We are bipolar disorder experts and scientists, ask us anything for World Bipolar Day!

Why are so many psychiatrists "so bad" at treating this? I've been bipolar for about 35 years, and it seems like the standard treatment regimen is "well, gee... let's try this drug and see what it does for you?"

"OK, Doc. What can I expect?"

shrug "It's different for everybody. Call me back if you experience thirst, or you're not thirsty. Let me know if you get hungry, or you're never hungry. Also, side effects might include manic episodes or bouts of depression. That'll be $150 for our session."

Are the drugs just that poorly understood, and, if so, why the hell should we ever trust them, since those of us with the problem seem to be a running laboratory?

EDIT: Thanks for the gold, kind stranger.

EDIT 2: I also want to point out that this is one large reason no one particularly trusts "you guys" in the mental health "profession." The implication of an AMA is that you actually answer some of the tough questions, not ignore them. Whyever would someone trust any of you to give us brain altering chemicals if you don't answer questions about them?

Trisha here - I am a psychiatrist working at a specialized center for mood disorders. In this center, I and my colleagues see many individuals with bipolar disorder who have been struggling for a long time to find the right treatment. With this experience, let me start off by saying that I 100% understand the frustration at the seemingly arbitrary nature of prescribing treatments for bipolar disorder.

There are many reasons why it can be difficult to find the right medication for an individual. One reason that I will focus on in this response is the current lack of ‘personalized medicine’ in psychiatry. We have many medications that have been studied for the treatment of bipolar disorder, and many that have shown efficacy. The problem is that these studies demonstrate efficacy by showing that a group of people who received the medication overall did better than a group of people who received placebo. These types of studies are essential to establish that a medication provides some benefit in treating symptoms. Unfortunately, these types of studies can’t tell us which particular individuals would benefit from this particular medication. I can estimate that, based on the studies, if I give medication X to 10 people, 6 people would benefit and 1 might experience side effects. However, I can’t estimate with any degree of certainty whether the individual sitting in front of me will be one of those six who might benefit, or the one who will experience side effects.

There are a number of ongoing studies looking at genetic and symptom profiles, and how this might help us with individual prediction of response and side effects. Unfortunately, though, we still have a ways to go in this area of research. We currently have treatment guidelines (like those from CANMAT) that ‘rank’ medications based on the efficacy they show in these types of group studies, the quality and quantity of studies that back them up, and the overall side effect burden. Taking a thorough clinical history, getting a detailed medication history, and combining that with recommendations from treatment guidelines is currently the best approach we have in deciding on treatment options. Sometimes using this approach we can fairly quickly find the best fit for the person, but unfortunately sometimes it is a much longer process.

AMA people, you are missing out by not answering questions like these. No one needs to hear you repeat the same tired facts you're repeating in other answers: they need to understand what you the experts know that we don't, and that's exactly what questions like these are asking.

Please don't take them as people attacking you, but instead as people who genuinely want to understand why we humans are so bad at dealing with this disease when we're so much better at dealing with other ones (even many other mental ones)?

EDIT: Thank you for the "energy" fellow Redditor! Never gotten one of those before.

Erin here. I don’t for a moment take this type of question as an attack :-) Please know that we’re not not going to answer this question, but that it’s quite a sizable task to address over 100 questions and counting, that some of us need to take breaks during this process, and that some questions are easier to address and answer quickly than others. We’re coming around to it, thanks for your patience.

Hello! I'm a research assistant with CREST.BD who lives with bipolar disorder and has a degree in psych, so maybe I can give a perspective as someone who knows both the mental health system and people who work in it?

I think the thing is that a lot of these medications actually DO work for a lot of people, but they don't work for everyone. The process of finding the right medication can take years, because everyone's different. Scientists are still working on ways to analyse brain chemistry and match people up with the right medication, so for now it is just kind of trial and error. Which sucks for those of us who start to feel like guinea pigs being run on a wheel of medication. :/

Also, there are some crappy psychiatrists out there. That's just the unfortunate truth. Or just psychiatrists that you don't see eye to eye on. It honestly can be so exhausting to try to find the right person to help, but I really think it is worth it in the long term.

Personally, for me, JUST using medication never worked. I needed to get my lifestyle in balance, too. What balance looks like is different for everyone, but some of the resources that have helped me are CREST.BD's bdQoL.com tool, the iMoodJournal app, making my sleep schedule more consistent, and adjusting my caffeine depending on where my mood is. I hope that helps.

Has any link been established or observed between mood disorders and gut flora? Have any studies been undertaken?

Steven Barnes here - There is an emerging literature on the role of the gut microbiome is psychiatric disorders. There are known differences in the constituents of the gut microbiome in individuals with bipolar disorder, but it is currently unclear which differences matter and whether the addition of a specific microbe might alter the course of bipolar disorder. There are a handful of good review articles on the topic, though they are all pretty technical. If you feel comfortable with the technical language, here is a good recent one:

Järbrink-Sehgal, E., & Andreasson, A. (2020). The gut microbiota and mental health in adults. Current Opinion in Neurobiology, 62, 102-114.

Thank you! Has fecal transplantation from healthy donors been considered as a possible course of research?

Steven - There are a few clinical trials trying just that! Here is an example: https://clinicaltrials.gov/ct2/show/NCT03279224?term=microbiome&cond=bipolar+disorder&draw=2&rank=3

Does anyone on the staff responding here actually have bipolar disorder? And if so, how has it influenced your path to where you are now?

We often don’t have people to look up to because there’s such a stigma that few people are open about it. I plan to be a physician, and it’s tough for a lot of us in higher level education (of course, it’s hard for all of us; I’m just speaking from my own experience) to handle so many things including coursework, clinical duties, exams, medical appointments, medication adjustments, sleep cycle disturbances, etc. Mark Vonnegut is the only openly bipolar physician that I’ve come across.

Steven Barnes here - I have bipolar disorder Type I, and talk about it openly both when teaching about psychiatric disorders and in general (as you can see...). Having bipolar disorder has had an immense impact on where I am and what I am doing (and probably vice versa). Some of those have been positive impacts, some negative. It continues to guide the choices I make in my career. For example, I am less tolerant of stressors than many around me, so I tend to avoid higher stress activities.

Erin here. I know quite a few MDs who are living with bipolar disorder and are doing well in their careers (and the rest of their lives). Many of them have chosen not to disclose though. I think you’ll enjoy this video: https://www.outofdarkness.ca/post/physician-heal-thyself

This might be a slightly silly one. I've been on lithium for 14 years, and from the day I started I haven't had one single insect or flea bite. Previously, I was irresistible to them. Is this a recognised side benefit to lithium?

Steven Barnes here - Not a silly question at all! Lithium does kill mites (e.g., the type that kill honeybees) and has deleterious effects on the larvae of certain mosquitos (e.g., the ones that cause yellow fever). However, I know of no studies that have looked at the incidence of insect bites in people who are on lithium.

Erin here. This should be a question for a Citizen Science project! :-)

I have a huge question: Is it typical for bipolar disorder to get worse or develop new facets with age? I ask because as I've gotten older my symptoms have become worse, harder to control with medication, and over the last few years I've developed psychotic features that were never present before (ex: visual and audio hallucinations). I can't seem to find any clear answers about this.

Steven Barnes here - What we know about the natural progression of bipolar disorder is that, when left untreated, the mood episodes (i.e., mania, depression) tend to become more severe and more frequent over time. We know much less about what happens with people who have been on mood stabilizers for an extended period of time, given that there are so many different mood stabilizers available and because it is hard to conduct the sorts of studies that would address the question. If you are seeing increases in the intensity of your symptoms, I would highly recommend you speak to your healthcare provider about this.

