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Bipolar Through the Years – Getting Your Diagnosis Right

Difficult to diagnose Bipolar Disorder?

I am not bipolar!  I am (insert other diagnosis here)

I received my first bipolar diagnosis when I was about 30… ish minus a few years.  I am 40… ish plus a few years, so for most of All About Bipolar Disorder20 years (yes I know the math doesn’t work out but this is a true story), I have known that I have Bipolar Disorder.

If you are bipolar yourself you will know that when I say “I have known” it really means “I was told”.  I didn’t believe it at first.  I thought of every other thing it might be and tried really hard to convince the therapist “that isn’t me… not really”.

As an untreated, newly diagnosed bipolar, I felt compelled to express clear objections to specific parts of the diagnosis that did not fit.  I was trapped by the details… a problem which I have often suffered – or more like, caused others to suffer because of.

Over the years and through several different diagnoses and many periods of “those” risky behaviors, going on and off various meds, wrecking certain parts of my life – and recovering once again, I find that those details don’t matter anymore.

I used to have a vitriolic reaction to the suggestion that I should want to be “normal”.  NORMAL, I said… I don’t want to be Bipolar TherapyNORMAL.  Normal is boring.  I was many things but boring was not one of them.

I no longer have that reaction.  My life would have been easier if it were normal.  I would have missed all the bright, scribbly colors.  I would have missed all the scary but fun stuff… but then maybe I wouldn’t have gotten so tired.  Maybe I wouldn’t have had to shut the curtains and hibernate.  Maybe I would have missed all the scary and dark stuff.

Anyway – as usual, I veer off of my topic.  Today, I am 99 percent sure that I am bipolar but I do reserve that remaining 1 percent – just in case.

Over those years – starting before (way before) I was diagnosed as bipolar – I sought treatment.  At 14, I asked my parents to take me to a psychiatrist because there was “something wrong with my brain.” They said “no, there isn’t” effectively telling me that I was just a mouthy, disgruntled, histrionic teenager – which I was, but I was also bipolar.

I often wonder what might have been if I had been treated then and do watch my kids for the same occurrence.  Unfortunately at that time, a proper diagnosis was highly unlikely and probably wouldn’t have changed much.  Except I would have felt heard – and I didn’t.  I do try to hear my kids.

Once I was able to seek treatment for myself, I was diagnosed with several other things long before they hit the jackpot.  The first was “dysthymia” – oddly, this diagnosis came in the middle of a severe depression.

Dysthymia for a bipolar

I was in college, just a hair short of being suicidal, and had to sit down one day and decide if I was going to kill myself – or study.  Serious DoctorLacking concrete plans and lacking a sincere wish to die, I decided to study – but I did go to the student health center the next day where a kindly graduate student decided I was dysthymic and would benefit from group therapy.  Being the mixed-manic that I am, I was in a temporary state of “not so bad” and failed to mention the depth of my despair.

I went to group therapy with a bunch of whining college kids and two well-meaning graduate student supervisors for almost a year.  To be fair, some of these people may have had real problems.  A homosexual boy who was still “in the closet”, a secret cross-dresser, a bulimic, a giant athlete with a sever anger issue and mommy problems… and a couple of other whiners.

I never once mentioned that I was hallucinating at night… or that I couldn’t keep my thoughts going in a straight line….or that I was living in a dark grey fog… or that despite all this, I still wasn’t sleeping.  My dysthymic self simply whined away with the others about parents, childhood, professors…it may have kept me from killing myself but mostly it was just entertainment.  It also kept me from failing out of college, as the dean of my college was informed that I was “in counseling”.

Major Depression for a bipolar

When I finally admitted the hallucinations – that got some real attention.  It also got the notice of a physician – and her medical Medical Doctorstudent who proceeded to ask me stupid questions like “how much LSD have you done?”  I also got a very “fun” visit to a sleep clinic — where the results were inconsequential even though my case was examined by a neuropsychiatrist – or a psychiatric neurologist – whatever that is.

