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Bipolar Disorder

Bipolar Disorder

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

Bipolar Disorder – Euphoria vs. Dysphoria or Mixed Episode

Most symptoms of Manic Episodes appear to be positive

Manic-depression or Bipolar disorder is usually perceived on of two ways – a person who alternates between depression and euphoria – or a person who alternates between depression and craziness.

Often a person who is told that they are bipolar will identify one of those two states – and will object based on the fact that they have never been “euphoric“, and they have never been actually psychotic or “crazy”.

Bipolar disorder or Manic-Depression is defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) – “the Bible” of psychiatric disorders – as “…clinical course that is characterized by the occurrence of one or more Manic Episodes…”

7 “points” retrieved from: DSM IV Criteria for Manic Episode – Food and Drug Administration

A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week. With three or more of:

1. Inflated self-esteem or grandiosity
2. Decreased need for sleep (e.g., feels rested after only three hours of sleep)
3. More talkative than usual or pressure to keep talking
4. Flight of ideas, or subjective experience that thoughts are racing
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
6. Increase in goal-directed activity (either socially, at work or school or sexually) or psychomotor agitation
7. Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

There is another specifier – “The symptoms do not meet criteria for a Mixed Episode” which is left out in a lot of thought processes.

Bipolar - EuphoricOne problem that is often encountered when diagnosing Bipolar disorder – or when trying to convince someone who has Bipolar disorder that they do, indeed have the illness – is that most of the “symptoms” of a Manic Episode appear to be “positive” or “happy.”  If you examine the wording – it looks on the surface and is often described as periods of “Euphoria” or extreme happiness.

In truth, many people with Bipolar disorder don’t have periods of “euphoria,” they don’t have what is perceived as “inflated self-esteem or grandiosity“, and they don’t seek out “excessive involvement in pleasurable activities.”  They may have “dysphoria,” they may believe that they have to do everything themselves, they may experience psychomotor agitation…they may be in a really active bad mood.

This is a state of “dysphoria.”  It is also called a “mixed state” where the Manic Episode and the Depressive Episode occur at the same time.  Features may include the racing thoughts, irritability, lack of sleep, psychomotor agitation of a Manic Episode but also include anhedonia or lack of enjoyment, inappropriate guilt, or suicidal thoughts which are symptoms of depression.

Unfortunately, this disconnects in presentation, and lack of awareness of mixed states (in both the patient and some professionals) often gives the bipolar patient an “easy out” in acceptance of the diagnosis.

Melissa Lind

Mixed Episode or Manic Episode with Mixed Features is given too little attention!

Getting Out of Depression

Some tips to get you out of depression

Major depression is the third most common mental disorder in the US.  Nearly 7 percent of the US population is affected in any one year.  Incidentally, if you are keeping track, the two most common mental disorders are Anxiety disorders and Phobia disorders, including Obsessive-Compulsive Disorder and Post-Traumatic Stress Disorder.

Major Depression, also called Major Depressive Disorder (MDD) has an average onset of 32 years of age and is more common in women than in men.  It is also called “unipolar depression” by those who are familiar with Bipolar disorder.  It may include a subset of depressive disorders such as Seasonal Affective Disorder (SAD), which affects people yearly – usually in the winter and Dysthymic Disorder, which is a less severe form of depression.

In order to be diagnosed with Major Depression, a person must meet the DSM criteria including at least five of the following for at least two weeks:
•    Depressed mood most of the day
•    Diminished interest in all or most activities
•    Significant, unintentional weight loss or gain
•    Insomnia or sleeping too much
•    Agitation or psychomotor retardation (slow movement) noticeable by others
•    Fatigue
•    Feelings of worthlessness or guilt
•    Diminished ability to think or indecisiveness
•    Suicidal thoughts

In some cases, depression can be relieved by changes in lifestyle or with psychotherapy, but in severe cases – medication may be warranted.  We are fortunate today in that there are a number of effective medications that have fewer side effects than previous treatments, and the category continues to evolve.

Even with medication – that may not begin working for at least several weeks – some lifestyle changes, and habits may help a person “emerge” from their depression and manage symptoms in the future.