I have severe Bipolar in my family with my mom, grandma, brother and a cousin afflicted. Where is “Gattaca” science on this for potential parents? I perhaps want to be a dad, and that window is happening now, but I would never forgive myself for having a severely disturbed child.

Where are we with risk factors and the ethics of this whole thing? Thx

Erin here. I’m really glad you asked this question as the answer is so important. And you’re not the only one asking it - check out this 2020 study I just found of Redditors’ discussions about bipolar disorder and reproductive decision-making decisions. It found that “Genetic risk was often raised in the context of Redditors' discussions about whether or not to have children. Reproductive decision-making for Redditors with bipolar was complex and influenced by factors from their past, present, and imagined future”.

As Dr. Rob rightly suggests - see a genetic counsellor before you make such a big decision. Our team member Dr. Jehannine Austin and her group run a free genetic counselling clinic for people living in British Columbia who have a diagnosis of a psychiatric disorder, or a family member with a psychiatric disorder:

http://www.bcmhsus.ca/our-services/genetic-counselling-(the-adapt-clinic))

Her group will also advise you on where to go if you’re elsewhere in North America.

Also, know that having a diagnosis of bipolar disorder doesn’t automatically mean that the person will be “severely disturbed” - lots of people live perfectly well with the condition with the right supports and treatments :-) Good luck!

Erin again. I messaged Dr. Austin and she has these further resources to offer:

1. Is mental illness inherited? (a blog)
2. How to protect mental health when genetics makes you vulnerable
3. Is there a gene for depression/schizophrenia etc?

Erin again: one more resource has been provided by Dr. Austin by email: “Here's what to expect from genetic counseling about psychiatric illness”: https://www.nsgc.org/p/bl/et/blogaid=277

Dr. Rob – We’re not at the level of genetic engineering for mood disorders, but we are at the level of sophisticated genetic counselling. There are psychiatric genetic counsellors who can help you to understand your particular risk profile for having children with a mood disorder, and I would highly recommend you seek out a consultation if you are considering parenthood.

Hi! I was wondering what the link is between bipolar disorder and anxiety? I have bipolar ii but sometimes I feel like my anxiety is worse than the mood changes (although I might not say that if I were depressed right now..)

Dr. Rob - The single most common mood state in someone with bipolar disorder is anxiety. It is typically present when you’re depressed, when you’re hypomanic, and when your mood is level. It is the constant unwanted companion. So, you’re not alone. It is treatable! I would definitely bring this to the attention of your psychiatrist and your therapist (if you have one), since there are medication strategies, cognitive strategies, and behavioural strategies that are helpful and evidence-based.

Erin here. And it will be no news to you that these are, well, exquisitely anxiety-provoking times with the COVID-19 outbreak. We’re doing our best at CREST.BD to provide people with bipolar disorder evidence, tips and tools for anxiety management. For example, we’ve started a series of online (Zoom, livestream) events, the first of which focused a lot on anxiety management. You can watch the recording here: http://www.crestbd.ca/TalkBD/

What is the best way to support someone close to you who suffers from BPD and anxiety?

Edit: my apologies, I know now that BPD is for borderline personality disorder.

Dr. Rob – I don’t think there is any single best way to do it. Support is going to come mainly in a lot of little ways and occasional big ones. Acknowledging and validating the anxiety is important, while also recognizing that it may be trying at times for you. So, self-care is a big piece in supporting someone with a mood disorder and anxiety.

How do you detect bipolar in young children such as a 7 year old?

Dr. Rob - Although bipolar disorder can be diagnosed in young children, it is actually quite rare. Typical onset is during adolescence. However, there can be bipolar mimics in young kids, such as ADHD, and if there is a behavioural concern, it is certainly worth bringing to the attention of a physician.

Emma here - The research we have suggests that bipolar disorder is rare in children, more common in adolescents, and yet more common in adults. It is substantially less common that other disorders which have similar features, like ADHD, unipolar depression, or conduct problems. Non-specific symptoms like irritability can be a warning flag for distress in a child, but unfortunately they are not very helpful at uncovering what is causing that change in behaviour. A review with a healthcare provider is needed to carefully consider all possibilities, and will involve carefully examining a young person’s current circumstances and family history, using a combination of a structured clinical interview and screening measures supported by research.

1. Were you aware the link on your website points at last year's AMA not this one?
2. Are there any new drugs on the horizon? I heard there is a "son of aripiprazole" that might be coming onto the market soon?? The side effects of the current gen of anti-psychotics are a real burden, sometimes even worse than the disorder.
3. If one is diagnosed with ADHD as well as bipolar it is safe to be prescribed ADHD meds that sound like they would be a catalyst for mania?
4. Same Q as some others what is the state of research around co-morbid anxiety with bipolar and whether there are any novel treatments beyond benzos?

Dr. Rob – There are always new medications in the pipeline, and it is difficult to predict how they will do once they are rolled out to a wider clinical population. I agree with you that antipsychotic medications do have a high side effect profile, regardless of generation. I’ve never seen any medication yet that, from a side effect perspective, beats standard mood stabilizers. It is quite common for ADHD to be comorbid with bipolar disorder, and once an individual has achieved mood stabilization, it is rational to treat any residual attention deficits with standard ADHD treatments, including psychostimulants. Medication treatments for comorbid anxiety in addition to benzodiazepines can include the anticonvulsant mood stabilizers, such as Epival or carbamazepine, other anticonvulsants such as gabapentin or Lyrica, and in certain cases, used judiciously, SSRIs.

Hello! I had a question regarding the development of bi polar disorder, is it more of a genetic thing to inherit, or can you acquire it after an event happens in your life? Both maybe?

Hello! Erin here. The swift answer to this is both. People who develop bipolar disorder often have members of their family who have experienced mental health challenges - they have a genetic vulnerability to the condition. But genes don’t necessarily dictate whether bipolar disorder is ‘expressed’ in a person. We know from research that psychological experiences - like negative life events or trauma - can trigger its onset. On the other side of the coin, positive psychological and social factors, like good social support systems and good self-management techniques, can help maintain resilience and help protect people who are at risk.

The association between genetic factors, mental health conditions and protective factors is at the heart of one of our team members, Dr. Jehannine Austin’s crestbd.ca/jehannine-austin/. work - she’s a psychiatric genetic counsellor. Psychiatric genetic counsellors specialize in helping people to understand risk information relating to different types of mental illness. Find out more about this field via the website of the National Society of Genetic Counselors https://www.nsgc.org/ or there is excellent information provided by Dr. Austin’s group at: http://www.bcchildrens.ca/our-services/mental-health-services/genetic-counselling

Hi ! Did my cannabis use when I was young (15-18 years old) possibly trigger or create my bipolarity?

Erin here. I’m going to lean on the expertise of Dr. Rebecca Haines-Saah here, who’s one of the people I respect the most working in the Canadian cannabis/mental health/public health arena. She has said to me previously “Specific to bipolar disorders I would look at this high-level review evidence from the NAM review”

Previously the guidelines have stated that it is best to avoid cannabis if you have a risk for, or family history of mental illness. This new version is updated to be specific to psychosis, chiefly. This is because this is one area where there is general consensus that there is a clear and robust relationship between use and onset - but there is however much fierce debate about the direction and nature of this relationship (i.e. correlation or causal).

This is a fast-moving and controversial area of research and public health policy though - I’ll be interested to hear whether other members of our CREST.BD team have insights to offer. I’ll also drop Rebecca a message to see if she wants to weigh in further on this question.

Thank you for doing this. How would you recommend that a newly diagnosed person begin navigating the vast world of treatment and understanding this disorder?

And how can one channel their diagnosis to something more positive? It almost feels like a death sentence at first.

