In September of 2017, I began this journey of writing blogs regarding the topics of mental illness and suicide prevention. I have learned a great deal by having the opportunity to write these blogs, and it has also contributed to my continued healing. Hopefully, you have also benefited from reading these blogs. The content of many of these blogs has been largely academic, while others have been more personal in nature. Today’s blog regarding bipolar disorder is personal.
As many of you know, our oldest son Michael died by suicide on March 13, 2009 at the age of 33. Michael lived with bipolar I disorder, seasonal affective disorder, anxiety disorder and substance use disorder with alcohol. Unfortunately, much of what I will convey to you in this blog was learned after Michael’s death.
According to the Mayo Clinic, “Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression).” Episodes of mood swings may occur rarely or multiple times a year. Bipolar disorder is divided into the following subgroups: Bipolar I disorder, Bipolar II disorder, Cyclothymic disorder, and other specified and unspecified bipolar and related disorders.
Bipolar disorder can occur at any age, but the average age of onset is 25. According to the National Institute of Mental Health (NAMI) 2.8 percent of adults in the United States have experienced bipolar disorder in the past year, and both men and women have a similar incident rate. According to the Canadian Mental Health Association, 1 percent of the adults in Canada have experienced bipolar disorder in the past year. Unfortunately, up to 50 percent of those living with bipolar disorder will attempt suicide, and up to 20 percent of those living with bipolar disorder will die by suicide. NAMI has found that the presence of bipolar disorder results in a nine-year average reduction in life expectancy.
The two primary symptoms or phases of bipolar disorder are mania or hypomania (a mild form of mania), and depression. Each phase can last a period of days or weeks depending on the type of bipolar disorder. Common symptoms of the manic phase include feelings of elation or anger, racing thoughts, rapid speech, decreased need for sleep, having grandiose and unrealistic plans, and poor judgement. Common symptoms of the depressive phase include great sadness, being anxious, restlessness, decreased energy and activity, trouble concentrating and making decisions, and feeling hopeless and worthless.
In addition, anxiety disorder, misuse of drugs and alcohol, and eating disorders often co-occur with those living with bipolar disorder. The presence of a mixed state is when a depressed mood accompanies manic activation; and rapid cycling is when four or more episodes occur within a twelve-month period. This occurrence might be on a weekly or monthly basis.
While the exact cause of bipolar disorder is unknown, most researchers believe it is the result of a chemical imbalance in the brain. There is also evidence that genetics, periods of high stress, and the misuse of alcohol and drugs increase the risk of developing bipolar disorder. While there is no cure for this illness, it is treatable, and the illness can be managed.
Treatment includes medications and psychotherapy. The most common medications are lithium, mood stabilizers, anti-seizure medications, anti-psychotic medications and antidepressants. Psychotherapy typically includes cognitive behavioral therapy, individual therapy, and family-focused therapy. In addition to medications and psychotherapy, the following are essential: regular sleep, healthy diet, regular exercise, limited stress, and no use of alcohol and drugs.
Those living with bipolar disorder can face distinct challenges. For example, the combination of medications includes many undesirable side effects. The mania phase of bipolar disorder can often be enjoyable to the affected individual because of the period of high energy and creativity. It can also be a challenge for those living with someone affected by bipolar disorder, because it can be difficult living with someone as they traverse the extremes of manic highs and depressive lows.
As disruptive as untreated bipolar disorder is, the available treatment can help individuals living with the illness function quite well. There are many notable figures who live with bipolar disorder you may recognize, such as: Jane Pauly (Anchor of CBS Sunday Morning), Terry Bradshaw (current NFL commentator and an all-time NFL great), Dorothy Hamill (an Olympic champion figure-skater), Michael Phelps (an Olympic champion swimmer), Mike Tyson (legendary boxer) and John Daley (legendary golfer). There are examples throughout history as well including Beethoven, Charles Dickens and Winston Churchill.
Unfortunately, our oldest son was misdiagnosed during his teenage years as having clinical depression (which I now know is a common misdiagnosis); he wasn’t diagnosed with bipolar I disorder until an attempt to end his life at age 29. With the lack of knowledge about mental illness and shame associated with it, our entire family lived in silence on this topic for many years.
A quick blog housekeeping note: each March is difficult for me and my family, and I sense more fragility this year due to the pandemic. Therefore, I will wait until April to produce my next blog post.