Sometimes I get so wrapped up in research, I forget some people are looking for some introductory information like the different between the types of bipolar disorder. Thanks to commenter on my GooglePlus feed, I was reminded of this fact and I decided to answer her question here so I could give her more detail.
Bipolar Terminology
Unfortunately, within bipolar terminology resides more bipolar terminology. But don’t be scared, I have information on most terms on my site and I shall try to walk gently into that good encyclopedia.
But let’s try to get rid of the terminology confusion: What is the difference between bipolar type I and bipolar type II?
Bipolar Disorder Type 1
Bipolar disorder type I was the first recognized form of bipolar disorder and truly personifies “manic depression.”
Manic Depression
Manic depression was the old term for the disorder and in spite of the fact that the term “bipolar” has been around since the 1970s, you still see manic depression in a variety of places both for historical reasons and simply due to lack of up-to-date knowledge. In reality, manic depression and bipolar are the same thing.
Bipolar Disorder I
As the term manic depression implies, bipolar type I consists of two mood states: Depression and mania.
Depression is a low mood state and in bipolar disorder the diagnostic criteria for depression as the same as for major depressive disorder.
Bipolar I Depression:
- Has symptoms like lack of pleasure in previously enjoyed activities, weight and sleep changes, loss of energy and preoccupation with death or suicide
- Goes on for two weeks or more
- Can become psychotic
Bipolar type I also includes mania. Mania is a high mood state.
Bipolar I Mania:
- Has symptoms like delusions of grandeur, lack of sleeping and eating, racing ideas and speech, distractibility and high risk behaviors
- Lasts at least one week
- Can become psychotic
- “The mood disturbance is sufficient to cause impairment at work or danger to the patient or others.” – it tends to be life-threatening
Mixed Episodes
Mixed moods, where evidence of mania and depression occur together, are currently considered part of bipolar type I (and not bipolar II) but will be included as part of bipolar type II in the next version of the Diagnostic and Statistical Manual of Mental Disorders (DSM).
Bipolar Disorder Type 2
Bipolar disorder type II was actually recognized very early on as well but wasn’t initially included as a mental illness diagnosis. In bipolar II, a person experiences the same depression as in major depressive disorder but they experience hypomanias – literally “lesser” manias – elevated moods that aren’t as high as manias.
Bipolar II Depression
Bipolar II depression is identical to bipolar I depression and major depressive disorder and is diagnosed in the same way.
Bipolar II Hypomania:
Has the same diagnostic criteria as mania except:
- Lasts four or more days
- Does not cause life threatening consequences
- Does not contain psychosis
And, “The mood disturbance is observable to others.”
Cyclothymia
Cyclothymia is a mild form of bipolar disorder where a person mood swings over a period of years that go from mild depression to elevated mood and excitement.
Bipolar Moods
Bipolar moods last the minimum duration as noted above, but can last for weeks or months beyond that. There may be periods of “normal” mood in between mood swings.
Note that there are rapid-cycling versions of bipolar disorder where moods last shorter periods of time (sometimes only hours) but these are not officially represented in this version of the DSM.
More Questions About Bipolar Disorder?
Just ask.
Hi Natasha,
I like and enjoyed reading your concise and distinctive description of Bipolar Disorder. Thank you very much for your sharing.
About Mixed Mood Episodes, I like to find out whether it is grouped under Bipolar Disorder II in DSM V (the latest updated version for 2013)?
Thank you for time and help.
Cheers,
Cheng
Love your blog. In a future episode a definition of psychosis / psychotic could be useful. Most people I speak to have heard the term but can’t explain it when asked. My other soapbox is on the use of the term “high” when talking about manias. I know it’s been used for a long time and is used to describe a mood position but… These days the term “high” is more often than not used to describe an altered state of mind and mood brought on by the use of illicit or recreational drugs. I like to keep the terminology seperate. My hypomanias don’t happen by choice (unless I choose to stop taking my meds, which I understand but don’t choose to do). People, at least initially, choose drug use (often for tragic, escape/avoidance reasons). I want to see a clear line of demarcation with this terminology. Off my soapbox now. If people want to read about a first hand bipolar kind of life Disclosure:casting out the shadows plus strategies for mind health resilience is a great start if I do say so myself. Go to http://www.jacquichaplin.com/amemoir to find the best place to buy it in your part of the world.
How do I know what my fiancée has. Which type. We were doing well. Then she broke it all off. Told me I will always love you and never get over you You deserve the best. Tho I told her and my parents told her she is the best. She’s not moving in with her best friend even though she wanted to be on her own. She doesn’t call me or text me. I’m trying to make contact and I keep asking her what’s going on she keeps saying I have to do this for me. I don’t know That’s all I get. I’ve see her weight increase even tho she eats the same. ( don’t get me wrong I’m in love with everything. I can care less if she’s 90 lbs or 500lbs. I love her soul and her ). She changed meds and I feel that’s where it started. Because before that we were on track to have a kid and get married. I let her know I’m standing by her I’m here and I want to be with her. But I’m scared and need support and don’t know what to do.
I was diagnosed Bipolar I with hypomania which i feel isn’t correct as I have started doing something that had stopped for a little over a year. I am hearing voices and every now and then i see things moving out of the corner of my eye. of course when i look there’s nothing there and i then feel crazy. It isn’t fun being diagnosed other things while being bipolar. I was seeing one doctor that refused to diagnose me and I was on prozac. it didn’t help and then she gave me bipolar medicine that worked but side effects were horrendous. (sp?) any way thank you for your posts i feel like im not alone now and i am able to read the comments and feel better about my future. sorry so long.
