How do I handle my bipolar disorder?

October 6, 2007 5:59 AM

How do I handle my bipolar disorder?

A bit of background on myself: I'm in my early twenties, male, physically healthy (although a bit underweight), and I live with my relatively stable and loving girlfriend. Sorry for the length of this post, but I know the people here are very sincere and at least a few of them are willing to read whatever tripe I blather out.

I have come to the conclusion that I am bipolar. This is more of a "duh", slap on the forehead type of realization than anything, because I have been going through very obvious cycles of depression and immense happiness since I was about thirteen, but only now am I willing to accept the fact that I have this disorder and that it is very real and that it is screwing with my life every three to four months.

During periods of hypomania (I believe that's the correct term, because I never feel that I can't sleep or function properly when I'm not depressed) I have a great appetite, I actually make new friends and want to go out and do stuff with them, I feel energetic and productive and I'm altogether a great person, so I've been told.

On the other hand, when I'm going through a depressive episode, the only thing I want is to be totally and utterly alone. In the past I have pretty much shirked all shirkable responsibilities -- I've dropped out of school twice, quit every job that I've had, gone into debt, and totally ignored and lost all friends that I've made since high school. I haven't talked to my mother (who has been diagnosed with bipolar disorder) in four years. These are not things that I take lightly, and I'm sure some of you can understand the horrible shittiness that a person goes through when they repeatedly fuck up their own dreams and goals. I have tried to shrug off my self-deprecating behavior as some kind of valiant "test" that I put myself through regularly to boost my resistance to the world's evils (who knows...), but that is very obviously total BS.

I love where I am right now. I'm going to a great school in a great new city, I want to graduate, travel, get a fantastic job, get married and live my life to the fullest. Unfortunately, I know that the possibility of losing any or all of these things is very real and I'm quite capable of throwing it all away. I'm not suicidal, but after watching Stephen Fry's The Secret Life of a Manic Depressive, the odds are that I very well could be in a few years if I don't do anything about this (do 20% of bipolar people really end up killing themselves!?).

To make a long story short, I'm totally at a loss here and I need some help. I know the first thing to do is always get thyself to a doctor, but I'm ashamed, penniless and going through a down period. I'm afraid to take medicine because it might hamper me when I'm feeling good, and I hate to be dependent on some external force. I don't think I can regularly go to a therapist because A, it's expensive, and B, when I feel like shit I'll just end up skipping sessions and it will be useless. See, even as I type this I'm shirking responsibility for myself. What I want to know is, how did you do it? How did you, or someone you know, overcome or manage their bipolarity?

posted by anonymous to health & fitness (20 comments total)

I know you would like to hear something else, but you've got to go to a doctor. In the first place, you don't know that you've got bipolar disorder. You've made a diagnosis of yourself that you aren't qualified to make. I wish that there were a way for you to get through this without going to the doc, but there isn't, and you need to. Treatment comes after diagnosis. Sorry.
posted by OmieWise at 6:09 AM on October 6, 2007 [1 favorite has favorites]

1) Stay busy and very goal-oriented
2) Exercise vigorously and regularly
3) Consume fatty-fish rich with Omega 3 (which is good for the brain and can help stabilize your moods)
4) Have an attitude of gratitude and always think positive thoughts (which kinda correlated w/ number one).
posted by JaySunSee at 6:25 AM on October 6, 2007 [1 favorite has favorites]

your school should have a counseling service, which should be covered by your student insurance (or at least be free, or affordable). they will help you. please go to them.

there are a lot of treatments for bipolar disorder these days. don't be afraid that they will change who you are--the right one won't. please take control of this and advocate for yourself and your goals for treatment. it's the only way.
posted by thinkingwoman at 6:28 AM on October 6, 2007

do 20% of bipolar people really end up killing themselves!?
Yeah. And that number is actually under-reports the problem, cuz it only counts suicides. Bipolar individuals tend to self medicate with all sorts of illegal pharmaceuticals, and undertake risky behavior when manic; but dying from overdose or accidents aren't counted in the "suicide" numbers.

Other than that, ditto what OmieWise said. Contact your local bipolar support group or county mental health office; they can probably hook you up with a low cost or no cost psychiatric evaluation if you are poor.
posted by jytsai at 6:28 AM on October 6, 2007

I'm afraid to take medicine because it might hamper me when I'm feeling good, and I hate to be dependent on some external force.

