Michael Pipich Guest Post: Are You Just Depressed or Is It the Onset of Bipolar Disorder?

Are You Just Depressed or Is It the Onset of Bipolar Disorder_

This guest post hits close to home. For twenty-one years, from ages eighteen to thirty-nine, I was diagnosed with chronic depression (dysthymia). I’d tell doctors that I was at least cyclothymic, for I my over-productive workaholism led to cyclical depressive crashes. Finally, at thirty-nine years old, I was diagnosed bipolar II. — Kitt

Are You Just Depressed or Is It the Onset of Bipolar Disorder?

Michael G. Pipich, MS, LMFT

About two-thirds of people with bipolar disorder are misdiagnosed with other mental health problems before bipolar is discovered.[1] Among those individuals, a significant majority are given a diagnosis of major depression. Most people with a major depressive disorder that is unrelated to bipolar disorder (typically known as non-bipolar depression or unipolar depression) can be treated safely and effectively with a combination of antidepressant medications and psychotherapy. But when people with undetected bipolar are treated this way, a host of mental health problems can occur, making the underlying bipolar condition much worse.

It’s understandable that someone may not immediately be given the bipolar diagnosis if their first mood swing begins in a depression mood zone. This seems particularly true of people who have bipolar II disorder. And sometimes, there may be more than one depressive episode before a manic or hypomanic episode happens in a person with bipolar.

If you’re wondering about whether you may have depression or the beginning of bipolar, there are some keys to keep in mind when seeking treatment.

First of all, when assessing if your depression is a part of bipolar, know that bipolar disorder has distinct genetic foundations. In other words, it runs in families and is passed through family genes. So if you suspect that any family members may have had bipolar disorder, it’s important to inform your doctor or therapist when entering treatment. If the information is available, a thorough family mental health history can really support a proper bipolar diagnosis. Unfortunately, such information isn’t always asked for, so be prepared to volunteer all that you know during an evaluation or treatment session.

Next, your personal history of mood swings should be explored. If you’ve had severe ups and downs during childhood or adolescence, these may be more than the common tumult of growing up. They may instead be early expressions of bipolar disorder. It’s especially important to review periods of hyperactivity, bouts of unexplained rage, self-harm, or suicidal thoughts or actions that could have occurred at any time in life. There certainly may be other explanations for these, such as early life trauma or severe loss and grief experienced during these formative years. But if explosive behaviors or deep depression occurred at different times, especially with little or no provocation, it can point to underlying bipolar disorder.

Usually, most people with bipolar who seek treatment on their own are currently or recently depressed, or are experiencing consequences of untreated bipolar disorder. Any history of mania or hypomania is less obvious, however. And often, bipolar patients will either not understand manic symptoms or will avoid discussion about them. If you have had at least one occurrence in your life of intense euphoria, excitability, unexplained energy and creativity, avoidance of sleep, or impulsive behaviors, inform your treatment professional. But also bear in mind that mania and hypomania may be marked by intense periods of irritability and agitation, know as dysphoria. This is in contrast to the euphoria that most people think about with bipolar mania. Often a dysphoric type of manic or hypomanic episode can be mistaken for the kind of agitation seen in major depression. This can mislead the course of treatment to focus only on depression, while missing the full bipolar condition.

This brings us to the most important part of knowing whether you have depression or bipolar onset. According to the Diagnostic and Statistical Manual of Mental Disorders (5th edition), if a patient is given an antidepressant medication, and it produces manic symptoms, the person is then diagnosed with bipolar disorder.[2] While this is a very clear indication of bipolar, how the mania surfaces in the individual may take different forms. For example, a person in a depression mood zone can improve early in the treatment, and as a result, may not show manic symptoms right away. Any slight improvement may provide a hopeful sign that treatment is working, but when the person starts to get worse because of emerging mania—especially if it’s dysphoric—the unwitting response may be to apply more antidepressant medication. Now we have some real problems.

So, if at some point in your treatment, an antidepressant medication makes you feel more agitated, more irritable, more aggressive, or you start to experience hyperactivity or greater impulsivity, tell your treatment professional right away. This could be the start of a manic episode that is revealing a previously undiagnosed bipolar disorder. Even more importantly, any increase in suicidal thoughts or possible psychotic symptoms, such as hallucinations, should be reported immediately, as these can be life-threatening. Any antidepressants will either likely be eliminated at this point, or possibly paired with a mood stabilizing or antipsychotic drug to keep a lid on mania.

