10 Top Myths About Bipolar Disorderby Julie A. Fast Patient Advocate
Bipolar disorder can confuse people who are not familiar with the diagnosis. It's common to hear someone say, "Everyone gets moody, isn't everyone a little bit bipolar?" Not at all. Bipolar disorder (there are four types) is much more complex than simply having a bad or happy mood now and then. I was diagnosed with a form called rapid-cycling bipolar II at age 31, after dealing symptoms for 15 years. Since then, I've dedicated my career to helping others understand what it's really like to live with and manage bipolar. Clearing up common myths and misunderstandings is a big part of what I do, so let's get to it.
MYTH: Bipolar Disorder is Just Extreme Moodiness.
It's true that people with bipolar shift between periods of depression, mania, or hypomania , but these cycles usually take place over long periods of time, like weeks or even months, according to Mental Health America. The symptoms of these states are typically severe and signifcantly impact energy levels, activity, and sleep, according to the National Institute of Mental Health, and they tend to occur without any apparent cause.
People who are moody, however, tend to experience mood changes in reponse to some situation, according to an article by Russ Federman, Ph.D., director of counseling and psychological services at the University of Virgina. "We all have good days and bad days," Federman wrote. "Someone who thinks of themselves as "moody" may perceive that they've had more than their share of bad days. But if you're truly bipolar then you've had episodes of fairly acute depression which at some point have lasted two weeks or more. Additionally, you've seen elevated mood that has lasted a minimum of four days and often longer. Unless your different mood experiences have met these duration criteria and your "up moods" have involved symptoms such as high energy, lessened need for sleep, accelerated thought, rapid speech, impulsivity, euphoria and/or intense sustained irritability, then your moodiness probably reflects something other than bipolar disorder."
MYTH: Bipolar Disorder Includes Only Symptoms of Mania and Depression.
This one is tricky. It’s true that there are two mood swings in bipolar disorder: depression and mania. But during one of these mood swings, people with bipolar can experience an enormous variety of symptoms: Anxiety is extremely common with depression and is always present with dysphoric mania, which occurs when people experience symptoms of mania and depression at the same time. The majority of people with bipolar I are also often psychotic during periods of mania.
Mood swings can lead to attention and focus problems, irritation, anger, and violent behaviors. We often have photographic memories while manic and then lose our ability to remember much at all when depressed. To complicate matters even more, some people have black outs during manic episodes where they simply don’t remember anything that happened. We can be narcissistic and cruel and then overly emphatic and rudely inquisitive.
It’s easy to think that people with bipolar have a variety of conditions due to this wide range of symptoms, but bipolar is completely different from other mental health disorders in one important way: It is always episodic. Our symptoms come and go. When we are not in a mania or a depression, we're stable and all symptoms of anxiety, psychosis, irritation, etc., disappear. Our stable mood is called euthymia. Symptoms that aren't attached to a mania or a depression mood swing are not about bipolar disorder and are considered a separate diagnosis.
MYTH: Bipolar Depression is Weepy, Sad, and Hopeless.
It can be! But for many of us with the bipolar disorder, depression is mean, nasty, negative, and aggressive. I call this irritated depression. Symptoms include restlessness; the feeling that nothing is ever good enough; trouble sleeping and waking up too early; anxiety; hopelessness about the world in general; snappiness; yelling; isolation; and having a very short fuse even for the people you love. This is combined with a feeling of gloom and the pointlessness of life.
People in this episode will not weep, they will rant and rage. The mean streak that comes with irritated depression greatly affects relationships. Please note that this is not dysphoric (mixed) mania as there is not a decreased need for sleep or an increase in energy. People with irritated depression have trouble staying asleep, but they need the sleep and get very tired from the disruption. As with all mood swings, irritated bipolar depression will be episodic. When at baseline, the person is not mean and nasty.
MYTH: Bipolar Mania is Happy and Joyful!
There are two levels of mania, hypomania and full-blown mania. People with mania have a very high level of energy, less need for sleep, feelings of grandiosity, and often engage in risky behaviors. Hypomania causes similar behaviors but at a lower intensity.
Within these two levels of mania, there are two types: euphoric and dysphoric. While it’s true that euphoric mania feels and appears happy and joyful, in reality it’s over the top, narcissistic, predatory and completely created by the brain. In other words, it’s a manufactured mood.
Dysphoric mania, also called a mixed episode, is the opposite: This is energized depression, anxiety, and irritation. It’s our most dangerous mood swing as it leads to the most violence and has a high risk of suicide as well as accidental injury or death. So, yes, this explodes the happy mania myth pretty completely.
MYTH: Manic Hyper-sexuality is Fun.
My first hyper-sexual manic episodes felt like personal revolutions. Meeting guys was so easy! I could have sex with anyone I wanted! I had no worries about my body or looks. I was a goddess. The mirror was my friend, and every man I found attractive was my target.
As exciting as this sounds, the repercussions are much different. For me, they included excessive drinking, unwanted pregnancies, herpes, sleeping with total strangers, waking up in hotels and not knowing what city I was in or who was next to me, even marrying someone I'd only known a few weeks.
