References

T., & Coppen, A. (1986). Who responds to prophylactic lithium Journal of Affective Disorders, 10, 115-125, Akiskal, H. S. (1996). The prevalent clinical spectrum of bipolar disorders Beyond DSM-IV, Journal of Clinical Psychopharmacology, 16(Suppl. 1), 4-14. Akiskal, H. S., & Akiskal, K. (1992). Cyclothymic, hyperthymic, and depressive temperaments as subaffective variants of mood disorders. In A. Tasman & M. B. Riba (Eds.), American Psychiatric Press Review of Psychiatry...

Is It an Illness or Is It Me

N Chapter 3 we discussed the rather dry (though useful) DSM-IV diagnostic criteria. What these criteria do not address or convey is the emotional impact of learning you have bipolar disorder and acknowledging its reality. Most of my patients go through painful struggles in coming to terms with this diagnosis. Initially, they experience anger, fear, sadness, guilt, disappointment, and hopelessness. These are not manic-depressive cycles but rather a process of forming a new sense of who they are,...

Info

What Bipolar Disorder Looks Like to You, to the Doctors, and to Everyone Else Ihough bipolar disorder is very difficult to diagnose, the textbook descriptions of it make it sound like it shouldn't be so hard. After all, what could be more dramatic than shifting between extraordinarily manic behavior, feeling on top of the world and supercharged with energy, to feeling depressed, withdrawn, and suicidal Consider a surprising fact On average, there is an eight-year lag between a first episode of...

How Do You Know tf Youre Getting More Depressed The Mood Spiral

One symptom of depression seems to feed on others negative moods like sadness and anxiety, along with the physical symptoms of depression like lethargy or insomnia, produce negative thinking (for example, negative self-statements, the harshly critical voice in your head), and vice versa. The combination of negative mood, negative thought patterns, and physical changes can make you feel less motivated to try hard, which can make you withdraw and, in turn, worsen your negative thinking and mood....

Bipolar Depression An Illness Not a Character Flaw

Alexis, a 37-year-old woman with bipolar II disorder, had been dealing with an ongoing depressive state for years a state that occasionally became worse and incapacitated her. She had tried to alleviate her depression through various antidepressants, medicinal herbs, cognitive therapy, group treatment, and, at times, exercising to a fault . driving myself constantly until my body gave out. Her depressions were usually accompanied by self-accusations about being weak, not having the courage to...

Bipolar Disorder and the Work Setting

Louise, a 35-year-old woman with bipolar I disorder, had a manic episode that led to a short (five-day) hospitalization. Prior to the development of her episode, she had worked as a paralegal in a law firm. The trigger for her hospitalization appeared to have been a legal case, for which the firm had insisted that she work late at night for several weeks to help prepare the attorneys' arguments. Her episode kept her out of work for almost a month. When she had mostly recovered, she returned to...

What Can I Do If I Think Im Getting Manic

Robert, 45, managed a successful landscape architecture firm. He'd had three manic episodes in the four years since he had been dating his current girlfriend, Jessie, with whom he was now living. Two of his episodes involved hospitalizations. He maintained close contact with his two kids from a previous marriage, 18-year-old Angie and 22-year-old Brian. Jessie had no children. His most recent manic episode, which had led to a hospitalization, involved an identifiable set of warning signs. The...

Beliefs about Drinking Drug Abuse and Bipolar Disorder

People often have mistaken beliefs about alcohol, drug substances, and bipolar disorder. Some of these are listed in the sidebar on this page. I've heard people with bipolar disorder claim that marijuana or cocaine is just as effective as a mood stabilizer such as Depakote in controlling their mood states. They argue that alcohol calms them down, or reduces their anxiety, or improves their depression they argue that marijuana boosts their mood when they are depressed. One patient said, For me,...

What Family Problems Might I Encounter after an Illness Episode

During your period of recovery, your close relatives are going to have confusing feelings about your illness and confusing thoughts about how to help you. In the following sections I explore the most common problems that may arise. Negative Emotional Reactions from Your Relatives Randy, a 45-year-old plumber, had two episodes of depression and several hypomanic episodes. His most recent episode, a depression, led to the loss of his job. His wife, Cindy, had a rudimentary understanding of...

Whats Different about Thinking Patterns in Bipolar Depression

So far, the cognitive restructuring method I've described could apply to almost any form of depression or anxiety. The method applies well to bipolar disorder, but bipolar depressions tend to be much more severe than those experienced by people going through life transitions. So, in constructing your alternative or balanced thoughts, consider the role of your disorder particularly, its biological and genetic underpinnings in modulating your view of the causes of negative events. Do chemical...

The Relapse Prevention Drill

How important is it to know when you are getting manic One study indicated that there were two predictors of rehospitalization in bipolar disorder not taking medications, and failing to recognize the early signs of relapse (Joyce, 1985). On a more hopeful note, people with bipolar disorder who receive educational interventions, such as learning to identify early warning signs of mania and then seeking mental health services, are less likely to have full recurrences of mania and have better...

Resources for People with Bipolar Disorder

Depression and Bipolar Support Alliance (800-826-3632 www.dbsalliance.org) is devoted to educating consumers and their family members about mood disorders, decreasing the public stigma of these illnesses, fostering sell-help, advocating for research funding, and improving access to care. You can fill out a confidential on-line mood disorder screening questionnaire to help you identify whether you have the signs of bipolar disorder, Positive results front this questionnaire suggest that a more...

Zung Selfrating Depression Scale

Read each statement and decide how much of the time the statement describes how you have been feeling during the past several days. Make check mark (V) in appropriate column. 3. I have crying spells or feel like it 11. My mind is as clear as it used to be* 12, I find it easy to do the things I used to* 13. I am restless and can't keep still 14. I feel hopeful about the Future* 16. I find it easy to make decisions* 17. I feel that I am useful and needed* 19. I feel that others would be better...

The Desire to Escape

People with bipolar and other depressive disorders often feel hopeless, as if nothing will ever change for the better. They feel a strong need for relief from ''psychic pain colored by the fear and anticipation of increasing, uncontrollable, interminable pain (Fawcett et al., 2000, p. 147). Some people honestly want to die. But in my experience, most people with bipolar disorder want relief from the intolerable life circumstances and the emotional, mental, and physical pain that goes along with...

Where Does Bipolar Disorder Come From

Stress Vulnerability Model

Stacy, 38, had two young daughters and worked part time for an accounting firm. She had carried the bipolar I diagnosis for at least 15 years and took Depakote on a regular basis. Although she agreed that she'd had severe mood swings, her interpretations of their causes tended toward the psychological rather than the biological. She often doubted that she had bipolar disorder She was scientifically trained and felt that the absence of a definitive biological test meant that the diagnosis should...

Contract For Preventing Mania

Your physician's name _ Phone number, office _ Your therapist's name _ Phone number, office _ Name of local hospital _ Emergency room number _ Your insurance carrier _ Policy number _ 1. List your typical early warning (prodromal) signs of a manic episode (from the exercise on page 192 above). 2. List the circumstances in which these prodromal symptoms are most likely to occur. 3. Ask one or more members of your core circle to add any other early warning signs they've observed, and, if...