With bipolar finally recognized, bipolar medications can be introduced to decrease manic-type symptoms, while keeping depression in check. Alongside medications, it’s important to have therapy focus on the unique challenges facing people with bipolar disorder. Major depression is frequently considered an acute condition because it often can resolve in time, so medications may be discontinued at some point, along with a shorter overall approach to therapy. But bipolar disorder is a lifelong condition. Even though its symptoms can come and go in episodes, the genetic nature of the condition means the bipolar patient will need continuing care through the lifespan.


[1] Hirschfeld R. M., Lewis, L., & Vornik, L. A. (2003). Perceptions and impact of bipolar disorder: How far have we really come? Results of the National Depressive and Manic-Depressive Association 200 survey of individuals with bipolar disorder. Journal of Clinical Psychiatry, 64(2), 161–174.

[2] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author, 128-130.


Owning Bipolar: How Patients and Families Can Take Control of Bipolar Disorder by Michael G. Pipich, MS, LMFT. Foreword by Joseph Shrand, MD.

Michael G. Pipich, MS, LMFT is a psychotherapist and author of Owning Bipolar: How Patients and Families Can Take Control of Bipolar Disorder, (Citadel Press, Sept 2018). He practices in Denver, Colorado, and can be reached at MichaelPipich.com.

Press Contact: Janet Appel Public Relations
205 West 54 Street, New York, New York 10019
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Quick Update

What’s Up?

What’s Up with Me?

This morning I woke up feeling sick to my stomach. Unlike my son, feeling crappy doesn’t keep me from eating nor do I sleep all day. Even though I was nauseated and loopy, I managed to finish my first chapter of my book. Working with Sarah Fader as my book coach starting last week, I’ve drawn up character sketches, a book outline, and a draft of the first chapter. The first chapter focuses on childhood up to eighth grade: born in San Francisco, five years in Saudi Arabia, two years in Massachusetts, ending the chapter in Rancho Palos Verdes. The second draft will begin with our move to Valley Forge, Pennsylvania. My goal is to have a working draft by the time I attend the Sunriver Writers’ Summit in late May.

Parenting a High Needs Chronically Ill Teen

My 17-year old son’s been sick and suffering from migraines (again, still, nothing new). He frequently gets ill, has had migraines since he was a toddler, and struggles with anxiety and depression.

Honestly, I’m exhausted trying to care for him, trying to take him to doctors’ appointments when he won’t or can’t drag himself out of bed, trying to get him to eat when he doesn’t feel well, trying to get him out of bed and to school. He’s been a very challenging kid to parent. Now he’s a young man — a sweet, highly intelligent, and handsome young man — but difficult to help, difficult to parent. I’ve tried. Oh, how I’ve tried.

Recently my husband took him to his psychiatrist (my son has an army of specialists). They agreed on lowering his topiramate dose. My son doesn’t like the negative cognitive side effects of topiramate, nicknamed “Dopamax.” When I took it as a mood stabilizer over a decade ago, I was a complete idiot. My son can’t find words or understand concepts as quickly as he once did. He complains that he used to read his Spanish vocabulary once and had it memorized. Now he has to read it multiple times. I told him, “Welcome to everyone else’s reality. Most people must study harder than you do.”

My son keeps hoping that he’ll outgrow the migraines, which he still may, for testosterone protects against migraines. He had asked to see an endocrinologist hoping he’d be prescribed testosterone, but the pediatric endocrinologist wouldn’t prescribe it. He just told Matthew that he had delayed puberty (late bloomer), and that he’d catch up.

When I heard that the psychiatrist again suggested lowering the topiramate dose, I emailed his neurologist who responded that it was a bad idea, for his migraines return whenever the dose is reduced. Got him back up to his therapeutic dose, but he’s still not 100%. Last night he threw up, as he did once last week. Migraines + viral illness = miserable son sleeping 24/7.

Sarah Fader: Parenting a Special Needs Child

Guest Post by Sarah Fader

Being the parent of a child with special needs is inherently difficult. But when it comes to a child who has mental health problems it is another echelon of challenges. I never imagined that my son would have special needs. But I guess nobody knows that they will have a child with special needs when they’re pregnant. There are exceptions to this rule. People find out that their child has downs syndrome or spina bifida or an obvious disability that can be detected in pregnancy. But mental health issues, that’s a different story. There are exceptions to this rule. People find out that their child has down syndrome or spina bifida or a very obvious disability that can be detected in pregnancy. But mental health issues, that’s a different story.

