UNDER THE COVERS
(The little known truth about Bipolar Disorder!)
BY SHARI SCHREIBER, M.A.
If you've already tried antidepressants but felt they "didn't work" or they only worked short term, you may have fallen slightly below the radar of your physician or referring psychotherapist, in terms of an accurate diagnosis. In many instances, Bipolar Disorder (formerly referred to as manic-depression) is under-diagnosed or misdiagnosed, and if this happened with you, your treatment was seriously compromised, and antidepressant therapy probably left you feeling disappointed and discouraged.
Growing up with a bipolar condition, you're usually not aware that you have a problem or something’s wrong, because you have no frame of reference for feeling differently! Your moods have never really been consistent or stable for extended periods, so what you've experienced thus far, is your definition of “normal,” even if every few months (more or less) you can barely make it out of bed for several days or longer. Between these intervals, you may feel fine and be able to socialize and function well in your chosen field of work, but when a depressive cycle hits, it pulls the rug out from under you--and all you really want to do, is to hide under your covers 'till it passes!
Bipolar Disorder may be only a part of an individual's diagnostic picture, and other critical diagnoses are very frequently overlooked. This disorder may be genetically inherited, and is often attended by other neurological issues like ADD/ADHD--but patients could also have features of Borderline Personality Disorder, and a dual-diagnosis should at least be ruled out. This wellness site houses a great number of articles on BPD. Be sure to explore them!
Borderline personalities engage in acting-out behaviors, such as extreme jealousy, drug/alcohol abuse, desperate attempts to gain attention, lying, self-harm (cutting or burning skin), intense/irrational abandonment concerns, lack of empathy, stalking, rebound relationships, perceptions that rapidly shift from loving, glorifying and idealizing you~ to diminishing, criticizing, and rejecting you (and back again), hypersexuality, 'crazy-making' interactions, histrionics, low self-esteem, poor impulse control, infidelity, selective memory or recall, emotional cut-off, cognitive distortions, suicidal ideation, eating disorders, anxiety or OCD (Obsessive-Compulsive Disorder) traits, emotional blackmail, extra-marital affairs, etc.
While these two disorders can easily coexist within the same person, they're distinctly separate issues! It would be like comparing apples to oranges, to ignore the differences between a mood disorder and a personality disorder, which is precisely how folks remain confused and untreated. It's extremely important to make this distinction so that you can determine what you're up against, and find appropriate, useful help.
New studies are suggesting there's a link between ADHD (seldom seen or diagnosed in females) and Borderline Personality Disorder. Attention deficit issues are attended by mood cycles, which can certainly heighten acting-out behaviors. This newfound awareness may help us more readily discern what type of pharmaceutical interventions can lead to favorable outcomes. While this does not imply that BPD problems are exclusively neuro-chemical rather than emotional, we might begin to treat and manage the symptoms of this disorder differently and more effectively.
There are three main types of Bipolar Disorder: Bipolar I is characterized primarily by manic episodes, Bipolar II has mostly depressive periods with hypomanic (or brief) episodes, and Bipolar III (or Cyclothymia) is a rapid-cycling mood disorder that can produce numerous high and low mood swings during the course of a day. The diagnostic criteria for these types of BD are very specific, according to the DSM-IV (the Diagnostic and Statistical Manual of Mental Disorders, fourth edition), but what happens if your symptoms fall slightly outside these sets of criteria--are you ever diagnosed and treated, or do you slip through the cracks?
The unfortunate truth is, thousands of people suffer with Bipolar Disorder, but their cycles are non-specific or atypical, in relation to how it's generally identified or thought of clinically! They may struggle through numerous drug trials to alleviate depression, and some could be temporarily more effective than others, but short term relief can frequently be attributed to inaccurate or inadequate diagnosis of a Bipolar II type mood disorder. If your physician overlooks a bipolar issue and medicates you only for depression, it's very likely you'll be dissatisfied with treatment, and feel "what's the point?" in reference to pharmaceutical intervention. Just be aware that the right drug therapy can prevent fatal consequences (suicides) commonly associated with depressive spirals, and help you surmount this daunting condition.
Atypical features of Bipolar II might mean that severe depressive episodes occur on an extremely rare basis. There could be months, or even years in-between a down spiral that may have to be relieved with electro-convulsive therapy (ECT) or 'shock treatments,' used to restore neurological balance. If you know someone who suffers from these horrible occurrences, they might need you to function as their advocate, by helping them find highly qualified care to avoid this invasive procedure.
For effective relief from bipolar depression, a mood stabilizer is often needed in addition to your antidepressant therapy, and vice-versa. Some doctors believe that a mood stabilizer alone will be effective for treating Bipolar II symptoms--but in my experience, this is seldom true. Finding the right drug combination that works with your body is imperative, as everybody's system is somewhat different. If your antidepressant triggers a manic response, this might indicate a bipolar issue. Manic or hypomanic episodes can present as extreme irritability or rageful outbursts, as opposed to elation, extravagant shopping sprees, or compulsions to paint a room of your house in the middle of the night.