Hi I was diagnosed at 14 with bipolar, mine appeared with the onset of puberty at 9. I am high functioning most of the time, I have had my job for 18 years been with my husband for 12 years and have 3 children. I am ok most of the time as long as I am busy, I have a schedule that would kill the average adult. Besides my meds that I religiously take this is the only thing that helps keep my bipolar manageable. It has a rather nasty side effect though, the schedule I have is not sustainable and after a while my body starts to break down. And then I think think think and I want to die die die so I get up and force myself to go go go. I am a train wreck granted I’m still on the rails but a train wreck none the less…the rant I just had is all because I took a nap this afternoon, something my body abviously needed but usually leaves me in a state where death is appealing. What the Hell!
Hi, I’ve been often depressed since I was 4 years old, and I think I had my first hypomanic episode as a teen. At 32 I was finally diagnosed with Bipolar II. At 37, by luck, I found an amazing psychiatrist, and we found a combination of medications that has my symptoms mostly under control. I am so very sensitive to side effects that it was hard to find anything I could take that worked. I say mostly because I still get depressed, just not very depressed and not as often or as long. I am completely functional, which says so much. The contrast between this and my situation two years ago (I’m 39 now) is huge. Unfortunately, I can’t take higher doses of my current meds because we’re already having side effect problems that are substantial and I can’t take anything else because the side effects were debilitating.
What I want to point out is that I have discovered slowly what the professionals already knew, that what I do has a tremendous effect on my mood. I know some people do much better when they exercise, but that has only a moderate effect on me. The two things that do the most to pull me out of a depression are talking to people and doing things. So, for example, if I played a board game with someone and talked at the same time, it would help a ton. The trouble is that when depressed, I tend not to want to do these things. I want to go to bed. So I’m learning, slowly, with the help of counseling, to overcome this. So I’m putting a lot of energy right now into making sure that I’m prepared to DO stuff when I’m depressed. For anyone who knows ahead of time that they’re going to have a mania or depression, schooling themselves to try a technique might help.
Another tip – you can have a crisis plan written out so that if you’re too far gone to think properly, you can look at the folded paper you always keep in your wallet and call the right help. Mine says 1. call mom 2. call counselor (they have an emergency thing and their phone # is on the paper) 3. call 911. The idea is to try #1 if possible, #2 if you’re worse than that, and #3 if necessary. I’ve never had to use it because by the time I had a counselor who said I should write one, I was no longer getting that bad. But hey, the piece of paper is there if I ever need it.
I’m so old, they used me to establish carbon dating (71 yr ). Presently I,m extremely over the top. I haven’t had more than 4 hrs sleep the past 5 days. I have dealt with ptsd since dec 1966. Cuban blockade and Vietnam.I had joined navy to keep from crawling through the mud being shot at, naturally they assigned me to lousy marine and made me 1st barman, 1st platoon, 1 st squad. Now it good for a laugh and by Gods grace I was spared still cant deal with reality. I was diagnosed bipolar 9 yrs ago until then I was classified as just plain old nuts. I have been through alchol drugs wild spending sprees . I Joke all the time but cant listen to any music that doesnt make me breakdown and fightback from crying. Terrible thing but I m happy and thankful . I ve been blessed with my present wife and financially successful. I wish there were some way we could love and take care of those who hurt so badly. Had me on seriquel (didnt work) lithium for awhile(got shakes) currently on lamical seems to work well plus several high strength pain meds.I’ve ramble on enough , Hang in there and God bless.
Hi, I’m Rhuby. I’m seventeen this year. I often cry before going to bed without reasons and get irritated very fast. When I’m angry I couldn’t control my emotions that sometimes I attempt to suicide. I keep a knife in my room always. I have problems in sleeping. When its out of control , I’ll just take a drowsy pills to make asleep. Do you think I got a bipolar disorder?
Hi Natasha,
My husband is bipolar type 1. We live in india where the awareness to this is very low. He has just started counselling. But he is having this depression episodes from past 10 years. It was wrongly diagnosed as SAD and hence we relocated from London to india.
He is an extremely smart intelligent guy, who is great at work, winning all kinds of awards and rankings. He is very ambitious, wants to grow in his carrier etc etc. he is extremely confident, competetive and aggressive, all set to conquer the world. But once in 6 months he gets into this low phase which stays on for a 15 days to a month. he starts doubting himself and trying to reset his goals in life.otherwise an active person who wakes up without an alarm at 4.30am everyday, snoozes his alarm everytime it rings. Though he doesnt think lextremes like suicide. He just tries to settle down with watever we have. I and my husband have observed that it usually his work that triggers him and puts him into depression. And again something good in his work, like a good appraisal or an increment that will make him bounce back.
I am always with him in this situation. I constantly talk to him. I try to explain to him that we are doing great the way we are and i try to soothe him down. I sit with h at night when he completes his work, so that he has no backlog of work, which can add on to his anxiousness.
We try and be inbetween friends and relatives to keep his mind of from wandering away. We have tried to work on things that may pile on and add on to his anxiousness. He handles it much more maturity now.
Do you think medication is necessary in a situation like this? Do you think mood stabilisers are something that are safe. Or can we handle it just with counselling.
