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Are people with Bipolar Disorder always in a cycle?

Are people with Bipolar Disorder always in a cycle?


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I know that people with bipolar cycle between moods, say, roughly a few times a year, and I know that there's conditions like ultra-rapid cycling. But something I don't understand, particularly with bipolar 2, is if that person is always in a cycle or not? For example, do they have a depressed episode for, say, a month, and then a hypomanic episode for another month, and then life is normal until they have another episode? Or are they always somewhere in an episode?


5 Things People With Bipolar Want Others To Know About Their Condition

For starters, having the condition doesn&rsquot mean you&rsquore manic or unstable.

When you hear that someone&rsquos been diagnosed with bipolar disorder, you may have some questions and concerns. There&rsquos also a good chance you&rsquoll make some assumptions about what it&rsquos like to live with the mental illness, many of which may not be based on facts. After all, thanks to misrepresentations of the disorder in the media&mdashas well as the flippant use of the word bipolar to describe everything from the weather to someone who just changed their mind&mdashthere are plenty of myths about this mental health condition that are perpetuated.

Kaity Cash, a 29-year-old publicist in Sommerville, New Jersey, who was diagnosed with bipolar disorder in college, can relate. &ldquoPeople talk about depression and anxiety so much that those conditions have become normalized, yet there&rsquos still such a stigma around bipolar,&rdquo she says. Melanie Carlson, a 39-year-old who was also diagnosed with bipolar in college agrees. &ldquoPeople often think that I&rsquom always in one emotional extreme or another, or they look at me and say, &lsquoYou have a job?&rsquo&mdashlike they&rsquore shocked,&rdquo says Carlson, a social worker who&rsquos also getting her Ph.D. in psychology. &ldquoThere&rsquos so much great activism happening around other mental health conditions, but we&rsquove still got a long way to go when it comes to bipolar.&rdquo

That&rsquos why we sat down with Cash and Carlson. We wanted to understand the common misconceptions about bipolar disorder these women face&mdashand to hear from them why these assumptions just aren&rsquot true.


Symptoms

Bipolar disorder is a recurring disease that goes in cycles. One part of the cycle is marked by symptoms of mania, the other by symptoms of depression. These "mood episodes" are often intense. During the manic phase, an individual can be cheerful, outgoing, talkative, and energetic. Until the mania gets out of control, he or she can be extremely productive and wonderful company.

During a manic episode an individual may:

  • feel very energetic
  • talk a lot about different things
  • have trouble sleeping or relaxing
  • jump from thought to thought or project to project
  • develop exaggerated self-confidence or thoughts of power and wealth
  • do risky things like abuse alcohol or other drugs, recklessly spend or invest money, engage in reckless sex

During a depressive episode an individual may:

  • feel down or worried
  • lose interest in activities or relationships
  • have trouble concentrating
  • have trouble sleeping
  • think about death or suicide

The symptoms of bipolar disorder are not always easy to distinguish from other serious conditions. Mania can be difficult to tell from schizophrenia. People who take amphetamines or corticosteroid drugs or people with overactive thyroid glands have symptoms similar to those of people with the manic phase of bipolar disorder. Some people have bipolar disorder for months, if not years, before it is diagnosed.

Untreated, the manic phase can last as long as 3 months. As the mania fades, the individual may have a period of normal mood and behavior that lasts for weeks, or even years. Eventually, the depressive phase of the illness sets in.

About 10% to 20% of people with bipolar disorder develop what is known as rapid cycling, with more than four episodes of mania and depression a year. The chance that there will be future attacks rises with each new episode.


What psychological approaches are used to manage bipolar disorder?

Pharmacotherapy, or drug therapy, is essential for the treatment of bipolar disorder. It usually involves the use of one or more mood stabilizers, such as Lithium, combined with other medications.

There is now strong evidence that psychological interventions can be added to drug therapy in order to help people better manage their illness and reduce repeated experiences of mood episodes.

Psychoeducation consists of giving patients and their relatives’ adequate knowledge about bipolar disorder and teaching illness self-management skills, so that people have a better understanding of their illness and its treatment. Psychoeducation is usually given in short-term (i.e., 5 to 10 sessions) group format.

Cognitive-Behavioural Therapy (CBT) and Interpersonal Therapy (IPT) are both short-term forms of psychotherapy that have been shown effective in the treatment of mood disorders, including depression and bipolar disorder.

In bipolar disorder, Cognitive-Behavioural Therapy uses psychoeducation and mood monitoring to help people identify triggers of mood episodes and develop a written relapse prevention plan.

Increasing activities in depression, reducing activities in mania, and correcting over-negative or over-positive thoughts are also strategies used in CBT. An adapted version of IPT, Interpersonal and Social Rhythm Therapy (IPSRT), has also been shown effective for bipolar disorder.

The main goals of IPSRT are to help people better deal with relational difficulties and learn how to maintain a stable and healthy daily routine in order to regulate important biological rhythms, such as sleep, that can trigger mood episodes like mania.

Family Therapy interventions, which have been found to be helpful in schizophrenia, have also been successfully adapted to bipolar disorder.

In Family Focused Therapy (FFT) patients and their families learn how to better understand bipolar disorder by getting information on the disorder and its treatment (psychoeducation) and learning communication and problem-solving skills in order to deal more effectively with the consequences of bipolar disorder.

Finally, social support is also very important for people with bipolar disorder and therefore joining local support groups for mood disorders may be helpful.

Where do I go for more information?

More information regarding bipolar disorder can be found on the following websites:

  • the Mood Disorders Society of Canada (MDSC) at http://www.mooddisorderscanada.ca
  • the Depression and Bipolar Support Alliance (DBSA) at http://www.dbsalliance.org or
  • the Canadian Mental Health Association at http://www.cmha.ca.

You can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial and some municipal associations of psychology often maintain referral services. For the names and coordinates of provincial and territorial associations of psychology, go to http://www.cpa.ca/public/whatisapsychologist/PTassociations/.

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Martin D. Provencher. Dr. Provencher is a Registered Clinical Psychologist in the Province of Québec and is Full Professor at L’École de psychologie de l’Université Laval in Québec City. His primary interests include Cognitive-Behavioural Therapy, mood and anxiety disorders, Bipolar Disorder and Generalized Anxiety Disorder.

Your opinion matters! Please contact us with any questions or comments about any of the Psychology Works Fact Sheets: [email protected]

Canadian Psychological Association
141 Laurier Avenue West, Suite 702
Ottawa, Ontario K1P 5J3
Tel: 613-237-2144
Toll free (in Canada): 1-888-472-0657


8 Comments

Hi Natasha. Love your work, so does my husband. It’s helped him a lot. I’m currently in hopsital due to, originally mixed state, now mania. I guess it’s low level but not hypomania. S* loads of drugs to keep me calm. The problem I face is that I know how bad things can get and how fast, so doctors and nurses don’t see me as ‘too unwell’. My vice when manic is online shopping. I never shop online. I hate it. So I gave majority of my money and bank access to my husband as soon as I saw what was coming. Doctors and nurses-‘oh you seem so much better. No this is Just a different phase from angry mixed. My insight works against me. I’ve worked hard to learn my illness. My kids have disabilities. I need to be in control of my life as much as I can but insight often prevents me from getting adequate treatment until I’m in emergency. I’m learning and using my skills and tools. The doctors and nurses need to listen and learn.

Are panic attacks part of or in and of itself a mental disorder?

Hey, Natasha! I love seeing your name everywhere! I just hi and see how you’re doing. I’m okay. We’ve been re-building for a year because we got hit pretty bad by Harvey, but it’s all good. I volunteer at an unbelievable place, and I have an agent in NYC pitching my book (I’m a writer.) That’s really exciting for me. Well I know you’re swamped. Love this article. Great writing. See ya’!

Insight into my disease was NOT an overnight experience
For many yrs I was in denial I was as sick as I was,not taking it seriously .
Having episodes where I’d be on/ off my meds playing chemist…….
Enjoying the highs,b/c I’d drop 7-8 pounds in a week!
Getting so much accomplished” & one time recalling so delusional thought I was Janis Joplin ( in Emerg by then
Psychotic) given pills every 2- h) I couldn’t shut up I must’ve been a real pain in the ass to staff.
But as we all know,have no control in that state of mind……….it’s stuff I try to push to the back of my brain in order to forget.
But,if I forget totally I might one day get into that head space as we’re all familiar w ” screw meds” & such
I’ve been stable many months,but I must be truthful I don’t enjoy swallowing a huge pill cocktail not only for
Bipolar but epilepsy chronic back pain,bunch vitamins I’m deficient in,migraine headaches……..ulcer…..
Some are huge to swallow causing GI issues,that last 1/2 the nite,yes I want to be well.
But there’s a price to be paid for wellness.
Insight also means you know your life should be routine- oriented.
Boring,but true.
If you take your meds on time as your psych directs you’ll get better results.
If you eat more healthfully & try your best to stay away from fast food ( but have once week cheat day) you’ll less
Likely be overweight,it’s not only the pills,it’s also your eating habits ….if it was just pills I’d weight over 300 lbs.
Try & move around a bit here & there even if it’s only a 10 min stroll,better than nothing.
Insight means you understand your illness for what it is & how serious it is
This isn’t a joke
We’re talking hardcore serious mental health disease that kills,you have to learn to live & manage it.
Like an adult,not a two yr old child.
It’s got maturity to it I think that comes more so w age,as I grew older it became easier to deal.
Yes the beast still rears her ugly head ( I’m rapid cycler) difference is I’ve my sword at my side for protection!
I feel for others that are not where I am now in my life,only hope that one day soon,they too will see bipolar disorder for what it truly is.A serious mental disorder that destroys/takes lives.
Thanks.

