Everybody loves Dr. Google and every generation has their version of it. When I was in training, we all swore we had whatever disorder we were studying at the time. You feel jumpy around spiders? Phobia. Saw something move out of the corner of your eye? Hallucinations. Worried that your classmate didn’t like you? Paranoia. Mood swings? You must have bipolar disorder.

It’s easy to jump to conclusions. We all have symptoms of lots of different disorders even though we might not meet full criteria for a diagnosis. What does the term “mood swing” mean, anyway? It’s more of a colloquial term. If you get upset easily, or react defensively to someone who makes an inappropriate joke, or are happy-go-lucky when you wake up, but are miserable by the time you get off work, that doesn’t necessarily mean you have bipolar disorder. You could just hate your job…

Let’s think about mood in terms of the weather and climate. In Cincinnati, Ohio we “theoretically” live in a temperate climate. Which means we are supposed to have 4 seasons: Spring, Summer, Fall, and Winter. It takes days to weeks in order for the weather to change fully. And over time those weather patterns emerge as our more stable climate. But even during the winter you may have a hot spell, or a pop-up thunderstorm in the spring.

It’s the same with bipolar disorder. It may take days to ramp up or down, and you may stay there for weeks to months. There are two types: Bipolar Type I and Bipolar Type II.

Bipolar Type I

Bipolar Type I is when you have a manic or elevated stage where you may behave very differently from how you do at baseline. You may believe things are real that aren’t (like thinking you’re a god or you can fly). You may feel like you can go without sleep or food for days, you may want to have sex with anything that can walk, or not care about maxing out your credit card when you’re typically financially fastidious. You may speak so loudly and quickly that you’re hard to interrupt, or want to start 80 different projects all at once. You may have the impulse to sell off all your assets and drive across country. There’s a significant lack of impulse control, minimal to no filters operating coherently, and frequently little insight into the matter. You can see how this could definitely disrupt your life and the lives of those you hold dear.

Mania

This period of mania can last days to weeks, and is usually followed by depressive crash. These folks need medical intervention ASAP. They may initially look like the life of the party, but consistently staying in a state of mania is like driving your really nice car across country without stopping for gas or an oil change. It will burn you out quickly, and may actually cause brain damage.

Depression

The depressive period for most people can last weeks, months, or even years. This is accompanied by a lost of interest in hobbies or doing things you love, frequent social isolation, loss of appetite, sad mood, guilt feelings, loss of a sense of future, and even self-harming or suicidal thoughts. Again, especially when faced with the latter, these folks need medical attention ASAP.

Mixed State

What is known as a “mixed state” is the worst of both worlds: you can feel both depressed and agitated, a state that puts most people into a very dangerous state of mind where the risk of committing suicide is at its highest. People may or may not go through this period, but it is important to recognize it so your treatment can be adjusted immediately.

Bipolar Type II

People with Bipolar Type II, instead of cycling between mania and depression, spend the majority of the time in a state of depression, with occasional periods of hypomania, which is characterized mostly by agitation and irritability. You may be getting a little less sleep, but you’re not operating on fumes as in full-blown mania.

Treatment

The most effective treatment for both Type I and Type II is of a combination of psychotherapy and medication management. The role of medication is to help stabilize the mood. The role of therapy is to begin to recognize the signs of mood changes in your own life, and learning to cope with the fallout in the hopes of preventing major disruptions in the first place. Many therapists will recommend keeping a mood journal or diary to see if you can pinpoint when you start feeling differently and intervene early. There are also a number of neurocognitive quizzes available online you can take to check out your scores on a daily weekly basis. Everyone is different, and when you start recognizing your own “tells” or signs you may be moving into a manic or depressive phase, you will be able to keep in better charge of your own health.

Complicating Factors with Bipolar Disorder

There are a few complicating factors with diagnosing and treating bipolar disorder. The first is that people with bipolar disorder present to treatment with depression 80% of the time so even the most well-meaning providers can misdiagnose bipolar disorder as depression. The treatments for depression versus bipolar disorder can be quite different and some antidepressants can exacerbate manic symptoms.

The second complicating factor is that bipolar disorder has a seasonal component. The amount of light during specific times of year affects both your hormones and your neurotransmitters. For instance, frequently during the spring, people may need either less antidepressant or more mood stabilization because the amount of light present during the day can contribute to manic episodes. In the same vein, the lack of light during fall and winter months can contribute to increased periods of depression and may require more antidepressant medication.

The third complication is that it can be difficult for people to recognize when they are manic and to seek treatment. Oftentimes loved ones will recognize signs of a problem first. Not only is it hard to see in ourselves, but mania can feel euphoric so why seek treatment when it feels awesome?! Meanwhile, what loved ones see is a scary reality where you are doing things that put your safety, stability, and wellbeing at great risk.

The takeaway from this is to work with your loved ones and your treatment providers in order to find the right treatment combo for you, and one that is hopefully safe, effective, and with either minimal or tolerable side effects.

There are professionals who can help

Does any of this sound familiar to you? Even super intelligent people may not recognize these patterns in their lives because they can’t see the forest for the trees. But if you have noticed a difficulty in maintaining friends (because you’re too inconsistent or you are too hard to get a hold of), difficulty holding down a job for a longer period of time, or radical changes in your finances or living circumstances, it’s possible that this could be an issue for you. If so, don’t hesitate to reach out. We’re here to help. We look forward to working with you to reach your best self.

I’m really moody… does that mean I have bipolar disorder?