There is so much to write. I hope i am making sense.
Hi Madhuri,
I’m sorry you and your husband are in this state. It is tough, to be sure.
I can’t say what treatment is right for your husband but it is great that he’s in counselling. Personally, I think mood stabilizers are a safe and appropriate option for many people with bipolar disorder but only a doctor can decide whether they are right for your husband. I would recommend finding the best psychiatrist you can and working with him to find the best treatment.
– Natasha Tracy
Hi Natasha. Sorry to disturb you with my silly questions….
I was recently diagnosed as bp with rapidy cycling. It is so overwhelming. Does people with bp ever get to a point where they can livenormal life? With rapid cycling, as i understand is the same type you suffer from… How do you distinguish normal mood swings from the bp ones? They always goes high up and lowdown or can be less sever?
i’m in a point that I don’t know if I want to live with this condition, if it is worth… The weird part is that my swings seems to be related with situation like… Spend the day at home makes me feel terrible, but if I try to go out and find friend I get better with time… If i make an effort to distract myself from my diagnoses and prognosis, i can enjoy although the feeling of depression is always in the back of my mind…. It is like I swing from normal to depressed.
I’m intrested in nkowing howyou handle this swings. I had a dream of being a mother, but I can’t imagine that now with this diagnosis.
Hi Natasha. Thank you for putting an effort and helping people understand bipolar better.
I was wondering if you can help me with something.
I was recently diagnosed as bp with rapidy cycling. It is so overwhelming. Does people with bp ever get to a point where they can livenormal life? With rapid cycling, as i understand is the same type you suffer from… How do you distinguish normal mood swings from the bp ones? They always goes high up and lowdown or can be less sever?
i’m in a point that I don’t know if I want to live with this condition, if it is worth… The weird part is that my swings seems to be related with situation like… Spend the day at home makes me feel terrible, but if I try to go out and find friend I get better with time… If i make an effort to distract myself from my diagnoses and prognosis, i can enjoy although the feeling of depression is always in the back of my mind…. It is like I swing from normal to depressed.
I’m intrested in nkowing howyou handle this swings. I had a dream of being a mother, but I can’t imagine that now with this diagnosis.
I WANT TO KNOW THAT CAN LAMITOR DT 100 M.G. PER DAY CURE BIPOLAR DISORDER
Hi Ashok,
Nothing can cure bipolar disorder but that may or may not be an effective treatment for you.
– Natasha Tracy
I have bipolar II and have found articles claiming that the depression in that diagnosis is often longer-lasting and possibly more severe in the long term than in bipolar I. Do you have any further information about that? Thanks.
not so much a comment, more of a question. I have days where im angry and aggravated very easy and im sad also. I don’t want to feel this way I feel hopeless on those days. it happens anywhere from lasting a day to lasting 3,4,5,days at a time. Im currently on Zoloft 150mg a day. My dr wants to try oxcarbazepine? is this even for anger? and why do I have these anger days?
Hi Nicolette esveld
I don’t know if you will ever see this and I hope Natasha got back to you. I also have bipolar and I have always noticed that whenever my mood changes my thoughts do too, and whenever my thoughts change my mood follows through. They become, sometimes irrational and dangerous and sometimes just wrong, sometimes very helpful and very right. My question to you and everybody else who sees this comment is this: What thoughts go through your mind when you are angry, agitated and sad. If your hypo-manic, or euphoric, im sure you want to share
Sincere regards
Damon
Natasha,
Thank you for your articles. I was recently diagnosed with Bipolar 1 along with panic disorder and generalized anxiety disorder between my psychologist and general physician. They are making an awesome team to work with. While it is a constant battle within myself to accept the idea of having to take medication daily, I have come to understand that right now its necessary. I also see my psychologist once a week with a couple of extra emergency appointments when things get to rough. Ive had to apply for FMLA because currently Im not stable and having plenty of doctor appointments.
I think the hardest thing in my life is that my parents refuse to accept the diagnosis. I feel like they are refusing support by denying this. I do have some amazing friends who are pushing me to better myself and pushing me to seek out all the necessary help. They have become like family and are there around the clock when I need someone.
I find the worst part about the illness is the obsession with suicide and the fact that anytime I panic, I become suicidal even over the smallest things. My mind has trouble grasping in those moments that the problen will pass and I will be okay. I also struggle with audible hallucinations. It took the diagnosis to finally understand what I was experiencing. It also took me years to admit to having them but it confirmed my psychologist’s diagnosis.
Anyways, thanks for the great articles. They do help.
How I cope with suicidal thoughts and feelings is by thinking of them as symptoms of my mental condition that give me information about the state of the chemicals in my brain and body.
When I’m stable, thoughts of suicide in response to some scary situation or when I’m feeling overwhelmed–those thoughts are fleeting and relatively rare. They’re easily dismissed with the thought: “I’m feeling overwhelmed/scared. Thinking about that (suicide) isn’t going to help.”
When those thoughts aren’t so easily dismissed, when they predominate, then instead of taking them as something that’s worthy of consideration, I take them as painful symptoms that something’s still out of whack.
How I put it to my doctor is: “I’m not going to act on these thoughts. I just take that I’m having them as information about my current state. I’m telling you about them so that you know what’s going on with my condition.”
Panic attacks are awful. I had a bunch when I was dealing with PTSD. DBT helped me a lot. The skills can help reduce the frequency and duration of attacks.