Emma here - The process of adjusting to a new diagnosis is complicated, both emotionally and in terms of the practical steps you need to take. Unfortunately there is a lot of scary information out there, and treatment pathways can be complicated. If you have a healthcare provider you trust, that’s a great place to start, and there are a number of online reputable, non-stigmatising sources I would recommend like CREST.BD, the International Bipolar Disorders Foundation, or SANE Australia.

In terms of finding the positives, that’s going to be a deeply personal process, but one that other people with lived experience may be able to guide you along. If you have access to peer support, (whether that is in person support groups or online) it may be helpful to hear from others how they have adjusted and found meaning or positives in their circumstances.

From the research side of things, we know that many people with bipolar disorder flourish and live well with their diagnosis. There is even research to suggest that people with bipolar disorder have unique strengths, including creativity, resilience, empathy, and spirituality. My own research has shown that people with BD found completing our CREST.BD Quality of Life Tool (https://www.bdqol.com/) a positive experience, as it was helpful for identifying both areas where they needed extra support and areas of strength.

Stéphanie here – I would like to reinforce Emma’s great answer, from my own lived experience, particularly with respect to stigma and peer support. When I was diagnosed with BD type I, I happened to know that one of my coworkers had bipolar disorder. She became my model and reduced my own stigma about this diagnosis. She was taking all recommended steps to reduce symptoms and episodes, while maintaining performance at work, having a kid, and being lovely. The good thing about this diagnosis, is that there are plenty of people (who seek resources and apply self-management) who find ways to fulfill their dreams.

I have a friend whose son is bipolar and goes through cycles where he won’t take his medication and is quite emotionally and mentally abusive to my niece (his now ex-wife). How do I show empathy and acceptance for his disorder when mostly what I feel is anger at the pain he has caused her?

Emma here - this sounds like a really emotionally challenging situation, and it sounds like you are trying your best to be compassionate while understandably being concerned for your niece. It is important to get support for yourself if you are finding this situation very difficult. Depending on where you live, you may be able to access family supports (whether that is formal family therapy or carer peer support services) that can give you advice on setting boundaries and coping emotionally. Searching ‘mental health carer supports’ and your location will often help you identify local organisations that can help you, even if it is just a friendly ear from someone who has been in the same situation.

Is there any way to reduce the chance of developing the disorder if you have a family history?

Dr. Rob - The literature on prevention in mood disorders is, I’m afraid to say, rather thin, and we have little in the way of evidence-based guidelines. Also, unfortunately, the best ways to prevent psychiatric disorders in general are often out of our hands, because they depend on things like having grown up in a warm, secure, nurturing family of origin, having not experienced abuse or neglect, and so on. If you’re a parent, and you’re worried your kids may be in an environment of increased risk for adversity, get help early from a social worker or family therapist.

Could you possibly give me an ELI5(explain like I'm 5) about how the spectrum works, differs?

Emma here - there are two main categories of mood changes present in bipolar disorder (sometimes people experience both at the same time). These mood changes are more extreme forms of the usual ups and downs in emotion that everyone experiences.

Depression is an extreme form of low mood: You may be sad all the time, or you feel empty – you don’t get any pleasure out of the things you used to find enjoyable. You might feel more hungry or lose your appetite, or find you are sleeping lots (or can’t sleep at all), have trouble concentrating, feel slowed down, or have negative thoughts (like feeling worthless or wanting to die).

Mania (and to a lesser extent, hypomania) might involve feeling unusually sped up, extremely positive and excited, sometimes extremely touchy and irritable, for a distinct period of time. You might be feeling full of energy with lots of plans, experimenting with new things, be the life of the party, chatty, and wise-cracking, but in a way that’s out of character. Those plans might not be things you would usually consider or well-thought out - things like spending too much money, saying things that upset others, or taking risks.

A healthcare provider diagnoses bipolar disorder type one when someone has had at least one period of mania in their life (although most people who have experienced mania also experience periods of depression). A diagnosis of bipolar disorder type two is given when a person has experienced times of depression as well as hypomania (a type of mania that is less extreme, but still out of character). There are other less common types of bipolar disorder as well, including cyclothymic disorder (people experience some mild symptoms of depression and hypomania for most of the time in a two year period).

If my diagnosis came from a drug induced mania (caused by an ssri) how likely is it that I will continue to have bipolar symptoms in my life?

Dr. Rob – What we have discovered over the past 20 years is that SSRIs kind of act like bipolar detectors, although we would never prescribe them that way. Individuals who rapidly switch into a manic, mixed, or hypomanic episode shortly after being prescribed SSRIs for depression are almost always experiencing a bipolar depression rather than major depressive disorder. The evidence has been so compelling that SSRI-induced mania is now a diagnostic criterion in the DSM. I would encourage you to maintain close follow-up with your physician to see what happens in your case.

Hello!

Any advice for those who’s psychotic manic episodes causes them to be angry and cruel to their loved ones or to just do hurtful things in general? I know these behaviors are so hard to understand from the outside but do you have any advice for self forgiveness and repairing relationships?

Erin here. We do know that it’s common for symptoms of irritability/anger to be experienced by people with bipolar disorder. These symptoms can be extremely distressing for both the person themselves, and those who are at the receiving end of it. Here are some resources that you may find helpful:

- https://bipolarcaregivers.org/taking-care-of-yourself/maintaining-or-rebuilding-your-relationship-with-the-person

- - On bipolar anger: https://www.bphope.com/bipolar-stories-video-blog/video-bipolar-anger

Hi y'all! So I am diagnosed with bipolar (I always forget which one, but I have more severe depressive episodes and hypomania) and am finding that because I'm an essential worker and my job involves live captioning and therefore I wind up talking about COVID all day everyday, and then go home with my dog and just, can't. I'm also discovering that when this is triggering I'm rapid cycling, unless I intentionally dissociate.

I know I need to talk to my psychiatrist about all this, but outside of the stuff they might handle, have you heard stories like this? Do you have any suggestions for someone finding that work is causing just as many issues as being at home and unable to leave?

Dr. Rob here - First, be assured that you are not alone. This pandemic has left a lot of people anxious, depressed, and depleted, and that’s especially so for anyone with mood vulnerability. Literally everyone I talk to has increased anxiety and decreased productivity. Dissociating to avoid mood cycles is understandable, and again, many people I talk to, with or without a psychiatric problem, tells me they feel like they’re walking around in a dream. So, yes, I’ve heard stories like this! As for work, are there opportunities to be pulled into less intense “front line” duties? If not, this may be a situation where you might want to discuss extra medication support with your psychiatrist to help keep the agitation at bay, recognizing it’s not ideal, but it’s really important in the short term to preserve your stability long term.

Hello. Is bipolar treatable? Also if I ever had one hypomanic episode and have no recollection of it, do I still qualify as bipolar?

Dr. Rob - Absolutely treatable! Many people achieve long term remission. A single hypomanic episode could potentially qualify, but this would need to be explored in a diagnostic interview with a psychiatrist.

Erin here. And it depends how you understand what “treatable” means to you. Many people will continue to experience mood episodes, but consider themselves “in recovery” and have excellent quality of life.

After watching the new season of Ozark, the way this disorder is described is sort of similar to the highs and lows I seem to experience in my life. How would you suggest sorting this out?

Dr. Rob - A consultation with a psychiatrist might go a long way to clarifying what you’re experiencing, and either providing reassurance, or else getting you on the road to treatment and recovery.