Hi Natasha,
Relatable! My last hospitalization the nurses all told me I had very good insight into
My disorder.
I’ve always been interested in psychology,been a big reader,but I know myself very well
Thus,I get what works for ME & what DOESNT that’s the key.
There’s not always a pill for me there’s other forms of therapy a big one is any kind
Of distraction,computer work,doing a face mask while in the tub, trying on new makeup
Taking pics of the new looks & mailing them out,walks in nature,making a wish list
If I had a million dollars,poetry writing,quiet time w my cat,naps,tea / sweets!
Calling a help line if feeling overwhelmed before things reach crisis point,cooking
In the microwave!) not allowed use stove,mind is too one track,I’d set fire to something!
Making up new recipes from traditional ones,feelings when mum or dad are here
They are both deceased) but I’ve psychic abilities,I know many think it’s BS but it’s been
Proven they come usually only when I really need them.Im not religious,but I do
Practice some Buddhism & believe in their path it’s beautiful,can’t fast though!
Learning meditation finding it very very hard w bipolar brain!
I think too,to feel inner peace & calm you must just w bipolar learn to live one day at a time
I’m telling everyone,once I began to live my life this way I slept better was calmer
Without a raise in meds or anything.It truly is the way to find serenity & your life your outlook on life
Will go from negativity to much more positivity ( but no mania) these things I’ve listed work for me
Everyone can benefit living life slower one day @ a time,please trust me.

Very much looking forward to your next article. This problem has gotten me into more trouble than anything else in my life.

Very good post! It is helpful to see all of the reasons you listed. A couple I wouldn’t have come up with myself, at least not right away.

Before my diagnosis, I had almost no insight into my elevated states (hypomanias and mania), unless there was extreme anxiety and/or depression mixed in. Being fairly ignorant about mental illness at the time, even the mixed/anxious states and depressions to me were just like “brain flues” that came on like a virus and would go away, some I would clearly attribute to situational triggers. Never, until one year after my diagnosis (I didn’t accept it at first), did I think it was a chronic condition that would continue to reappear throughout my life. Like with severe flues, I would sometimes go to a doctor (mostly GP) for help, but only when I felt bad. I’d get an antidepressant, take it a few days to a couple weeks, and then feel better. The antidepressants were like antibiotics in a sense. There was never any follow up with the doctors. They only saw me in certain conditions, plus they were mostly unqualified about mental illness to ask certain questions. And even if they did, I wouldn’t see my mood elevations as illness. Anyway, I’d take an antidepressant for maybe three days to week and quit them. I only saw a GP again when I was depressed or anxious again.

Elevated moods were just “my way”. People knew me as that as sort of a baseline. Even when it was irritable, that was “me”. During irritable states, I felt justified being angry and offensive. Hypomanic/manic behavior did affect me negatively at times, but I had a tendency to brush that off or blame others.

Eventually a GP did refer me to a psychiatrist who gave group therapy. I hate group therapy, but it was what got me finally diagnosed bipolar. That psychiatrist gave me an antidepressant, but unlike GPs that never saw me for follow-ups, that psychiatrist did. He, himself, saw the transition to developing mania. When he took me aside and told me I had manic depression and should switch to a moodstabilizer, I blew him off and quit him there and then. I didn’t even know what manic depression or bipolar disorder was. I felt fine and didn’t think my behavior that day was “ill”.

Eventually my manias grew very severe and self-medicating was involved. The * hit the fan and I was hospitalized for the first time. Nine more followed. I guess I did acknowledge the diagnosis after my first hospitalization, but still lacked insight into the onset of mood elevations, until they turned mixed.

Fifteen years has passed. My insight into my manic states has improved (isn’t perfect, though), and that helps me get help sooner sometimes. My husband’s education on the matter helps, too.

I’m on a good medication mix. I’ve sort of learned what “stable” is and have started to have peace with it. I even like the stable me because some disadvantages of manic states have eased. The increase/improvement in my insight goes beyond these two things, though. Good therapy, hitting a bottom enough, maybe maturity, and other factors play a part.

Always, always dead on…you’re amazing Natasha! Fifty percent of those with bipolar disorder suffer with anosognosia. That’s an alarming number of people and families suffering…this is such a brutal illness in and of itself. But to experience it with no insight…pure torture.

Dr. Zavier Amador figured out an miraculous way to address this while helping his schizophrenic brother. I share this (termed the LEAP program) with individuals who suffer this way and it has been extremely effective and powerful….I’d be happy to share some examples with you anytime.

thank you Natasha for helping me and so many others…

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Lingering Myths About Bipolar Disorder

It’s hard to believe that some myths and stereotypes about bipolar disorder continue to circulate. We’re here to dispel them and set the record straight.

Bipolar disorder is a complex neurocognitive condition characterized by shifts in mood.

There are a handful of types of the disorder, and more features and specifiers that make each person’s diagnosis nuanced. The manifestations of the disorder can also change as a person ages.

Manic episodes can manifest as bouts of overflowing energy, increased confidence, and a sense of invincibility, among other symptoms. Depressive episodes can bring about feelings of hopelessness, lack of motivation, and suicidal thoughts.

Treatment for bipolar disorder can incorporate any combination of:

  • medication
  • talk and behavioral therapies
  • exercise and lifestyle changes
  • a strong emotional support network

The difference a solid routine makes for the condition is significant and evidence-based.

With support and the right care, it’s very possible to successfully manage bipolar disorder.

Sometimes, even people living with the disorder can get caught up with self-doubt and believe the exaggerations of their condition.

Myth: ‘My bipolar disorder is going to ruin any chance I have at a meaningful relationship’

FACT: While having bipolar disorder can present significant challenges to one’s romantic and intimate life, healthy, fulfilling relationships are absolutely possible.

Research does indicate that people with bipolar disorder marry and divorce at higher rates, are more likely to experience sexual dysfunction, and feel less satisfied in their relationships — but that’s not the end of the story.

When both partners have a continuing education approach to bipolar disorder depression, recognize what the early stages of bipolar disorder psychosis are, and learn how to predict or possibly prevent manic episodes, they can cultivate their relationship and adapt to whatever comes their way.

Myth: ‘I can drink alcohol or use cannabis as much as the next person who doesn’t have bipolar disorder — not that big of a deal’

FACT: Substance use is a serious and common co-occurrence among people with bipolar disorder. Research shows that alcohol, cannabis, and other recreational drugs can worsen mania and interfere with your meds.

Not convinced? Here are some stats:

  • A review of multiple studies found at least 40% of people with bipolar I disorder will experience a substance use disorder (SUD) during their lifetime. At least 20% of people with bipolar II disorder will.
  • An existing SUD can make managing bipolar disorder more difficult . with bipolar disorder develop an SUD more often than women with bipolar disorder.
  • A high rate of manic episodes and suicidal ideations is also linked to an increased risk of SUD.
  • Certain folks with bipolar disorder are uniquely at risk of an SUD, including veterans and transgender people.

You can manage bipolar disorder and also have a healthy and robust social life. Many people use substances to relax, or with the hope to calm an episode of mania, hypomania, or hypomanic symptoms. There are other ways to achieve the same goal, like with self-care and exercise.

Myth: ‘It’s not me, it’s bipolar disorder — I don’t have to apologize’

FACT: You never have to apologize for having bipolar disorder. But you can and should take varying degrees of responsibility for harmful actions that may stem from bipolar disorder episodes, treatment changes, or decisions to suddenly stop medication unsupervised.

If you’re comfortable sharing your diagnosis, letting people know you are managing a mental health condition can help them understand and contextualize what they might observe.

As Dr. Descartes Li, director of the bipolar disorder program at the University of California, San Francisco, and professor of psychiatry explains, sharing your diagnosis with select people may provide crucial support in times of crisis.

“Having family members or friends who are aware of your situation, who can jump in and help out when needed, can be literally a lifesaver,” he says.

For those in your life who may already know, and who were hurt or otherwise negatively affected by your actions, making amends in real time can help preserve those core relationships.

“Sorry goes a long way,” Li says, “but you don’t have to acknowledge a 100% responsibility” or apologize for having a mental health condition.

He adds that sometimes sudden changes in behavior can stem from recent treatment adjustments under your prescribing clinician.

But other times, people may still need to take a degree of responsibility for actions that may take place after stopping meds without professional supervision.

Myth: ‘My meds are going to make me less creative’

FACT: Medication may affect your life in unforeseen ways, but relying on bipolar disorder episodes for productivity works against overall well-being.

