Sit Down, Buckle up, and Hang on Tight: Riding the Bipolar Roller Coaster

(If you’re curious about the cover picture, it’s a self-portrait I drew a few years back with mania and depression anthropomorphized into fictional characters. I’ll let you figure out which is which.)

What is bipolar disorder?

To quote Wikipedia:

“Individuals with bipolar disorder experience episodes of a frenzied state known as mania, typically alternating with episodes of depression.”

It’s a teeny-weeny bit more complicated than that (<– please note the sarcasm in this statement). I’m not going to launch into a full, in-depth explanation, because plenty of books have already been written on the subject (for an excellent, highly entertaining book check out Welcome to the Jungle by Hilary Smith. It’s the first book I read about bipolar disorder, and it’s by far the best. I guarantee you’ll get a laugh– something you won’t be getting from most other books on the subject. Instead, I’ll just walk you through the terminology I make use of:

Manic episode – You’re bursting with energy. Sleep is impossible. You’re either euphorically happy, alarmingly irritable, or paranoid, or some combination of all three. Some people fly into rages (thankfully I’ve never had that problem). Your thoughts are speeding along at roughly a million miles per minute, which starts out exhilarating, but it gets old very quickly (just staying focused on one conversation is difficult, let alone trying to read something or plan your day). The speeding thoughts can enhance your creativity, but you have the attention span of a gnat, so you might start a dozen new projects in the course of a day, but you won’t ever finish them. Your judgement goes out the window. You do stupid things: driving recklessly, maxing out your credit cards on spending sprees, breaking up friendships, quitting your job. Hypersexuality is another symptom. Ordinarily you might be a very chaste, conservative wall-flower, but in the throws of mania you are liable to get into a lot of trouble if you’re in the wrong place with the wrong person (or people). You aren’t in your right mind, so you aren’t morally culpable, but when sanity returns you might end up facing some devastating consequences (this is something I’ve never had to deal with, thank God, since my only major manic episode took place while I was safely with my family). If things progress far enough you can become psychotic. You have delusions of grandiosity that leave you convinced that you’re a celebrity, or that you’re Jesus (this is actually a very common delusion, even among non-religious people), or you’re on a mission to save the world, or you’re invincible, can control things with your mind, can fly, etc. Hallucinations are also a possibility. The symptoms of psycho-manic episodes are very similar in some ways to the symptoms of schizophrenia.

Hypomanic episode – This is another way of saying “mild mania.” Take manic symptoms and turn them down a few notches. It still interferes with your life, but you’re able to function at least semi-normally. Sometimes hypomania can actually be a positive thing, since the extra energy and creativity isn’t compromised by incapacitating racing-thoughts. It can also be quite enjoyable if euphoria happens to be a symptom.

Depressive episode – In other words: depression. Anyone who has ever experienced it probably doesn’t need an explanation. Bipolar depression is very similar to major depressive disorder. Symptoms of depression include utter misery and despair (that’s not an exaggeration), crying, lethargy, exhaustion, apathy, loss of interest in formerly enjoyable activities, inability to feel pleasure, morbid thoughts and suicidal ideation, excessive and irrational guilt, intense self loathing, insomnia, loss of appetite and weight loss, and withdrawal from friends and family. There are three potential differences in bipolar depression: firstly, antidepressants usually kick in immediately and have the potential to shoot you over the moon into mania, so you have to be very careful with them. Secondly, some people experience hypersomnia rather than insomnia. They are unable to get out of bed for days. This is not due to laziness, but rather absolute exhaustion (the intensity of it defies description) and apathy.  The third potential difference is an increase in appetite, rather than a loss, which can result in impressive weight gain (eating a whole tub of ice cream every day, for example, or sitting down and eating spoonfuls of sugar straight from the bag. It doesn’t help that a number of medications used to treat bipolar have weight gain as a side-effect). When someone experiences hypersomnia or increased appetite  it’s considered an “atypical depression.” I’ve never had either of those problems. My depressions are pretty typical. Unless they’re mixed episodes.

Mixed episode (also known as Dysphoric Mania or Agitated Depression) – You’re depressed and manic at the same time. I’m not joking. This happens rather frequently (in my experience, anyway). Take the emotional anguish of depression, along with its self-loathing, guilt and suicidal ideation, and mix it with the energy, impulsiveness and racing thoughts of mania, and you have a very dangerous cocktail. According to the stats, about 40% of people with bipolar disorder attempt suicide at least once in their lives, and roughly half of them are successful. In other words, 1 out of every 5 people with bipolar disorder end up killing themselves. Mixed episodes are the main reason for this. In straight depression, exhaustion and apathy make suicide less likely. Exhaustion and apathy are probably the only two depressive symptoms missing in a mixed episode. Energetic impulsiveness + thoughts of suicide = dangerous. In my experience, mixed episodes are also the time when self-harm urges hit you the hardest (if you’re someone who has that problem).

Rapid Cycling – In ordinary bipolar disorder, a person doesn’t get more than 4 episodes per year (that doesn’t sound like much, but one episode can last anywhere from a few days, to months). But it doesn’t always work that way. If you have more than 4 episodes over the course of a year, you are considered to be rapid-cycling. It’s a common problem in bipolar teens, and antidepressants can play into it in a big way as well.

So there’s your brief overview. If you have any questions, drop me a comment.

Take care, and God bless!

Kasani

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