Erin here. There’s a technique we use a lot clinically called “life charting” - it’s basically a process for graphing out the highs and lows you’ve experienced over your lifetime, in the context of the other things that were going on in your life (e.g., your work/school/family functioning, positive or negative life events). You record whether the mood episodes were major (like an episode of major depression) or less severe (what we call “sub-threshold”). That can be one route to looking back over your history with an eye to looking for patterns. BUT the major problem with this is that it’s retrospective and it can be hard to remember the details or timeframes. Plus it’s easier to do with the support of a clinician or experienced peer supporter. More accurate is measuring your mood prospectively - day to day, moving forward. You can find a bunch of paper-and-pencil or app-based tools to help you do this. Good luck!

Is it at all possible for an individual, however unlikely (so I guess more "has it ever been recorded") to manage their bipolar disorder WITHOUT the use of stabilizing medications? As in to be of sound mind and will enough to recognise what is happening to them as it happens and almost functionally disconnect themselves from it (or some other form of self-management)? Or does the very fact that their mind is the thing being affected make these basically impossible?

Sorry if this is a naive sounding question guys, keep up the great work.

Dr. Rob – If this person exists, I would like to meet them. Generally speaking, if your mood instability is severe enough that it comes to clinical attention and gets a diagnosis, then it has gone beyond the stage where it was being successfully self managed. In theory, I suppose it is possible that there is somebody out there who simultaneously has severe enough mood instability that they would be diagnosed as bipolar if they came to clinical attention and yet has normal function. If I was a betting man, I would bet against. What is far more common is individuals who may have severe mood instability and are surrounded by chaos but who do not want to seek out clinical attention and live lives far below their potential.

Emma here – we know from interviews with people who are living well with bipolar disorder that one of the self-care strategies most central to staying well is having a treatment plan, which most typically involves some kind of mood stabilising medication. Having said that, a well-rounded self-management plan does not involve only medication – there are lots of changes you can implement to help improve your sleep, manage changes to your mood, and control the impacts of bipolar disorder on your life (see our website for tips: www.bdwellness.com - unfortunately it's down at the moment, but it should be online again later). If you don’t want to be on medication, it’s really important to not stop cold-turkey – have a conversation with a trusted healthcare provider about the pros and cons, and a plan for getting support early if things start to look wobbly (e.g., get a friend or family member involved, who knows your early warning signs of mood change well, and whose opinion you trust)

Erin here. I’ll add this qualitative study into the mix for this question: Managing bipolar moods without medication: a qualitative investigation.

https://www.ncbi.nlm.nih.gov/pubmed/25527994

After fighting for adequate treatment since October due to wait times, I was due to see a Bipolar specialist in April. Now this treatment is likely to be postponed or online due to the virus. Do you have any advice on managing bipolar (most likely type 2) in these turbulent times without treatment?

Emma here - that is a really unfortunate situation, I’m so sorry to hear that you are experiencing so many challenges in getting support. If online treatment is offered, that would be better than nothing (and may be a way to get your foot in the door with a healthcare provider, rather than being put back on a waiting list). While research does show that medication is, for most people, a central part of their stay well strategy, there are many self-management tools that you can employ yourself. We have a website (www.bdwellness.com - unfortunately it has been down a bit lately, so check back later if it's not working) which lists evidence supported self-management strategies you can use to stay well, or to help recover from the impacts of a mood episode.

One of the most central things you can do to stay well (based on both clinical research and interviews from people who live well with bipolar disorder) is get adequate, regular sleep. We talk about “sleep hygiene” - that is, habits and environmental factors that support good sleep - on our website, but naturally some of those things are harder to do right now. Many people are experiencing higher levels of anxiety and changes to their routine that make it difficult to sleep well. CREST.BD is hosting a series of online chats to discuss ways to adapt your usual self-management strategies in these turbulent times - you can see the recording of the first one here: http://www.crestbd.ca/talkBD/ - we’re also polling on twitter to see if there are particular topics (like sleep) that you’d like to have us focus on for future events.

Is it possible to be diagnoses with Bipolar Disorder after being diagnosed with other mental conditions (i.e Depression and Anxiety) if symptoms of Bipolar are perceived? Or is it more likely that there was a misdiagnoses of Bipolar on the first place?

Also thank you for doing this. It's really great to meet some people doing awesome work :)

Dr. Rob – It can take a lot of time and multiple diagnostic assessments to fully piece together a mood disorder, especially a bipolar mood disorder. This is because when individuals are manic or hypomanic, they feel good, and people who feel good typically don’t go and see their doctor. The doctor only sees depression getting presented, because depression feels bad, and people typically want relief. This cycle can go on for one to two decades, and it is certainly something that I have seen many, many times in practice.

Bipolar 2 here! How are explosive episodes subdued? What is the way of treatment for someone stuck in that cycle of rage with what seems like no way out?

Emma here - anger and irritability is a common experience during hypomania and mania, and unfortunately, coupled with impulsivity, many people end up saying or doing things they regret during a mood episode. To manage anger during mood episodes, many of the same techniques from anger management can be helpful: for example, using breathing exercises to calm down, or practicing expressing yourself assertively and not aggressively so you can share your feelings to others in a helpful way. If impulsivity is a particular challenge (feeling like you have no control over how you behave or the things you say when angry), it may be more helpful to identify your warning signs of an anger episode (for example, feeling particularly tense, feeling hot, clenching your fists) and knowing what is likely to trigger you (maybe particular things a spouse says, or people behaving rudely on the road) and removing yourself from the situation before it gets out of control. See more tips here: https://www.bphope.com/bipolar-anger-unravel-your-wrath/

My mom was diagnosed with bipolar II roughly 15 years ago, and has been treated with medication since that time and is currently thriving and just doing so much better. My question is: can bipolar or the medications to treat it cause memory problems? She has a hard time recalling events that happened when she was symptomatic but prior to her diagnosis, and even sometimes now will forget little things an hour or two after they happen.

Ivan here - It is not uncommon for a person diagnosed with bipolar disorder to exhibit some form of cognitive difficulty, usually involving things like attention, memory, processing speed, or problem solving. For many, this can be considered one of the symptoms that is part of the illness. However, if these common cognitive problems are present, they usually do not get progressively worse over time. It is also possible that some cognitive difficulties could result from side effects of medications, but usually these side effects are fairly mild compared to the effects on memory from the illness itself. In your mother’s situation, an important consideration might be whether the problems seem to be getting worse over time. If so, there may also be a possibility that declining memory might be due to another medical condition - this is particularly true in older individuals. If it does seem like memory problems are getting worse, it may be a good idea to let her doctor know, and a cognitive evaluation (also called a neuropsychological evaluation) could help determine the severity of any cognitive problems and what may be causing them. Having this knowledge could be very useful to help determine what the treatment or management plan should be.

I’m going into my third week of quarantine. I live alone + single And had a break down today (BP2). First break down since I was hospitalized last year.

I’m doing all the “right” things like body weights 3-4 times a week, running and yoga the other days. Super healthy diet and also make sure to go for a walk once a day. I have a great job that I love. Practice mindfulness, video chat with friends, etc..

My Pdoc was able to make a last minute appointment so I’m taking tomorrow off work for the appointment. But I have to be honest that if I’m like this after two weeks, I really don’t know how I’m going to survive 2, 3, 4, 5 months from now.

So what else can I do?

Emma here - this is a really disruptive and stressful period, and the anxiety, disruption to routine, and isolation are throwing a wrench in many people’s self-management plans. It sounds like you are doing the best you can amidst some really challenging circumstances. CREST.BD is hosting a series of online chats to discuss ways to adapt your usual self-management strategies to respond to the additional challenges posed by the COVID-19 crisis - you can see the recording of the first one here: http://www.crestbd.ca/talkBD/ - one thing that came up repeatedly in our first session was the need to be extra compassionate and gentle with ourselves, in recognition that we are facing an extraordinary set of circumstances. We’re also polling on twitter to see if there are particular topics that you’d like to have us focus on for future events.

