Understanding Bipolar Disorder – What you Need to Know.

Bipolar disorder is a common condition affecting approx. 5.7 million adults or 2.6 percent of the US populate 18 years and older every year. Although, it is a common disorder, it is unfortunately one of the most commonly misdiagnosed conditions in psychiatry. On average individuals living with bipolar disorder have 3-4 diagnosis before they receive a correct diagnosis. Furthermore, this generally takes a LONG time on average of 10-15 years
10-15 years from the onset of symptoms to get a correct diagnosis.
Bipolar disorder (formerly called manic-depressive illness of manic depression) is a mental illness that causes unusual shifts in a person’s mood, energy, activity levels, and concentration. These shifts can make it hard to carry out day-to-day activities.

There are different types of bipolar disorder including:

• Bipolar I disorder – an illness in which people experience one or more episodes of mania lasting at least 1 week or more or requiring hospitalization.
• Bipolar II Disorder – a subset of bipolar disorder in which people experience hypomanic episodes, but not a “full” manic episode.
• Cyclothymic disorder – is a chronically unstable mood state in which people experience hypomania and mild depression for at least two years. People with cyclothymia may have brief periods of normal mood, but these periods last less than eight weeks.

Symptoms of Bipolar Mania/hypomania include:

– Feeling very “up” , high, elated OR feeling extremely irritable or touchy
– Feeling wired, jumpy, more active than usual
– Having a decreased need for sleep
– Talking fast about a lot of different things
– Racing thoughts
– Feeling able to do many things at once without getting tired
– Having excessive urges to eat, drink, engage in sex or other pleasurable activities
– Feeling unusually important, talented or powerful

Symptoms of Depressive episodes associated with Bipolar Disorder

– Feeling very down, sad, anxious
– Feeling slowed down or restless
– Having trouble falling asleep, waking up too early or sleeping too much
– Talking very slowly, feeling unable to say anything, or forgetting a lot
– Having trouble concentrating or making decisions
– Feeling unable to do simple things
– Having a lack of interest in almost all activities
– Feeling hopeless, worthless or thinking about death or suicide

How does this happen? Why is a correct diagnosis important? What can you do to reduce your chances of a mis-diagnosis or a loved one?
Why is bipolar disorder misdiagnosed?
Bipolar disorder is often misdiagnosed or missed for different reasons.

First, research shows that bipolar disorder may show up and be initially major depressive disorder – that is because a subset of individuals will not have a manic or hypomanic episode prior to their first depressive episode. It can be fairly common to present with depression first and than later “convert” to bipolar disorder after an episode of mania or hypomania. Current studies
show that 1 in 4 individuals being treated for major depressive disorder, generally with antidepressants at the family or primary care doctor actually have a bipolar disorder.

Secondly, Bipolar disorder has many comorbidities including anxiety disorder, substance use, eating disorders which can make getting to the root cause or getting to the right diagnoses difficult. Individuals with borderline personality disorder, conversely, may get a diagnosis when it is actually bipolar disorder and vice versa.

Third reason bipolar disorder diagnosis is missed and delayed is that screening can be difficult. Often times in the outpatient office setting, individuals generally present with concerns regarding depression. Mania or hypomania go un reported or underreported because in some cases individuals in a manic episode may not remember or recognize it and those with hypomania may actually feel this is ‘normal’ and perceive it as a “good” and “productive time.’

Treatment for Bipolar Disorder –

There are effective, FDA approved medications for Bipolar disorder. There is hope that you can cope and thrive despite living with bipolar disorder.

Medications: There are medications such as antipsychotics that help with various phases of bipolar disorder. These antipsychotic can come in both oral or pill form, or delivered as a monthly or every two month injection
that is given at a pharmacy or health care provider’s office. Mood stabilizers like lithium, valproate are also used. The most recently approved medication is for treatment of acute bipolar I and II depression with or without lithium or valproate called, lumateperone lumateperone
. All medications carry a risk of side effects. It is important to understand the risk and benefit of treatment options.

Psychotherapy: Psychotherapy, or talk therapy, can be an important part of treatment for people living with bipolar disorder. Therapy can provide support, education, and guidance. It can also help people identify and change bothersome emotions, thoughts, and behaviors.

Electroconvulsive therapy (ECT): is a noninvasive procedure that is FDA approved to treat severe depressive episodes in people with depression or bipolar disorder. It is generally used if a person is not responding well to medications and talk therapy. This procedures requires that the individual is sedated with an anesthetic and muscle relaxer

How do you increase your chances at an accurate diagnosis?

– Know your family history – ask about your family history of mental health disorders including bipolar disorder.
– Take a self screener such as the Mood Disorder Questionnaire and talk to the results to a mental health care provider
–Bring a close family member, friend or significant other to your appointment if you are comfortable
– Ask your HCP if you have been screen for bipolar disorder
– Know the warning signs of bipolar disorder, bipolar mania and hypomania