Is there a bright side to being bipolar? *Article of interest*

By Madeline Vann, MPH

Medically reviewed by Pat F. Bass III, MD, MPH

People with bipolar disorder who have experienced mania or hypomania (the state leading up to mania) describe periods of emotional intensity, creativity, energy, and productivity as appealing aspects to being bipolar. These “advantages” to bipolar symptoms can be so strong that bipolar patients may actually stop taking their medications because they miss this side to the disease.
While a small number of bipolar patients stay in the state of hypomania (a pre-manic phase) without progressing to the more dangerous heights of mania, the majority of people with bipolar disorder are not so lucky.
“The drawbacks to bipolar disorder far outweigh any benefits,” says psychiatrist Charles Lake, MD, PhD, professor in the department of psychiatry and behavioral services at the Kansas University Medical Center in Kansas City.
Symptoms of depression are far more common and frequent among people with bipolar disorder than the highs of mania.
Dr. Lake offers the example of artist Vincent van Gogh to demonstrate the course that mania can take. Although van Gogh was never officially diagnosed with bipolar disorder, certain patterns of depression followed by high-energy productivity and creativity suggest bipolar disorder. While his moods improved and moved toward mania, he was incredibly productive, says Lake, producing works of art that are admired and beloved to this day. But as the days passed, his brushstrokes would become less controlled and ultimately he was unable to paint at all. Meanwhile, his personal life bore many of the hallmarks of bipolar disorder, including suicide at 37.
Understanding the Bright Side
Here are some of the elements of bipolar disorder that are considered advantages, for a brief period:
  • Productivity. People with bipolar disorder sleep less as they become manic and have more energy. As a result, they are often more productive than their peers, at least for a while. The lack of sleep and high-energy work can eventually lead to burnout and may contribute to symptoms of psychosis, such as paranoia and hallucinations.
  • Confidence. Feeling more self-confident is one of the benefits described by people with bipolar disorder. Unfortunately, as mania increases, this self-confidence can become unrealistic fantasies about power and success, leading to poor life choices and impulsiveness.
  • Charm. Along with greater energy and self-confidence, people with bipolar disorder may be more outgoing and charming as their mood improves. This can draw people to them, making them the life of the party (for a while). However, as mania progresses, increasing irritability, impulsiveness, irrational behavior or speech, and risk-taking also can drive people away.
  • Euphoria. Intense joy and pleasure in life, including a heightened awareness of details, may also be experienced by bipolar patients as they approach mania. This perception of the world in bright and beloved detail is often what patients cite as the most missed element of bipolar disorder.
  • Insight. Many people with bipolar disorder experience a feeling of greater intellectual ability and insight as they approach mania.
There are some known negative aspects to hypomania in addition to the positives listed above. They include irritability, carelessness, poor impulse control, and increased substance abuse.
The so-called advantages of mania can fool many people, including the patient with bipolar disorder. Patients often cite these positive experiences as reasons for not taking the medications that keep their mood stable.
Unfortunately, these perceived advantages are only temporary and, for most people, progress to increasing mania, disruptive lifestyle choices, and even psychosis. As a result, these advantages are not good reasons to stop a treatment plan. In fact, they are signs that additional treatment may be needed to prevent worsening symptoms.
*What do you think? Is there a bright side to being bipolar?

The Four Keys to Managing Bipolar Disorder

The 4 Keys to Managing Bipolar Disorder

By MARGARITA TARTAKOVSKY, M.S.

Bipolar disorder is a complex and chronic illness. It produces major shifts in mood and energy. It impairs all areas of a person’s life, including work, relationships and daily functioning. Fortunately, however, effective treatment exists, and you can get better. Below, two bipolar disorder experts share the four keys to successfully managing bipolar disorder, along with overcoming common barriers.

Medication
With most psychiatric illnesses, medication is optional, and individuals can improve with other treatments, such as psychotherapy, said John Preston, Psy.D, a psychologist and co-author of Loving Someone with Bipolar Disorder and Taking Charge of Bipolar Disorder. However, “Bipolar disorder is probably the main psychiatric disorder where medication is absolutely essential. I’ve had people ask me if there’s any way to do this without medicine. [My answer is] absolutely not.”

Patients typically need to take multiple medications. “On average, people with bipolar disorder take three medicines at the same time,” Preston said. A large study by the National Institute of Mental Health found that 89 percent of people with bipolar disorder who were doing well were taking several medications.