Introverts or extroverts has more bipolar population?

I'm guessing introverts, but why if it's so?

Steven Barnes here - The literature tells us that individuals with bipolar disorder (both Bipolar Type I and Bipolar Type II) are more likely to be extroverted than people without a psychiatric illness.

Are there milder versions of bi-polar? Also, can it get worse or better as you age?

Dr. Rob – At present, there are two versions of bipolar disorder. Type I involves manic episodes and depressive episodes and is considered the more severe form. Type II involves hypomanic episodes and depressive episodes. Hypomania is basically a less severe form of mania, although it can be substantially functionally impairing, and can be much harder to detect, because it may be less distinct behaviourally. The changes are often more subtle. Also, there is a disorder called “cyclothymia disorder” which consists of mood symptoms but which do not rise to the severity of a bipolar disorder or a depressive disorder. This could be considered the mildest form of mood disorder. There can be variability of mood disorders with age, In both directions. Individuals who have early diagnosis and treatment may often experience reduced severity and duration of mood episodes in later life, while individuals who go undiagnosed may have more severe duration and intensity of their mood disorders.

How is it determined that one has bipolar, and not another mood or personality disorder that shares some of the symptoms?

What is a way that a good doctor diagnoses a person with bipolar?

Trisha here - A thorough clinical assessment is the best way to get an accurate diagnosis. Some questions that a physician will try to answer through an assessment is whether the symptoms are ‘episodic’ (occurring during discrete periods of time and clearly representing a change from the person’s well self) or whether they are part of a stable pattern of interacting with the world and others (this indicating a personality disorder). Getting information from family or friends who know you well is very helpful. And not uncommonly, you and your physician will have to work together over a period of time before the diagnosis becomes clear.

Thanks for doing this ama! I have BP2 and I’m currently medicated and the side effects affect my memory (not quite memory loss) so I feel frustrated over what seems like cognitive decline related to all of this. Is there anything that can be done about this or will there ever be progress you think relating to this?

Ivan here - Hello - experiencing memory problems is not uncommon in people living with bipolar disorder. In fact, research is showing that is a common feature associated with the illness itself. In addition to that, it is possible that some memory problems could be related to side effects of some medications. However, the problems due to medication are likely to be less prominent than the problems due to bipolar disorder. To deal with potential side effects from medication, it would be important for you to discuss this with your doctor, and possible changes to your medications could be considered. Regarding cognitive problems related to bipolar disorder, there is currently a lot of interest in developing ways to treat memory and other cognitive problems associated with bipolar disorder, but we don’t have any proven, research established treatments available yet. There are some promising drug treatments that are still being studied, and there are some behavioural interventions (cognitive remediation) that also have the potential to provide some beneficial effects. To learn further about these issues I would recommend the links to the following resources:

- http://www.bdwellness.com/Quality-of-Life-Areas/Cognition
- https://www.isbd.org/Files/Admin/Cognition-Booklet(1).pdf.pdf)

Thank you all for doing this AMA. I appreciate the professional work and contributions that all of you do to make this disorder more bearable and better understood for those inflicted and for their loved ones.

I would love to hear some insight from your experiences with how lamictal / lamortigine impacts patients, specifically pertaining to physical side effects.

Is there any strong evidence for the onset of tinnitus or visual complications from taking lamortegine as a regular medication? I've read about melanin-binding propetries of this medication, has this been observed to be a significant occurrence for patients over time?

Do any of you have any interesting observations on how lamortegine affects sleep (during euthymia or not)? As in, do patients have significant changes in sleep study results or self-reports before and after having taken lamictal for a therapeutic time period? If so, and if applicable, what do these data signify and how can this be reapplied to better understand ones psychiatric scenario?

Thank you very much.

Trisha here - from my own experience with patients, I have generally found lamotrigine to be quite well tolerated.

It is rare (about 1 in a 1000), but there is a risk of developing a severe skin reaction when starting lamotrigine. The risk is minimized if the lamotrigine dose is increased slowly.

The tinnitus question is interesting. There is some (very preliminary) research looking at lamotrigine as a treatment for tinnitus. However, there are case reports of people starting lamotrigine for bipolar disorder or epilepsy who then develop tinnitus. Very recently, I had a patient who had to stop lamotrigine because he developed tinnitus within a few days of starting it. It resolved completely within a few days of stopping.

In my experience, most do not notice any effect on their sleep. Amongst those who do, they tend to find it sedating. However, I have had one patient who found it caused significant insomnia. I’m not sure if there are any studies looking at objective measures of sleep with long-term lamotrigine use.

Would you view a patient with a bipolar I/II diagnosis made retroactively after a unipolar depression diagnosis led to a manic/hypomanic episode after starting anti-depressant therapy (antidepressant induced mania) as any different than one fulfilling criteria for BPI/II prior to pharmacotherapy (with regards to treatment or pathophysiology)?

Dr. Rob – No different. The DSM now recognizes SSRI-induced mania as a diagnostic feature of bipolar disorder. In a sense, the SSRI unmasks the underlying disorder. If clinicians are sensitive to this, they can rapidly institute mood stabilizers.

Hello, I have a question about Covid 19. Do you think people with bipolar are finding it particularly difficult to cope? How could they mitigate this?

Erin here. Great question, thank you. We’re acutely aware of how anxiety-provoking these times are for everyone right now, and even more so for people with mental health challenges. Social distancing can be a particular challenge for people with bipolar disorder. So can loss of routine. We’re trying to help by creating an online series of events (delivered by Zoom and livestream) focused on managing bipolar disorder during the COVID-19 outbreak. You can watch the recording of the first one here: http://www.crestbd.ca/TalkBD/

Hello! I was diagnosed bipolar II as a teen and have been on medicine ever since (12 years)

As an artist, I am constantly worrying that medication is blunting my emotional receptiveness and my motivation. This is especially true in cases like last night. I had forgotten my to take my pill yesterday (I ended up taking a half before bed to avoid headaches/vertigo today). But by the end of yesterday I was fairly emotional. I watched an episode of Better Call Saul that made me cry and it felt very good and inspiring to cry. Truth be told though, I wasn’t in a normal state— I was over emotional. That episode was good but not particularly intense.

Anyway, this makes me sometimes seek to lower my dosage or get off meds, but I can rarely handle the tumult of a medication change and my weekly moods are so different that my confidence in a change doesn’t last long.

I was wondering if there are suggestions for counteracting the “blunting” effect of meds through non-medical means?

Victoria here – I’m a playwright and actor and speak. So I know of the fears and concerns of which you speak. Three things come to mind.

1. What I find is that when I wasn’t taking my meds, I wrote a lot more BUT what I wrote was crap. The quality and sustainability was extremely low. And my life was a mess. A study I know of (but haven’t been able to find since) showed that artists were more productive creatively on medication, because their moods didn’t disable them.

This is what I have found – I am more creative, and my creative projects are of better quality and I can sustain that over time.

1. I needed to ensure I was on the right medication, the right dose and the right combination. I initially was on some that blunted my ’affect” – I felt like a walking piece of chalk. So I worked with my psychiatrist to find the best medicine with the lowest side effects and highest positive impact.

2. When I feel those lulls in creativity – I go to those things that inspire awe and wonder in me as well as what makes me laugh. For me it’s watching animals, birds, their songs, nature, looking at the night sky and the stars, watching children play. Walking through a forest and looking at the colour. For laughter it’s watching reruns of Friends and Cute Emergency on Twitter.

Even if I only get a glimmer of “oooh” I know I am on the right track. I try to inject that on a daily basis even when I’m not in a low creative ebb – it seems to build inspiration inventory.

Bipolar disorder can obviously impact many interpersonal relationships.