Still, I got the diagnosis of Major Depressive Disorder… I still wasn’t sleeping – and people were literally terrified of me.  Describing me as agitated would be like saying the Niagra River is a stream.  Major Depressive Disorder.  They did give me meds though, stopped the hallucinations and got rid of all that grey fog and I managed to finish college.

Codependent for a bipolar

Moving on a few years on and off antidepressants and anxiety medicines – never feeling right….risky this, risky that….institutionalization (not jail or at least not this time, but still…).  After a particular disturbance, one “therapist” told me I was “codependent”… little did he know how dependent I was…or on what.  I ignored him.

The “intensive treatment” did get me the diagnosis for bipolar disorder which I denied, and did so for many years.  On and off meds, risky this, risky that…back on meds…off…on.

ADHD for a bipolar

A few years later I was pregnant (married too, woo hoo) and had to go off the meds.  After I had my kids – the doctor that I saw said that I was ADHD – not bipolar.  Still not wanting to be bipolar, I took the prescription he gave me….which was of course an amphetamine.  Well that worked well – nuf said.  To be sure, my kids are fine.

Bipolar HeartbeatEventually, I came to reality and the bipolar diagnosis and back to the right meds.   This has required honesty.  Honesty with health professionals and honesty with myself and it requires taking my meds.  I am tired from all the bright squiggles and the darkness.  I do want to be normal.

Now, as a bipolar, I get to watch my kids and see if they have “it” or something else.  Either is scary, both are scary but I hope I will be more help than my parents were.  I still take my meds but I also still retain the right to act on the 1 percent in case something better than bipolar disorder comes up.

Kids and Mental Disorders – ADHD

Children and mental disorders – when is too soon for diagnosis?

I spend a decent chunk of my time cruising chat boards and reading journals, news, social media posts and such about mental disorders.  My own “specialties” are Bipolar Disorder, Adult ADHD, Autism Spectrum DisorderBorderline Personality Disorder, Anxiety Disorder, Depression, Abuse Disorders, OCD… nevermind – I really “specialize” in them all, because I know most Attention Deficit Hyperactivity Disorderof these disorders within my social circle, and I know them on a professional level.

Anyway, I was on a Facebook page the other day for ADHD. (attention deficit hyperactivity disorder)  A woman posted a question about how to manage a kid with ADHD who wakes up and wreaks havoc within the house while everyone is trying to get ready for school and work.  Naturally he was disagreeable, confrontational, oppositional, had “meltdowns” – and it was all exhausting.  (pretty typical behavior for a truly ADHD kid)  A therapist once told me that the ADHD brain doesn’t “wake up” right away and cause all this trouble partly because their brain is not actually engaged yet.  The mom was asking for advice.

Comments on the page gave some really good answers. Some of them are common. Like plan your morning before you go to bed (get out clothes, get backpack ready, make lunch), let the kid make some choices – blah blah blah, stuff we have all heard.

Others were less common, but possibly better advice. Advices like; give the kid an extra 30 minutes to “wake up” in silence, give the child an incentive to get dressed NOW – like playing Minecraft after he is dressed.  I handle mine with the “don’t talk to him yet” option – waiting about 20-30 minutes before making him get busy.  His siblings aren’t allowed to bug him during this time either.  He can wrap himself in a blanket, stare at the wall or whatever – just don’t go back to sleep.

One lady suggested that the kid should be woken to take his meds an hour before he has to be out of bed. Then let him go back to sleep so that his medicines are working by the time he actually gets up.  I found that last piece of advice to be very helpful. My husband with adult ADHD takes his meds about 4 am and gets up at 6, ready to go rather than rude, obnoxious and unhelpful.