Major DepressionLifestyle changes are difficult, particularly when depressed, but the effort it takes to “soldier through” is worth it in the end.  These tips for helping with depression are not easy – especially when you do not have any energy and don’t feel like getting up, but even though they may not provide a cure – they almost always provide some help.

  1. Get up and move – this is the hardest for most people to do.  It may take a tremendous amount of efforts but even simply getting off the couch or out of bed and walking around the house will help.  Getting up and moving around will increase your blood flow and heart rate will help increase blood flow to your brain and may convince your body that “hibernation” is over.
  2. Get dressed – you may have been wearing the same clothes for many days.  Changing into a “daytime” outfit can help regulate your time clock and may help you feel like you can accomplish something.  If you wear makeup or fix your hair, do so – and by all means, take a shower.
  3. Get out in the sun – don’t stay long enough to get a sunburn but studies have shown that bright light helps your brain wake up.  It resets your internal clock by adjusting your melatonin levels (a hormone responsible for inducing sleep).  It also triggers a “springtime” effect – that again tells your brain and body that winter is over, and it is time to come out of hibernation.
  4. Talk to a friend – making a phone call may not be tops on your mind, but even a wordless chat can help you feel like someone else is aware of your existence.
  5. Watch something enjoyable – even if you don’t want to enjoy anything, do something that would normally make you happy.  Just a little bit of happiness peeking through can go a long way.
  6. Go to bed and get out of bed at normal hours – sleep patterns are often destroyed by depression.  Reestablishing those normal patterns will help reset your internal clock to a natural level.
  7. Don’t take naps – again with both the normal sleeping hours and with the “getting up.”  Reinforcing physiologic habits will help establish normal brain functioning.
  8. Eat healthily – you may want to eat everything, nothing, or only certain foods.  Likely, no matter how much or how little you are eating, you are deficient in some of the necessary vitamins and nutrients – so eating a healthy diet and taking a multivitamin mineral supplement is a good idea.  B vitamins are especially helpful to restore nerve cell functioning, C and E are useful for combating inflammation that can cause sluggishness, D vitamins are useful to aid in the “sunlight” phenomenon discussed before, Calcium and Magnesium are good for the brain cells which are malfunctioning.

Most people who are depressed will find a lot of these activities difficult – and you may only be able to do one or two a day.  None of this is meant to be insulting, but there is science behind all of it – and others have been through it before.
With the help from the medication and the lifestyle adjustments – you will feel like you are coming out of the fog – and be able to do all of them – or sometimes, choose not to.  Choosing not to do something is different than feeling like you are unable to do something – and you want to have control of your life.

– Melissa Lind

Bipolar Disorder and the Famous

Celebrities and bipolar disorder

Kurt Cobain - Bipolar MusicianKurt Cobain (1967-1994) American “Grunge” Musician – diagnosed with bipolar disorder and known drug abuse, suicide from self-inflicted gunshot wound to the head.
Bipolar disorder can be a devastating disease.  Some people might also claim it is a gift in a sense.  There are a lot of famous people with bipolar disorder – and a lot more who are suspected of having it but have never been diagnosed – or just haven’t admitted it.

Kay Redfield Jamison is one of the most well-known people with bipolar disorder as she has been a pioneer in removing the stigma associated with the disease – and other mental health disorders.  Jamison is the author of the book Touched with Fire which has had resonance with people around the world, but she isn’t the only one.

People alive today that are known to have bipolar disorder

  •  Adam Ant (musician)
  • Russell Brand (comedian, actor)
  • Patricia Cornwell (author)
  • Richard Dreyfus (actor)
  • Patty Duke (actress)
  • Carrie Fisher (actress, author)
  • Mel Gibson (actor, director)
  • Linda Hamilton (actress)
  • Jesse Jackson Jr. (politician)
  • Margot Kidder (actress)
  • Debra LaFave (schoolteacher convicted for having sexual relations with student)
  • Jane Pauley (journalist)
  • Axl Rose (musician)
  • Britney Spears (singer-songwriter)
  • Ted Turner (media mogul)
  • Robin Williams (comedian, actor)
  • Catherine Zeta-Jones (actress)