Evidence suggests people with bipolar disorder are highly creative, and in fact over-represented in artistic occupations at large. Worries about medications’ impact on creativity is a major contributing factor to some people with bipolar disorder when considering treatment via medication.

It’s also a prevailing inaccuracy. Some experts have said their clients find creative space to explore when on their prescribed medication since it provides clarity.

Taking medication is still considered the cornerstone of treating bipolar disorder in most cases.

Myth: ‘I can go off my meds when I feel better’

FACT: Stopping a medication “cold turkey” can be incredibly dangerous. Changes or adjustments to medication should only be made in full concert with your healthcare team.

Not taking medication as directed by your doctor is called “nonadherence.” It’s very common at some point or another while managing bipolar disorder long term.

Li observes that nonadherence can occur when people are far out from acute episodes, feel stable, and sometimes wonder why they’re still on medication: “I don’t even feel like I have an illness anymore,” you may say to yourself.

When that happens, Li urges, “What I want you to do is come and talk to me, and let’s have a discussion about it.” Clinicians are used to, and expect, patient needs and goals to change.

Ultimately, it’s important to always be transparent and honest with your doctor about how you’re feeling, and what you want out of your treatment.


7. Bipolar disorder is something you have to learn to manage for the rest of your life.

“Bipolar is a lifelong diagnosis that starts usually in the late teens or early 20s,” Dr. Marsh says. “And, ideally, very soon after those first mood-elevated episodes, that person is getting word from the appropriate experts and clinicians that they are at risk for the rest of their lives of having another [episode].”

So, a person with bipolar will very likely be on medication and working with a therapist all throughout their life. “The symptoms don't magically disappear because I go to therapy and I have medication and I've taken the time and effort to develop coping mechanisms,” Emma says. “Having a mental health disorder is like having a cold, but the cold is in your head. Sometimes I need to sleep a little more. Sometimes my appetite isn't there. And I need my medication to help the process along.”


Could Sleep Disorders Actually Lead to Bipolar Disorder?

Some scientists speculate that one reason the incidence of bipolar disorder has risen in modern times is the development of bright artificial light.   Once upon a time, most people's sleep/wake cycles were regulated by the sun. The artificial light changed all that and made it more likely that people who have a genetic predisposition toward bipolar disorder would actually develop the condition.

While a causal relationship hasn't been proven, sleep disturbances in people with bipolar disorder have also been linked with changes in the microstructure of the white matter of the brain.


3 Stories of Rapid Cycling

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Rapid cycling is defined as four or more manic, hypomanic, or depressive episodes in any 12-month period. Rapid cycling occurs in 10-20% of all people with bipolar disorder, and is more common in women (read this article for more facts about rapid cycling).

Bipolar disorder varies greatly from person to person. Similarly, rapid cycling can also mean different things for different people. To meet the clinical definition, there must be 4 episodes in a year. But some individuals can experience multiple mood shifts in the same day (for a visual depiction of this, check out the graphs in this article). Rapid cycling can also vary in how consistent it is: some people see the same patterns year after year, and for others it seems to be random. In this article we will hear from 3 different perspectives:

  • Melanie, who often experiences several cycles in the same day
  • Lauren, who’s rapid cycling changes throughout the year
  • Lyndsay, who consistently has around 4 mood shifts per year
What does rapid cycling feel like?

Melanie: For me, rapid cycling is when I experience multiple “highs” and “lows” in a day. I am an extreme rapid cycler and I have several mood shifts throughout the course of a day. It’s really hard to handle, and it’s exhausting, as someone who works full time in an office setting. It doesn’t change minute to minute, but it sure feels that way! It really affects my energy levels and how I interact or want to interact with other people.

Rapid cycling feels like your mind is playing tricks on you. You are sad one minute, hyper the next, giddy, and then back to sad, teary, and wanting to hide. It’s very confusing and it’s scary how fast your mood can change and change and change. You feel like your moods are changing so quickly and you don’t know when you will feel “right” again. It is one of the most frustrating parts of having bipolar disorder.

I have to say that I have had to become a very good actress and very good at suppressing my moods at work, and as a result, at the end of the work day, or on the weekend, the moods can be more severe. I become frustrated with how emotionally labile I am, and I feel terrible that I have anger outbursts, am agitated and rude when I am in a hypomanic state, or that I am “useless” and amotivated when in a depressed state, i.e. unable to cook, clean, empty the dishwasher, put things away etc.”

What is also confusing and frustrating about rapid cycling is that you can be anxious regardless of what state you are in. Or at least, that’s what happens to me.

Lauren: Rapid cycling feels like a large roller coaster- but one that is never ending, with highs and lows of unknown duration and height/depth, going around over and over again. The depression of knowing you’ll fall, and the happiness when you’re climbing up, the anxiety when you realize you’re going to start falling again any moment.

Lyndsay: It feels painful (mentally and physically), stressful, scary, and dramatic. Most people think mania is great, but it’s not. During my manic episode, I spend a lot, I can’t feel any emotions, I shut people out, I’m impulsive, and I’m mean. Then I cycle into a depression, and it’s a quick transition. It’s usually a mixed episode for a couple weeks (both manic and depressed), and turns into full-blown depression. That’s when I deal with the repercussions of the mania. I’ll have spent all my money and find myself in severe debt. My relationship will need mending. My physical health will deteriorate. Imagine experiencing the mania to depression (back to mania) four or more times a year. It’s exhausting. And it hurts. It hurts my brain and it hurts my body. I think the worst part is knowing that it’s going to happen. No matter how hard I try to treat it in advance, it always happens and I never know the severity in advance.

How often do you “rapid cycle”? Do you have mania or depression more often? Has it changed over time?

Melanie: It depends on the day. I notice that on a typical work day, I start off in a hypomanic state, I am okay for a few hours, then I feel a wave of sadness after lunch, then I have trouble focusing for the rest of the day. By the time I leave work, I can be a little hyper, and my mood will change again. Sometimes I get so hyper by the end of the day that I have trouble sleeping.

I first noticed the rapid cycling a couple of months after my diagnosis. Initially, my “main” state was hypomania. After a couple of years, it changed to depression. I am not sure if this had to do with life circumstances and events or if it’s “normal” for this to change over time. I do notice that when I am under stress, my predominant state switches to “hypomania”, because in that state, you feel “invincible”.

My rapid cycling involves multiple cycles throughout a day. The day will end with whatever the predominant mood is. Under stress, I am very hyper and have difficulties sleeping, experience insomnia and of course, this is a dangerous cycle in and of itself!

I think my rapid cycling will change again and again, depending on what is going on with my life.

Lauren: My rapid cycling varies- in the summer I get longer but more frequent lows, and in the winter I get higher and more frequent highs. My cycles could change on a weekly or monthly basis. Sometimes I feel ahead of the game and my meds are on track, other times it’s a guessing game and I can’t keep up. I’ve had several major depressive episodes, which add even more frustrations to the mix. Because of this, I usually have to adjust my medications several times a year. The doctors I’ve seen said this might just be my new “normal”.

I was diagnosed with Bipolar type 1 over 13 years ago, when I was 18, but it wasn’t until a few years later they determined it was rapid cycling. It’s been suggested that I had child onset bipolar, but since they didn’t think that was possible at the time they just called it ADHD. So honestly, I don’t remember a time in my life when I was “normal”. I remember getting in trouble a lot growing up, and not being able to control my emotions, but also not really knowing what my emotions even were in the first place. I look back on it now and honestly remember it as living in a haze until I was diagnosed properly and started on the correct medications.

Lyndsay: My rapid cycling is generally four times a year with little episodes in between. I would explain my episodes throughout the year like this: Every spring (March/April), I cycle into a manic state. My doctors and I assume it’s because of the time change, plus spring is “happier” than winter. I experience this mania for about four months, until a depression cycle comes along in August. I’m curious if this could be related to the start of school, as life changes from fun and playful to busy and structured. I become stable in October and stay that way until January when I find myself in a depression. Mania hits again in March/April. It’s like clockwork.

As I’ve gotten older, I find myself having more manic episodes than depression. I live in Southern California, so the abundant sunshine helps A LOT with managing depression (plus my sun lamp). When I lived in Ohio, the winters would generally be a time of severe depression.

It seems that all people with bipolar would experience this, but they don’t. My brother, for example, has bipolar disorder and generally cycles once or twice a year (between hypomania and depression). The important thing to remember is that there are multiple types of bipolar disorder. My brother is generally depressed most the time but he’ll have a few hypomanic episodes here and there (they do not last long). Plus, he’s never experienced full-blown mania.

Do you have any tips on how to cope with rapid cycling?

Melanie: I try my best to avoid triggers like negative people, too much sugar, anxiety-provoking situations and too much stress. And don’t watch the news before bed!

It is hard to avoid stress, especially family emergencies and there is always “the unexpected”. You have to figure out what calms you down. I highly recommend meditation or hypnosis (hypnotherapy- it’s not what you think it is- not how it is portrayed on TV!). I have learned many techniques to calm down, even if it is short-lived from hypnosis. One technique that I tell people to try is counting backwards from 25, and picturing yourself writing each number down on a blackboard, one at a time, and erasing each number before writing the next. Visualization exercises help. And don’t forget to breath. Another good one is counting backwards from 25 and picture yourself walking down a staircase, one step at a time. And each time you write down a number or walk down a step, take a deep breath!