Mood stabilizers are different drugs than antidepressants, as they are anti-convulsive medications that control extreme mood shifts or swings.
Once your physician has found a solid drug protocol to effectively treat your unique chemistry, symptoms should feel reduced/controlled within 48 hours. You'll likely experience significant relief from this neurological balancing, and have some hope for a brighter future. Do not settle for minimal outcomes.Keep trying to refine your drugs and dosages to where you're feeling mostly at ease, and able to function well in your personal and professional spheres.
Manic episodes can feel wonderful. If you're afraid you'll have to give these up if you take medication, this is an erroneous belief associated with up or down (good or bad) feelings, which typically accompany a bipolar issue. Rest assured, you'll still be able to access good, positive, empowered feelings on medication, but they won't be as likely to play out in self-destructive ways (compulsive behaviors or substance abuse), especially if you're in solid talk therapy to help you resolve any underlying emotional issues.
Bipolar Disorder is a medical condition that must be ruled out by a therapist and/or prescribing physician, to avoid treating you for other issues (like personality disorders) that may not be the cause of your difficulties. If you live with this disorder, you can easily have a dual or mixed diagnosis, which includes Attention Deficit Disorder (ADD/ADHD) and/or Dysthymia (chronic, mild to moderate depression), so a full evaluation of your symptoms and emotional history is critical in determining your treatment needs! ADD is also a cyclical disorder that can cause mood fluctuations, and prompt you to wonder if you're "a little bipolar." While ADD symptomology is less severe than with a bipolar condition, this neurological issue can definitely interfere with mood stability, and the effectiveness of your antidepressant therapy.
You should be advised that alcohol is a depressant; drinking counteracts the positive effects of medications you're taking to combat your discomfort, and undermines even the most solid therapeutic intervention. This aside, if your current drug therapy feels insufficient for managing your symptoms, talk to your therapist and/or physician about switching to a different prescription, or increasing the one you're on. If it seems like your doctor is unresponsive to your concerns or needs, find another one!
Typically, Bipolar Disorder is genetically inherited or brought on by severe head trauma, but more recent studies indicate that environmental influences can also predict outcome. A baby's brain continues to develop in critical ways in the first eighteen months or more of life: Inadequate amounts of nurturant care/attention during early stages of life, can inhibit normal neurological development specific to parts of the brain that control mood regulation, and put a child at risk for acquiring a bipolar condition or Borderline Personality Disorder (BPD).
Some people finally seek help when depression overtakes them to the point they’re contemplating suicide. Those with BPD traits may hear voices telling them to kill themselves ("why not~it's a way out of the pain") and suicides are fairly common during depressive episodes. Acute depression is seldom observed in someone with a Bipolar Disorder, because he/she withdraws and virtually disappears from social functioning during a spiral or down cycle. Typically, friends and relatives are shocked by a loved one's suicidal demise, having had no prior awareness of this disturbance. Sometimes there’s a precipitating event that triggers a depressive episode, but often there’s not--which makes this a frustratingly unpredictable issue!
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THE UNTREATED BIPOLAR PATIENT
Many celebrities suffer from undiagnosed/untreated mood disorders. The risk of public shame they'd experience if their condition were disclosed, usually keeps them from seeking the help they desperately need. Bipolar Disorders are often the cause of celebrity suicides or attempts. We're always surprised and confused when we hear that someone we've perceived to be very jovial, has tried to do away with him/herself, or died of a drug overdose! Sadly, most "rehabilitation" facilities target addiction with behavioral or emotional interventions, but neglect to address neurochemical imbalances which could have spawned the addiction in the first place! When rehab clinics neglect to properly assess and balance/normalize a client's brain chemistry, relapses are inevitable--and so is lucrative repeat business. Every relapse magnifies a celebrity client's shame; on one hand, they've failed at something that "should have worked" for them, and on the other, each regressive episode turns into a media event! Hence, the very thing this individual had hoped to avoid, becomes a deeply humiliating reality.
My perspectives on Bipolar Disorder have altered dramatically over the past decade or so. Graduate schooling suggests that an individual must fit one of three specific sets of diagnostic criteria to have a bipolar diagnosis. Atypical variations are often missed during a clinical consult or psychiatric evaluation ("psych-eval") with a psychopharmacologist or physician, because of doctor or therapists' limited clinical experience--or a client/patient's reluctance to fully disclose their symptoms, due to feelings of shame.
Are you resistant to any medical intervention? Well, you're not alone! Your entire life may have been spent defending against the notion of having any kind of deficit or need. When you've been programmed from an early age to repress your needs, feelings of shame are triggered when they finally begin to surface. Shame is the primary sensation of core trauma (or narcissistic injury), which first occurs in infancy, and is reinforced during childhood. You couldn't have averted this trauma, any more than you could have avoided inheriting genetic factors, and this depression is not your fault!
