This is an interesting question: how does a person with bipolar disorder think? Of course, it’s hard for me to compare it with your average person as I have bipolar. I don’t have the two thought processes in my one brain to compare.
Nevertheless, I do have some ideas on how people with bipolar disorder think that seem to stand out amongst the “normals.”
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Recently, I wrote a piece for PsychCentral that outlined some recommendations for treatment-resistant bipolar disorder. This piece talked about first-line and second-line agents for the treatment of bipolar disorder but I wanted to delve a little further into the novel agents that are now being studied for the treatment of bipolar depression. These are medications that are not typically used to treat bipolar disorder, work in new ways and show promise in recent studies. This is cutting edge and if you’re treatment-resistant this is an area that can offer you hope.
The reason why this piece is about unusual bipolar depression medication and not medication for mania is because the medications we have for mania are quite effective for most people. It is the bipolar depression that, typically, is very hard to treat. Additionally the two Food and Drug Administration (FDA)-approved bipolar depression treatments (quetiapine and an olanzapine/fluoxetine combination) tend to carry very serious side effects like weight gain, risk of diabetes including diabetic ketoacidosis and others. We also know that most people with bipolar disorder spend vastly more time in a depressed state than in a manic state.
According to Dr. Prakash Masand, CEO and founder of Global Medical Education, “Less than 30% of bipolar patients achieve remission that is maintained long term. There are great unmet needs in the treatment of bipolar depression. Innovative approaches are needed rather than ‘me-too’ agents that offer little incremental benefit.”
Dr. Masand notes the following are new, novel agents that look promising in the treatment of bipolar depression.
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Do you feel broken? I sometimes do. I sometimes feel very broken. I sometimes feel like the bipolar disorder has damaged me beyond repair. I sometimes feel like the bipolar disorder has damaged me beyond reason.
I sometimes feel like it would be impossible for another human being with a functioning brain to want me.
And this is too bad because it can lead to some very bad decisions regarding relationships. I’ve seen people with bipolar who feel this way stay with people who were entirely beneath them because they feel like that broken toy. The person with bipolar disorder feels like she/he doesn’t deserve any better.
This may be wrong. This definitely is wrong. But it doesn’t mean that some part of our brains doesn’t still believe it.
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As I’ve mentioned before, people with bipolar disorder, statistically, spend more time depressed than they do manic or hypomanic. People with bipolar II have it the worst. People with bipolar II can spend up to 35 times more time depressed than hypomanic. This means that if you’re a symptomatic bipolar II, you’re probably feeling depressed right now.
And, of course, depression is a big problem in bipolar disorder as there are only two Food and Drug Administration-approved treatments for bipolar depression (although other treatments are prescribed off label).
While that picture is dark, I would argue there is one aspect of depression that’s more within our control but is equally debilitating. It’s (often obsessively) feeling bad about feeling bad.
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