What are some aspects regarding bipolar disorder you feel are misunderstood and how can someone looking to form an intimate relationship with someone who suffers from bipolar disorder create a stronger support network for their partner?

Emma here - this is really considerate question, and something we have been hearing a lot from the community is that we need more resources to help people support their loved ones with bipolar disorder. One thing I have heard from people in my clinical practice is that it can be very invalidating to have their partner attribute any concerns or frustrations to bipolar disorder symptoms - if your partner is upset about something, it is important to hear out their perspective and try to see things from their point of view too. Try asking “how can I support you in this?” rather than “did you take your medication/have you told your doctor this”. Practicing open and honest communication and coming up with ‘ground rules’ for discussing sensitive situations (for example, when and how to bring up concerns about medication, substance use, or changes in mood) is a solid foundation. Make sure you are getting support for your own stress levels and mental health too.

What do you guys think about how bipolar disorder is represented in the media?

Emma here - there are some media outlets doing good work with non-stigmatising representations of bipolar disorder in the media, but unfortunately there are still some damaging or inaccurate representations. When public figures with their own lived experience of bipolar disorder speak out about their experiences, or well rounded characters in media are shown to have BD (without it being the sole defining characteristic of their storyline), this can help reduce stigma and draw attention to some strengths, like creativity and resilience, that many people with bipolar disorder have. It can also be pretty moving and powerful to listen to music written by someone with BD, or watch a show that accurately reflects your own experiences.

Some media can contribute to stigma, for example by attributing any negative personality characteristics of public figures to their BD, or describing their behaviour with loaded terms like ‘erratic’ or ‘dangerous’. Depending on the country you live in, there are often media guidelines for responsible reporting about mental health, and lived-experience organisations that keep tabs on what shows are doing well for representation. In the past some CREST.BD bloggers have written posts about comics that covered mental illness well - we might return to the topic for future posts about films or other media.

Can bipolar disorder be triggered by a trauma in a person who otherwise showed little to no signs of bipolar disorder? Also, beyond mild to severe mood swings, what are behavioral indicators of bipolar disorder?

Dr. Rob – We do know that there are a mix of genetic and environmental factors which lead to the onset of bipolar disorder, known as the “stress-diathesis hypothesis.” Beyond mood changes, indicators of mania include easy distractibility, increased propensity toward risk-taking which is outside of a person’s normal character, a tendency toward suddenly starting lots of new projects without bringing any of them to conclusion, rapid speech, and an uncontrollably busy mind full of ideas.

I can't really figure out the distinction between just feeling good and having an hypomaniac episode.

I read the other answers but they sounded like "its a manic episode but smaller". How much smaller exactly?

If a patient experiences mood swings with energetic episodes that make his life easier, and this carries on for many years, how can he tell whether he has a mood disorder or just evolved to be a person that is more energetic?

Is BP2 really a separate disease, or is it just what we call people who don't fit other diseases because they sometimes feel great?

Honestly, if a psychiatrist asked me if I have hypomanic episodes, I wouldn't know the answer.

L here, living with BD - to build on Emma's answer, the "out of character" thing for me looks like... well, a lot of confidence, haha. I'm usually a pretty shy, unassuming person that lets other people speak. When I'm hypomanic, I become extremely eloquent and confident, and I start to feel like I can do no wrong. A lot of things definitely do feel easier. I also start to realllly believe in karma, and think things like, “If I steal this lipstick, the universe will balance it out!” Lol.

So yeah. At least in my experience, it feels more like a high than a good mood. Hope that helps!

Emma here - we all experience ups and downs in our mood, so it is sometimes a challenge to draw a line and say “past this point is hypomania”. A key distinction is to what extent these energetic episodes are negatively impacting a person’s life and out of character.

After an individual has a juvenile bipolar break, is there any way to treat stunted mental development?

I know someone who had their initial break and required hospitalization at 13 years of age. At the time, the doctors all said this would freeze her mental abilities. Unfortunately, this has proven somewhat true- before any symptoms she was extremely gifted and now, decades later, has trouble with many adult things, requires daily assistance from her parents, and is extremely naive/gullible as if she's still a child. Is there anything that can be done to help move her back towards maturity?

Dr. Rob - The best chance at normal adolescent development and successfully starting adulthood is early diagnosis, early treatment, and maintenance therapy. This allows an individual to continue with emotional and intellectual development, and many people with adolescent onset bipolar disorder have excellent long-term outcomes.

Could a head injury or brain hemorrhage cause/worsen bipolar disorder order?

Steven Barnes here - Traumatic brain injury (TBI) is associated with an increased likelihood of subsequently developing bipolar disorder (as well as many other psychiatric and neurological disorders). Even mild-TBI (formerly known as concussion) has that same association. I know of no research that indicates that it can worsen BD symptoms (but there are also no studies that I know of that address that question).

When are we going to get a proper objective laboratory test to diagnose Bipolar?

Dr. Rob – Unfortunately, your guess is as good as mine. This is my area of research, and it is a focus of research for many people. For now, bipolar disorder is fundamentally a clinical diagnosis based on historical features. Although we have seen many “promising leads” in terms of biomarkers, most of them have, frankly, fizzled out. Nevertheless we persist.

Hello!

If someone is questioning weather or not they have bipolar disorder who should they go to?

Ivan - This could be investigated through several avenues. A good place to start would be to go to your GP or family doctor and tell them about your concerns and possible symptoms. Your doctor would likely take a more extensive history and possibly refer you to a mental health specialist. The other avenue would be to go to a mental health specialist directly, typically either a psychiatrist or clinical psychologist. Such a clinician would be in the best position to provide a diagnosis and initiate a treatment plan.

Hi there and thanks for doing this AMA. I was diagnosed with bipolar disorder but my symptoms began as part of an intense religious experience. In fact all of my episodes happened during periods in which I was undergoing a religious awakening of sorts. I’m curious, what is the connection between bipolar and religion according to all of you? Have you found other patients that have had religious experiences and then still hold on to those beliefs long after they are back to normal?

I often call my condition tripolar because not only is it affecting the two hemispheres in my brain but it affects a third aspect of my mind which connects me to the world beyond our own.

Emma here - thanks for sharing your personal experiences with spirituality and bipolar disorder. Unfortunately this is not a well researched area, but the studies that have been done suggest that spirituality (including both organised religion and spirituality in the sense of connection to something greater than oneself) and mental health have a bi-directional relationship. That is to say, people’s experiences of bipolar disorder can influence their spiritual practices (for example, people may have intense spiritual experiences or beliefs during an episode of mania or psychosis), and spirituality can also influence mental health (in both positive and negative ways - it can be a source of coping and strength, but for some people it can be a source of stigma - so this is all dependent on your personal experiences). We know that for people with bipolar disorder, spirituality can be a core part of their quality of life - we have some information and resources about this on our website, www.bdwellness.com (which is unfortunately down right now, but hopefully tech support will have it back up soon!)

Because spirituality is so personal, it is hard to give a one size fits all answer to your question. It can be confusing to have had a spiritual experience during a mood episode, and can cause you to question the reality of that experience. Having said that, for many people these experiences can enrich their spiritual practice and feelings of connectedness even after a mood episode has passed. It is worth talking through your experiences with someone you trust, whether that’s a therapist or someone who shares your culture/belief systems, to help you process and figure out how you want to relate to those experiences.

Hope I'm not too late.

Hi guys. I was diagnosed with bipolar around 7-8 years ago after what was described as a hypomania episode, supposedly triggered by an unwise prescription of Prozac.

I was on lithium for several years afterwards, however a couple of years ago I adjusted my medication to 30mg of mirtzapine, which helps me maintain my sleep pattern and, in turn, maintain a solid, healthy routine.