The compulsion to write is called hypergraphia, and you don’t have to have bipolar to get it (but it helps). Hypergraphia is more a trait than an illness. A whole lot of successful professionals in the arts have it (sometimes the compulsion is to draw). It can manifest with or without talent. People who have it along with talent frequently use it professionally and are thankful we have it.
I’m sorry your lithium isn’t working. Sometimes it can take as much as three years of your pdoc trying you on different medications and combinations to get your symptoms in check. _Most_ people eventually respond to medication, so hang in there.
Everyone’s body chemistry is different, everybody reacts to different meds a little differently, so the psychiatrist has to listen to your symptoms and make her best educated guess about what will work for you, then take the information from what happens and her growing amount of information on your symptoms to figure out which of the many available medications to try next.
If you are not imminently inclined to harm yourself or somebody else, the chances you will be “put away” are tiny. The reason for that is that there are a LOT of mentally ill people who are, at any one time, in imminent danger, and there are few psychiatric “beds” to put them in. If you aren’t in imminent crisis, somebody else needs that bed more than you do, and the psychiatric professionals in hospitals and facilities don’t want you taking up one of their scarce beds.
If you do not have a living will, it’s a good thing to pursue when you can. It can specify, if you are ever hospitalized (which would ordinarily be brief), who you want to make decisions for you if you become unable to make them yourself. It prevents a judge from having to guess who to put in charge of decisions in a crisis.
If you are ever hospitalized, your stay will generally be as short as the imminent crisis and getting you stabilized to the point you’re out of crisis and can pursue care outpatient again. If you’re feeling a bit paranoid about it (and I don’t blame you if you are), realize that when you are hospitalized, other people are having to spend money out of pocket for you to be there. Other people _generally_ hate to spend money unless it’s on something cool for themselves. Thank god for philanthropy when it happens, but generally, the problem isn’t with putting people healthy enough for outpatient care in institutional beds unnecessarily, it’s a _lack_ of beds for the people who really do need them.
(The exception is the “troubled teen” racket, but that’s another subject for another day.)
I know it’s frightening, but it would probably really help your psychiatrist for you to be candid about all of your symptoms. Your psychiatrist is going to need to choose a “plan B” after the lithium. Bipolar has all these vague subtypes because multiple genes can cause it, different genes are causing it in different groups of patients, and different patient histories can make some drugs a good idea or some drugs a bad idea for that patient.
One bizarre example is at least one psych med is that that particular one can give people with a history of concussion or other traumatic brain injury problems. If it seems like your pdoc is asking weird questions, a lot of times there’s a good medical reason for the question.
Many bipolar people get good results in stabilizing their mood from one of the class of drugs called “atypical antipsychotics”. It’s not as scary as it sounds. I’ve taken one, it helped me at the time, and I didn’t have any of the “One Flew Over The Cuckoo’s Nest” horror story effects you hear about from the old drugs.
That doesn’t mean your pdoc will suggest trying you on any particular med or class of meds. I’m not an MD. The pdoc is. She’ll take your whole medical history into account in recommending a plan B. She’s not Moses on the mountain bringing down the stone tablets from God, she’s your partner on your treatment team participating with you in _your_ management of your condition.
Anyway, free advice is worth what you paid for it. My advice is to take a deep breath, choose to tolerate the feeling of vulnerability, and be candid with your pdoc about your symptoms.
Hi.
I’m- how to put this….
I just got diagnosed with Bipolar 1, and I was given Lithium to help (it’s not working)… and I was wondering because everything I’m reading on the internet just confuses me more, is seeing and hearing things normal for Bipolar 1? I want to ask my therapist this stuff but I’m literally scared to death of getting ‘put away’.
Also I have all these random stories and images running thru my head and I literally ‘HAVE’ to put them on paper and if I don’t I start freaking out-is that normal?
My mind goes fifty miles an hour and nobody seems to understand what I’m trying to talk about. The mood swings are getting better just not everything else…
Hi Sabrina,
I’ll try to answer your questions.
Seeing and hearing things is part of psychosis and psychosis can be part of bipolar I. Psychosis can be dealt with, with medication, typically antipsychotics. Don’t be scared of it, many people experience it but you _have_ to tell your doctor otherwise he or she won’t be able to find the right medication for you.
I can’t promise what will or will not happen, but I will say that if you’re not a danger to yourself or others, you shouldn’t get “put away.” Just admitting to psychosis isn’t going to do it.
Remember, it’s just a symptom of the disorder.
Needing to write is actually something I’m familiar with, can be a compulsion, and can be part of the illness. Again, lithium may not be the right way to handle this so you need to talk to your doctor.
It’s natural to be scared when you’re first diagnosed and it’s natural to be confused but you’re not alone and it will get better.
– Natasha Tracy
Maybe you’re describing your experience to others as “seeing and hearing” but in reality paranoia is at work, which can also be a symptom of bipolar. I can imagine how scary it can be and I really am sad to hear this. Only thing that can help is medication, rest, and time – unless other things complicate it. Antipsychotics are prescribed if you’re experiencing psychosis, to wind things down as it were. Even if your symptoms are overwhelming at the moment, always remember there are certainly others who have experienced something similar if not worse. And that person will be sitting before you telling you their story, telling you this from a place of calm, and you will look at that person in awe because you cannot believe that they were actually in a place even darker than the one you are in now, darker and scarier than you could ever imagine.