I'm sure you know how dumb this is, since you seem sensitive to your own rationalizations/bullshit, but just to spell it out: is the "feeling good" really worth wrecking every opportunity you have and possible suicide? As for the "dependent on some external force," come on. We're all constantly dependent on external forces. You're just trying to talk yourself out of doing what you know you need to do.

Good luck—I hope this thread gives you the impetus you need!
posted by languagehat at 7:11 AM on October 6, 2007

Diet
Exercise
Meditation
Therapy
Medication

My girlfriend suggests looking for a free or low cost clinic. Check your services at school. If you must go to a full cost doctor or therapist, ask if they have a sliding scale or if they'll give you the rates they charge insurance companies.
posted by brevator at 7:15 AM on October 6, 2007

Untreated, bipolar disorder will get worse over time. Your depression will be more unbearable, your hypomania will turn to mania, and these peaks and valleys will begin to cycle more rapidly.

Definitely go to the student health center. They should have psychiatrists who work there, and once you have been diagnosed, they may be able to tell you about sliding scale clinics or other treatment options in your area.

Congratulations, though, on realizing you have a problem and deciding to deal with it. You do need to go see a doctor, and it won't be as bad as you imagine it will be.

Also, you might try reading "An Unquiet Mind" by Kay Redfield Jamison, a bipolar woman and a psychiatrist.

And you know, you may only be depressed and not bipolar. "Only" is a bad word choice, as depression can be terrible. But coming out of a depression may seem like hypomania, because you feel better about yourself and are capable of doing the things that you feel you should be able to do.

So take it one step at a time, one very small step at a time. Make an appointment. Go to the appointment. See what comes of it. Don't worry about the big picture yet, because it seems that is what is overwhelming you.

Good luck.
posted by brina at 7:45 AM on October 6, 2007

Sorry to go against the grain on this one but, ....

No need to diagnose yourself, (or have anyone else do it for you) everyone suffers from every disorder to some extent, accepting a diagnosis only cements it. People around you will expect it from you and you will be more quick to notice BiPol tendencies in your own behaviour.

That said, I'm pretty similar, I'm early 20's was in a great school I loved for a year, went a little crazy, joined the military, now live in Japan. Although I despise the Military life and everything they stand for. The regular exercise and regimented schedule have worked wonders for me.

Before the military I was on several medications, an anti psychotic right before I left for boot camp. I have to say, medication is not the answer and I cannot believe it took me so long to realize it. Yes, it can "help" but kind of like the way a friend is helping when they ignore the food on your face so as not to embrace you. Psychiatrists are trained to find something wrong with you even if its not there. It is a self preserving system, don't trust it, trust yourself.

I too took advantage of my school's free counceling, and guess what, they found something wrong with me too. These are usually grad students looking to make any and every diagnoses (but, honestly, with the best intentions) they can. They are good people, but don't trust their opinions.

Don't forget, Bipolar is a fairly recent addition to our "known" disorders, it is not a real thing. Yes, people do suffer from something that the term bipolar attempts to define, but it is just an attempt.

As for the suicide thing. I know three people that have bipolar, my Mom, my Uncle and myself, my uncle killed himself six months before I joined the Navy. Good luck, and be careful, stay happy and remember that life is just a ride, no matter how scary and shitty it gets.

DSM IV talks strictly about people "having" a disorder not being a disorder, E.G. he suffers, or has bipolar disorder, not, he is bipolar. I know it's small, but that idea has made a big difference in my thinking, we are not our disease.
posted by nintendo at 8:05 AM on October 6, 2007

Keep in mind that since you are self-diagnosing, the real problem may be what keeps you from going to a professional and trying to figure it out on your own.
posted by rhizome at 8:10 AM on October 6, 2007

Oh, crap! don't let people like brina get to you bro, there will always be people like that, you need help, seek help. I believe it is where we get into trouble, thinking that there is someone out there who can help, or fix the "problem" theres not solution, no one has an answer. Please be careful taking advise from anyone, including me. Bipolar is not a broken leg.