Breathing is important. It is very scary when your heart is racing and you feel nauseous from anxiety, because you feel like you can’t breathe. I think if you can stay calm, maybe your moods won’t change as often, or you can make it slightly more bearable for yourself. I also recommend finding a hobby, or a distraction. Distracting your mind is very important. Recently, I bought adult “colouring books” and have been enjoying colouring in them and find it relaxing. Journaling or blogging is another great outlet- writing your feelings feels like I am getting the thoughts out of my system.

Lauren: Some people keep a log, but that can be difficult if you have a lot of cycling, so I get help from family and friends. My spouse has bipolar as well, and is able to clue me in on different changes so we can tackle them head-on. I also try not to get upset with myself if I get into a depression funk. I have little notes around my bed so when I wake up I can see them and remind myself that it’s not permanent. Sometimes the switch in cycles is so quick, I wake up feeling a complete 180 from the day before. I’m not going to lie, some days it’s really hard to be a functioning human, but somehow I always come out ok.

Lyndsay: Visit your doctors every single month, no matter what. I used to think I only needed to see my therapist and psychiatrist when I was depressed or needed medication. Boy, was I wrong. Seeing my therapist regularly meant she could see my cycling before I could. This happened multiple times. It’s important to have someone who is unbiased (and truly, just someone else) to tell you when things are changing. We don’t always recognize it until it’s too late. By seeing your doctors regularly, together, you can catch an episode before it happens. This usually results in tweaking medication or seeing your therapist more often. That may sound awful to some, but it will help you get through the episode/cycle with minimal effects (to yourself and your loved ones).

Also, keep a mood journal. I never realized how “scheduled” my episodes were until I started keeping a journal. It was only then that I knew when I would become manic or depressed, which helped me to plan/prepare in advance. It’s made such a difference.

As for coping, don’t shut people out. I used to do that, and it only made things worse. I had to learn how to let people in, and it took me a while (by a while, I mean years). It’s much easier to handle the episodes with someone stable around you. For example, during a manic episode, my boyfriend will monitor my spending and take away my credit cards (not forcefully we made this agreement before the episode). When I am depressed, he will be calm and understanding, and know to get me ice cream when I need it. It helps tremendously to have someone who understands the best they can, and that only comes from allowing them to come into your life completely.

What do you wish other people knew about rapid cycling?

Melanie: I wish people knew how exhausting it is. It really is like being at war with yourself. You are fighting with your mind. You want to find a neutral state, but it’s very difficult when your moods keep shifting, shifting, shifting. It’s very hard to find “a happy medium” and to find calm when your mind is always in flux.

Rapid cycling is frustrating, and can seem scary and confusing to the person who experiences it and the people around him/her. The best way to help someone who experiences rapid cycling is to just be there! Be there by offering a hug, being patient, learning about it and lending an ear. Anyone who wants to support me, has to be willing to 1. Educate themselves and 2. Listen.

Lauren: I wish there was a way to read it better, not just for other people but for myself as well. Sometimes people don’t get it, they will remember I was depressed/upset, and then if I am suddenly happy, but then get down again, they just give up and get frustrated that they can’t read me or track how I am. It’s not like there is a countdown timer going for each cycle. If it’s frustrating for them, how do they think I feel?

Lyndsay: I wish other people knew that rapid cycling is a part of bipolar disorder, and I don’t need pity. That might sound harsh, and I don’t mean it to be. I don’t want people walking on eggshells around me, no matter the episode I’m in. I’m not “crazy” and I will be okay it’s simply a part of my life. If I had an employer, I would hope they would somewhat understand that I will cycle frequently, and I’ll either need time off or need accommodations. Though I suppose that’s the reason I am self-employed. I’ve gotten used to the idea that “other people” won’t understand bipolar disorder or what I go through but I don’t expect them to. I used to get really upset at people’s ignorance, but you’ve got to understand that they don’t experience what we do, so how would they know? And that it’s okay for them not to know. As long as they try to understand, that’s enough for me.


7 Ways to Stay Steady With Bipolar Disorder in 2021

If you are one of the 5.7 million people living with bipolar disorder, or a friend or family member of someone who has the condition, then you know it can play out like the wildest of rides—teetering at the summit of high moods and then plummeting to the lowest of lows, with multiple twists and turns along the way (none of which you asked for). The more you can do to minimize these swings, the better off you’ll be.

It’s tricky, though, because moods can swing unexpectedly with bipolar. “The onset of a new mood episode can happen overnight,” says Aimee Daramus, Psy.D., a psychotherapist in Chicago and adjunct professor of psychology at City Colleges of Chicago. Typically, mood episodes can last weeks or months and occasionally longer. By spotting and minimizing triggers in advance, you can keep on top of this condition. Here, 7 ways to help you cruise into the new year in control.

The hallmarks of bipolar disorder are periods of mania and bouts of depression. Recognizing these moods can help you them control more quickly. “With mania or hypomania, you may feel more confident or impulsive, or even angrier than usual,” Daramus says. Signs of a depressive episode include sadness, emotional numbness, and lack of motivation. “Over time, people with bipolar will be able to be more specific about their signs,” she says. “For example, someone might know that he’s shifting to a depressive episode if his taste in music or food changes.”

One of the most predictable indications of bipolar swings is a disruption in normal sleep patterns. For example, if you have trouble sleeping at night but you still feel fine during the day—or even feel a surge in energy—you could be shifting into a manic episode, Daramus says. In fact, research shows that 69% to 99% of bipolar individuals report less need for sleep during a manic episode or have difficulties falling and/or staying asleep.

On the flip side, if you suddenly need more sleep than usual or you’re feeling super tired during the day, even though you got plenty of sleep the night before, you may be moving to a depressive state. During depression cycles, studies show 38% to 78% of bipolar patients suffer from hypersomnia (excessive sleepiness). On the other hand, in some cases people with bipolar say their depression cycle causes severe insomnia instead. Bottom line: Changes in sleep schedules correlate with changes in mood.

Tracking mood changes and medication use via a journal or app can help you stay steady and notice any signs of swings. Give each symptom you want to track a rating from 1 to 10, with 1 being severely depressed, 5 being stable, and 10 being severely manic or hypomanic. “If you haven’t had a mood episode in months and you feel pretty stable, it might be enough to track once a week,” says Daramus. “If you’re still working on getting your moods stable, track symptoms once a day.”

Your nearest and dearest often notice changes in mood before you do, says psychiatrist Lindsay Israel, M.D., chief medical officer of Success TMS in Palm Beach Gardens, FL. Maybe your mania has you talking so much friends can’t get a word in, calling loved ones in the middle of the night, or buying a swag new handbag every week. Or friends may see you crying out of the blue and avoiding invites to get together. If your closest crew spots these trends, let your prescriber know—a simple tweak in meds could help.

Something as simple as a time change, like traveling to another time zone or even turning the clock back for daylight savings, can set a bipolar patient off kilter, triggering a manic episode, Dr. Israel says. Time changes affect the body’s circadian rhythm, the internal alarm clock that regulates our sleep-wake cycle. “Staying up later or trying to sleep when your brain wants to do the opposite throws off your rhythm and you can end up inducing a decreased need for sleep, which is a symptom of a manic state,” Dr. Israel says.

Drinking alcohol has been shown to increase the severity of bipolar symptoms both on the depressive and manic spectrums. Because alcohol is a known depressant and has sedating effects, it can trigger a depressive episode in those with bipolar, Dr. Israel says. And on the other side of things, studies have shown individuals with bipolar who drink alcohol can be more violent, more impulsive, and more likely to engage in other types of substance abuse—and they exhibit more manic symptoms than those with bipolar who don’t drink alcohol.

“Sticking to a routine that includes daily activities and steady sleep patterns can help to regulate your mood,” Dr. Israel says. “We know exercise and sleep are very good together. If you’re getting better sleep, you’ve got more energy to exercise. And when you’re exercising, you typically have better sleep. And if you’re exercising and sleeping, then typically that lends itself to having a better diet.” Exercise also releases neurotransmitters like dopamine in the brain, which helps maintain an elevated mood.

Effects of Sleep on Bipolar: Nature and Science of Sleep. (2016). “The Role of Sleep in Bipolar Disorder.” ncbi.nlm.nih.gov/pmc/articles/PMC4935164/

Alcohol and Bipolar: Bipolar Disorders. (2002). “Impact of Concurrent Alcohol Misuse on Symptom Presentation of Acute Mania at Initial Evaluation.” pubmed.ncbi.nlm.nih.gov/12519103/

Impact of Exercise on Bipolar: Journal of Psychiatric Research. (2016). “Lifestyle Interventions Targeting Dietary Habits and Exercise in Bipolar Disorder: A Systematic Review.” ncbi.nlm.nih.gov/pmc/articles/PMC4744495/

Jennifer Tzeses is a writer and content strategist specializing in health, beauty, psychology and lifestyle. She's written for The Wall Street Journal, Mind Body Green, CNN, Architectural Digest, Barron's, Cosmopolitan, Harper's Bazaar, Psycom, Elle, Marie Claire, and more. Follow her on Instagram @jtzeses.


