Welcome to Bipolar in Focus. I'm Jane Pauley. Bipolar isn't actually one disorder. It is a spectrum of issues, of varying degrees.
Dr. David Kahn of Columbia University and New York Presbyterian Hospital is here. What do we mean when we say spectrum?
Well bipolar disorder comes in a lot of sizes and flavors. Bipolar I disorder, bipolar II, cyclothymic disorder,
in psychiatry we also have a category called NOS (not otherwise specified) for people who don't quite fit but look like they have it.
And then other ranges of personality traits that may be on the fringes of bipolar disorder but not quite there to the level of being well recognized.
What does bipolar I look like?
It's really the classic form of the illness:
full-blown mania, full-blown episodes of depression, marked impairment during both phases of the illness and an unmistakable effect on the course of one's life.
Most likely to get treatment?
Most likely to get treatment, end up in a hospital, end up in an emergency room and end up unmistakably recognized by people around the person as having really distinct phases.
In contrast, what you call bipolar II you'll sometimes hear at and described as soft bipolar or mild bipolar?
You know in a way, it is just as severe. It's called soft or mild only because the highs are lower. The highs instead of being called mania are called hypomania under the threshold for mania.
Many of the same symptoms decrease need for sleep, high energy, increased grandiose and self-esteem but not severe functional impairment.
The person with hypomania can feel very good, very functional on top of the world --
--but when they are depressed, the depressions in bipolar II disorder are devastating, very prolonged, very hard to get out of and the suicide rate is higher in bipolar II illness than bipolar I.
Cyclothymia, what is that?
Cyclothymia is milder, the lows are less low, the highs are less high
and a person with cyclothymia will often vary over the course of the few weeks between being a little bit high and a little bit low.
Often, they'll appear to have a personality that we would call a very fluctuating or brittle or unstable personality because they may have high energy and ability to function better for a few weeks
and then suddenly kind of go into a shell and disappear and not return phone calls, feel a little bit down in the dumps and then reemerge from it again full of beams a few weeks later.
If you look it up sometime, you'll see bipolar III and bipolar IV mentioned, what are they?
These are informal terms that we use to describe people who only get manic when they are taking antidepressant medication
or have very frequent bouts of depression that cycle so frequently that we wonder if they are related to bipolar illness.
And there are other subtypes as well, what are they?
Seasonal affective disorder, postpartum depression, rapid cycling illness as well as forms of bipolar illness that are caused by substances or by medication.
Umm, rapid cycling?
Rapid cycling is a course of bipolar illness in which individuals have four or more episodes per year.
The episodes are often relatively brief but the fluctuation in symptoms can have a very complicated effect on treatment.
People with rapid cycling illness tend to be thrown off course more by antidepressants. They'll cycle up into mania, cycle down into depression and it's much more difficult to stabilize.
The good news however is that as difficult as it is, it is treatable.
It is treatable. Most people with bipolar illness can be helped tremendously by taking mood stabilizing medications,
by using psychotherapy to understand how stress affects them and intersects with the illness.
Dr. Kahn, thank you and thank you for joining us for Bipolar in Focus.