Are you moody, bipolar or misdiagnosed?

To suffer from bipolar mood disorder is rough. It is often difficult to treat, with two mood stabilisers and an antipsychotic being needed, before even a bit of control is achieved. This hand full of pills can come with serious side effects like weight gain, sedation, hormonal imbalances and movement disorders. As if that’s not enough, as soon as you get a diagnosis of bipolar mood disorder, you get exposed to the stigma of such a label. People with serious mental illnesses have employment difficulties, get excluded from certain benefits and get labeled “mad” by loved ones.

Despite all these problems, untreated bipolar mood disorder is even harder. I always tell my patients that suffering from the disorder is crap, but if you don’t manage it, it will destroy your life. Patients with uncontrolled bipolar mood disorder lose loved ones. Even the most saintly of spouses cannot deal with the infidelities, rages, unchecked spending and reckless drug use which mark the manias; or the long months on the couch, pessimism and suicide attempts of the depressed phases. Children and friends create distance lest they get sucked into the chaos. Patients who don’t control their illness can’t keep good jobs. They might be very talented and super intelligent, but even understanding bosses struggle to condone overcommitting with grandiose plans (common in mania) and then failure to even show up to work on other days (common with depression).

Lovely people with uncontrolled bipolar mood disorder often end up alone, destitute and die young (either due to suicide or risk-taking behaviours such as substance abuse, unsafe sex or reckless driving).  One of my patients told me that her medication helped her “put the demon in a box.” Another said “without my meds, I cannot rely on myself for anything. I cannot make plans. I can’t even be sure whether I will go clubbing or kill myself.”

When we consider the challenges of both the illness and the treatment, it is essential to get the diagnosis right. So what is bipolar mood disorder? Bi means two and polar means poles. The two poles they are referring to is mania and depression. Most people think of being manic as being happy and being depressed as being sad. Since being happy and sad are part of the human condition, and every moody adolescent can swing between the two states a few times in every hour, aren’t we all a little bit bipolar?

Well, no. The basic premise that bipolar mood disorder is a happy mood and a sad mood is faulty.

Mania is a symptom cluster saliently characterised by being “sped up.” You move more, and your thoughts are fast. You feel energised after just a few hours sleep. It can feel great.  Creative ideas flow, and there is a sense of inspiration. But it can just as easily be horrible. Like you are bursting out of your skin, you are agitated and irritable, you can’t settle or get rest.

We all know what it feels like to have depression. Clinical depression, however, is more than just a funk. You are “slowed down” to the point that your bones feel like lead and your head is full of wool. Your senses are dulled; food has no taste, sex holds no pleasure.

In bipolar mood disorder, it might be months between mania and depression, or it might be within the same day. One can understand why patients get desperate form life on this relentless rollercoaster.

To further complicate matters, bipolar mood disorder is a spectrum condition. You get bipolar one mood disorder with its high-high manias. So high that the patient might lose touch with reality, become psychotic, and believe that they have special powers or have an ordained purpose.  Bipolar two mood disorder is more subtle than bipolar one; the manias are less extreme and called hypomania. Then there’s induced bipolar mood disorder, where a trigger  (often an antidepressant) results in manic symptoms.

Manic and depressed symptom clusters can occur with substance abuse, some personality styles (like borderline personality disorder) and chronic PTSD. It is possible not to be appropriately diagnosed, or to be incorrectly diagnosed, with bipolar mood disorder. A good psychiatrist will re-evaluate their initial assumptions as more evidence unfolds.

People with bipolar mood disorder do have genetic abnormalities on genetic testing. Their brain scans do show abnormalities, particularly in the frontotemporal regions. With depression serotonin is low and with mania dopamine is affected.  However, and this a critical point, there is no definitive test which can make the diagnosis. So the psychiatrist can’t send you for a blood test or a brain scan to help make the diagnosis. Psychiatrists rely on what the patients tell them about symptoms, on patterns of behaviour in the patient’s history and on what they observe in the in the interview.

Misdiagnosis or missed diagnosis can happen. You can help get the correct treatment by finding a psychiatrist whom you like and working closely with them. Let them know when things change. Don’t hesitate to ask questions.

It is possible to have a good and functional life with bipolar mood disorder. Many of my bipolar patients have come to value the struggle of the illness and say that even if a total cure was discovered the next day, they might not take it. They say that their illness has forced them to live their lives more consciously, that they have had to work harder to live healthier lives than they otherwise might have.

If I can help my patients steer away from the destructive nature of bipolar mood disorder, then they sometimes manage to focus its energy in very creative and spiritual ways. Indeed, bipolar sufferers have changed the world.