8 Comments

Hi Natasha. Love your work, so does my husband. It’s helped him a lot. I’m currently in hopsital due to, originally mixed state, now mania. I guess it’s low level but not hypomania. S* loads of drugs to keep me calm. The problem I face is that I know how bad things can get and how fast, so doctors and nurses don’t see me as ‘too unwell’. My vice when manic is online shopping. I never shop online. I hate it. So I gave majority of my money and bank access to my husband as soon as I saw what was coming. Doctors and nurses-‘oh you seem so much better. No this is Just a different phase from angry mixed. My insight works against me. I’ve worked hard to learn my illness. My kids have disabilities. I need to be in control of my life as much as I can but insight often prevents me from getting adequate treatment until I’m in emergency. I’m learning and using my skills and tools. The doctors and nurses need to listen and learn.

Are panic attacks part of or in and of itself a mental disorder?

Hey, Natasha! I love seeing your name everywhere! I just hi and see how you’re doing. I’m okay. We’ve been re-building for a year because we got hit pretty bad by Harvey, but it’s all good. I volunteer at an unbelievable place, and I have an agent in NYC pitching my book (I’m a writer.) That’s really exciting for me. Well I know you’re swamped. Love this article. Great writing. See ya’!

Insight into my disease was NOT an overnight experience
For many yrs I was in denial I was as sick as I was,not taking it seriously .
Having episodes where I’d be on/ off my meds playing chemist…….
Enjoying the highs,b/c I’d drop 7-8 pounds in a week!
Getting so much accomplished” & one time recalling so delusional thought I was Janis Joplin ( in Emerg by then
Psychotic) given pills every 2- h) I couldn’t shut up I must’ve been a real pain in the ass to staff.
But as we all know,have no control in that state of mind……….it’s stuff I try to push to the back of my brain in order to forget.
But,if I forget totally I might one day get into that head space as we’re all familiar w ” screw meds” & such
I’ve been stable many months,but I must be truthful I don’t enjoy swallowing a huge pill cocktail not only for
Bipolar but epilepsy chronic back pain,bunch vitamins I’m deficient in,migraine headaches……..ulcer…..
Some are huge to swallow causing GI issues,that last 1/2 the nite,yes I want to be well.
But there’s a price to be paid for wellness.
Insight also means you know your life should be routine- oriented.
Boring,but true.
If you take your meds on time as your psych directs you’ll get better results.
If you eat more healthfully & try your best to stay away from fast food ( but have once week cheat day) you’ll less
Likely be overweight,it’s not only the pills,it’s also your eating habits ….if it was just pills I’d weight over 300 lbs.
Try & move around a bit here & there even if it’s only a 10 min stroll,better than nothing.
Insight means you understand your illness for what it is & how serious it is
This isn’t a joke
We’re talking hardcore serious mental health disease that kills,you have to learn to live & manage it.
Like an adult,not a two yr old child.
It’s got maturity to it I think that comes more so w age,as I grew older it became easier to deal.
Yes the beast still rears her ugly head ( I’m rapid cycler) difference is I’ve my sword at my side for protection!
I feel for others that are not where I am now in my life,only hope that one day soon,they too will see bipolar disorder for what it truly is.A serious mental disorder that destroys/takes lives.
Thanks.

Hi Natasha,
Relatable! My last hospitalization the nurses all told me I had very good insight into
My disorder.
I’ve always been interested in psychology,been a big reader,but I know myself very well
Thus,I get what works for ME & what DOESNT that’s the key.
There’s not always a pill for me there’s other forms of therapy a big one is any kind
Of distraction,computer work,doing a face mask while in the tub, trying on new makeup
Taking pics of the new looks & mailing them out,walks in nature,making a wish list
If I had a million dollars,poetry writing,quiet time w my cat,naps,tea / sweets!
Calling a help line if feeling overwhelmed before things reach crisis point,cooking
In the microwave!) not allowed use stove,mind is too one track,I’d set fire to something!
Making up new recipes from traditional ones,feelings when mum or dad are here
They are both deceased) but I’ve psychic abilities,I know many think it’s BS but it’s been
Proven they come usually only when I really need them.Im not religious,but I do
Practice some Buddhism & believe in their path it’s beautiful,can’t fast though!
Learning meditation finding it very very hard w bipolar brain!
I think too,to feel inner peace & calm you must just w bipolar learn to live one day at a time
I’m telling everyone,once I began to live my life this way I slept better was calmer
Without a raise in meds or anything.It truly is the way to find serenity & your life your outlook on life
Will go from negativity to much more positivity ( but no mania) these things I’ve listed work for me
Everyone can benefit living life slower one day @ a time,please trust me.

Very much looking forward to your next article. This problem has gotten me into more trouble than anything else in my life.

Very good post! It is helpful to see all of the reasons you listed. A couple I wouldn’t have come up with myself, at least not right away.

Before my diagnosis, I had almost no insight into my elevated states (hypomanias and mania), unless there was extreme anxiety and/or depression mixed in. Being fairly ignorant about mental illness at the time, even the mixed/anxious states and depressions to me were just like “brain flues” that came on like a virus and would go away, some I would clearly attribute to situational triggers. Never, until one year after my diagnosis (I didn’t accept it at first), did I think it was a chronic condition that would continue to reappear throughout my life. Like with severe flues, I would sometimes go to a doctor (mostly GP) for help, but only when I felt bad. I’d get an antidepressant, take it a few days to a couple weeks, and then feel better. The antidepressants were like antibiotics in a sense. There was never any follow up with the doctors. They only saw me in certain conditions, plus they were mostly unqualified about mental illness to ask certain questions. And even if they did, I wouldn’t see my mood elevations as illness. Anyway, I’d take an antidepressant for maybe three days to week and quit them. I only saw a GP again when I was depressed or anxious again.

Elevated moods were just “my way”. People knew me as that as sort of a baseline. Even when it was irritable, that was “me”. During irritable states, I felt justified being angry and offensive. Hypomanic/manic behavior did affect me negatively at times, but I had a tendency to brush that off or blame others.

Eventually a GP did refer me to a psychiatrist who gave group therapy. I hate group therapy, but it was what got me finally diagnosed bipolar. That psychiatrist gave me an antidepressant, but unlike GPs that never saw me for follow-ups, that psychiatrist did. He, himself, saw the transition to developing mania. When he took me aside and told me I had manic depression and should switch to a moodstabilizer, I blew him off and quit him there and then. I didn’t even know what manic depression or bipolar disorder was. I felt fine and didn’t think my behavior that day was “ill”.

Eventually my manias grew very severe and self-medicating was involved. The * hit the fan and I was hospitalized for the first time. Nine more followed. I guess I did acknowledge the diagnosis after my first hospitalization, but still lacked insight into the onset of mood elevations, until they turned mixed.

Fifteen years has passed. My insight into my manic states has improved (isn’t perfect, though), and that helps me get help sooner sometimes. My husband’s education on the matter helps, too.

I’m on a good medication mix. I’ve sort of learned what “stable” is and have started to have peace with it. I even like the stable me because some disadvantages of manic states have eased. The increase/improvement in my insight goes beyond these two things, though. Good therapy, hitting a bottom enough, maybe maturity, and other factors play a part.

Always, always dead on…you’re amazing Natasha! Fifty percent of those with bipolar disorder suffer with anosognosia. That’s an alarming number of people and families suffering…this is such a brutal illness in and of itself. But to experience it with no insight…pure torture.

Dr. Zavier Amador figured out an miraculous way to address this while helping his schizophrenic brother. I share this (termed the LEAP program) with individuals who suffer this way and it has been extremely effective and powerful….I’d be happy to share some examples with you anytime.

thank you Natasha for helping me and so many others…

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7. Bipolar disorder is something you have to learn to manage for the rest of your life.

“Bipolar is a lifelong diagnosis that starts usually in the late teens or early 20s,” Dr. Marsh says. “And, ideally, very soon after those first mood-elevated episodes, that person is getting word from the appropriate experts and clinicians that they are at risk for the rest of their lives of having another [episode].”

So, a person with bipolar will very likely be on medication and working with a therapist all throughout their life. “The symptoms don't magically disappear because I go to therapy and I have medication and I've taken the time and effort to develop coping mechanisms,” Emma says. “Having a mental health disorder is like having a cold, but the cold is in your head. Sometimes I need to sleep a little more. Sometimes my appetite isn't there. And I need my medication to help the process along.”


7 Ways to Stay Steady With Bipolar Disorder in 2021

If you are one of the 5.7 million people living with bipolar disorder, or a friend or family member of someone who has the condition, then you know it can play out like the wildest of rides—teetering at the summit of high moods and then plummeting to the lowest of lows, with multiple twists and turns along the way (none of which you asked for). The more you can do to minimize these swings, the better off you’ll be.