Mental Disorders - ADHDWhat troubled me was a comment from a woman who didn’t actually give advice, but chimed in to complain about how hard her four-year-old was to manage.  She said that he had been diagnosed with ADHD and was on meds, but also said that he had bipolar disorder, and still was a screaming banshee in the morning.  This gives me pause for concern.

I certainly can’t do anything about this particular kid, and I don’t really know the exact circumstances but I find the dual diagnosis with bipolar disorder very troubling for a four-year-old child.  Certainly, kids can exhibit ADHD symptoms at 4, and some will benefit from treatment.  But the medications weren’t working, and I am not so sure about the bipolar disorder.

Traditionally, until a few years ago, no one was willing to consider bipolar disorder as a pediatric concern.  Still today, though bipolar disorder obviously exists in childhood – most of the major issues don’t come out until adolescence.

The Diagnostic and Statistical Manual of Mental Disorders does not recognize the bipolar disorder in children under the age of 13

The National Institutes of Mental Health does acknowledge that bipolar disorder in children MAY exist but also warns that many children are misdiagnosed when the main problem is ADHDNIMH recommends that these children be labeled with Mood Dysregulation Syndrome until such time as a diagnosis can be relied upon.

The main problem in diagnosing young children with any mental disorder is that symptoms in children are vastly different from those in adults.  To complicate matters, symptoms of various Cerebrum Lobesdisorders in children are similar to one another.

Symptoms such as irritability, excessive mood swings, meltdowns, oppositional behavior, trouble in school, social inadequacies, explosive behavior, frequent frustration, and hyperactivity, etc. can point to a number of disorders.  Frankly the child may be ADHD, Bipolar, Depressed, Autism Spectrum… or even have food intolerance.

Because of our family history (not just mine), I watch my children very carefully.  I do analyze everything that happens, and I know that all of them probably have a disorder of one type or another.  Two may have ADHD, one is likely bipolar and one has Asperger’s or mild ASD.  I have sought treatment for some issues – but with others, I hesitate to run to a physician – likely a pediatrician who just doesn’t really know.

Our understanding of mental disorders is still evolving

I was personally diagnosed with the wrong disorder for over 15 years – and I was an adult.  How damaging would it have been if I had been labeled with a disorder that I did not have when I was only four years old?
The particular woman I described with the dual diagnosis child was beside herself.  Despite the fact that the four-year-old was receiving medical treatment for both disorders – it wasn’t working.  To me, this means that the treatment was with the wrong meds and for the wrong disorder(s).  In addition, her management skills weren’t the best.

As I said, I know that my children are likely to have disorders of their own but I don’t want to treat them for just any disorder.  I will want them to be treated for the right disease.  My advice to this parent, or any parent whose child had been put on medication that wasn’t working would be to seek a second opinion.

I am more emphatic about that advice if the doctor was willing to “add” a diagnosis to provide more medication; she should definitely seek another opinion.  Preferably the opinion of a pediatric Ritalin - ADHD Medicinepsychiatrist – or even a pediatric behavioral neurologist.  These specialists are few and far between, but it isn’t worth doing anything, but suffering through all the misery because the treatment isn’t working.

Medications are beneficial in the treatment of some types of mental disorders, but they do “change the brain”.  That is how they work – changing the brain can be harmful if you are changing it in the “wrong” directions.  Just seems like common sense.

Melissa Lind

Bipolar Disorder and Suicide Risk

Physical Proof and a Big Shocker – Bipolar Disorder and Suicide Risk

Bipolar HeadI read a lot of news about bipolar disorder and other psychiatric disorders (OCD, ADHD, chronic depression, borderline personality disorder, etc.).  In my reading, I came across an article that describes brain scan abnormalities in teens and young adults who have attempted suicide but I found a lot more.

A study conducted at Yale School of Medicine examined brain scans of 26 young adults and teenagers with bipolar disorder who had attempted suicide.  These were compared with scans of 42 bipolar patients who had not attempted suicide and with 45 non-bipolar subjects.  The results were not really surprising – as many research studies are not.

