On verge of tears
Too many demands
Too many changes
Must scale back
Spoke to psychologist
On verge of tears
Too many demands
Too many changes
Must scale back
Spoke to psychologist
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
Michael G. Pipich, MS, LMFT
About two-thirds of people with bipolar disorder are misdiagnosed with other mental health problems before bipolar is discovered. 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. 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.
 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.
 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author, 128-130.
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.
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Irritable. Hypomanic. Overwhelmed?
Unfortunately, social stimulation triggers and worsens hypomanic symptoms in me.
Upcoming events that may overstimulate me:
Frustrated with my newly adult 18-year old son who struggles with social anxiety and migraines. Though highly intelligent, he has not completed high school, nor has he taken scheduled high school equivalency tests.
Anxiety. Migraines. Reschedule. Repeat.
Yesterday, he did not go to his scheduled cognitive behavioral therapy (CBT) evaluation. The CBT psychologist told me that we must make structured household changes in which we design and implement consequences. As is, he lacks motivation to change.
After drafting this post, I went to the pharmacy to fill my clonazepam prescription. I rarely take clonazepam, a benzodiazepine, for it’s a potentially addictive controlled substance. But, today I need it.
Treated myself to chicken enchiladas mole for lunch. I love Olamendi’s mole sauce. Chocolate and spices in the over 50-ingredient sauce help. Magic.
Now, I chill out.
Those who know me well would hardly be surprised to hear (or read) that my mind is fried. Focused? Who me, focused? Nope. Instead, one project or comment gets me going in one direction, another in another direction. I end up juggling multiple projects, with my mind racing and jumping all over the place.
So here’s what’s going on. I’ve intended for a few years now to publish a collection of my blog posts as a book. Not able to import my posts into Scrivener, I labored to cut and paste them back in 2014 and later in 2017.
Recently, I hired Sarah Fader as a book coach, and with her help realized that I have a memoir in me. I’m starting to see them as two separate projects — a memoir and a collection of blog posts or short essays — and am itching to get the posts I had copied and pasted published. I want them off my back, out of my mind. They want to be collected and published. What can I say? The writing demands it!
At the end of May, I’m attending a writers summit where I will workshop my memoir (or post/essay collection, or both). In the meantime, I’m going off in multiple directions, as is like me when overstimulated. Overstimulation, social and intellectual, triggers mood cycling and hypomania in me.
It’s Wisdom Wednesday. Keyword: mailing list. Do you have one? If yes, how are you growing your subscriber base? Do you send a monthly newsletter? Inquiring minds want to know.
My first reaction was: “Nope. I’m really bad about it because I find mailing lists obnoxious.” But, then I went ahead and created a MailChimp email list (click on link to a my fancy sign up page on MailChimp), which now has a total of five members. Creating this list involved a crap load of work.
To protect my personal privacy and for basic professionalism, I didn’t want to use my personal email or my personal address. To create an email account using my URL, kittomalley.com, I signed up for G Suite as the owner of my URL. Sounds simple, but I jumped through hoops to verify that I owned every iteration of my URL (kittomalley.com, http://www.kittomalley.com, kittomalley.wordpress.com, etc.).
For a mailing address, I rented a local mailbox. Luckily, the owner knows me and I was able to handle the transaction over the phone and by email, because I was sick when I was doing all this work online. The new mailing address has the added benefit of protecting my privacy online, for I’m licensed with the state of California as a Marriage and Family Therapist. (Recently completed CEUs to renew license.)
Once I had completed all that, as the graphic nerd that I am, I went through several design iterations for the mailing list pop-up, ending up with the least obnoxious: a simple white footer with no graphic design elements that allows readers to scroll my content without clicking to close the form. I’m just asking for email addresses. Don’t want to ask for too much information.
Honestly, I’m not sure what exactly I’ll use the list for. Not to send notifications of blog posts. People can sign up for those through WordPress.com. Rather, to let people know perhaps on a monthly basis the status of my book(s). Perhaps to write a monthly newsletter. Who knows? Just don’t want to inundate anyone with email. Hate email spam, thus my initial reaction.
Oh, I almost forgot. Yesterday was St. Patrick’s Day, my parents’ fifty-sixth anniversary. My husband and I visited them at their memory care community. Yes, they both have dementia. My father due to alcoholism. My mother secondary to a stroke. Visiting them is always emotional for me. My father asks the same questions over and over. My mother cannot speak and at best understands 40% of receptive speech. She doesn’t understand symbolic language either — the part of her brain responsible for language has been destroyed. Her frontal lobe, too, was damaged leaving her with behavioral complications on top of underlying undiagnosed mental illness predating her stroke. As I’m her daughter and not her psychiatrist, I can’t really diagnose what was going on with her, I can only say that she could be emotionally abusive. Those stories I’ll save for my memoir.
Upon returning from our visit, I decided to take on finishing our income taxes. I had completed most of the return on TurboTax. Just had to go through a pile in my inbox that dated back to my mother’s stroke. Seems that’s what I had put on hold. Going through the papers triggered painful memories. As I look at the dates on documents, I recalled what we were going through at those times.
My mother had her stroke one month after my son started at a new private high school due to his health problems and frequent absences. My son still struggles. Honestly, as the parent of a son struggling with multiple complex intertwined health issues, I feel like a failure. I do not have a magic wand. I cannot take away his suffering. I cannot make him get up out of bed. I take him to doctors. I try to get him to eat, or at least to drink.
Sounds like a lot? It is. I rely on my husband. We order take-out. I write, I blog, for I can. It’s something I can do. Something I can control in the midst of so much I cannot control.