Bipolar Disorder -- Three Things You Should Know

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Bipolar disorder is a mental health illness that involves extreme, unpredictable mood swings, from unhealthy high energy (mania) to concerning depression. While less common in those over age 65, it can nonetheless affect older adults. Every caregiver should be familiar with three important facets of bipolar disorder.

What Do Manic Episodes and Mania Look Like

Recognizable symptoms include:

  • Long periods of extreme euphoria
  • Irritability
  • Fast talking or jumping from one thought to another
  • Needing little sleep
  • Unrealistic ideas about one's capabilities
  • Engaging in high-risk but pleasurable activities
  • Aggressive behavior
  • Substance abuse (less common among older adults)

All those with bipolar disorder experience manic episodes, but not all will experience depression.

Recognizing Depressive Episodes and Depression

Recognizable symptoms include:

  • Long periods of sadness or hopelessness
  • Loss of interest in usual activities
  • Difficulty concentrating or remembering things
  • Fatigue/low energy
  • Changes in appetite
  • Sleeping more or insomnia
  • Thoughts about death or suicide

Using Medications to Treat Bipolar

Several types of medication are used to treat bipolar disorder.

  • Mood stabilizers: The FDA warns that these most commonly prescribed medications may increase risk of suicidal thoughts. Patients taking mood stabilizers should be closely monitored for unusual changes in behavior.
  • Atypical antipsychotics: Often used to treat mania, these may cause changes in a metabolism. Patients on atypical antipsychotics should be monitored for increased risk of developing diabetes or high cholesterol.
  • Antidepressants: Often taken with other medication, these treat depression only. Taking an antidepressant alone can increase the risk of manic episodes.

Using Therapy to Treat Bipolar

When done in combination with medication, several types of psychotherapy are helpful for those with bipolar disorder.

  • Cognitive behavioral therapy: Helps patients change negative thought patterns
  • Family-focused therapy: Involves loved ones in recognizing symptoms and learning problem-solving techniques
  • Interpersonal and social rhythm therapy: Helps patients manage daily routines, including consistent sleep schedules and exercise, which can lessen the frequency of manic and depressive episodes

In addition to psychotherapy, general support groups may be beneficial.

Caring for Someone With Bipolar Disorder

For Your Loved One
There are many steps you can take to support your loved one who seeks treatment for bipolar disorder.

  • Learn more about bipolar disorder.
  • Keep track of symptoms.
  • Listen to your loved one.
  • Recognize small accomplishments.
  • Provide ongoing patience and encouragement.
  • Create a plan for emergencies in case symptoms become severe or hospitalization is required.

For Yourself
Remember to take care of yourself; it's important for your own health as well as the success of your loved one's treatment. Building a support network of friends and relatives may not only help your loved one but you as well.

Sara Rattigan

Sara Rattigan received her MS in Health Communication from Tufts University School of Medicine in 2009 but discovered her passion for health promotion nearly a decade earlier as editorial assistant for StudentAdvantage. See full bio

almost 3 years, said...

Yes, this article was helpful. I have many of the symptoms and wasn't sure that they were normal for B-Polar. Thank you.

over 3 years, said...