“Don’t be discouraged if it takes a while [to find the right medicine]. Almost everyone who’s successful has to go through the same process.” That’s because in order to find the best treatment for each individual, doctors prescribe various medications and combinations. The goal is to find the right combination with the fewest side effects.

Unfortunately, troublesome side effects are the rule, not the exception, Preston said. In fact, around 50 to 60 percent of patients stop taking their medication or don’t take it as prescribed. This is why having regular and honest communication with your prescribing physician is critical.

But many people feel uncomfortable. They don’t want to “complain,” or assume their physician will be upset with them, Preston said. “I find that clients often don’t think they’re allowed to disagree with their doctors, and often end up going off their meds rather than having candid discussions with their doctors,” said Sheri Van Dijk, MSW, a psychotherapist and author of five books, including The Dialectical Behavior Therapy Skills Workbook for Bipolar Disorder.

Remember that you and your doctor are a team. “You have every right in the world to talk about every problem you run into,” Preston said.

The other reason people stop their medication is denial or wishful thinking, he said. It can take months after stopping medication for an episode to occur. This only validates the person’s belief that they don’t have the illness.

But while episodes may not be fast, they tend to be furious. Episodes typically get more and more severe, Preston said.

“Long-term studies that have followed people with bipolar disorder who have stopped taking their medication and have current episodes show progressive damage to parts of their brain.”

Lifestyle Management
According to both experts, cultivating healthy habits is paramount. Sleep deprivation and substance abuse exacerbate bipolar disorder and derail treatment, Preston said. Even patients who receive effective treatment don’t end up getting better if they’re abusing drugs and alcohol, he said.

If you’re struggling with substance abuse, seek professional help. Make sleep a priority. Try to get seven to eight hours of slumber per night, and wake up at the same time each morning. Consult your doctor if you’re traveling between time zones, which boosts the risk for manic episodes.

Social Support
“Often the success or failure of treatment has to do with how the family is involved,” Preston said. Family can either play a positive part in treatment or unintentionally undermine it. For instance, a family member who finds out their recently diagnosed loved one is taking medication might say, “You don’t need to take medication; you can handle this on your own,” Preston said. Again, not taking medication for bipolar disorder “can spell disaster.”

On the other hand, families can advocate for their loved ones. For instance, a parent might accompany their child to therapy when they’re in the throes of an episode and can’t articulate their concerns or symptoms.

Support groups, whether in person or online, also can be helpful, Van Dijk said. They remind individuals they’re not alone.

Psychotherapy
“The backbone of treatment is medication. But psychotherapy is enormously important,” Preston said. “While medications help to stabilize mood, they don’t change our thinking patterns, and the way we think affects the way we feel,” Van Dijk said. For instance, learning to change the negative stories swirling in your head may help prevent depressive episodes, she said.

Take the example of a client who was upset because her family pretended to forget her birthday, so they could give her a surprise party. “Instead of focusing on the surprise and the thought that her family had put into the surprise party, she was focused on how ‘cruel’ it was for them to pretend they had forgotten her birthday,” Van Dijk said. She helped this client “take a less negative and more neutral perspective on these kinds of situations.”

Van Dijk also teaches her clients mindfulness or “living in the present moment and practicing acceptance.” This helps clients not only accept their diagnosis but also become more self-aware. “We become more aware of our thoughts, our emotions, and our physical sensations because we’re in the present moment more often, and because we’re working on allowing ourselves to have these experiences, even if they’re painful.”

This self-awareness may prevent symptoms from escalating. By being more mindful, patients can spot an emotion and figure out what to do about it — “if anything” – before letting it careen into a full-blown episode.

According to Preston, “Numerous studies show that family-focused psychotherapy plus medication is really successful.” The goal of family-focused psychotherapy is to help the patient and family fully grasp the gravity of the illness and the importance of ongoing treatment, he said. It also teaches families how to provide support.

Interpersonal and social rhythm therapy also involves the family or significant other. The goal of this therapy, Preston said, is for “families and couples to learn to communicate more effectively and reduce really intense emotional experiences. It also incorporates strategies for lifestyle management.”

A big problem with psychotherapy is that clinicians who specialize in these treatments can be tough to find. Preston recommended checking out the Depression and Bipolar Disorder Support Alliance for facts on finding a professional along with other valuable information.

Accepting that you have bipolar disorder can be difficult. But not following your treatment will create a life filled with “one catastrophe after another,” Preston said. Instead, as both experts stressed, be honest with yourself. And make a strong commitment to taking your medication as prescribed and practicing healthy habits, without abusing drugs or alcohol.