The bipolar patients, who had attempted suicide, showed abnormalities when compared to the other two groups, specifically in the  which showed “less integrity”.

Frontal lobe animationThis means that the frontal lobe (which controls impulses) is not as “connected” to areas that control emotion, motivation and memory.  Researchers indicate that the brain abnormalities may disrupt the ability of the impulse control mechanism to filter emotion and motivational messages appropriately.

In short this means that those patients can’t stop negative emotions and impulses to do something drastic… like attempt suicide and not surprisingly, less integrity or more abnormality – likely means more suicide attempts.

While it is good that they are discovering some physical proof of actual defect, eventually to move bipolar disorder into a category that can be scientifically documented, it doesn’t offer a lot of real-life solutions.  Most of us who are bipolar or know someone who is bipolar, know that there is something wrong or at least different about our brain…and it only makes sense that a person, who is trying to kill himself, is probably a little worse off.

As usual, I found myself thinking “…and… the point is…” which I often do when I read a synopsis of a largely inconsequential research study but then something caught my eye.  It was something that was a lot worse than I thought – statistics.

About 4 percent of Americans are afflicted with bipolar disorder, though sometimes we feel like it is others who are afflicted.  That is not surprising either.  Some groups show a slightly lower percentage at about 2.6 percent of the population.

Bipolar SuicideWhat surprised me was the statistic regarding suicide.  The article – that is from a reputable source – indicates that 25 to 50 percent of people with bipolar disorder are likely to attempt suicide and that 15 to 20 percent are likely to succeed.  Wow.  I didn’t know that.  Funny thing that I didn’t know since of the 20 or so bipolar people I have been close friends with at one time or another – at least four of them are dead.

When searching for confirmation (which I found from the NIH that about 1 in 5 bipolar patients complete suicide), I also found a number of additional shocking statistics:

  • Bipolar disorder results in a 9.2 year reduction in lifespan
  • Bipolar disorder is the 6th leading cause of disability, worldwide
  • Bipolar disorder is found in all races, ethnicities, ages, genders and socioeconomic groups
  • A child with one bipolar parent has a 15-30% chance of having the disorder
  • A child with two bipolar parents has a 50-75% chance of having the disorder
  • There are 3.4 million CHILDREN with depression in the US but up to one-third of those kids may actually have bipolar disorder
  • Bipolar disorder criteria have likely been met for at least 1 percent of all adolescents

Maybe these aren’t shocking for you.  Maybe you already knew all this – but maybe you didn’t.

I have known I had bipolar disorder for a long time – and have known a lot more people with bipolar disorder and I didn’t know all this stuff or maybe like everything else, I chose not to remember.

Food for thought; Take your medicines!

Melissa Lind

Bipolar Disorder and Adolescents

Symptoms of bipolar disorder in children and adolescents may look like other disorders

Traditionally bipolar disorder has been thought to first show in early adulthood – and more often in females.  Bipolar disorder was considered to be quite rare as few as 20 years ago, to be more exact. The first emergence came in the early 20s, mainly in females. But, our knowledge about bipolar disorder has grown rapidly in the last 20 years.

Instead of the single manic-depressive diagnosis – which included diagnostic criteria of both depressive periods, alternating with manic periods – described as “euphoria”?

Those who did not have clearly rhythmic, alternating periods of a “happy” and frantic manic phase with a classic depression period were mishandled, misdiagnosed, mistreated, or dismissed.

Bipolar ChildrenIn addition, it wasn’t really known that bipolar disorder could start in adolescence or even childhood, or that there are different types of bipolar disorder.  Today, it still isn’t “officially” recognized in the “psychiatric bible” – the Diagnostic Statistical Manual of Mental Disorders (DSM), but at least more practitioners do know that it exists.