After going through the first 37 yrs. of my life with BP, failed relationships of every kind, my own family except for one, not wanting to help, I was finally diagnosed and medicated, 6 yrs. ago, by my MD, and have learned a lot of awareness about myself and coping with the depression, and knowing when swings are coming. In that awareness, I've actually discovered how to control or suppress altogether, both. I have done quite well, with very minimal instances that haven't been even remotely impactful, and my life has improved dramatically in that time. A year ago, I opened my own business, and by pure chance met a woman with the intelligence, compassion, family dynamic, and love, that I have always needed in my life. Someone, whom I came to respect, admire, appreciate, and consider the most all around beautiful woman on the planet, since we first said "hello." The feeling from her has been equal and shared, and the effect of that on my self control has been tremendous in every way imaginable. Even through a tough first 7 months with business, and a few altercations with her that weren't unsolvable, we have been very much in love, and committed, and I was taken in by a family, that has loved and respected me as well. About two and half months ago, at the tail end of my business troubles, I started feeling a dip. I was chasing clients for payment and not to much success. I thought I had things in order emotionally and while my dream girl was having some time of her own dealing with the anniversary of losing a loved one, and a bit of a pile up of daily stuff. I chose to focus more on her, and not distract her focus to me. I thought I had it together. About 3-4 weeks into a slide that seemed to have stopped and was climbing back up, I had a complete explosive episode, that to the time I am writing this, I am still trying to recall all of. My bipolar has never led me to physical violence toward other people, but the yelling, it's content and the aggressiveness of it terrified her. It was the most severe event I have had in 6yrs. and the worst kind for her to see up close. No one truly understands what BP can look like, we are all different as people, and severities can change, along with the length. After that happened, I saw my MD, and increased my medication, Depakote from once a day to twice. Seeing the apprehension, fear, and doubt in her eyes started to eat away at me. My own fear of loosing her, and the entire family that I loved so much grew within the following days. It grew to a point, where I started clinging to her tighter and tighter, where she was already in a self preservation frame of mind, as anyone would be after an exposure like that. Things got heated, I went into a state of panic fearing the loss, and it even got to hateful. Not considering her feelings, and what she needed from me, panic added frustration at her needing some time to process. At this point, I was so wrapped up with myself still in cycle, and needing that life raft in her, I wouldn't let up, and couldn't do anything right in our relationship. The last fight we had because of that abuse was the worst it could've been, and in front of one of her children. There had been some caring, and productive conversation since the original incident, but I couldn't control my fears and patience and resumed the grip on her immediately after the fight. The stupidity and abuse to her over my fear of loosing it all, is now what has driven them all away. I feel like I've lost my entire family in terrorist act, and I was the terrorist. I can't POSSIBLY Describe my realization to what I've done is like. The loss of respect companionship, love, and concern, and the fear created BY MY OWN DOING is DESTROYING me! Especially knowing now that more consideration to her feelings, and her family's, and paying more attention to myself being healthy is what has done it. I am having a serious problem living with myself right now, and simply don't know how to recover from this. I have been keeping in contact with my MD, and using some phone resources at a Mental Heath Facility locally, but the longer this feeling is in me, it's getting worse! I am completely consumed by it. I am just trying to make it through today, and then tomorrow. I have plans to get to my doctor on Monday EARLY! but if there is anyone who reads this PLEASE RESPOND! if you might know of something to help get through this. This disorder sucks! to get to such an excellent stability, and high sense of awareness for myself, HOW IN THE HELL could I do so much damage, and cause so much pain to so many people I love. PLEASE, anyone. Let me know what might work, because my toolbox is empty!

over 3 years, said...

I was diagnosed with BP disorder when I was 30 years old. At that time I was working for the local electric-power utility company and had been there for 10 years. After my diagnosis, I continued to do my job for another 17 years...while taking my meds. It wasn't easy, most of my stress and difficulties came from ignorant fellow employees and management personnel. There was a lot of bullying, prejudice and dealing with the stigma that comes with the condition. If you got angry or animated during some kind of interaction with a fellow worker. The first assumption was whether or not if I took my medication that day. I was labeled crazy, weird and incompetent and a few other adjectives. If it is a big company or corporation that is supposedly EEOC compliant don't expect fair representation, treatment or any reasonable accommodation. In my case, not even the union was on my side when there was a conflict or disciplinary actions. The union representative suggested that I resign, transfer or take a disability because management didn't like what I was all about. After all, it was the company nurse that drove me to the local mental health hospital when I was eventually diagnosed. I was employed for close to 27 years and was fortunate to be able to keep a job while being treated for BP disorder. I must have been doing something right? The worst thing I did was file a complaint with the local district attorney/ EEOC office complaining of harassment, hostile work environment and violations of the ADA. The thing that I would like to share is...don't expect your local, state or federal officials to come to your aid or provide assistance. You are on your own. Somebody who is disabled in any way, will not have the resources or the strength to take on a large company or a corporation, with an army of attorneys who will do anything to make your life more miserable than it may already be. The courts these days are on the side of big businesses and not the common person. I eventually lost my job because of the aforementioned, but the good news was that I got my SSDI benefits, three months after I filed. I am in a better place, or thought I was until the diagnosed me with MS a few years ago at the age of 51. There's more with that diagnosis and trying to work part-time...But, that's enough for now.

over 3 years, said...

I think there should be expanded treatment advice.

over 3 years, said...

I have dealt with this for over 30 years ............ I take medication for this and need it .... I see a great Phyc. Dr........... It is you life you must deal with it in your own way ............... You can believe in God , Higher Power , or whatever ........... Nothing will help except your Control of the problem ... Live you life for you .....not anyone else !!! It is all a Mental imbalance of some sort , not your fault....... it is a mental problem ,,,,

over 3 years, said...