Deceased

  • Kurt Cobain (musician, songwriter)
  • Ernest Hemingway (author)
  • Margeux Hemingway (actress, granddaughter of Ernest Hemingway)
  • Abbie Hoffman (activist)
  • Vivien Leigh (actress)
  • Marilyn Monroe (actress)
  • Sylvia Plath (poet)
  • Edgar Allan Poe (poet, author)
  • Jackson Pollock (artist)
  • Frank Sinatra (musician, actor)
  • Brian Wilson (musician)
  • Amy Winehouse (musician)
  • Virginia Woolf (writer)

This is only a short list of those who are known to have bipolar disorder as there are many more – and many more than that is suspect, including some who are alive today.  Mostly these are celebrities – known as bipolar only because they are famous.  We can guess who might have bipolar disorder through the news stories about repeated brushes with the law involving drug and alcohol abuse and bizarre behavior.  We can also look at the list of the deceased and see how many of those have died through suicide.

It seems that there are an abnormal amount of celebrities with bipolar disorder – or that more people with bipolar disorder are celebrities.  It is doubtful that either case is true, simply that the bipolar person is a “shiner” – usually amazing in their accomplishments at the best of times, and tremendously tragic at the worst of times.

In many cases, we learn of a famous case of bipolar disorder when a celebrity has a notorious (or repeated) encounter with the law – often involving alcohol or drug abuse.  Also in many cases, these encounters will continue until the person is diagnosed, incarcerated or dead – or a combination of these events.
Substance abuse and bipolar disorder often go hand-in-hand – whether this is because the person is self-medicating or because their brain tells them the rush is good.  Many people – not just celebrities “hide” behind substance abuse as an excuse for wild and unusual behavior.  Think of the celebrities who have gone on very public benders, breaking into houses, repeated visits to jail, long and dangerous rants in public, lewd and dangerous behavior.  This is not normal– even for a drunk.

It is a sad fact that substance abuse is more readily accepted today than a mental disorder – but it is.

Think about that the next time you hear of a celebrity doing something heinous – or a series of something’s heinous – or a celebrity committing suicide.

The Last 48 Hours of Kurt Cobain

Abuse, bizarre behavior and bipolar disorder often go hand-in-hand.

Diagnosis and Symptoms of Bipolar Disorder

Bipolar disorder is difficult to diagnose.

The average bipolar patient will see three mental health professionals before getting the right diagnosis. In fact, one-third of bipolar patients will not be diagnosed with the disorder until more than 10 years after they first seek treatment.

There is a lot of similarity between the symptoms of bipolar disorder and other psychiatric conditions, but that isn’t the only reason why it is so difficult to diagnose. Here are some of the complicating factors:

Bipolar Disorder PatientThe patient only talks about depression – as bipolar disorder is a condition that has periods of depression alternating with manic episodes, many patients present when they are depressed. This is particularly true when a patient seeks treatment for themselves. Manic patients feel good or at least energized and are unlikely to believe that anything is wrong. Either they feel terrific, or they are in a heightened “bad” mood – and likely to blame that on other people or life circumstances. Consequently when they first seek treatment – they only profess to the depression as that is most bothersome.

Bipolar disorder looks like anxiety – in actuality, many, if not most bipolar patients also have some type of anxiety disorder. Consequently it may be very difficult for mental health professional to root out bipolar disorder. If patients are seen as agitated, hyperactive or fidgety, they may be only asked about anxiety or given a self-rating scale for anxiety. This would immediately lead the practitioner to diagnose an anxiety disorder – unless careful investigations were done.

Substance abuse can be complicating the issue – many bipolar patients spend years self-treating with substances of abuse. This includes prescription medications, recreational drugs and alcohol. There is not any particular drug that is more often abused by bipolar people as a whole – some will choose alcohol, some will prefer stimulants, some will choose pain medications – all of which will mask the symptoms to some extent. In some cases, the substance abuse appears to be more problematic than anything else and in cases of addiction; the substance abuse must be treated before an accurate evaluation can occur.