Today, we don’t exactly know what causes bipolar disorder (only that there is a genetic link of some kind, and often some past trauma). But, we can at least identify adolescent and childhood bipolar illness.  We also recognize a variety of different types of bipolar disorder (Such as mixed manic episodes, rapid cyclers, people without a depressive phase, hypomania, dysphoria rather than euphoria and cyclothymia). We also have a “catch-all” type – Bipolar NOS or “not-otherwise-specified”.

Adolescent or childhood bipolar disorder is official known as: “early onset bipolar disorder”.  In fact, childhood bipolar disorder can be more serious than a similar disease in adults and may have slightly different symptoms.

Symptoms of bipolar illness in children can often be more severe, and the cycling period may be more frequent.  Children also have more mixed episodes.  Children also have slightly different symptoms – so even the depression phase of the cycle may not be obvious.

Pediatric patients (children and adolescents) with bipolar disorder may have:

Bipolar Disorder in Children•    Abrupt mood swings
•    Periods of hyperactivity followed by lethargy
•    Intense temper tantrums
•    Frustration
•    Defiant behavior
•    Chronic irritability

These symptoms have to appear in more than one setting (school and home) and cause “distress”.

The problem is that many of these symptoms may look like other disorders.  They might be disorders such as ADHD, childhood depression, anxiety disorder, obsessive compulsive disorder, conduct disorder, premenstrual syndrome, oppositional defiant disorder and others. The danger might come from a misdiagnosis and improper treatment.

Bipolar disorder is treated with anti-manic agents (lithium), anti-convulsants (Depakote, lamotrigine) or atypical antipsychotics (Abilify, Risperdal).  In many cases, anti-depressant won’t be needed.  Treatment for other disorders like ADHD or depression may make bipolar disorder worse. Childhood bipolar disorder is something that desperately needs treatment as the distress caused to the patient, and the family can predispose the youngster to

•    Drug or alcohol abuse
•    Stealing
•    Involvement with law enforcement
•    Poor social integration
•    Poor academic performance
•    Suicidal tendencies
•    Premature sexual behavior

The Balanced Mind has a good self-check list of symptoms that can help a parent or a teen decide if bipolar disorder might be an issue.  Self-testing is not always accurate and should be discussed with a doctor, (preferably with test results in hand).  Not all doctors accept pediatric bipolar disorder. Parents may have to seek advice from more than one mental health professional and be aware that insurance may not cover the illness.

Melissa Lind

Robin Williams – Another Life Lost Through Mental Illness

Another Life Lost Through Mental Illness

I recently wrote about “Celebrities and Bipolar Disorder,” many of whom are also drug addicts, alcoholics and suicide victims – but the recent death of Robin Williams has brought the issue of other mental health disorders including depression – and suicide to the front of my mind once again.

Of course, you know that Robin Williams died of “asphyxiation” – notable suicide by hanging. At first we were shocked, then sad as a great talent was lost. In a few days, many people will become angry at him. Many people don’t understand depression; some don’t even believe it exists.

Robin Williams - Depression KillsRobin – and I call him that purposefully rather than the more proper journalistic reference “Mr. Williams” or simply “Williams” – has made an impact on my life and that of my children. Like many people, I felt like I knew him. I haven’t seen all of the 80 movies he was in, but my personal favorites were the movies that were not comedies. He was a gifted actor and a tremendously funny man.

I said I “felt” like I knew him – but I didn’t. My children “feel” like they knew him – but they didn’t. I don’t know much about his childhood – other than that he was raised in a family where, though there was probably plenty of money, he spent most of his time with nannies or alone. He obviously had a brain that never quit – which leads me to believe he may have had ADHD, he certainly had troubles with substance abuse and he had periods of severe depression, one of which led to his death.

People are already questioning why such a talented man – who had given so much – would “go and do something like that.” Many of those people will feel like he was selfish – as many people feel like suicide is the ultimate in narcissism. Under all that hilarity, under all that spectacle, under all that talent, was a seriously sad man.