No one will ever know more about what's wrong with you that you will.
posted by nintendo at 8:11 AM on October 6, 2007

Wow, this question was like reading a self-description. I am not a doctor, but I am bi-polar, male, in my 20s, and I don't have health insurance or take any kind of prescription medication. I have been through six or seven jobs in the last two years, and I have serious debt problems. I self-medicate with marijuana and nicotine, and to some extent alcohol (although I am trying to quit). All of these 'treatments' are bad.

I know this will sound hypocritical, but fuck it: if you are bi-polar, avoid alcohol, marijuana, nicotine and caffeine, in that order. Please. Be honest with yourself and be aware of what you do to self-medicate. Alcohol abuse can trigger severe mania and even cause insomnia, which can be big problems for someone with BPD. Marijuana and other illegal drugs can also be harmful and make worse your condition and have for me in the past as wel. My solution for now is to utterly avoid alcohol. It has been a struggle, but it's worth it.

It should go without saying that you ought to eat healthy and watch your diet, but I'm telling you to watch your intake - drugs and food. It's very important.

Guard your sleep well too - have you noticed your mood changing a lot based on your sleep? I have. Ask people around you. Don't take offense when someone points out you've been moody.

Finally, exercise. You will feel worlds better, but you have to be consistent. It is great stress release. If you're like me at all, don't try to go it alone - get involved in a group activity or a gym where people exercise as a class, it makes it much easier. Have a buddy who will go with you or motivate you. It seems like whenever I try to do anything myself, I make a really good show of it at first and eventually drop off.

But please, see a doctor. If I wanted to, I could walk into the offices of three different doctors and get three different diagnoses if my own reporting of my symptoms is biased towards a certain desired outcome. There are co-morbidities between bi-polar disorder and lots of other mental disorders, so it is possible that you have something else but with very similar symptoms to BPD. It should also be noted that people don't all have bi-polar disorder in the same way, some people have it far more severely than others. All of these factors can contribute to how you go about treating the disorder.

Avoid what triggers mania for you (it's drugs and lack of sleep for me). The problem is I would get manic and do a bunch of terrible shit that felt good at the time, and then later the depressive side would kick in and I would dwell on what I did and want to kill myself, consumed by guilt and self-hatred. This cycle feels endless sometimes, and is the conscious, mental manifestation of what is first a neurological and physiological condition of swinging between the poles. I don't have suicidal thoughts as often as I used to, for example. I guess I'm in the 80% group, and I mean to stay there for a while.

Please be honest with your doctor, and don't 'tailor' your answers to their questions for the result you expect or possibly hope for.

Please be honest with yourself. It took me a long time to just come to terms with the fact that I have a mental illness. I was not officially diagnosed until I was 23. It was a severe blow to my ego and my own pride got in the way of me accepting my diagnosis and seeking treatment - only the weak and feeble have mental problems and I was a jock in high school, and we were supposed to never show weakness. It was hard for my family and friends to come to terms with, and many of them still don't understand. I refuse to use it as an excuse or a crutch when I treat people poorly, but I have to recognize that BPD plays a factor in that and I must work really hard to prevent it from hurting others.

The best way to gauge how you are doing is through other people - stable people outside your own subjective, emotional filter. Trust me, you are your own worst doctor. Get a support group. I have not done the anonymous support group route but I have a good group of friends and family who I trust to be honest with me. It helps keep me in check when I start cycling. Good luck, and if you have any more questions or just want to talk, my email is in profile.
posted by chlorus at 8:14 AM on October 6, 2007 [2 favorites has favorites]

Don't forget, Bipolar is a fairly recent addition to our "known" disorders, it is not a real thing.

You don't know what the hell you're talking about. You may be trying to suggest that Bipolar Disorder is a current fad diagnosis, something with which I tend to agree, but the notion that it's a new disorder is just plain wrong, and the notion that it isn't "real" is too wacky to comment on. You might want to read a bit about Emil Kraepelin, whose ideas I don't agree with for the most part, but whose diagnostic nosology (look it up) included manic-depression (bipolar disorder) at the end of the 19th century.
posted by OmieWise at 10:21 AM on October 6, 2007

Don't forget, Bipolar is a fairly recent addition to our "known" disorders, it is not a real thing. Yes, people do suffer from something that the term bipolar attempts to define, but it is just an attempt.

This is so muddled, I don't know where to begin. You say "it is not a real thing" but also "people do suffer from something that the term bipolar attempts to define." So it IS a real thing.

