Bipolar - We Are Not All the Same

John McManamy Health Guide
  • Last week, I revisited a piece I published here at BipolarConnect more than four years ago, a top ten list of bipolar myths. To my surprise, the list was not much different than something I would have written today, though I did manage to come up with three additions.

    The piece drew 33 insightful comments, which I will take up in a future post. Today I will focus on my first reply, from Lori, who had this myth to add:

    People with bipolar all have the same symptoms.
    I try to explain to people that it is not true. The symptoms that I have may be similar to others, but not the same.  Then again, someone else may be experiencing something totally different. We do have a lot of the same symptoms as people with bipolar, but we are not all the same.

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    Dang! Why didn’t I think of that? Thanks so much for reminding me, Lori. I don’t know about the rest of you, but I am unaware of another individual on this planet with the exact same symptoms I have or behaves the same way I do. How about you?

    Where Lori was going with this is that we tend to get lumped in with those who get all the negative attention or attract the bad publicity. Never mind that your idea of a wacky and wild time is coupon night at the Olive Garden - in the eyes of too many people you’re no different than Bonnie and Clyde.

    So how are we different? For a start, most of us have other stuff going on besides our bipolar, what I call “bipolar plus.” Our bipolar is never a stand-alone illness. It comes fully loaded with other stuff: bipolar plus ADD, bipolar plus anxiety, bipolar plus substance use, bipolar plus trauma ...

    Even just “a little bit” of something like anxiety is going to add an element of unpredictability and uniqueness to our depressions and manias. And while we’re on depression and mania, try this on for size:

    Imagine two individuals with the exact same biological mania. One individual has an introverted personality, the other is an extravert. Neither is going to react the same way to the mania. Perhaps the introversion acts as a brake for the first individual’s mania and the worst thing that happens is this person gets grumpy. On the other side of the coin, perhaps the extraversion acts as rocket fuel for the other guy.

    Or, it could be the other way around. Perhaps mania is no big deal for a person already used to dancing on tables but proves a total disaster to someone who prefers staying home with a book.

    Even classic DSM depressions and manias leave wide room for variance. Depression, for instance, is an amalgam of both mental and physical symptoms. So, if you are depressed, is your major problem that you’re ruminating too much? Or is it that you can’t get out of bed in the morning?

    Unfortunately, it’s not just the uninformed public that treats all depressions as the same. So does the drug industry, which heavily influences psychiatry. In clinical trials, virtually no attempt is made to tease out different types of depression. To the drug industry, a depression is a depression. A clinical trial that results in getting 50 percent of subjects 50 percent better is regarded as a success. An FDA indication based on these results amounts to a license to print money.

  • It may be that Drug A gets 80 percent of individuals with a particular type of depression 80 percent better, but proves relatively useless for other types of depression. Unfortunately, we have no data on this nor will we ever. The drug companies have their license to print money and have no motivation to conduct further trials.

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    It gets worse. Until fairly recently, it was assumed that a unipolar depression episode was exactly the same as a bipolar depression episode. The DSM preserves this myth by copying and pasting the symptoms from unipolar depression to bipolar depression. At least now we know the two need to be treated differently, but we have a long long way to go.

    As for mania, I recall attending my first psychiatric conference in 2001 in which Robert Post MD of the NIMH informed his audience that our population is depressed way more than it is manic. You could have heard a pin drop. Until I heard Dr Post, I thought I was an anomaly. I just assumed that I was missing out on the big mania party. Apparently, I was living in a myth, as were most of the experts sitting in the same room.

    So, on one hand it’s nice to know that I’m not a diagnostic fluke, that I have much in common with nearly all of you. On the other, it’s vital for me to know that I am as different from you as you are from everyone else. Some of the general public is aware of this, but too many are not. Too often, the people charged with treating us fail to appreciate our uniqueness, as well. Thus the critical importance of becoming our own experts.

    We are not the same. Thank you, Lori, for bringing this up.

Published On: January 29, 2010