It’s tricky, though, because moods can swing unexpectedly with bipolar. “The onset of a new mood episode can happen overnight,” says Aimee Daramus, Psy.D., a psychotherapist in Chicago and adjunct professor of psychology at City Colleges of Chicago. Typically, mood episodes can last weeks or months and occasionally longer. By spotting and minimizing triggers in advance, you can keep on top of this condition. Here, 7 ways to help you cruise into the new year in control.

The hallmarks of bipolar disorder are periods of mania and bouts of depression. Recognizing these moods can help you them control more quickly. “With mania or hypomania, you may feel more confident or impulsive, or even angrier than usual,” Daramus says. Signs of a depressive episode include sadness, emotional numbness, and lack of motivation. “Over time, people with bipolar will be able to be more specific about their signs,” she says. “For example, someone might know that he’s shifting to a depressive episode if his taste in music or food changes.”

One of the most predictable indications of bipolar swings is a disruption in normal sleep patterns. For example, if you have trouble sleeping at night but you still feel fine during the day—or even feel a surge in energy—you could be shifting into a manic episode, Daramus says. In fact, research shows that 69% to 99% of bipolar individuals report less need for sleep during a manic episode or have difficulties falling and/or staying asleep.

On the flip side, if you suddenly need more sleep than usual or you’re feeling super tired during the day, even though you got plenty of sleep the night before, you may be moving to a depressive state. During depression cycles, studies show 38% to 78% of bipolar patients suffer from hypersomnia (excessive sleepiness). On the other hand, in some cases people with bipolar say their depression cycle causes severe insomnia instead. Bottom line: Changes in sleep schedules correlate with changes in mood.

Tracking mood changes and medication use via a journal or app can help you stay steady and notice any signs of swings. Give each symptom you want to track a rating from 1 to 10, with 1 being severely depressed, 5 being stable, and 10 being severely manic or hypomanic. “If you haven’t had a mood episode in months and you feel pretty stable, it might be enough to track once a week,” says Daramus. “If you’re still working on getting your moods stable, track symptoms once a day.”

Your nearest and dearest often notice changes in mood before you do, says psychiatrist Lindsay Israel, M.D., chief medical officer of Success TMS in Palm Beach Gardens, FL. Maybe your mania has you talking so much friends can’t get a word in, calling loved ones in the middle of the night, or buying a swag new handbag every week. Or friends may see you crying out of the blue and avoiding invites to get together. If your closest crew spots these trends, let your prescriber know—a simple tweak in meds could help.

Something as simple as a time change, like traveling to another time zone or even turning the clock back for daylight savings, can set a bipolar patient off kilter, triggering a manic episode, Dr. Israel says. Time changes affect the body’s circadian rhythm, the internal alarm clock that regulates our sleep-wake cycle. “Staying up later or trying to sleep when your brain wants to do the opposite throws off your rhythm and you can end up inducing a decreased need for sleep, which is a symptom of a manic state,” Dr. Israel says.

Drinking alcohol has been shown to increase the severity of bipolar symptoms both on the depressive and manic spectrums. Because alcohol is a known depressant and has sedating effects, it can trigger a depressive episode in those with bipolar, Dr. Israel says. And on the other side of things, studies have shown individuals with bipolar who drink alcohol can be more violent, more impulsive, and more likely to engage in other types of substance abuse—and they exhibit more manic symptoms than those with bipolar who don’t drink alcohol.

“Sticking to a routine that includes daily activities and steady sleep patterns can help to regulate your mood,” Dr. Israel says. “We know exercise and sleep are very good together. If you’re getting better sleep, you’ve got more energy to exercise. And when you’re exercising, you typically have better sleep. And if you’re exercising and sleeping, then typically that lends itself to having a better diet.” Exercise also releases neurotransmitters like dopamine in the brain, which helps maintain an elevated mood.

Effects of Sleep on Bipolar: Nature and Science of Sleep. (2016). “The Role of Sleep in Bipolar Disorder.” ncbi.nlm.nih.gov/pmc/articles/PMC4935164/

Alcohol and Bipolar: Bipolar Disorders. (2002). “Impact of Concurrent Alcohol Misuse on Symptom Presentation of Acute Mania at Initial Evaluation.” pubmed.ncbi.nlm.nih.gov/12519103/

Impact of Exercise on Bipolar: Journal of Psychiatric Research. (2016). “Lifestyle Interventions Targeting Dietary Habits and Exercise in Bipolar Disorder: A Systematic Review.” ncbi.nlm.nih.gov/pmc/articles/PMC4744495/

Jennifer Tzeses is a writer and content strategist specializing in health, beauty, psychology and lifestyle. She's written for The Wall Street Journal, Mind Body Green, CNN, Architectural Digest, Barron's, Cosmopolitan, Harper's Bazaar, Psycom, Elle, Marie Claire, and more. Follow her on Instagram @jtzeses.


Could Sleep Disorders Actually Lead to Bipolar Disorder?

Some scientists speculate that one reason the incidence of bipolar disorder has risen in modern times is the development of bright artificial light.   Once upon a time, most people's sleep/wake cycles were regulated by the sun. The artificial light changed all that and made it more likely that people who have a genetic predisposition toward bipolar disorder would actually develop the condition.

While a causal relationship hasn't been proven, sleep disturbances in people with bipolar disorder have also been linked with changes in the microstructure of the white matter of the brain.


Lingering Myths About Bipolar Disorder

It’s hard to believe that some myths and stereotypes about bipolar disorder continue to circulate. We’re here to dispel them and set the record straight.

Bipolar disorder is a complex neurocognitive condition characterized by shifts in mood.

There are a handful of types of the disorder, and more features and specifiers that make each person’s diagnosis nuanced. The manifestations of the disorder can also change as a person ages.

Manic episodes can manifest as bouts of overflowing energy, increased confidence, and a sense of invincibility, among other symptoms. Depressive episodes can bring about feelings of hopelessness, lack of motivation, and suicidal thoughts.

Treatment for bipolar disorder can incorporate any combination of:

  • medication
  • talk and behavioral therapies
  • exercise and lifestyle changes
  • a strong emotional support network

The difference a solid routine makes for the condition is significant and evidence-based.

With support and the right care, it’s very possible to successfully manage bipolar disorder.

Sometimes, even people living with the disorder can get caught up with self-doubt and believe the exaggerations of their condition.

Myth: ‘My bipolar disorder is going to ruin any chance I have at a meaningful relationship’

FACT: While having bipolar disorder can present significant challenges to one’s romantic and intimate life, healthy, fulfilling relationships are absolutely possible.

Research does indicate that people with bipolar disorder marry and divorce at higher rates, are more likely to experience sexual dysfunction, and feel less satisfied in their relationships — but that’s not the end of the story.

When both partners have a continuing education approach to bipolar disorder depression, recognize what the early stages of bipolar disorder psychosis are, and learn how to predict or possibly prevent manic episodes, they can cultivate their relationship and adapt to whatever comes their way.

Myth: ‘I can drink alcohol or use cannabis as much as the next person who doesn’t have bipolar disorder — not that big of a deal’

FACT: Substance use is a serious and common co-occurrence among people with bipolar disorder. Research shows that alcohol, cannabis, and other recreational drugs can worsen mania and interfere with your meds.

Not convinced? Here are some stats:

  • A review of multiple studies found at least 40% of people with bipolar I disorder will experience a substance use disorder (SUD) during their lifetime. At least 20% of people with bipolar II disorder will.
  • An existing SUD can make managing bipolar disorder more difficult . with bipolar disorder develop an SUD more often than women with bipolar disorder.
  • A high rate of manic episodes and suicidal ideations is also linked to an increased risk of SUD.
  • Certain folks with bipolar disorder are uniquely at risk of an SUD, including veterans and transgender people.

You can manage bipolar disorder and also have a healthy and robust social life. Many people use substances to relax, or with the hope to calm an episode of mania, hypomania, or hypomanic symptoms. There are other ways to achieve the same goal, like with self-care and exercise.

Myth: ‘It’s not me, it’s bipolar disorder — I don’t have to apologize’

FACT: You never have to apologize for having bipolar disorder. But you can and should take varying degrees of responsibility for harmful actions that may stem from bipolar disorder episodes, treatment changes, or decisions to suddenly stop medication unsupervised.

If you’re comfortable sharing your diagnosis, letting people know you are managing a mental health condition can help them understand and contextualize what they might observe.

As Dr. Descartes Li, director of the bipolar disorder program at the University of California, San Francisco, and professor of psychiatry explains, sharing your diagnosis with select people may provide crucial support in times of crisis.

“Having family members or friends who are aware of your situation, who can jump in and help out when needed, can be literally a lifesaver,” he says.

For those in your life who may already know, and who were hurt or otherwise negatively affected by your actions, making amends in real time can help preserve those core relationships.

“Sorry goes a long way,” Li says, “but you don’t have to acknowledge a 100% responsibility” or apologize for having a mental health condition.

He adds that sometimes sudden changes in behavior can stem from recent treatment adjustments under your prescribing clinician.

But other times, people may still need to take a degree of responsibility for actions that may take place after stopping meds without professional supervision.