Someone in a group told me I should read about Vivienne Leigh, but I couldn’t bring myself to do it because I really hated where I was at (where I still am, due to complications). Is it really fair to diagnose the dead? I don’t think so. BUT she is one of the more definite well known people who suffered from BP. What good does it do? It makes you realize that it can happen to ANYONE. You weren’t singled out. It was how the dice rolled.
Wishing you a speedy recovery.
Family member has these symptoms
Repeatedly lies for no reason
Dreams big and rambles about how great things will be
Ignors any disapproval of her brhavior
Mskes up stories about things in the past that never happened to make herself look good or someone who is deceased look bad.
Excagerates to make people feel sorry for her.
What is this??
Debbie,
That sounds very much like borderline personality disorder to me.
I have several friends who have been diagnosed with either bpd or borderline traits. A diagnosis of borderline traits is often employed to avoid various insurance or even child custody issues (even if the patient’s psychiatrist/psychologist “real” diagnosis is bpd).
The traits you are seeing in your family member mirror my friend “Anne”‘s behavior very closely. Does the family member in question have a history of trauma? Trauma of all sorts – especially when experienced as a child – is associated quite strongly with the development of personality disorders, while mood disorders often do not manifest until adolescence or early adulthood.
I hope your family member has received the assistance he or she needs, or has at least accepted and admitted that his or her behaviors do deviate significantly from those of lucky souls who do not suffer from mental illness. Change must be preceded by awareness, and unfortunately awareness only opens the door to the possibility of change.
For me (I have bipolar 1), the support I received from my family at the time of my diagnosis, as well as through the devastation and triumphs of treating my illness, was absolutely crucial. My parents read Kay Jameson’s “An Unquiet Mind” as an introduction to the new understanding of my mood disorder, and they have continued to educate themselves about my illness and my various treatments. Readi g Jameson’s memoir was also amazing for me, because finally I was reading a book filled with my own thoughts, moods and troublesome and dangerous behaviors. I am confident that you could find similarly helpful resources about bpd.
It was very important for both my loved ones and me to understand that my diagnosis did not change who I was in any way. I was Mandi suffering from undiagnosed bipolar 1 and then I was diagnosed AND treated: the same exact Mandi, except with a better understanding of myself and someone(s) to help me manage my illness.
Debbie, I wish you and your family member well, and hope a solution has or will be sought and found.
Evening,
I am on 300mg of Lamictal 150mg at bed and 150mg in the morning. I am also on 90mg of Cymbalta. I was diagnosed with Bipolar II but that was almost 6 years ago and I think they are wrong.
I used to be extremely manic. My episodes would last for a few weeks. I would sleep a few hours a day and then all of a sudden I would crash and sleep for days. I was a Master’s student at the time and the manic phases were great because I accomplished so much. I was also working full time. I was in financial crisis because of it. I kept pushing my then husband away. I was struggling with suicidal thoughts and planning.
Now, I work half time because I am on FMLA for my mom’s health. I work 25 hours a week. I have been well managed on medication and self care for my six years. In the last year I have, gotten remarried, my daughter graduated from cosmetology school and moved out, my mom has gotten very sick and I have taken time off from work to care for her. This has caused issues with my finances, my home is in foreclosure, my mom is sick, my brother was diagnosed with stage 4 esophageal cancer, I have a severe case of frozen shoulder, and now my mom’s long term care insurance is denying her claim and we are trying find a solution so she can stay there. Now that I am so busy with my mom’s care, I don’t have time to care for myself with exercise. I have gained a bizarre amount of weight. I am not depressed but I can tell it is because of the medication.
Are there better choices for medication that will still help my depression but make it feel more real? Does that sound weird? I don’t want to hurt myself or anyone else but at the same time my non-depression feels fake. Robotic? I can’t explain it well, I guess.
All ideas are welcome!
Lucy
Hi Lucy,
Well, you said a lot. :) Here are a few thoughts:
1. You have not said why you think you are not bipolar. If you were having manic episodes it is very likely that you are. The medication has likely controlled them since.
2. You may find you are simply on too much medication if you are not feeling “real.” But then, that feeling may be as a result of worsening depression, which would be understandable given your circumstances.
3. There are many choices of medications our there so yes, there are many other medications that could likely control your symptoms but you need to work with a doctor to find the right combination that would work for you.
4. You need to find time to put you positive coping strategies (whatever you were using before) back into place. Those are really important in getting, and staying, well.
I hope that helps.
– Natasha Tracy
I have bipolar número uno…Diagnosed six years ago, had to be sectioned three times..thankful for each one as it saved my life. I don’t understand sufferer’s worries regarding lifelong medication for a life threatening illness, there is as yet no cure so what is the problem with taking tablets. Other diseases often require a much more punishing medicalised regimes such as kidney dialysis, ms, motor neurone, cystic fibrosis etc etc.
Yes bipolar disorder is hard to get you head around!…but humour and a ‘why not me’ attitude helps considerably, taking the tablets saves your life even if it takes years and changes of doctors to get the right neuro-chemical fit for yourself. if anyone has to ask if they are bipolar 1 then they aren’t because believe me or any other polar bear who’s had even one manic episode..there ain’t no mistaking the condition.. despite the DSM stretching the parameters of the illness for insurance purposes..but that’s another story..
So be as happy as you can when you can..great blog by the by..
Hi Sheila,
Thanks for the comment.
