Understanding Bipolar Disorder

What does it mean to have bipolar disorder? What is it? Isn't it a bad thing?


In my career, I have found bipolar disorder to be highly stigmatized, and highly misunderstood. Let's break it down.


The Diagnostic + Statistical Manual (DSM V) is what we use to diagnose in psychiatry..and it created by a bunch of white dudes who decide what constitutes a disorder. Sounds REAALLL reliable.


The DSM says that there is a Bipolar I and Bipolar II.


Bipolar I includes something called "mania" which means that a minimum of 3 of these symptoms occur together for a minimum of a week (or just period if you get hospitalized for it): feeling amazing about yourself, racing thoughts, no need to sleep, more talkative than usual, more impulsive/risky than usual, feeling restless (which may present as anxiety), making lots of intense plans suddenly, being very irritable, and being distractible.


Bipolar II constitutes something called "hypomania." The symptoms are the same as above -- and you need 3 minimum four days or more in a row.


Mania is something that gets you in trouble, and is VERY noticeable. Hypomania can feel like functioning, feeling "normal" or "good" -- like you finally broke out of a funk of depression. It doesn't feel abnormal. You might just feel creative, motivated, want to clean things, party, not really need any sleep and feel good. It may not be noticeable or memorable.


For Bipolar II, hypomania is typically followed by very, very low depressions. These ARE memorable.


Then there's major depression, dysthymia..and a bunch of other shit.


A lot of people fit in these categories. Maybe you are like, "yeah, I vibe that."


Or maybe you're like wtf no.


This is where I think the DSM fucked up. They should have put depression on a spectrum - just how Autism was moved to "high functioning/low functioning" to SPECTRUM.


Here's how I view it:


Primarily, from our standpoint..what it means is that you do not respond well to medications like antidepressants (Lexapro, Prozac, Wellbutrin etc etc). Even if it feels like it may have worked at first, it will continue to push you up and down into depression after depression. These mood swings occur quickly. Maybe a good week, a really horrible few days, then a few good days..and so on. These medications make some people hallucinate, not sleep, become very impulsive or even suicidal if there's an underlying mood disorder.


At the end of the day, Bipolar/mood disorders are a type of depression that is highly genetic. It has more up's and downs, and is worsened by taking certain types of medication. Boom.


I've always explained mood disorders to my patients and students with a visual.


The Yellow line indicates Bipolar I. There's a 10 for a mood (highest possible mood ever) followed by a lower period.


The Purple line indicates Bipolar II disorder. We get to an 8 for the mood for awhile (woo doing good), and then we get a very SHARP drop into depression. The depression is severe


The Red line indicates unipolar, good ol' fashioned Major Depressive Disorder. Just sittin' real low. No family history of bipolar. Same shit every day.


The Black line indicates we are somewhere on a mood spectrum. There are up's and down's which are significant. Sometimes we go up to normal for a few weeks followed by severe depression, and we might even bounce back for a few days and be hit again with a severe depression. Sometimes it may be just a LOT of anxiety and restlessness that is so severe you do not even notice the moods fluctuating.


A lot of people fit in the last category. A LOT.


That's where the DSM fucked up in my opinion. We end up giving out that as an "unspecified bipolar disorder" which I just explain as a mood disorder which doesn't respond to antidepressants.


The unfortunate thing is that a lot of people sit and think "shit, I'm bipolar" once we move away from antidepressants or have that talk.


But Bro, for real, it just means your genetics got you. You can be mad at your great grandma, but it's not going to change anything. It could even be a combo of genetics and experiencing trauma.


The endgame is that your brain isn't set up to take antidepressants. You are going to need to be cautious of making sure you get enough sleep, nourish your body, meditate, exercise, [inse

rt healthy habit here] to keep yourself good. That's all it means. THAT'S Bipolar. THAT's a mood disorder. It's just a type of depression.


It's all depression. Kind of like there's different kinds of toast. You can have avocado toast or peanut butter toast. Sunbutter toast. Shit, you can have gluten free vegan raw toast.


But It's all just toast.


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