Whether you’ve been diagnosed with bipolar disorder or you care about someone who has it, you know it’s a complicated condition.
WebMD hosted a Facebook Live event to get expert answers to your questions about the disorder. Here are some of the highlights from psychiatrist Smitha Bhandari, MD, and WebMD Senior Medical Director Arefa Cassoobhoy, MD.
I think I have bipolar because I feel so euphoric at times, but then so depressed at others. Are these normal feelings?
Everyone can feel happy or strained with the ups and downs of life. “But when it's bipolar, these things are happening either outside of stressors, or they're happening to a greater magnitude, a much stronger degree than what you would expect,” Bhandari says.
The two phases of bipolar disorder, mania and depression, are more than feeling very happy or sad. When you’re manic, you may have tons of energy, talk very fast, have racing thoughts, don't feel the need to sleep, or take a lot of risks. During the depressive phase, you can feel hopeless or worthless, have no energy or motivation, have trouble sleeping, or even think about harming yourself.
Your doctor or a therapist can help you sort out the differences between normal feelings and signs of a mental health problem. Think about taking a friend or family member to your appointment with you – they can often point out patterns or behaviors you didn’t notice in yourself.
What are the differences between bipolar I and bipolar II?
Both types have the same symptoms of depression, but their manic phases are different. People with bipolar I have “typical” mania -- feeling uncontrollably excited, energetic, and invincible. Some may believe things that aren’t true or feel paranoid.
Bipolar II is a “milder” version of mania, called hypomania. It still makes you feel energetic or restless, have racing thoughts, and take risks, but those feeling are less intense than in mania. It also usually lasts for a shorter period of time.
“But that minor version can still be disruptive to your work and personal life,” Cassoobhoy says.
Is it true that bipolar often gets misdiagnosed?
The condition has symptoms that are common in other mental health problems, too. For example, trouble concentrating is a symptom of ADHD, depression, anxiety, and bipolar disorder.
If a doctor or a therapist is only able to look at one symptom or one period of time in your life, it may be harder for them to diagnose the condition. That’s because bipolar mood changes don’t happen day-to-day. Some people have months or even years between episodes of mania or depression.
It will help if you can establish a good relationship with your doctor or therapist, and see them regularly. “There's a real importance to continuity of care, really seeing the big picture over time,” Cassoobhoy says.
Is bipolar always hereditary?
Scientists are still studying how bipolar disorder might be linked to the genes you inherit from your parents. But they are finding that the condition tends to run in families.
“Does every person with bipolar identify a family member that has bipolar? No. But there is definitely a growing genetic component,” Bhandari says.
It can be hard to get reliable facts about a family history of mental health, Bhandari notes, because past generations may not have known about bipolar or had access to mental health care. But even if you know you have a relative with the condition, it’s not a guarantee that you will have it, too.
I've been taking bipolar medication for a year. Due to financial issues, I can no longer afford my medicine. What do I do? Is it bad to quit meds cold turkey?
It’s not a good idea to suddenly quit your treatment. “Stopping medicines cold turkey can be uncomfortable, and it can actually be quite dangerous,” Bhandari says.
You could go into withdrawal, or it can make your depression or mania worse.
If money is keeping you from taking your meds, the best thing to do is to talk to your doctor. They might be able to switch you to a more affordable generic drug, or call your insurance company to talk about your drug costs. “They might be able to give you some alternatives,” Bhandari says.
What is the importance of family members and caretakers for people with bipolar?
It can be hard for those with the disorder to notice their own moods or behaviors, especially during a manic episode when they feel on top of the world. But those symptoms can also make you less able to recognize that something's wrong.
“And that's when it's really important to have family members and caretakers help you monitor, and sort of keep tabs on what your energy's doing, your sleep is doing, maybe what your mood is doing,” Bhandari says.
They also may be able to help you recognize when a bout of mania or depression is about to start. That can give you a chance to get a handle on your mood before the problem begins.
How can I manage the mental exhaustion that comes from the roller coaster ride of ups and downs?
There’s a cycle to bipolar disorder. It’s stressful and tiring to deal with your symptoms, but those feelings can also trigger mood swings. So it’s key to try to manage those ups and downs. Bhandari says she tells her patients to try to find a balance between stress and support.
“In the times when you feel like your stressors are really high, so you are exhausted because of the ups and downs of moods, look at what your supports are,” she says.
Support can come in different forms, depending on what your needs are. It could be something as simple as a friend cooking a dinner for you or watching your kids for a couple of hours. It could mean that you ask someone to live with you while you get through a rough time.
Your own healthy habits are also important ways to balance your mood. A healthy diet, getting enough exercise and sleep, and having a healthy routine can make you less likely to get worn down by stress and exhaustion.
My daughter and I both have bipolar disorder. We have enough burned friendships to make us afraid to start new ones. How can we keep bipolar from affecting new relationships?
Friends and family are a key part of your support system. So it’s worth it to work on how to protect and grow those relationships.
Therapy can help you improve how you communicate with others, such as how you ask for things or convey your emotions. A therapist can also teach you good ways to manage stress, which can trigger mood swings. There are many different forms, including group therapy, couples counseling, and family therapy.
Bhandari also encourages people with the disorder to be honest with their friends about how it affects them.
“Saying, hey, I have this diagnosis, and sometimes it makes me irritable, or sometimes it affects the way that I feel about you, or the way I feel about myself,” she says. “Sometimes being honest with somebody about that can really help.”
My sister-in-law has violent bipolar mood swings. I want to understand more about why this happens, and how I can help them have a normal life. How should I react when they have this explosive behavior?
It’s a challenge to be close to someone with a mental illness when you don’t always understand their behaviors.
“In the midst of it, you're wanting to protect yourself and not take it personally. At the same time, you want to support the other person, get them through their episode,” Cassoobhoy says.
During an outburst, try to stay calm. If they say or do something hurtful or embarrassing, remember that it’s the disorder, not the person, that’s to blame. It’s also a good idea to come to an agreement ahead of time about the things you can do for them when they're in a crisis.
And don’t forget to take care of yourself. Think about joining a support group for family and friends of people with bipolar. If you’re a caregiver for someone with the disorder, protect yourself from getting burned out. Take breaks, and find ways to manage your stress.
I know someone who displays all of the symptoms of bipolar disorder. What can I do if they refuse to get help, or don’t think they have issues?
A person in the middle of mania feels on top of the world. So they can’t see that there are any problems with their behavior. On the other hand, if they’re depressed, they may feel hopeless or totally unmotivated about getting better.
Bhandari says the best thing to do is talk to the person, but keep the conversation focused on specific behaviors or symptoms instead of delivering your diagnosis.
“You could say, hey, I noticed you're not sleeping well. Let's go to your doctor and talk about sleep. And that's usually not so threatening,” she says.