Denial is very common – Denial is a nice way of saying dishonesty. That would be lying. This sounds very harsh but in many cases, bipolar patients will not be honest about difficulties that they have had. It may be subconscious dishonesty in that they, themselves do not really know what the problem is. Lack of awareness is common but outright denial is also common. Many bipolar patients absolutely refuse to accept the diagnosis when it is first presented – even after years of not being treated properly. Oddly, this may make it more likely that the practitioner believes that the patient has bipolar disorder but such outright denial delays treatment.

These are just a few of the reasons why bipolar disorder is so difficult to pin down and, unfortunately, delayed treatment can have huge life implicationsBipolar disorder is one of the riskiest psychiatric illnesses to have and can have severe consequences for the patient who is not properly diagnosed and medicated – including job losses, family disturbance, institutionalization, jail and even death.

Bipolar disorder affects not only the patient himself – but family and loved ones as well.

Why is it so difficult to diagnose bipolar disorder?

Mental Illness in Children

Mental Illness In Children – Are We Too Afraid To Find Out?

Up until about 20 years ago, the idea of mental illness occurring in children was pretty much unthinkable.

Boys who were extremely active were sent outside to play.  Defiant children were punished or sent outside to play.  Irritable children were sent outside to play.  Depressed children were sent outside to play.  Get the picture?Get the Idea

Today we do know a lot more about mental illness and have a lot more medication to treat it.  As mental illness becomes more easily diagnosed in adults, it is natural that we begin to look at our children and wonder.  It is also natural that we look back on our own childhoods and wonder or even know that we were ill then too.

Even though most psychiatric diseases are not diagnosed until the teens or early adulthood, it should be fairly obvious that those diseases did not suddenly happen when the kid turned 18. Likely there were signs of existing mental disorder long before the diagnosis.  Unfortunately, some parents may be too afraid to look.

The problem with recognizing mental illness in childhood is that symptoms of mental illness are different from the symptoms in adults.  Children’s symptoms can be masked with other signs or even opposite to those in adults, so they are not obvious. In addition, the symptoms of many different psychiatric disorders are so similar that it is difficult to distinguish one disorder from another.  Some examples:

Depression in children can show as: Depression, Insomnia, Nightmares, Bedwetting, Anxiety, Combativeness, Lack of interest, Anger, Poor grades

Anxiety in children can show as: Insomnia, Nightmares, Bedwetting, Fearfulness, Depression, Poor grades, Social inadequacies, Lack of interest, Combativeness, Anger.

Mental Illness in ChildrenADHD can show as: Inattentiveness, Lack of interest, Fidgetiness, Poor grades, Irritability, Inability to make friends, Excessive anger, Lack of organization

Asperger’s can show as: Lack of interest, Poor grades, Inability to make friends, Excessive anger, Lack of organization

On the other hand normal childhood occurrences such as puberty can show as: Lack of attention, Difficulty getting along with friends, Unexpected anger, Excessive sleep, Inability to sleep, Nightmares, Irritability, Mood swings, Excessive anger, Excessive crying, Poor grades

And Sexual abuse can show as: Nightmares, Bed-wetting, Excessive anger, Anxiety, Depression, Mood swings, Irritability, Disinterest

So how can we determine if it is something that happened to the child, something that is temporary or something like a mental illness?

The best things we can do are to pay attention, know your children.  If they change, find out why.  Know your family history.  If they seem “different”, talk to their teachers.  If they are continuously exhibiting behavior outside of the range of “normal”, there may be something wrong.  Listen to your kids, if they tell you that something is wrong, it probably is.

Don’t be afraid to ask for help.  Educate yourself.  Take the self-test quizzes.  Have your spouse or the child’s other caregivers take the tests.  Take all of this information to your healthcare provider and if that doesn’t work, find someone who will listen.

Most mental disorders are not diagnosed until the late teens or early adulthood – bipolar disorder, depression, anxiety disorder and schizophrenia.  There is more recognition today, but a lot of resistances to – both from parents and health professionals.  Don’t be afraid to seek help just because you are afraid of medication, knowing what is wrong and knowing your options can head off problems.

Recognizing an oncoming issue may help prevent years of anguish for your child and yourself.

Melissa Lind