The thing is... Part of me thinks I may have been misdiagnosed. Although I have experienced maybe 2 or 3 more periods of increased activity and confidence, none of them quite matched the level of my first hypomanic episode. I wonder if actually my first episode was really just a few months of being an emotionally charged young male.

However, I also understand that "I was misdiagnosed" is a super common thought for someone entering a hypomanic episode. I rarely realise I'm experiencing these kind of episodes until they're over, and so I realise that I'm not exactly the most reliable person to be making such a statement.

My questions are,

Do misdiagnoses of bipolar happen often?

and,

What risks are there if I do have bipolar and continue to go on without using mood-stabilisers? Will I be able to avoid progression of symptoms, so long as I maintain a healthy lifestyle and continue with CBT?

Many thanks in advance for both your answer and your work.

Erin here. I’ll start by saying that we know that it takes 10 years on average for people to get a diagnosis of bipolar disorder. Getting a correct diagnosis of BD type II is often harder than BD type I (mania is more obvious and easy to detect than hypomania).

why is mania persistantly taken far more seriously than depression? Depression was alienating me from my friends, negatively affecting my studies and causing me to self harm and even attempt suicide, when I or my family tried to get help with it I was brushed off as a typical teenager or a timewaster; when my family got me to go see a psychiatrist while manic I was on my way to a locked ward after about 20 minutes. The same story could be told by most of the manic depressives I've met. I was completely open about manic episodes and suicide attempts in earlier appointments, I was neither suicidal nor violent when sectioned.

Erin here. Actually, the research evidence points to exactly what you allude to - that it’s the depressive phases of bipolar disorder that account for the largest proportion of the disability associated with the condition. There are probably multiple answers to your question. One answer is that episodes of mania are often very frank - very obvious to everyone else - and they often come hand-in-hand with clear changes in peoples’ behaviour. So they’re easier to detect clinically. Symptoms of severe depression can be less obvious for people on the outside and more insidious in their onset (they can take longer to develop). I’d suggest trying to communicate with your family and treatment team (when you’re well, that’s the best time to advocate for yourself) about your perceptions of risk to yourself when you’re depressed.

I have bipolar and I am wondering if people like me ever get to a stable state? I’m in treatment but I still get pretty sizable peaks and valleys

L here - I’m a CREST.BD research assistant with a BA in psych and have bipolar disorder. I'd say yes, it is possible! It might never be completely smooth sailing - a quote our team likes from a former research participant is that "bipolar disorder is like a ship always righting itself" - but it is possible to live well with bipolar disorder.

In addition to attending treatment, I've found that understanding yourself, and what you personally need, can go a long way in helping to treat bipolar disorder. "Self-management" is increasingly being researched and seen as important to living a good life with BD. The info from CRESTBD's bdwellness.com, and the quality of life tool at bdqol.com, helped me a lot with finding self-management strategies. And good old fashioned journalling helped, too. :)

Also, I’ve found that when it comes to applying therapeutic recommendations to my own life, there's a bit of trial and error involved. It’s a bit of an experiment to find out what works and what doesn't - we’re all different, after all. But with access to treatment, dedication to exploring the options, and a lot of patience and self-compassion, it is possible to get well! Hope that helps.

Is it more common for people with bipolar to have issues with alcohol and drugs? I was diagnosed when I was 17 and have used/abused alcohol and others to try and cope. Thank you, stay safe.

Ivan here - It is quite common for individuals diagnosed with bipolar disorder to also have problems with alcohol or other substance use. In fact, probably the majority of people with bipolar disorder (as many as 60%) will have these types of challenges. For some, this vulnerability of using substances can be thought of as part of the bipolar illness. In addition, many people turn to using substances to help them with coping with having bipolar disorder (like yourself). However, due to the many negative consequences that substances can have, it is important to address both of these conditions (the bipolar disorder, as well as the alcohol/substance use). Unfortunately, continuing to use alcohol and substances in the long run is only likely to make coping with the bipolar disorder even more difficult.

I hate the way medication feels but would like to not let this take hold of my life. What are some more natural ways to regulate yourself when diagnosed with bipolar?

Dr. Rob – Certainly many people dislike the side effects of psychiatric medications, but that’s not necessarily a function of whether or not they are natural. For instance, lithium was created in the Big Bang, is the third most abundant element in the universe, and at 13.4 billion years of age, is our oldest natural remedy. We know that towns with higher natural lithium in the drinking water have lower rates of suicide and aggression. Towns and cities with less than usual lithium in the drinking water conversely have more. So, we can say with high confidence that human mood regulation has evolved to be lithium responsive. Other forms of mood regulation which don’t involve medication include individual therapy, group therapy, and behavioural activation. At an individual level, things like exercise, sleep management, and creative pursuits such as art or journaling, can all positively influence mood regulation.

I have a question in regards to bipolar and suicide (sorry if that's a difficult subject for some folks). I've heard many different things about the two, that women survive attempts more than men etc. I'm wondering what are some of statistics on suicide and bipolar? I ask because I want to eliminate any confusion of misinformation about the topic especially due to how highly stigmatized the subject is. (Thanks for doing this! This helpful for me as someone with bipolar two and PTSD.)

Erin here. Talking about suicide risk openly is vital - bipolar disorder can be lethal. One well-regarded summary of the statistics here comes from the International Society for Bipolar Disorders - this is an open-access paper: https://www.ncbi.nlm.nih.gov/pubmed/26175498

Does having really good meta-cognition equate to being considered a person with high functioning BD?

Ivan here - Having good metacognition, or good awareness and insight into your own cognitive functioning, is probably a feature that would help you adapt well and to function better overall. In other words, being aware of your cognitive strengths and limitations likely translates to engaging in behaviours that are more likely to be rewarding and meaningful, and in staying away from behaviours or situations that are more maladaptive or lead to bad outcomes. Having said that, it is important to keep in mind that metacognition is but one dimension of human behaviour that can influence overall functioning in bipolar disorder, and that there are other dimensions that can also be important (mood symptoms, coping style, cognitive functioning, substance use, etc.)

Recently I’ve wondered if I was misdiagnosed. Bipolar vs Cyclothymia?

Emma here - cyclothymia is considered a bipolar spectrum disorder. Symptoms are not as extreme as a full blown episode of mania or depression, but people with cyclothymia experience a much greater chronicity of symptoms (most of the type for a 2 year period). As cyclothymia is rare, there is little research about treatments that may be specifically effective for it, but pharmacological, psychosocial and self-management techniques used for bipolar disorder are likely to be helpful.

I had a “manic episode” a few years ago and have been low ever since. Anti psychotics and SSRIs don’t seem to help much. I started growing psychedelic mushrooms as psychedelics have done wonders (maybe more than what is normal) for my mood in the past (the two or three times I tried). Do you have any info on wether micro dosing shrooms is a good idea?

Also, could my Crohn’s disease have any links to my bi-polar and mental health? As my gut tells me there are (pun not intended).

Emma here - the question of whether psychedelics can be used therapeutically is one that the research is starting to look at, but unfortunately there has not been enough work done in this area to be able to weigh in on the benefits and risks for bipolar disorder. I expect we will be seeing a lot more large scale studies on this topic in the future.

To address the second part of your question, the link between diet, digestive health and mood is one that is being explored by some colleagues of ours in Australia. I don’t have an answer to your question, but if you want to stay in the loop about new research on this topic, I recommend following the Food and Mood Centre: https://foodandmoodcentre.com.au/our-research/

How do you care for a loved one who is bipolar? How do you make sure you’re helping them without “enabling” them if that makes sense?