Hyper-sexuality is not fun, and it's definitely not sexy. It’s a myth that having sex without thinking is a positive action. It’s not safe, and it’s not sexual: Instead, it’s predatory, thoughtless, narcissistic behavior that happens to involve the sexual act. Since 2010, I have chosen celibacy outside of a relationship as a way to manage what is one of my most common symptoms.
MYTH: People with Bipolar Sleep Like Regular People.
Sleep is affected negatively in the majority of people who have bipolar disorder, according to a study by researchers from Massachusetts General Hospital and Harvard Medical School. When a person is diagnosed, questions about sleep usually paint a picture of the type of bipolar a person experiences. For most, needing less or no sleep at all--and not being tired--is the number one indicator of mania. People in a down swing often sleep too much, or they feel too nervous and upset to sleep (they're wired and tired). They end up exhausted and unable to function. What's more, even during periods of stability, as many as 70% of people with bipolar have disrupted sleep.
The connection is so clear that scientists believe targeting disorder sleep could be an important and powerful way to help manage bipolar symptoms.
MYTH: Medication Should be the First-Line Treatment for Bipolar Disorder.
This myth often shocks people, and please know that I’m not saying that meds don’t work. They're an essential part of any plan. I use them daily for certain symptoms, but they're rarely enough to stop mood swings. To truly manage bipolar, the majority of people with the illness must regulate sleep, focus on healthy relationships, and avoid triggering behaviors (traveling without careful planning, accepting shift work, taking too many classes) and substances (antidepressants, stimulants, steroids, and marijuana due to THC).
If our lifestyle increases bipolar symptoms, all medications can do is keep a lid on a boiling pot. Side effects are the number one complaint about medications. By focusing on lifestyle changes first, we reduce the need for high doses of medications and automatically reduce nasty side effects. In my opinion, medications are for what we can’t manage on our own.
“It’s true that there's a dogma that medications are the only treatment for bipolar," says Jim Phelps, M.D., the author of three books on bipolar and founder of psycheducation.org . "It’s entrenched in much of the literature, but it’s just not correct. Putting management techniques first and meds second is so important.” Our current health care system is behind the curve when it comes to this myth. Medications are important, but lifestyle education comes first."
MYTH: It’s Safe to Use SSRIs as a Treatment for Bipolar Depression.
This is such a misunderstood topic, I asked my coauthor John Preston, Psy.D., to share his opinion along with the latest research. Dr. Preston is a neuro-psychopharmacologist and is the lead author of The Handbook of Clinical Psychopharmacology for Therapists now in its 8th printing. Dr. Preston notes:
"SSRI antidepressants are not recommended for people with bipolar I at all as they can trigger mania," he says. "In people with bipolar II, SSRIs plus a mood stabilizer should only be used if all other forms of depression management have failed. But even then only about 25% of people will benefit. Too many prescribers hear the word depression and start to use these drugs. They need to hear the words bipolar depression and follow the correct protocol.”
MYTH: Marijuana Can Help People with Bipolar.
There is no research that shows marijuana is a treatment for bipolar disorder. There is research that shows that marijuana can greatly increase the risk of psychosis in people with bipolar due to the high levels of THC found in the most popular strains of the plant.
This often difficult for those of us with bipolar to accept. We want relief and cannabis is marketed as a miracle cure for many ailments. The main problem is THC, which is the stimulating, hallucinogenic chemical responsible for getting people high; it's present in trace amounts in all marijuana-based products. This includes products that claim to contain only cannabidiol (CBD), the non-psychoactive substance that some people use for other conditions like anxiety or sleep issues.
No matter what benefits marijuana might have in the medical world, in our bipolar world, it greatly increases our chance of mania and psychosis, and in my decades of personal and professional experience, greatly increases our rate of dysphoric mania. (For more on the risks, I recommend the book "Tell Your Children: The Truth About Marijuana, Mental Illness, and Violence" by Alex Berenson.)
It's suggested that people with bipolar avoid marijuana products until the THC can be removed completely. This process is difficult to do at this time. If you struggle with cannabis use, please speak with a professional who can help you manage the symptoms created by the substance.
MYTH: Bipolar Gets Better as You Get Older.
This is a question of managed vs. unmanaged bipolar. Dr. John Preston notes, “If unmanaged, ignored, or exacerbated with lifestyle choices that increase symptoms, bipolar can get worse as we age. There is one research study that predicts a healthier future if the person is diagnosed during a first episode and immediately uses and sticks to treatment for life, but we know that is a rarity.”
Luckily, it’s not all hopeless! Bipolar may not get better as we age if left alone, but if we work on management? The future gets much brighter. Bipolar responds very, very well to a life-long management plan. Lifestyle changes and trigger management along with the judicial use of medications can greatly reduce mood swings. As my therapist once pointed out, “Julie, your bipolar is still really terrible, but your management has finally gotten stronger than the illness itself.”
If we stick to the facts and ignore the myths, we can create a plan that improves our moods and our lives as we age. This is a positive way to approach the illness.