My psychiatrist told me there was a 6% chance that my son would develop depression; that was my first pregnancy and I had no idea what I was in for. I knew that my family had a genetic history of panic disorder, depression, OCD, and anxiety. So there was a good chance that one of my kids would develop one of these issues or something else that was mental health related.

But I was naïvely optimistic and thought it would not happen to my kids. When I first had Ari I was a new mom and figuring things out. The last thing on my mind was whether he would have mental illness. I was concerned with developmental milestones and the chance of him potentially having autism because that is what is stressed when you have a child. Even in the hospital they don’t talk about mental illness they talk about shaken baby syndrome. They talk about caring for your infant and making sure that you satiate that baby’s needs. Doctors warn you about postpartum depression and the baby blues but they don’t tell you about mental illness for your child.

So when my nine-year-old son started showing signs of OCD I was nervous. When my baby boy who wasn’t a baby anymore showed me that he needed help and was oppositional and had irritability and rage, I didn’t know what to do. There is an extended timeline in which things happened and I felt like they were out of my control.

What was out-of-control wasn’t me. The thing that I could not control was what was happening to my son. I was doing the best that I could I am doing the best that I can trying to find the doctors to help my kid. Trying to fight with the flawed mental health care system and find out what it is that he needs and how I can provide that to him. But I am one person and asking my friends for help is getting exhausting for me and for them. I don’t want to be a burden on others. I don’t want to ask for something that people can’t give. All I want is for my son to find peace. I want him to live a life where he feels like he can be himself.

Speaking out about what I’ve been dealing with has been difficult because I faced much judgment from people online when I share my struggles. As the founder of a mental health nonprofit organization it is bizarre to me that people would criticize me talking about mental health issues even as it relates to my family and more specifically my child. Would people be angry if I was discussing my child diabetes? Would people be upset if I was talking about a child that had cancer? Mental illness is just as it indicates, an illness.

I’m writing this for every parent who has a child who is dealing with mental health issues. You are not alone and you don’t have to stay silent. You can do what you need to do to use your voice. You can be private about these issues or you can speak out. You can internalize them or you can tell the truth in whatever way you need to: whether that’s in your journal, call friends and family, or speak about it online. There is no right answer to this struggle. Just know that your experience is valid and your feelings are real. I’m listening. We should all be listening to your story, because one in four people in this country have a mental illness and one of them is my child.

Sarah Fader 10 Step Depression Workbook

Sarah Fader is the co-author of The CBT-based 10 Step Depression Relief Workbook, which is available on Amazon. She is the CEO and Founder of Stigma Fighters, a non-profit organization that encourages individuals with mental illness to share their personal stories. She has been featured in The New York Times, The Washington Post, The Atlantic, Quartz, Psychology Today, The Huffington Post, HuffPost Live, and Good Day New York.

Sarah is a native New Yorker who enjoys naps, talking to strangers, and caring for her two small humans and two average-sized cats. Like six million other Americans, Sarah lives with panic disorder. Through Stigma Fighters, Sarah hopes to change the world, one mental health stigma at a time.

www.sarahfader.com

Taking a Step Forward

Took a Step Forward Today

Today I took a step forward. I went to my psychiatrist. He adjusted my medications, putting me back on a low dose of escitalopram. Monday, we see a psychologist with our son to get some coaching on negotiating our battles and setting some reasonable boundaries.

Called NAMI Orange County’s Warm Line and briefly talked to a mentor. Looked into going to Orange County’s Wellness Center, which offers all kinds of support and activities, but I’m just not up to making the twenty-mile drive to the City of Orange. Maybe tomorrow I will actually drive up to The Wellness Center – then again, maybe not. I actually think that I may be sick, physically ill, which is exacerbating my depressive symptoms.

Yesterday I both called and emailed Saddleback Church, which offers support groups and is very close to my home. The main problem I have with Saddleback is that I’m very liberal – theologically liberal, socially liberal, and politically liberal. Saddleback is not.

Just got a call from the nurse’s office at my son’s school. Had to go and get him. He has a headache and feels sick, nauseated. Honestly, I feel pretty run down myself. And, so it goes…

Taking it one step at a time.