CREST_BD

Paula Nunes here: ADHD can be mistaken for bipolar disorder. ADHD can mimic the manic symptoms of bipolar disorder because symptoms such as apparent excessive energy, impulsive behavior, and poor judgment can be present in both conditions. Other symptoms that can be present in both conditions are being more talkative without realizing that others need to speak, too many thoughts at the same time or rapid speech that jumps from topic to topic, distractibility (attention is easily drawn to unimportant or irrelevant things), and increased goal-directed activities (e.g., social, sexual, or at work or school) or psychomotor agitation (purposeless non- goal-directed activity). However, in ADHD, these symptoms tend to be more stable in the lifetime - especially if untreated either by medication or by self-awareness and therapy - and in bipolar disorder these symptoms usually occur during mania. In bipolar disorder, mania is usually present in less than 10% of their life. An inflated self-esteem is more often present in mania - and not in other mood states in people living with BD.

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.

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.

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.

Natasha here – Wow I relate to this so much. The shame is real and it is hard trying to process the things we did when we were manic or otherwise unwell. I too for a long time lived in fear of another mood episode and I felt like I wasn’t really able to trust myself with, like, anything at all. I feel like I could talk about this subject for a long time as I think there are many pieces to this puzzle, but this is essentially my short story: For a long while after my diagnosis, my identity was sort of wrapped up entirely in the reality of having bipolar. It’s hard not to see everything from that lens; I truly felt bipolar and had a hard time seeing myself as anything else. Eventually I started taking little steps out of my comfort zone – the big one for me was working full-time, but it started as small successes like re-engaging a hobby or reading a book unrelated to mental health. Essentially it was recognizing I am more than my diagnosis, and even though it’s a large part of me, it hasn’t always defined me and it won’t always define me. Being at peace with the reality that relapse is possible helped me get out of survival mode as well, but with the caveat that I knew I had professional support and I was (and still am) seeing a counsellor (aka my amazing psychiatrist) to address these very issues.

We have this narrative in recovery of “have hope” and “it’ll be okay some day” without having concrete steps of how to get there. I’m certain there are other ways to answer this question, but the shift into thriving mode was essentially finding new passions in life and taking small and safe steps to create a life I wanted to live. It might help to ask yourself, “What does thriving look like for me?” Break it down into small, easily accomplishable steps and celebrate everything no matter how small. The shame will resolve itself more or less through the process and with support from professionals and loved ones. It is a difficult process, and I did have further mood episodes – but each one got easier than the one before. And yes, there’s more shame that sometimes feels like your own personal Everest to climb. But you can absolutely go from surviving to thriving. It’s a process with many steps and it took me years, but I truly do feel like I am thriving with my bipolar in tow now.