Bipolar types and their symptoms
Your doctor might have explained a bit to you about your illness, but you still find their words a blur. What’s bipolar I? II? NOS? Hypomania? Mania? Psychosis? (That last one initially sounded really scary, at least to me, but I have to say that I found it could be rather interesting – as odd as this may sound.)
Bipolar disorder is a chemical imbalance of the brain that causes our moods to become unstable. For a “normal” person, mood is directly related to things (triggers) happening around. When bad things happen, normal person feels bad. When good things happen, they feel good. This is why a lot of “normies” say offensive things, such as “you should pull yourself by the straps of your boots” or “everyone’s a bit bipolar sometimes”. They do not understand that our moods are not directly related to things happening around. For instance, my partner got seriously ill and landed in a hospital; I stressed, worried and lost sleep about it. It triggered hypomania rather than depression – I started feeling energetic and joyful, which made me feel guilty, which made me want to self-medicate with alcohol or drugs. Our moods do not follow “normal” patterns and do not respond to “normal” triggers in a way that is easy to understand. Our brain chemistry is not normal, and things that apply to “normies” do not apply to us.
The main difference between a major depressive episode (known as “depression” to most of the population) and bipolar depressive episode is that the standard depression responds to therapy more than to medication, and bipolar depression – the other way round. Therapy of a major depressive episode tends to be talking therapy aimed at finding out what is going wrong in patient’s life, what are past traumas that could have caused incorrect responses and formed wrong patterns, then correcting those. Therapy of a bipolar patient focuses on acceptance of the illness and related necessary lifestyle changes. It is, of course, possible for a bipolar patient to have negative thought patterns related to past experiences – you may suffer from both kinds of depression at once, so to say – but in general bipolar depression is mostly treated using medication.
Doctors have three handy drawers for us bipolars. Bipolar I is characterised by mania and less deep depressions. (In Europe, Bipolar I is diagnosed when you require hospitalisation.) Bipolar II is diagnosed when the patient is “more functional”, as it is characterised by hypomania and deeper depressions. And for everything else, there’s the Bipolar NOS (not otherwise specified) drawer. I suggest you don’t pay too much attention to those numbers – in my opinion they have mostly been invented by and for insurance companies. Therapy of all three is most often the same or very similar.
Bipolar disorder has the highest suicide rate of all mental disorders. As many as 20% bipolar patients commit suicide – fifteen times the rate of general population. This is a sad statistic, however, it is just a statistic. It does not need to apply to you – remember 80% do NOT commit suicide. There are very few cases of actual med-resistant bipolar. There are, however, a lot of cases of patients who refuse to take their medication as prescribed, combine it with drugs or alcohol or refuse to adapt their lifestyle to the illness’ requirements (see Lifestyle chapter). Here is where the real danger lies.
A lot of people believe they know what depression is. It’s that feeling, they think, when you just broke up with your boyfriend, you eat ice cream and listen to Nick Cave’s “Murder Ballads” a lot. You watch “Lost In Translation”. You’re depressed! Then you go out and hook up and come home with someone completely unsuitable but it’s okay because you’re “pulling yourself up by the straps on your boots” and getting over it.
Except, of course, it isn’t. Depression is an illness characterised by inability to function properly on the daily basis. Signs of depression include: low mood; inability to experience pleasure (anhedonia); ruminating over thoughts of guilt/regret; lowered self-esteem; hopelessness; self-hatred; decreased concentration and memory problems; insomnia or hypersomnia; fatigue; digestive problems or overeating; lethargy; decline in job/school performance. When depressed, I would find myself spending 45 minutes lying down after putting on ONE sock, because that used up all my energy. When I was lying down, I wasn’t having a rest; I was busy hating myself, my life, my inability to function and everything around me. You can’t pull yourself by anything out of depression.
I read a quote by Tyler Hamilton that what happens during depression is that your brain becomes convinced you are dying. It starts sending signals to your entire body that you are in agony. And so your body switches off, organ by organ… except there is nothing wrong with the body itself. You just find yourself unable to function, to perform the most mundane of tasks. And then, when depression passes, your brain – with its amazing capability of dealing with traumas – forgets about it. It’s very difficult to believe that you felt that bad a few hours or days ago. Until the next wave strikes and the process repeats.
As I wrote earlier, “standard” depression (for a non-bipolar person) responds better to therapy. Medication may be necessary anyway, as it was in my case – before bipolar diagnosis – because I was doing so poorly my therapist refused to work with me until I was able to walk without assistance and show up to appointments. But therapy can resolve the underlying issues to the degree where depression goes away and doesn’t show up again. With a bipolar depressive episode the opposite is true. Our depression is caused most often (not always – life isn’t that simple) by chemical imbalance in our brain. There is not enough therapy in the world that is going to correct the fact our brain doesn’t produce enough serotonin and/or dopamine for its own needs.