I think people are concerned about lifelong medications for a few reasons:
1. They don’t like the idea of being on meds (who does?)
2. They don’t like the side effects
3. They are worried about long-term effects
You are correct, though, that other illness do have much worse treatment – no doubt. Some people find the bipolar treatments mostly ineffective though and I think this just pours lemon juice into the wound.
I like that, “why not me?” I might use that in an article.
“So be as happy as you can when you can..great blog by the by..”
Great advice, and thanks :)
– Natasha Tracy
I find your information very informative. However It’s never been explained to me what I have been diagnosed which is Bi-Polar with psycotic features.. Can you help me out with my disorder.
My background for meds are
600mg of serequel (bedtime)
200mg of Lamictal (200@ bedtime)
(200@ morningtime)
3 mg of klonopin. (1mg 3x’s daily)
5 mg of abilify. ( Morning)
I still have very depressed days, in the last 1 year we have tried 5 different meds and it still doesn’t hekp with my down ward spirals of depression, at times I want to end it all cause this “disorder” dictates how I’m going to live my life…
Thank You,
Michael DiMaio
Hi Michael,
Perhaps you could contact me directly and let me know more about what you’re asking. https://natashatracy.com/about-natasha-tracy/contact-natasha-tracy/
(I removed your phone number from the post so you don’t get unwanted calls.)
– Natasha Tracy
this has been a bit helpful tonight, i was diagnosed a year ago (@ 38) after three years of serious probs- although my mental health issues go back to when i was about 12 really. the last few weeks, even when on mood stabilizers depokate) & antidepressants flouxetine) which many would dispute counteract the symptoms, has proved the best way pf stability for me. a month ago I stopped needing to take buspirone, as i did not find it helpful at all after a year. also, funnily enough, my wieght is now dropping down to where it was before I went on the buspirone (I had put it down th the depokate, plus several hospitalisations- suicidal self cutting, subsequent surgery, cellulitis due to the depth of cuts to thigh and shin- got the veign rather than the artery which apparently saved my life), also undiagnosed appendicitis all the way through which meant three stays in hospital, malapsorbtion of meds and eventual peritonitis. My question is, when the october appendix/ tummy bug stuff kicked off, and i didn’t have the confidence to ask for help as they didn’t do the right tests in june, therefore went from my usual hypermanic very excitable productive no need for sleep, ability to be irritable but funcitonally fine and life of party in social circles, as well as kicking butt at work, I actually got to the point where I was happily (yes it sounds shocking) carving myself to the bone, thinking my little girl wouldn’t notice (I have managed to never let her see me lose control- i know one day she will know but for now she thinks it was done by a stanley knife opening boxes- my ex husband knows now as social workers told him) and I have been told by friends that I was quite happily sat up in a & e with her (at seven years old!) with blood pouring from my pyjamas, with my local elderly friends, and my work laptop with a film on for her. it made sense at the time, she was safe, the cut was a release, no i didn’t really feel any pain… she had always been considered my “safety factor” and I know you are all thinking shit mum. but she has emotional behavioural difficulties and her dad was emo0tionally abusive to me and i had no local support network, so my social worker actually decided I was at that point too ill to parent her- i am her lifeline-. I spent 2 weeks in hospital and her dad had to look after her. i was all over the place. I guess my question is was that mania or hypomania?
and also to give a bit of hope- i can now recognise (like now) when i am in a hypomanic state- two weeks on 2 hours sleep a night, very productive at work, but a bit reckless driving, very flitty with thoughts and very irritated by my daughter’s spiteful comments- i had just got to a position of disassociation but struggle now with it. so i will see the gp tomoz @ five, know work is brill, they understand where i am at (just look at the time- i have been awake since five and am wired still) but am beggining to wonder on the grey areas of bp1 and bp2- by the way when i was in the hospital (for those of you in the us- they reeeeeally try not to ever get you as an inpatient) they talked about eid (borderline personality disorder) so am attending a course on that and its all about filters, cbt etc, but i think mine is very mild and is more about becoming overly stressed and emotional about the way i am treated by others as i am never physically or verbally agressive, internalise a lot (which i am working on changing) and now I can disassociate from my duaghters emotional behavioural disorder and my ex husbands bullying that is not really and issue. this really really feels bichemical. help!
Hi Kylie,
As to your question about hypomania vs. mania, I can’t say for sure but I suspect that was mania because, by definition mania is life-threatening and hypomania is not, although self-harm is not a symptom of either one. I might suggest though, as you were “happily” cutting away at yourself you were probably psychotic, and that _is_ a symptom of mania.
I’m glad to hear you are getting a variety of help for your situation. It sounds like you need it and I trust something will work for you.
I’m glad you’re still with us. Try to keep it that way. :)
– Natasha Tracy
heiio my name is tara and the father of my 3yr old daughter has just attempted suicide twice by an overdose on seraquil,which is a drug that has never benifited him.my question is what do we do with him now?where do i find the right doctors , therapists,suport and living conditions to substain him in to better educate and moniter his situation.and how do i prepare for my daughters future(asuming she may have dificulties that i have already noticed to affect her)
please help i dont know where else to research for education and support
Hi Tara,
I’m sorry to hear of the situation you are in. That’s very difficult to be sure.
Without knowing the details of your situation, here are some general suggestions.