I've been bipoarler all my life no meds help I feel like a test rat I've tryed revelry med you and think of it only works for a few mouth I always feel alone even in a room fool of people witch a can done that is sit in a room fool of people my anxiety is so bad I can't deal with people I don't leave my house I stay in pjs all the time my moods go up and down like crazy it's hard to deal with my self I'm 45years old and the older a get the worst I get I pray that god we'll help me o I'm on lithium and Prozac witch doesn't work god bless the people that fight this every day I help you find something that helps you cause I can't

over 3 years, said...

I've had a long history of depression and mania. In my teens it was treated as rebellion. Then, after the arrival of our 4th child, I had just turned 40. I had a total breakdown. I was on Lithium but became Lithium toxic. Finally, I was referred to a Neuro- psychiatrist. For the next 18 months he tried various medications while providing intense counseling. I am almost symptom free. Of course, extreme stress like caring for my mother the last month of her life, did trigger some symptoms, But I live a "normal" life now on an almost ever keel. I still get angry, I still cry. I'M STILL HUMAN with human responses

over 3 years, said...

I'm a caregiver for a 82 yr old woman who was diagnosed 9 yrs ago. PLEASE research the side effects of so many of the newer drugs that supposedly create "miracles." My mom had to use a feeding tube for 7 months because her miracle drugs "may cause trouble swallowing." She is now on an older drug and doing pretty well, no thanks to her psychiatrists. Her neurologist is the one who knew what had happened and suggested the change to the drug she's taking now. If not for her, my mom would be dead now. Please question "authority"!!

over 3 years, said...

I had BP from birth and by the time I was in my 20-30's I rapid cycled, meaning I had a mania at least every 2-3 weeks. There were a few "normal" days but usually I was flying with the mania. When I was diagnosed at 38 a very good MD told me that remission might be possible. Of course, I did not believe him and stayed on the Lithium for 9 years. My career fell apart as it messes with your concentration so much. At 9 years I have it up. AND I am perfectly BP symptom free. It has been 14 years now! So recovery is possible in some cases.

over 3 years, said...

As a survivor of BP2, I try to get the word out that pharmaceuticals only temper the symptoms. Psychiatrists, psychologists and neurologists need to stop their mantra that "...the right combo of meds will tame the disorder and you'll be able to work again!". That's a lie...but the meds for a small percentage of patients are effective to soften some symptoms, but always have bad side effects. This is a life-long struggle, and for me all meds have been worse than the disease. TREATMENT is not CURE. Be sure to question your Doc about success in treatments before you drink the koolaid.

over 3 years, said...

One thing about Bipolar II, there are longer periods of levelled emotions between periods of either ups or downs. Not always a rollercoaster ride between the two. "Normal" times happen for long stretches. I had major manias between ages 19-21 and 39-44 with very little mania and more depression between those times. For me these were times of vast loneliness which I feel is my main trigger for mania problems. Someone commented here Bipolar folk are more intelligent quotients, well it does not help much to have higher IQ's when your emotional quotients EQ's are not functional when dealing with this illness or trying to think through the fog of either this illness or the medications involved in treating it. To me one is as bad as the other. Oh well, Bipolar patients are not well known for sticking with their meds.

over 3 years, said...

yes as I am bi-polar it helps me more on understanding my disease more

over 3 years, said...

I suffer from bipolar II which wasn't diagnosed until I was 35. That was in 1995. I recommend studying up on the subject learning about new studies, learning the symptoms, talking to your health-care provider, what type of life events trigger manic, and recognize your mania, take your medication religiously. Don't self-medicate with alcohol this is a depressive!! Never worry about what people think, cause most are just plain ignorent and stupid anyway!!! KNOW YOURSELF!!!!

over 3 years, said...

Hi my son has been diagnosed as bipolar and I need what resources are there to help

almost 4 years, said...

The woman that wrote this expressed a lot of generalizations. Bi-Polar disorder varies from individual to individual and to fix specific attributes to it is a disservice to those of us that Live with the disorder. And I also noticed that she left out the FACT that individuals who have Bi-Polar Disorder generally have much higher I.Q,'s than the general public. It's easy to focus on the negative aspects of Bi-Polar Disorder - it takes some real integrity to Lift up the positive. Many have even put forth the possibility that Jesus Christ was Bi-Polar. Think about it next time you try to Pigeon Hole people with Bi-Polar Disorder. It's always the negative that's focused upon. I know - I'm a person with Bi-Polar Disorder.