Myth: ‘My meds are going to make me less creative’

FACT: Medication may affect your life in unforeseen ways, but relying on bipolar disorder episodes for productivity works against overall well-being.

Evidence suggests people with bipolar disorder are highly creative, and in fact over-represented in artistic occupations at large. Worries about medications’ impact on creativity is a major contributing factor to some people with bipolar disorder when considering treatment via medication.

It’s also a prevailing inaccuracy. Some experts have said their clients find creative space to explore when on their prescribed medication since it provides clarity.

Taking medication is still considered the cornerstone of treating bipolar disorder in most cases.

Myth: ‘I can go off my meds when I feel better’

FACT: Stopping a medication “cold turkey” can be incredibly dangerous. Changes or adjustments to medication should only be made in full concert with your healthcare team.

Not taking medication as directed by your doctor is called “nonadherence.” It’s very common at some point or another while managing bipolar disorder long term.

Li observes that nonadherence can occur when people are far out from acute episodes, feel stable, and sometimes wonder why they’re still on medication: “I don’t even feel like I have an illness anymore,” you may say to yourself.

When that happens, Li urges, “What I want you to do is come and talk to me, and let’s have a discussion about it.” Clinicians are used to, and expect, patient needs and goals to change.

Ultimately, it’s important to always be transparent and honest with your doctor about how you’re feeling, and what you want out of your treatment.


Symptoms

Bipolar disorder is a recurring disease that goes in cycles. One part of the cycle is marked by symptoms of mania, the other by symptoms of depression. These "mood episodes" are often intense. During the manic phase, an individual can be cheerful, outgoing, talkative, and energetic. Until the mania gets out of control, he or she can be extremely productive and wonderful company.

During a manic episode an individual may:

  • feel very energetic
  • talk a lot about different things
  • have trouble sleeping or relaxing
  • jump from thought to thought or project to project
  • develop exaggerated self-confidence or thoughts of power and wealth
  • do risky things like abuse alcohol or other drugs, recklessly spend or invest money, engage in reckless sex

During a depressive episode an individual may:

  • feel down or worried
  • lose interest in activities or relationships
  • have trouble concentrating
  • have trouble sleeping
  • think about death or suicide

The symptoms of bipolar disorder are not always easy to distinguish from other serious conditions. Mania can be difficult to tell from schizophrenia. People who take amphetamines or corticosteroid drugs or people with overactive thyroid glands have symptoms similar to those of people with the manic phase of bipolar disorder. Some people have bipolar disorder for months, if not years, before it is diagnosed.

Untreated, the manic phase can last as long as 3 months. As the mania fades, the individual may have a period of normal mood and behavior that lasts for weeks, or even years. Eventually, the depressive phase of the illness sets in.

About 10% to 20% of people with bipolar disorder develop what is known as rapid cycling, with more than four episodes of mania and depression a year. The chance that there will be future attacks rises with each new episode.


5 Things People With Bipolar Want Others To Know About Their Condition

For starters, having the condition doesn&rsquot mean you&rsquore manic or unstable.

When you hear that someone&rsquos been diagnosed with bipolar disorder, you may have some questions and concerns. There&rsquos also a good chance you&rsquoll make some assumptions about what it&rsquos like to live with the mental illness, many of which may not be based on facts. After all, thanks to misrepresentations of the disorder in the media&mdashas well as the flippant use of the word bipolar to describe everything from the weather to someone who just changed their mind&mdashthere are plenty of myths about this mental health condition that are perpetuated.

Kaity Cash, a 29-year-old publicist in Sommerville, New Jersey, who was diagnosed with bipolar disorder in college, can relate. &ldquoPeople talk about depression and anxiety so much that those conditions have become normalized, yet there&rsquos still such a stigma around bipolar,&rdquo she says. Melanie Carlson, a 39-year-old who was also diagnosed with bipolar in college agrees. &ldquoPeople often think that I&rsquom always in one emotional extreme or another, or they look at me and say, &lsquoYou have a job?&rsquo&mdashlike they&rsquore shocked,&rdquo says Carlson, a social worker who&rsquos also getting her Ph.D. in psychology. &ldquoThere&rsquos so much great activism happening around other mental health conditions, but we&rsquove still got a long way to go when it comes to bipolar.&rdquo

That&rsquos why we sat down with Cash and Carlson. We wanted to understand the common misconceptions about bipolar disorder these women face&mdashand to hear from them why these assumptions just aren&rsquot true.


What psychological approaches are used to manage bipolar disorder?

Pharmacotherapy, or drug therapy, is essential for the treatment of bipolar disorder. It usually involves the use of one or more mood stabilizers, such as Lithium, combined with other medications.

There is now strong evidence that psychological interventions can be added to drug therapy in order to help people better manage their illness and reduce repeated experiences of mood episodes.

Psychoeducation consists of giving patients and their relatives’ adequate knowledge about bipolar disorder and teaching illness self-management skills, so that people have a better understanding of their illness and its treatment. Psychoeducation is usually given in short-term (i.e., 5 to 10 sessions) group format.

Cognitive-Behavioural Therapy (CBT) and Interpersonal Therapy (IPT) are both short-term forms of psychotherapy that have been shown effective in the treatment of mood disorders, including depression and bipolar disorder.

In bipolar disorder, Cognitive-Behavioural Therapy uses psychoeducation and mood monitoring to help people identify triggers of mood episodes and develop a written relapse prevention plan.

Increasing activities in depression, reducing activities in mania, and correcting over-negative or over-positive thoughts are also strategies used in CBT. An adapted version of IPT, Interpersonal and Social Rhythm Therapy (IPSRT), has also been shown effective for bipolar disorder.

The main goals of IPSRT are to help people better deal with relational difficulties and learn how to maintain a stable and healthy daily routine in order to regulate important biological rhythms, such as sleep, that can trigger mood episodes like mania.

Family Therapy interventions, which have been found to be helpful in schizophrenia, have also been successfully adapted to bipolar disorder.

In Family Focused Therapy (FFT) patients and their families learn how to better understand bipolar disorder by getting information on the disorder and its treatment (psychoeducation) and learning communication and problem-solving skills in order to deal more effectively with the consequences of bipolar disorder.

Finally, social support is also very important for people with bipolar disorder and therefore joining local support groups for mood disorders may be helpful.

Where do I go for more information?

More information regarding bipolar disorder can be found on the following websites:

  • the Mood Disorders Society of Canada (MDSC) at http://www.mooddisorderscanada.ca
  • the Depression and Bipolar Support Alliance (DBSA) at http://www.dbsalliance.org or
  • the Canadian Mental Health Association at http://www.cmha.ca.

You can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial and some municipal associations of psychology often maintain referral services. For the names and coordinates of provincial and territorial associations of psychology, go to http://www.cpa.ca/public/whatisapsychologist/PTassociations/.

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Martin D. Provencher. Dr. Provencher is a Registered Clinical Psychologist in the Province of Québec and is Full Professor at L’École de psychologie de l’Université Laval in Québec City. His primary interests include Cognitive-Behavioural Therapy, mood and anxiety disorders, Bipolar Disorder and Generalized Anxiety Disorder.

Your opinion matters! Please contact us with any questions or comments about any of the Psychology Works Fact Sheets: [email protected]

Canadian Psychological Association
141 Laurier Avenue West, Suite 702
Ottawa, Ontario K1P 5J3
Tel: 613-237-2144
Toll free (in Canada): 1-888-472-0657


3 Stories of Rapid Cycling

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Rapid cycling is defined as four or more manic, hypomanic, or depressive episodes in any 12-month period. Rapid cycling occurs in 10-20% of all people with bipolar disorder, and is more common in women (read this article for more facts about rapid cycling).

Bipolar disorder varies greatly from person to person. Similarly, rapid cycling can also mean different things for different people. To meet the clinical definition, there must be 4 episodes in a year. But some individuals can experience multiple mood shifts in the same day (for a visual depiction of this, check out the graphs in this article). Rapid cycling can also vary in how consistent it is: some people see the same patterns year after year, and for others it seems to be random. In this article we will hear from 3 different perspectives:

  • Melanie, who often experiences several cycles in the same day
  • Lauren, who’s rapid cycling changes throughout the year
  • Lyndsay, who consistently has around 4 mood shifts per year
What does rapid cycling feel like?

Melanie: For me, rapid cycling is when I experience multiple “highs” and “lows” in a day. I am an extreme rapid cycler and I have several mood shifts throughout the course of a day. It’s really hard to handle, and it’s exhausting, as someone who works full time in an office setting. It doesn’t change minute to minute, but it sure feels that way! It really affects my energy levels and how I interact or want to interact with other people.

Rapid cycling feels like your mind is playing tricks on you. You are sad one minute, hyper the next, giddy, and then back to sad, teary, and wanting to hide. It’s very confusing and it’s scary how fast your mood can change and change and change. You feel like your moods are changing so quickly and you don’t know when you will feel “right” again. It is one of the most frustrating parts of having bipolar disorder.

I have to say that I have had to become a very good actress and very good at suppressing my moods at work, and as a result, at the end of the work day, or on the weekend, the moods can be more severe. I become frustrated with how emotionally labile I am, and I feel terrible that I have anger outbursts, am agitated and rude when I am in a hypomanic state, or that I am “useless” and amotivated when in a depressed state, i.e. unable to cook, clean, empty the dishwasher, put things away etc.”