In my opinion, anyone who has attempted suicide twice needs to be in an inpatient, probably locked, facility. This might be a hospital or a private facility depending on what you have access to. You can’t monitor a person like that, who is in constant danger, at home. They need more stability before they are not a danger to themselves.
I also recommend limited access to all drugs. Get one week of medications at a time from the pharmacy so that you don’t have enough on hand to overdose.
You didn’t mention a diagnosis, but you should be looking for a specialist in that area. Ask your GP (family doctor) who they would recommend. Be sure to note it is an emergency. Look for facilities in your area that specialize in treatment of the disorder if you can afford them. There are many site online that help you find a doctor by speciality like healthgrades.com (there are many others as well; you may wish to view multiple sites to see doctor ratings).
I recommend getting counselling for your daughter as all this will be difficult to deal with. Be sure and see a counsellor or psychologist who specializes in working with children. Again, web sites can point you in the right direction.
And while you are doing this, make sure you get help and support for you too. That might be professional support, like therapy, or it might be being surrounded by friends and family who can help you. Remember you are not alone in this.
I hope this helps.
– Natasha Tracy
Slightly confused by this as I have a Bipolar II diagnosis but had significant suicidal ideation and psychosis in my last acute episode …..
Hi ManicSleepTeacher,
Any one person’s diagnosis is often directly related to the opinions of the doctor rather than the official DSM diagnostic criteria itself. Perhaps you can ask your doctor why you have been diagnosed with bipolar II when psychosis specifically is considered a bipolar I indicator. They may have a very good reason why, I just don’t know what that is.
And suicidal ideation is present in bipolar I just as much as bipolar II, FYI.
– Natasha Tracy
Okay, yeah, but can I scream now? Natasha, I’d like to put in a column request for the next time you have something coming up for medline or one of the articles you get to put “out there” if they’ll let you. I know you sometimes may have very limited editorial say in the topics for articles (I’m a writer), but the “types” of bipolar are showing up more and more in the news and I have heard major media idiots more than once describe bipolar type II as a “lesser” or “less serious” version of bipolar disorder.
I’ve heard people with medical credentials after their name describe it as “lesser” or “less serious” or “less severe.” I’ve heard them use some kind of minimizing language comparing it to bipolar I that has implied that people who have bipolar II aren’t as sick as people who have bipolar I.
While our *ups* are less severe, if research exists that suggests we have a lower risk of dying than folks with other subtypes of the disorder, I haven’t seen it. In any case, rather than competing for who wins the ribbon for the most suicides, someone needs to shake up a little bit of sense out there.
Whether someone has I, II, Rapid Cycling, Ultra Rapid, NOS, whatever—maybe the cyclothymics don’t die, but as far as I know the rest of us all face about a 20% lifetime risk of suicide.
So anyway, I don’t know what your position on this is, but I have had trouble advocating for disability accommodations before because of minimization. My child is type I, so this wouldn’t affect her (and she’s almost grown). I rarely have to seek accommodations for myself. But when people do need accommodations, it can be a problem when the guy or gal you have to deal with looks you in the eye and says, “Yes, but I’m familiar with this disorder and you have the less severe version.”
Anyway. Just my thoughts. I seriously want to scream when people minimize the major mental illness that’s been trying to kill me since I was 5 years old and has damned near done so, repeatedly, and kicks my ass every day, as “less severe.”
Most of the Bipolar II’s I’ve known don’t hear voices, because only one or two external entities talk to them in their head and it’s not psychosis because they’re really there. But, you know, the pdoc and therapist wouldn’t understand that, so they kinda don’t mention it. Ya know? Besides, it’s not like they physically *hear* them, so it’s not a hallucination, right?
Um…tongue-in-cheek doesn’t always carry well over the internet. The post just above this one was dripping with irony, for anyone who missed it.
Hi Julie,
Well, I can see that _someone_ touched a hot button for you?
Yes, you are correct that some in the media to suggest that type II is “less severe” than type I and you’re correct that this isn’t remotely true. In face, just a while ago I was speaking with a doctor who has type I himself and he feels that type II is _more_ severe due to the prevalence of depression. People with bipolar II spend 35 times more time depressed.
So I can understand your pet peeve. I’ll put it on the list. And, in case you were wondering, I have complete editorial freedom in all my columns. :)
– Natasha Tracy
Being diagnosed with a mental illness created fear and relief–now I understood my problems and could get help but I feared how my next 40 years would unfold. I now seek out new information regularily to keep myself up-to-date.
From what I understand I have Bipolar I and looking back I believe I suffered from as early as my teens if not earlier and I was only diagnosed at 46 years of age. I too fear taking medication for the rest of my life but I understand how important it is that I do so. I tried going off the medication once as I challenged the diagnosis and I quickly learned what a mistake I’d made.
Since bipolar is genetic (my Aunt too suffered) I realise my role in keeping an eye on my children, nieces and nephews as I am likely to be able to recognise the illness and get them medical help. I don’t want anyone to have to suffer half a lifetime before they get relief.
Its been six years since I was diagnosed and I am still closely monitored to change my medication as required. I think we have the right dosages now but I know there is more work ahead.
How many among us can live a life without some illness? We all suffer, we all suffer something. It is not how we suffer that is important but how we shine.
Thank you for your site, it is comforting to know there are people keeping abrest of the issues so all I need to do is go to your and others’ sites.
Hi Lisa,
Thank-you for your comment and I’m glad to hear you are getting help, even if it took so long to get it.