Stéphanie here: This is such a great question. Your loved one is lucky to have someone who cares. I suggest you ask them this question. Give them some time to think about it and have a discussion – you both will learn something, and it might help your relationship in the future. Each person and circumstances are different, so the answer is unique. Here are some elements of answer that can help (myself living with bipolar disorder). Most importantly, protect your own health, for the short and long term. Seeking resources for you as a carer should be a priority for you (ex. family associations). Unfortunately, carers are at a higher risk of developing anxiety or depression. Self-management techniques are good for diagnosed people, but also for carers. Second, keep believing that your loved one has the strength to eventually cope with BD, if not immediately. Share hope with them, as hope is essential for your loved one to seek help when needed. Third, learn about the resources and illness (ex. peer support, group supports) and try to share that information with your loved one and encourage them to seek help (knowledge is one of the pillars to self-management). Finally, it might be appropriate to establish in advance an “intervention plan” in case of a manic or depressive episode, and to clarify what role your loved one would like you to play.

Is bi polar disorder related to high conflict personality disorder?

Dr. Rob – While individuals in the grip of the mood episode, particularly in irritable mania, can be quite conflict prone, personality usually completely reverts to normal in between mood episodes.

Hello! I have a friend that shows several intense symptoms related to BPD, but is not officially diagnosed. Do you think that as a close friend it is wise to vaguely suggest to them to look into the possibility of having BPD or rather let professionals deal with that part completely and not mention the disorder at all?

So far I have not made any suggestions to the friend that they might have BPD, but instead tried to show compassion when the symptoms appear. It seemed to make more sense to just focus on the feelings rather than talking about them possibly having a disorder. Is this the right approach?

Thank you for your work!

Dr. Rob – It is just about always okay to ask your friends if they’re alright and to express your own concern about particular aspects of their mood or behaviour. That may open up a conversation wherein they express their own concerns or maybe brush you off. It’s hard to predict how these conversations go. Even if the initial conversation goes nowhere, you have planted a seed which can be revisited later, as the individual feels ready to open up further.

Is it possible for seizures to complicate bipolar symptoms?

Steven Barnes here - Many people who have treatment-resistant (i.e., do not respond well to drugs) temporal lobe epilepsy (a form of epilepsy where the seizures originate in the medial temporal lobes and the seizures are of the complex partial variety) also have comorbid affective disorders. Bipolar disorder occurs more frequently in these individuals than those without temporal lobe epilepsy. This correlation doesn’t necessarily mean that if one has bipolar disorder and epilepsy that this will complicate one’s symptoms, as it is just a correlation at this point. There are theories (e.g., the kindling model of affective disorders) that hypothesize that seizures do complicate bipolar disorder and vice versa, but they need further evidence to support them. (As a side note, it is interesting that many medications used as mood stabilizers for bipolar disorder are anticonvulsants; e.g., lamotrigine, sodium valproate, etc.)

Is there a reason why some psychaitrists won't diagnose someone with bipolar disorder until they reach a certain age? I was told I couldn't be accurately disgnosed with it until I was in my 20s and even then, my psychaitrist at the time still just wanted to say "mood disorder, unspecified" on any paperwork.

Also. What are the main differences between Bipolar I and Bipolar II?

Trisha here - Pediatric bipolar disorder (a diagnosis of bipolar disorder in an individual below the age of 18) is a contentious issue in psychiatry. Some researchers and clinicians maintain that bipolar disorder is in fact very rare in children and adolescents, and that disruptive behaviors that are due to other causes (such as attention-deficit/hyperactivity disorder, problems in the young person’s environment, anxiety) are mistakenly attributed to bipolar disorder. There are studies indicating that a young person with a ‘disruptive mood’ - repeated temper outbursts, irritability and aggression - is more likely to be diagnosed with a (non-bipolar) depression and anxiety, rather than bipolar disorder, as an adult. So the argument from this side is that behaviors that might appear ‘manic’ and lead to a bipolar diagnosis in a young person is most often a manifestation of other environmental or mental health issues. Other researchers and clinicians, however, do feel that bipolar disorder in children and adolescents is real and requires immediate identification and treatment.

Whichever side of this debate you favor (and there are arguments for both), it is true that it is much less common for children or young teenagers to present with the ‘typical’ symptoms of bipolar disorder that allow for a clear diagnosis. For example, current diagnostic criteria requires that a person have mood episodes of a certain duration in order to diagnose a bipolar disorder. It is much less common for children/adolescents to have such clear cut mood episodes compared to adults. So some psychiatrists, even if they suspect that the young person may have a bipolar disorder, may prefer to just treat the symptoms that are there without making a formal diagnosis, and see how things evolve as the individual ages. Generally, the ‘typical’ symptoms of bipolar disorder become clearer as an individual enters their twenties.

For the bipolar I versus bipolar II question: these are the two main subtypes of bipolar disorder. To diagnose bipolar I disorder, the individual must have had a ‘manic’ episode. A manic episode is a period of at least 7 days where the person shows clearly abnormal energy and an abnormally happy or irritable mood, along with other symptoms such as impulsivity, not needing as much sleep, being more talkative. These symptoms may have been to the point where the person required hospitalization, developed psychotic symptoms (for example, hearing voices or becoming delusional about their abilities), or the symptoms caused a great deal of difficulty (for example, being impulsive to spending your entire life savings). Most people with bipolar I will also experience depressive episodes.

People with bipolar II experience ‘hypomanic’, rather than ‘manic’, episodes. Hypomanic episodes are characterized by similar symptoms to manic episodes, but they are generally milder and do not cause as much difficulty for the person. Individuals with bipolar II do experience depression.

It is important to note that even though hypomanic episodes are milder than manic episodes, bipolar II disorder is NOT just a milder form of bipolar I disorder. Individuals with bipolar II can experience an equal degree of difficulty overall as those with bipolar I, mostly due to long-term depressive symptoms. So both are important to recognize and treat.

Hope that is helpful!

What are some personality traits of Bipolar? My psychiatrist said I fit the bill including being an entertainer among other things, and I couldn’t really find that in literature, just standard DIGFAST and assoc traits

Erin here. There is a clear link between bipolar disorder and creativity. See for example these publications our CREST.BD members have produced in this area:

• https://www.ncbi.nlm.nih.gov/pubmed/22088366
• https://www.ncbi.nlm.nih.gov/pubmed/25814521

At a group level, people with the condition also tend to show higher “reward sensitivity” (show a higher propensity to take risks in pursuit of a reward) and highly level of impulsivity.

I know that this question was already answered but I’d like a deep-down explanation on how to support someone close to you that has BD?Thanks guys!

Erin here. There are some great resources provided by our team member Dr. Lesley Berk in Australia via https://bipolarcaregivers.org/ - you can download a detailed guide for caregivers there.

What color is your toothbrush?

Steven Barnes here - Purple!

How come I was diagnosed by 3 experts, told it is hereditary (even though no one on either side of my family suffers from it), and still managed to completely cure myself just by completing a thorough parasite cleanse and improving my diet?

And what does this mean for others who struggle with finding relief for this condition?

Stéphanie here - I am a person living with bipolar disorder myself. I am so glad to read that you haven’t been experiencing bipolar disorder symptoms lately. Your story reminds me of my own situation. Nobody else but me in my family had been diagnosed in the past and I seriously questioned the validity of my diagnosis, especially after being many years without any episode. What I did, and you might consider doing it, is to review with my psychiatrist the various events/symptoms that occurred in my life. It reminded me of what happened and what are the conditions for the diagnosis. In my case, I couldn’t deny that it really looked like bipolar disorder. And I know that this is a chronic condition (that can be managed but not cured). However, as demonstrated by science, each of us can use self-management techniques (chosen as best suited to each one of us), to reduce symptoms, recurrence and severity of episodes. These techniques can benefit anyone, even without living with BD. And they can help us all with fulfilling lives.