Never mind what we don’t know about his childhood, over the course of his life he had great success and tremendous loss, with the making of fortune and fame and the loss of loved ones and money. He ultimately chose to end the pain himself.

Metally Ill - Robin WilliamsDepression is not something that can be shared and Robin was a “smiler.” Even in my life, though I am not a “smiler” – when I am having great difficulty, I do not contact the people who matter. I do not call my friends; I do not call my family; I sit in my difficulties alone.

Like many comedians, Robin learned to be funny to cover pain and to cover loneliness – and to get attention that he craved. Mental illness is difficult to understand and even though we mourn his loss – we should reflect on who in our lives might be feeling the same pain.

Maybe – likely not, but maybe, if he had the kind of support he needed, if he had not felt like he always needed to be “on” he would not have felt the despair so strongly. Maybe if mental illness and substance abuse weren’t still stigmatized, maybe he could have gotten the help he needed.

Maybe, but maybe not.

Another famous actor – once said in a famous movie – “Momma says that dyin’ is a part of livin’… I wish that it wasn’t.” Unfortunately, some people feel they must choose to die early. Robin did.

Melissa Lind

Another famous actor died because of mental illness

Depression in Children

It may not seem possible, and most people don’t want to think about depression in children.

Different from developmental disorders such as ADHD or Autism Spectrum Disorders and different from mental disorders such as Schizophrenia, which have obvious symptoms, Depression can occur in children.

Childhood DepressionUp until about 20 years ago, depression in children wasn’t widely recognized.  It wasn’t that the depression didn’t exist; it was undoubtedly just that we didn’t know about it.  Two decades ago, even if the child was aware that “something” was wrong, the parents, teachers, and other adults were likely to dismiss it as a “stage” or “phase” that the child was going through.

There were several reasons for that way of thinking, such as:

  • A belief that children didn’t get depression – adolescents were dismissed as “moody,” younger children were dismissed as “difficult.”
  • Medication available for depression wasn’t appropriate for children due to severe side effects.  Newer antidepressants were not available until Prozac was approved in 1988 for adults.  These medications known as “serotonin specific reuptake inhibitors” (SSRIs) were not approved for children until 2002 and to date, only Prozac is recommended for depression in children though Zoloft and Luvox may be used for Obsessive Compulsive Disorder (OCD) in children.
  • The long-term effects of depression were not yet known.  Depression at any age can contribute to chronic diseases such as diabetes and heart disease.

Today, we recognize childhood depression.  About 11 percent of children have experienced at least one episode of childhood depression before the age of 18, according to the National Institute of Mental Health. Normal behavior can certainly vary from child to child and from age to age – as children are prone to “stages” that they will grow out of.  But if a child has an extended period of depression – it is something that should be properly addressed. Such serious issues should not be taken lightly.

Juveniles (those up to age 17) often have different symptoms of depression than those common in adults.  Children with depression may be excessively sad and lethargic, but depression may also show as:

  • Complaints of illness
  • Refusal to go to school
  • Clinging to a parent or caregiver
  • Excessive worrying
  • Sulking
  • Grouchiness
  • Anxiety
  • Acting out at school
  • Excessive negativeness
  • Feelings of being misunderstood

Depressed FeelingsThese symptoms are occasionally experienced by most children as they are growing up, but when symptoms persist for several months or interrupt normal activities and development, more investigation is needed.  One needs to find out what the cause may be.  If a child is being bullied – he or she may not want to go to school.  If a child complains of illness – it may truly be sick.  On the other hand if these events occur over and over, you need to discuss the problem with a doctor.  You may also need to see a child psychiatrist or psychologist.  In some cases, therapy may be warranted but in other cases, the child may benefit from medication suitable for depression.

In any event, you should not ignore symptoms of depression or any other mental illness signs – but investigate them.  It may be that your child is “going through a stage”, but it may be more serious.

Children complaining of illness may be depressed!