There's no such thing as an illness writ in stone. A broken arm "is" an abnormality because most people have agreed to classify it as one. They've come to this agreement because, in general, they've noticed that people are happier without broken arms than they are with them, and because there are steps we can take to turn broken arms into non-broken arms.

(For something to be deemed an illness, it has to be (a) an abnormality that many people find undesirable -- as opposed to one like "being a genius" which many people find desirable -- and (b) actually curable or conceivably curable. There's no conceivable cure for old-age, so we don't consider it an illness; there also isn't a cure for some cancers, but we can imagine such cures being discovered.)

These endless debates over whether X is or is-not an illness are wastes of energy. Instead, expend your energy thinking about this: does X make me (or those around me) unhappy? It it conceivable that this unhappiness can be fixed or mitigated?

A brain is not a special, magic thing. It's a body part. If you broke your arm or had a heart attack, would you avoid doctors?
posted by grumblebee at 10:49 AM on October 6, 2007

I hate to be dependent on some external force.

You already are--your brain chemistry.
posted by sondrialiac at 12:04 PM on October 6, 2007

Others have chimed in with helpful info but I wanted to point out, again, that diagnosing yourself with a mental disorder is even more fraught with pitfalls and peril than diagnosing yourself with a physical disorder. It's not like looking at your arm, seeing a compound fracture, and saying "Hey, my arm's broken."

It is very, very difficult to judge what is happening to your own mind from the inside beyond the most obvious things like being so depressed you want to kill yourself and the like.
posted by Justinian at 12:39 PM on October 6, 2007

Dont self-diagnose. There's a spectrum of mood and emotional disorders. Bipolar disease is just one of them. Find the social resources (contact your state or country health/human services) see a real doctor and get a real diagnosis and treatment. Good luck!
posted by damn dirty ape at 12:52 PM on October 6, 2007

Get thee to a doctor/psychologist/psychiatrist quick.

Yeah, you won't get as high anymore. On the other hand, you won't get as low anymore. The extremes of your swings will be damped.

Speaking as someone who has had quite a few close friends struggle with BPD and eventually come to terms with it, the sooner you man up and get going, the less you'll fuck up your life.
posted by ysabet at 4:12 PM on October 6, 2007

A few things here. First--having lived with bipolar myself, I know how difficult it can be. But it is not insurmountable--you can live and thrive with this disease, though at times it can be a handful. Moreover, while this is a medical condition, it does have a stigma associated with it that other physical ailments don’t have. There is absolutely no reason--I repeat, no reason--to be ashamed of having bipolar disorder.

Second--seeking help. I do think that you need to go to a doctor ASAP. You say that money is a big issue, and I can understand how that would be a huge problem. But again, this is a chronic medical issue. If you had, say, diabetes, you’d seek regular treatment, and this should be no different.

Third--living with it. This is a tricky one. When you say that you are worried that meds will hamper you when you’re feeling up, I understand what you mean. People who’ve never experienced a manic episode don’t always appreciate what it’s like; I’m honest enough to admit that I miss them sometimes. I’ve never felt more productive, or smarter, or more confident than when I was in the middle of an episode. The meds will bring you down, and in that sense “hamper” you.

But--and this is important--constantly cycling through hypomania and depression is far, far worse. I’ve found (and this is true of many bipolar individuals) that my hypomanic episodes got more and more dysfunctional. I ceased to be productive, I became much angrier, and I became much more willing to engage in risky or self-destructive behavior. (The downside of increased confidence being that the filter which usually tells you “hey, that’s not such a great idea” before you do something stupid gets very, very muted.) If you’ve really been cycling through hypomanic and depressive episodes, then that’s going to do much more to hurt your life than cutting the “highs” off your hypomanic episodes.

(Side note--on the idea that you don’t want to be dependent upon an external force. To some extent this is your condition talking. Bipolar people--myself included--tended to think we can do everything ourselves. It’s part of the hypomanic overconfidence, that feeling that pure energy can solve any problem, etc. And think of how you would feel if you knew someone with dangerous cholesterol or a hear condition who didn’t want to take a pill everyday because they’d feel dependent. Bipolar disorder’s a condition like any other.)