(On average it takes 10 years for someone with bipolar disorder to get appropriate help. FYI.)
– Natasha Tracy
Thank you for giving such an easy to read and understand description. I have not been diagnosed with Bipolar yet but I have been in and out of therapy for major depression in the past and was told that I needed to be evaluated for Bipolar. I ran from the therapist’s office and never went back. I was terrified for them to tell me that I had it and for the medications I would have to take. Nothing I ever took for depression helped me and I would go into these rages of anger and pure craziness. I am a 34 year old mom of 3 daughters and wife to a very patient and loving husband. A little over a month ago I went into a period of a downward spiral of sorts. I had been drinking more and more alcohol (wine) over the prior 6 months which is something I never had issues with before. I then engaged in a 2 week affair of sorts with a guy I went to high school with via social networking and texting. I sent pictures of myself with no clothes on ( a few of them quite graphic). My husband found it and confronted me. I went into a deep depression and realized that there was something very wrong with me. I could not answer why I did it, because I had no feelings for the guy, no emotional connection at all. The only answer I can come up with is that I was seeking attention maybe. I am thankful for his discovery because it is leading to me finally getting the help I so desperately need. I am terrified of taking the medications for the rest of my life but I know that I need it. My kids have suffered at the hands of horrible mood swings I have. My husband has paid a huge price with my illness as well. My prayer is that I get the help I need so we can live somewhat of a normal life.There is so much I still do not understand about this illness. I go for my psychiatric appointment next week and hope to get the answers I need. I am thankful to have found your blog and know that I am not alone.
Hi Melissa,
Thank-you for your kind words. I’m honoured I can help in any way.
I can understand the terror of the bipolar diagnosis. I felt that way when I found out I was bipolar. I was destroyed by the news. Like you, all I could think about was the medications I would have to take. But the thing I failed to realize is that in diagnosis there are answers too. And there is help. Maybe more help than you have ever had.
Unfortunately, if you are bipolar and you took antidepressants, they like would make you worse. You would experience anxiety, anger and “craziness.” That’s normal and shows improper use of medication.
“I am thankful for his discovery because it is leading to me finally getting the help I so desperately need.”
It’s good you see it that way – in a positive light, because getting help is a positive.
“I am terrified of taking the medications for the rest of my life but I know that I need it.”
Try to take it one day at a time. Work on getting stable today and let tomorrow take care of itself. Don’t think about medications for “the rest of your life” just consider what you need for today. And take a deep breath.
“I go for my psychiatric appointment next week and hope to get the answers I need. I am thankful to have found your blog and know that I am not alone.”
That is an excellent first step in getting answers. You are reaching out, getting help and that is just what you need.
And you are not alone. I have been where you are and so have many, many people. You’ll make it, just focus on making baby steps forward as any forward movement is movement in the right direction. You can’t fix everything overnight.
Good luck. Drop by here any time.
– Natasha Tracy
This is so very helpful and clear!
Thank you very much for posting it. . .
Valerie,
That’s just what I was hoping for :)
Glad I could help.
Thanks.
– Natasha Tracy
A polite challenge to your statement that use of the term manic depression reflects a lack of up-to-date knowledge.
Kay Redfield Jamison, author of “The Unquiet Mind,” is also the co-author of the bible of manic depressive illness and recurrent depression. The textbook, in its second edition, is titled “Manic Depressive Illness: Bipolar Disorder and Recurrent Depression” In the introduction to the textbook, she explains why she uses the term “manic depression” instead of bipolar. That explanation reads, in part:
“[W]e became increasingly convinced that isolating bipolar disorder from other major depressive disorders and unduly emphasizing polarity [mania or depression] over cyclicity (as do DSM-III and DSM-IV) prejudges the relationship between bipolar and unipolar illness and diminishes appreciation of the fundamental importance of recurrence. … Scientific and clinical advances [since the 1990s] has only added to the strength of our belief that, as important as polarity is, cyclicity or recurrence is fundamental to understanding manic-depressive illness. … Genetic findings will have the ultimate etiologic and diagnostic say, of course, but in the interim we think a broader rather than narrower concept of the illness is warranted by the data; we also think it is heuristically most valuable.”
Roland Behm
Hi Roland,
Yes, I read her perspective in An Unquiet Mind and perhaps I should have also said the term “manic depression” is also used simply due to preference. She, and others, personally respond more to the term “manic depression” which is their prerogative.
Her point that you quote above I agree with but I don’t think the term manic depression somehow addresses it any more than bipolar does.
But I respond to the word crazy and have many reasons as to why I think that’s better than either one of them. Of course, that doesn’t really make it an accepted interpretation.
– Natasha Tracy
Thank you so much for clearing this up for me. It really helped. :)
Hi Ashley,
You’re absolutely welcome – pass it along.
I always feel that if one person asks a question it means that 100 other people are wondering the same thing, but just not asking, so I like to answer questions where I can.
– Natasha Tracy
Bipolar -I from family past or why u get it
I lost my job got no medical aid the clinic don’t want to assist me with all bipolar meds iam off meds for 2mnths iam going crazy what can I do
Hi Isabella,
I’m sorry to hear that you’re in that situation.
I’m sorry, I don’t have any recommendations via funding. I suggestion you call a helpline or contact a local advocacy groups for more information: http://www.healthyplace.com/other-info/resources/mental-health-hotline-numbers-and-referral-resources/
– Natasha Tracy