Anti-depressants, unfortunately, are not always safe for people with bipolar, because they may cause a rapid switch into mania. We do not fully understand the functioning of bipolar brain quite yet. It might be that it isn’t even serotonin that is the problem, but dopamine or a combination of those two or something entirely different. For some people, anti-depressants are a good solution. For some, they just aren’t. Discuss the matter with your doctor. It is not a good sign if the doctor completely refuses to prescribe you any anti-depressants without trying out first; it most probably means they have experience with other patients who got manic on anti-depressants. However, you are not other patients.
Strangely, it is not depression that puts you at highest risk of suicide, because suicide requires action. When depressed, we most often do not have enough strength to actually take that action. This doesn’t mean that you should dismiss your suicidal thoughts; you may feel a bit better just in that crucial moment when there’s a knife around or enough pills at your disposal. If you start making actual suicide plans, including a method and how to make sure nobody interrupts you, please use your strength to call someone instead. Suicide is permanent. You can’t undo suicide. But what may be even worse is an “unsuccessful” suicide which will wreck your liver, stomach lining, make you blind, give you brain damage, permanently damage your nerves or put you in a wheelchair for the rest of your life. There is only one piece of advice I have for you if you want to kill yourself: get help, and get it quick. And remember in bipolar nothing is ever permanent. This depression will end, it always does. It might take months or even years, but it will inevitably end. You want to be around to witness that miracle.
Things other than medication that help with depression include:
Rest – make sure you get enough of it. I don’t mean sitting on the sofa hating yourself – this is not rest, it’s a full-time job and an exhausting one at that. Go for a walk instead. If you have a problem dealing with people, like I do, choose a deserted spot. Sit on a bench in the sunshine. Read a book. Nobody will notice if you’re wearing yesterday’s clothes. It’s surprising how little attention people actually pay to each other – use this to your advantage.
Exercise – yes, this is repeated all over the place and that’s because it’s true. Exercise corrects your hormonal balance. There are people who use exercise as the main means to control their bipolar mood swings and swear by it. If you’re already lying on the floor, gather enough strength to take a few push-ups. If you’re on the sofa, stand up and do sit-ups. It doesn’t matter if you have to spend an hour to gather this strength. If you can get yourself to the gym, awesome, but you honestly don’t have to do that. Just gather enough strength to move a bit – if you’re in the catatonic state, you’re unlikely to achieve much more anyway. Take your time. And be gentle with yourself – I’m not asking you to run a marathon here.
Pleasurable activities – of course there are times when nothing is pleasurable. There used to be a time when I would walk past a funny poster and say “ha, ha” in a dead voice, because I literally forgot how to actually laugh – I was able to appreciate that the slogan is “funny”, I just forgot what that meant. Nevertheless, even when it feels like nothing will cheer you up, be kind to yourself. While a long hot bath with scented candles and pleasant music playing from your smartphone won’t cure you, it might help you make one tiny step towards remission. The one thing I do not recommend is sugar – yes, it works amazingly well, but it works for a short time and then drops you deeper than before, just like alcohol.
Diet – you are what you eat, and unfortunately this is also true when you are depressed. I realise that when depressed you hardly feel like cooking healthy stuff and you’d love to stick to fast food, but you need to remember that fast food will not do you much good. Alcohol is even worse, because for every drink that will make you a bit better now you will feel two bits worse the day after. Try – it will be hard, I know – to consume fruit rather than chocolate; salad rather than boxed pizza; green tea rather than coffee. Avoid alcohol, sugar and saturated fats. Chances are you don’t feel the taste anyway (I didn’t at my worst) – but remember every healthier meal brings you closer to the end of this depressive episode. It will also help you avoid weight gain, which is a notorious side effect of most medication.
Light – it is actually true: daylight lamps work. Sometimes they work so well they throw people into mania! But you don’t have to buy an expensive lamp. Many people don’t realise that supermarkets and shopping centres have extremely strong lights (which have a psychological purpose, but I digress). At my worst a friend managed to get me out of totally lethargic depressive state by taking me to a 24 hour Tesco. We spent two hours there. Depression disappeared for a few days. It doesn’t sound like much, but at that point few days was more than I believed even to be possible. Search for “daylight lamp” on the internet and pick a cheap one – it doesn’t matter whether it’s expensive, all that matters is that it provides the correct sort of light.
Being kind to yourself – when you are depressed, your ability to do things decreases dramatically. If you spend time whipping yourself mentally about that, it will be entirely unhelpful and actually reduce your strength further (whipping is quite hard work, you might find). Yes, you can call in sick if you are depressed – you don’t have to say you’re depressed after all. People call in sick when they’re hungover, you can do it when you quite literally can’t get out of bed. If you can, try to read a book you enjoy. If you can’t, perhaps listening to music is an option. If both are too much, it’s fine too. Remember: you are seriously ill. You have the right to feel terrible.
Avoid loneliness – depression is a lonely place to be, and we tend to isolate when depressed. I am not suggesting you go out to bars and socialise. Call a friend to come over. Speak to your parents. Take your laptop to bed and chat with a friend. Explain how you are feeling and that you need help. If there is nobody available around, try to find a Depressives Anonymous meeting (also called Emotions Anonymous) in your area and attend it, then speak to people after a meeting and get their phone numbers. They all have been there before.