Fourth--the number of bipolar people who end up committing suicide isn’t 20%, but it is not much lower than that. But to some extent this comes from misperceptions about the disease even among those who suffer from it. Many believe (because they’ve read this, or been told this) that bipolar only ever gets worse, that however you feel at 25, your life will be worse at 45. This, in fact, isn’t true. The disease does *not* automatically progress like that. Everyone’s case is different, but fatalism here--and I use that term specifically--is uncalled for.

How to live with it? Don’t be ashamed. Seek treatment. Recognize that you will have to manage your life differently, which will include taking medication, getting therapy, and probably changing your lifestyle. (Things are different when you can no longer count on your mania to deal with some situations.)

And: build a support network. This means slowly bringing friends and family into your circle, explaining your situation to them, making sure that they can look out for you if your condition takes a turn for the worse. In my case, I cannot tell my family because they don’t “believe” in psychiatry. (They’d rather try to pray the disease away, which won’t exactly happen.) My wife knows, and knows all my doctors in case she needs to talk to them. Several friends know, as do my boss and human resources at my job (to protect me from discrimination, in case any co-workers are so inclined.) One friend even has the numbers of my psychologist and psychiatrist available if she thinks they need to know how I’m doing.

Asking for help doesn’t mean you’re dependent. You have nothing to be ashamed of; you just need to be diagnosed and treated. You can live and thrive with this; lots of us have.
posted by historybuff at 8:44 PM on October 6, 2007

Do not self diagnose. I caused no end of grief for myself when I self diagnosed myself as depressed and went to a GP to get medication for it... triggering a full blown mania because it turns out I had bipolar 2 and the medication pushed me over.

Do not self diagnose. Go talk to a doctor, try not to bias the discussion.

If you do end up with a bp diagnosis, it's not the end of the world.

drug talk
http://www.crazymeds.org/

it's not all about medication and "chemical imbalances". You can use CBT and diet and maintaining good sleep hygiene to help.

all of which I don't do so well, but doesn't stop me from recommending. :)
posted by bleary at 9:28 PM on October 6, 2007

Hi anonymous,

Sending you a cyber hug (((((anonymous)))))

Hang in there honeybun, you'll get through this. You're not alone.

Brave of you to share and a positive step forward to seek advice, while articulating what's going on for you. I find that talking about a problem, bringing it out of the shadows into the light of awareness, can be a huge relief and the beginning of things getting better.

There are excellent Bipolar and Cyclothymia recovery groups online of all kinds that you can join for free, anonymously, where people share their experience, strength and hope.

You may have cyclothymia, "a milder form of bipolar II disorder consisting of recurrent mood disturbances between hypomania and dysthymic mood."

Cognitive Behavioral Therapy (CBT) is the psychotherapy of choice. These therapists are trained to understand the issues of the depression phase and the hypomania phase. That's their job.

If you want to know more about CBT, you might wander into a Barnes and Noble and hang out there, checking out books on the subject for free.

If you go to a big hospital and talk with somebody there, they may well have a community clinic or a social worker to help you get treatment really cheaply. Reach out for help.

You can go to the U.S. Department of Health & Human Services in your area and say you need Medicaid, which will cover the cost of a shrink to diagnose you for bipolar medication.

A big hospital in NYC says "The Clinic accepts many forms of payment, including private insurance, managed care programs, HMO's, Medicaid, and self-payment on a sliding scale."

AskAPatient rates medications by people who take them. Here's the list of antidepressants people rated.

I struggle with depression. Depression has a kind of downward pull. Yes, it's so isolating and paralysing. It's hard to find motivation to move forward or out into the world. The thing is that it's basically controlled by brain chemistry. Medications can really help. Even for a short period of time. I've found taking taking an antidepressnt for half a year was enough to get me moving along ok. If your brain has a three or four month cycle, perhaps during hypomania months you might take another medication? Or not? Each person's brain and life is different.

Antidepressants are not addicting. I think brain medications may, in some cases, actually help heal the brain because depression scars the brain. When you're not depressed, if you do the healthy things for your body and mind, eating well and exercising, as best you can, I think you'll be surpised at the good results.

You sound sane, honest and clear about your situation. If you're not in the mood to connect with others offline, you might try online recovery groups first.

Best wishes on your recovery journey.
posted by nickyskye at 10:55 PM on October 9, 2007