What is also confusing and frustrating about rapid cycling is that you can be anxious regardless of what state you are in. Or at least, that’s what happens to me.

Lauren: Rapid cycling feels like a large roller coaster- but one that is never ending, with highs and lows of unknown duration and height/depth, going around over and over again. The depression of knowing you’ll fall, and the happiness when you’re climbing up, the anxiety when you realize you’re going to start falling again any moment.

Lyndsay: It feels painful (mentally and physically), stressful, scary, and dramatic. Most people think mania is great, but it’s not. During my manic episode, I spend a lot, I can’t feel any emotions, I shut people out, I’m impulsive, and I’m mean. Then I cycle into a depression, and it’s a quick transition. It’s usually a mixed episode for a couple weeks (both manic and depressed), and turns into full-blown depression. That’s when I deal with the repercussions of the mania. I’ll have spent all my money and find myself in severe debt. My relationship will need mending. My physical health will deteriorate. Imagine experiencing the mania to depression (back to mania) four or more times a year. It’s exhausting. And it hurts. It hurts my brain and it hurts my body. I think the worst part is knowing that it’s going to happen. No matter how hard I try to treat it in advance, it always happens and I never know the severity in advance.

How often do you “rapid cycle”? Do you have mania or depression more often? Has it changed over time?

Melanie: It depends on the day. I notice that on a typical work day, I start off in a hypomanic state, I am okay for a few hours, then I feel a wave of sadness after lunch, then I have trouble focusing for the rest of the day. By the time I leave work, I can be a little hyper, and my mood will change again. Sometimes I get so hyper by the end of the day that I have trouble sleeping.

I first noticed the rapid cycling a couple of months after my diagnosis. Initially, my “main” state was hypomania. After a couple of years, it changed to depression. I am not sure if this had to do with life circumstances and events or if it’s “normal” for this to change over time. I do notice that when I am under stress, my predominant state switches to “hypomania”, because in that state, you feel “invincible”.

My rapid cycling involves multiple cycles throughout a day. The day will end with whatever the predominant mood is. Under stress, I am very hyper and have difficulties sleeping, experience insomnia and of course, this is a dangerous cycle in and of itself!

I think my rapid cycling will change again and again, depending on what is going on with my life.

Lauren: My rapid cycling varies- in the summer I get longer but more frequent lows, and in the winter I get higher and more frequent highs. My cycles could change on a weekly or monthly basis. Sometimes I feel ahead of the game and my meds are on track, other times it’s a guessing game and I can’t keep up. I’ve had several major depressive episodes, which add even more frustrations to the mix. Because of this, I usually have to adjust my medications several times a year. The doctors I’ve seen said this might just be my new “normal”.

I was diagnosed with Bipolar type 1 over 13 years ago, when I was 18, but it wasn’t until a few years later they determined it was rapid cycling. It’s been suggested that I had child onset bipolar, but since they didn’t think that was possible at the time they just called it ADHD. So honestly, I don’t remember a time in my life when I was “normal”. I remember getting in trouble a lot growing up, and not being able to control my emotions, but also not really knowing what my emotions even were in the first place. I look back on it now and honestly remember it as living in a haze until I was diagnosed properly and started on the correct medications.

Lyndsay: My rapid cycling is generally four times a year with little episodes in between. I would explain my episodes throughout the year like this: Every spring (March/April), I cycle into a manic state. My doctors and I assume it’s because of the time change, plus spring is “happier” than winter. I experience this mania for about four months, until a depression cycle comes along in August. I’m curious if this could be related to the start of school, as life changes from fun and playful to busy and structured. I become stable in October and stay that way until January when I find myself in a depression. Mania hits again in March/April. It’s like clockwork.

As I’ve gotten older, I find myself having more manic episodes than depression. I live in Southern California, so the abundant sunshine helps A LOT with managing depression (plus my sun lamp). When I lived in Ohio, the winters would generally be a time of severe depression.

It seems that all people with bipolar would experience this, but they don’t. My brother, for example, has bipolar disorder and generally cycles once or twice a year (between hypomania and depression). The important thing to remember is that there are multiple types of bipolar disorder. My brother is generally depressed most the time but he’ll have a few hypomanic episodes here and there (they do not last long). Plus, he’s never experienced full-blown mania.

Do you have any tips on how to cope with rapid cycling?

Melanie: I try my best to avoid triggers like negative people, too much sugar, anxiety-provoking situations and too much stress. And don’t watch the news before bed!

It is hard to avoid stress, especially family emergencies and there is always “the unexpected”. You have to figure out what calms you down. I highly recommend meditation or hypnosis (hypnotherapy- it’s not what you think it is- not how it is portrayed on TV!). I have learned many techniques to calm down, even if it is short-lived from hypnosis. One technique that I tell people to try is counting backwards from 25, and picturing yourself writing each number down on a blackboard, one at a time, and erasing each number before writing the next. Visualization exercises help. And don’t forget to breath. Another good one is counting backwards from 25 and picture yourself walking down a staircase, one step at a time. And each time you write down a number or walk down a step, take a deep breath!

Breathing is important. It is very scary when your heart is racing and you feel nauseous from anxiety, because you feel like you can’t breathe. I think if you can stay calm, maybe your moods won’t change as often, or you can make it slightly more bearable for yourself. I also recommend finding a hobby, or a distraction. Distracting your mind is very important. Recently, I bought adult “colouring books” and have been enjoying colouring in them and find it relaxing. Journaling or blogging is another great outlet- writing your feelings feels like I am getting the thoughts out of my system.

Lauren: Some people keep a log, but that can be difficult if you have a lot of cycling, so I get help from family and friends. My spouse has bipolar as well, and is able to clue me in on different changes so we can tackle them head-on. I also try not to get upset with myself if I get into a depression funk. I have little notes around my bed so when I wake up I can see them and remind myself that it’s not permanent. Sometimes the switch in cycles is so quick, I wake up feeling a complete 180 from the day before. I’m not going to lie, some days it’s really hard to be a functioning human, but somehow I always come out ok.

Lyndsay: Visit your doctors every single month, no matter what. I used to think I only needed to see my therapist and psychiatrist when I was depressed or needed medication. Boy, was I wrong. Seeing my therapist regularly meant she could see my cycling before I could. This happened multiple times. It’s important to have someone who is unbiased (and truly, just someone else) to tell you when things are changing. We don’t always recognize it until it’s too late. By seeing your doctors regularly, together, you can catch an episode before it happens. This usually results in tweaking medication or seeing your therapist more often. That may sound awful to some, but it will help you get through the episode/cycle with minimal effects (to yourself and your loved ones).

Also, keep a mood journal. I never realized how “scheduled” my episodes were until I started keeping a journal. It was only then that I knew when I would become manic or depressed, which helped me to plan/prepare in advance. It’s made such a difference.

As for coping, don’t shut people out. I used to do that, and it only made things worse. I had to learn how to let people in, and it took me a while (by a while, I mean years). It’s much easier to handle the episodes with someone stable around you. For example, during a manic episode, my boyfriend will monitor my spending and take away my credit cards (not forcefully we made this agreement before the episode). When I am depressed, he will be calm and understanding, and know to get me ice cream when I need it. It helps tremendously to have someone who understands the best they can, and that only comes from allowing them to come into your life completely.

What do you wish other people knew about rapid cycling?

Melanie: I wish people knew how exhausting it is. It really is like being at war with yourself. You are fighting with your mind. You want to find a neutral state, but it’s very difficult when your moods keep shifting, shifting, shifting. It’s very hard to find “a happy medium” and to find calm when your mind is always in flux.

Rapid cycling is frustrating, and can seem scary and confusing to the person who experiences it and the people around him/her. The best way to help someone who experiences rapid cycling is to just be there! Be there by offering a hug, being patient, learning about it and lending an ear. Anyone who wants to support me, has to be willing to 1. Educate themselves and 2. Listen.

Lauren: I wish there was a way to read it better, not just for other people but for myself as well. Sometimes people don’t get it, they will remember I was depressed/upset, and then if I am suddenly happy, but then get down again, they just give up and get frustrated that they can’t read me or track how I am. It’s not like there is a countdown timer going for each cycle. If it’s frustrating for them, how do they think I feel?

Lyndsay: I wish other people knew that rapid cycling is a part of bipolar disorder, and I don’t need pity. That might sound harsh, and I don’t mean it to be. I don’t want people walking on eggshells around me, no matter the episode I’m in. I’m not “crazy” and I will be okay it’s simply a part of my life. If I had an employer, I would hope they would somewhat understand that I will cycle frequently, and I’ll either need time off or need accommodations. Though I suppose that’s the reason I am self-employed. I’ve gotten used to the idea that “other people” won’t understand bipolar disorder or what I go through but I don’t expect them to. I used to get really upset at people’s ignorance, but you’ve got to understand that they don’t experience what we do, so how would they know? And that it’s okay for them not to know. As long as they try to understand, that’s enough for me.