘I was not myself. I’m not like that. I don’t take risks like that,’” people have said to Dr. Mondimore. They might regret the consequences of their choices, but it’s more than that. “The insight that they develop is that they made that decision because they weren’t thinking the way they usually think,” he explains.

With cyclothymic disorder, or cyclothymia, patients have periods of both hypomania and depression for at least two years, but the severity of these episodes doesn’t quite meet the definition of bipolar II, according to the NIMH. Oh yeah, and there’s also a bonus fourth type of bipolar disorder referred to as “other specified and unspecified bipolar and related disorders,” which basically means you have some of these symptoms but don’t fit neatly into any of the above categories. As you can see, there’s a lot more to bipolar disorder than most people realize.  

People experiencing mania, and especially hypomania, may not recognize that their mood is abnormal. “They often feel like their mind is working extra well, that their thoughts are extra clear,” Dr. Mondimore says. That can make diagnosing bipolar II a challenge, Dr. Mondimore says. Many patients will often recognize their depression but require careful questioning from a mental health professional to reveal hypomanic experiences. And since treatments for depression and bipolar are very different, getting the right diagnosis is key.

How is bipolar disorder diagnosed? 

There’s no specific test for bipolar disorder because that would be too easy, right? So if you or those around you are experiencing symptoms of bipolar disorder, the first step might include checking in with a mental or physical health care provider. It’s possible that a primary care doctor will try to rule out other potential causes first, such as hypothyroidism or a reaction to medicine, before referring you to a mental health professional. 

People experiencing mania, and especially hypomania, may not recognize that their mood is abnormal. “They often feel like their mind is working extra well, that their thoughts are extra clear,” Dr. Mondimore says. That can make diagnosing the condition—especially bipolar II—a challenge, he says. Many patients will often recognize their depression but require careful questioning from a mental health professional to reveal hypomanic experiences. And since treatment for depression and bipolar disorder can be very different, getting the right diagnosis is key.

It can also be tricky to diagnose bipolar disorder because it shares symptoms with other illnesses. For starters, if you’re only noticing the depressive episodes, you might be diagnosed with major depression first. Or if you’re experiencing hallucinations during a manic episode it may be mistaken for schizophrenia. And it’s worth noting that someone can have more than one mental health condition. According to the NIMH, it’s common for people with bipolar disorder to also experience anxiety, ADHD, eating disorders, and substance abuse. 

To diagnose bipolar disorder, a mental health professional will ask about your symptoms, how long they last, how bad they get, and whether you’ve experienced them previously. From there, your diagnosis will depend on things like the frequency and severity of your symptoms. And while it can be understandably stressful to receive any diagnosis, it also means that you’re on the way to learning how to manage it. 

What does treatment for bipolar disorder look like? 

Bipolar disorder is most often treated with mood stabilizing drugs, such as lithium or valproate. Both drugs help to prevent both depression and mania, and lithium also helps prevent suicide, according to the NIMH. If lithium brings to mind old images of patients looking like zombies, you should know its modern dosage is much lower, Dr. Mondimore says. And mood stabilizers are a crucial part of treatment. “For a significant number of people with bipolar disorder, lithium is truly a miracle drug. It is necessary and sufficient to keep them well.”

People with bipolar disorder sometimes take antidepressants to treat depressive episodes, but they need to be taken in combination with a mood stabilizer, according to the NIMH. Antidepressants on their own can trigger mania or rapid cycling in a person with bipolar disorder.

Psychotherapy, patient education, and lifestyle changes can be super helpful in managing bipolar disorder too. But for most patients, these are not enough without medication. “​​I think the most important thing that patients can do for themselves is to learn as much about bipolar disorder as they possibly can so that they understand why medication is important and why various lifestyle changes are important,” Dr. Mondimore says. 

A lot of those lifestyle changes essentially come down to creating stable routines in your life. Avoid substance abuse, get enough sleep, and keep life stressors to a minimum, for example. “Staying well is often a matter of identifying all those different risk factors and eliminating them. And, again, medication is important. But that attention to the environmental risk factors is also really important,” Dr. Mondimore says. 

Bipolar disorder may be a chronic mental health condition but it’s something you can absolutely manage with the right treatment plan.

The post Here’s What Bipolar Disorder Actually Is (and Isn’t) appeared first on Wondermind.