Unfortunately, others can't relate to your struggle: Only if you've lived with depression all your life, can you know what the torment from constant psychic pain feels like! We humans are pretty resourceful when it comes to figuring out how to help ourselves feel better; whatever it takes, we'll find ways to escape our depression and feelings of emptiness or self-loathing, even if it means putting our personal or professional world in jeopardy.
The experience of needing therapeutic or medical help seems to activate an old stigma that stops us from seeking assistance. We may think; “if I need drugs or psychological support, something really must be wrong with me!” Ironically, we might have self-medicated most our life, with alcohol/illicit drugs, food or compulsive behaviors such as over-work, shopping, gambling, sex, excessive exercise or religious/cult affiliations, to alleviate or numb our pain--but when considering drugs that are made to balance brain chemistry and provide relief, this seems the hardest pill of all to swallow!
BIPOLAR TREATMENT - GOING THE MEDICAL ROUTE
Mood stabilizers most commonly prescribed for bipolar issues are; Neurontin, Topamax, Lamictal, Depakote and Lithium. Some of these drugs are more effective when smaller doses are taken 2 - 3 times throughout the course of a day, rather than only once within a 24-hour period. While Topamax is generally indicated for Bipolar I (manic) issues, in some cases it's been very effective for treating Bipolar II (depressive) symptoms with little or no side effects. Lamictal could be better tolerated at lower doses, but can cause lethargy or fatigue as dosage escalates (with some of these drugs, less is more). Depakote and Lithium require routine blood tests during initial/early months of treatment, to monitor potential adverse effects they may have on your liver.
Since the inception of this piece, the mood stabilizer, Abilify has been made available to the public, and you've probably seen television commercials on it. I've known a few folks who've done very well with this drug, whether it's been added to their existing antidepressant regimen, or taken alone.
Mood stabilizers can cause hand tremors and difficulty with fine/detailed tactile functioning (fastening a necklace, for instance), especially at higher doses. Your doctor may send you home with pharmaceutical sample packs that tend to increase dosage exponentially, forcing you to double your pre-existing intake. This can prompt repercussions, as your body tries to adjust to this significant change. A more gradual increase (cutting tablets whenever possible) may help you circumvent this difficulty, but always check with your physician before you explore any options relating to your medication dosage. This information is intended to help normalize the experiences you might have with a mood stabilizer, and alert you to potential issues that can be easily managed. I realize some of this could sound pretty scary--but overall, these drugs are very helpful/safe, and they can greatly enhance the quality of your life.
OKAY, HERE'S SOME EXCITING NEWS . . . !
I've been researching potential benefits of cranial adjustments, in relation to Bipolar and Attention Deficit Disorders. Preliminary information strongly suggests that this modality of treatment can positively impact neurological issues, particularly if onset of symptoms is associated with head trauma. I had an accident in September, 2007 that left me with a concussion--and this type of help assisted my recovery. Relatively few chiropractors specialize in this work, but if you think you'd benefit from seeing a practitioner who does, you can find cranio-sacral practitioners in your geographic area, by going to The Upledger Institute's website; www.Upledger.com.
Within the realm of natural treatment, Omega 3 (fish or flax) EPA/DHA oils can sometimes enhance mood and lessen bipolar symptomology. Some of us have difficulty with these 'repeating' (particularly the fish oil capsules) and understandably, neglect to take them consistently for this reason. Any deep sea or cold water (check the label) fish oil is especially well tolerated, and unlikely to repeat or leave an aftertaste. The brand, Nature's Bounty makes a 'deodorized' version of this product. Other types can be taken just prior to eating, to eliminate most of this unpleasantness. Both types can usually be found at most retail health food establishments--or local drug chains, like CVS pharmacy. If you cannot find this type of product, ask your local vendor to order it for you! Two to three capsules with each meal may alleviate depression and improve cognitive function. Omega 3 oils won't interfere with your drug therapy, but they might eventually decrease your reliance on it. Refrigerate these products once you get them home.
In context of natural approaches, I don't want to neglect to mention bio-feedback and homeopathy. You might be inclined to explore whether these options can be effective for you, before trying pharmaceutical intervention. As is the case with any treatment modality, results may vary widely. Some feel that homeopathy and bio-feedback are more effective for children than adults, but (so far) I haven't seen outcomes that seemed conclusive enough to justify the significant time commitment or costs associated with either approach. HGH (human growth hormone) may relieve bipolar symptomology in certain individuals, but this is an expensive way to go, and we're not yet certain if extended use is physically safe.
Life shouldn't have to be so tough and it can be infused with more joy, but healing takes place on many different levels. I've assisted people who've experienced fewer physical ailments or pain, lost weight, let go of crippling addictions, and expressed "feeling happy for the first time," because we've identified various obstacles and provided the help they've needed. What will happen if you don't attend to your mood swings? You'll continue to suffer with these terrible, disruptive cycles, and that's the problem! If you've experienced an ongoing pattern of emotional highs and lows, this can be due to a Bipolar Disorder. Recovery is never "just a chemical issue," but addressing this piece certainly helps you begin to see some light at the end of a very long tunnel. This is your Life that's on the line~why postpone living it any longer?
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