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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!

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.

Why do Bipolar Patients Quit Taking Their Meds?

Why do bipolar and schizophrenic persons quit taking medicine?

Talk to any medical professional about the trials and tribulations of dealing with bipolar patients and they will tell you that the single most bothersome thing is the frequency with which manic-depressives quit taking their meds.

This problem isn’t unique to bipolar patients, but it is more insidious and often more surprising.  Schizophrenics, who quit taking their meds, are identified fairly quickly.  Those with depression who quit taking their meds stay in their houses – this is troublesome but not a public nuisance.

People with bipolar disorder are usually quite memorable both at the best of times and the worst of times.  They are vivacious; they are shining; they are exasperating; they are amazing, and they are irritating.  Generally in order to be diagnosed, a bipolar patient will present one of two ways – either severely depressed or psychotic but their illness has gone unnoticed or unaddressed for a long time.

To be fair, psychiatric patients of any type may quit taking their meds for a number of legitimate reasons.  Well, semi-legitimate.

Mood DisordersLegitimately, a psychiatric patient of any type will have consulted with his or her physician before quitting can be medically supervised while doing so.  Even with medical supervision, the only really legitimate reason for a psychiatric patient to quit taking their meds completely is a person who has been taking anti-depressants for a short period of time (less than one year) who has only had one episode of clinical depression.  In this case, a psychiatrist would agree that a patient who does not have a long term history of depression can taper off the medication because they may not need it forever.  This patient is rare. Once another episode of depression or mood disorder occurs, virtually everyone will agree that it is a chronic problem that should be addressed with medication.  Permanently.

One legitimate reason for temporarily discontinuing use would be pregnancy, to avoid potential harm to the fetus.  In most cases, the medication would be re-started as soon as the patient is able.

Patients may also approach their physician about discontinuing a specific medication to switch to another.  Reasons for this might be ineffectiveness, intolerable side effects or cost.

Unfortunately, for most psychiatric patients there is no legitimate reason to discontinue medication altogether.  The physician will suggest or even prescribe an alternative medication.  The patient may feel that they have been unheard by their physician and while this may be the case, for most patients who “quit”, it is actually more likely that they have not talked to the physician at all.

Bipolar patients and those with other psychiatric conditions most often quit taking their medication without medical supervision or intervention in secret.  Oddly, this is because the brain is a tricky thing – most often they quit when they are doing well.  When the medication is working, they begin to believe that they do not need the medication – that they are “OK”.

Most psychiatric patients don’t want to have a mental disorder – or more likely they don’t want to be told that they have a mental disorder.  This may be in part due to the social stigma, but it may also be because they really like the way they are.  Medication often takes away the “spark” that has made them vivacious, memorable, brilliant and even irritating or dangerous.

It is very difficult to go from “outstanding” – whether it is good or bad to normal.  Bipolar patients in particular also quit taking their medication because their brains are bored.  The brain is used to go up and down, backwards and forwards, in and out.  When medication is working, the roller coaster goes away.

This may be good for a while, after the crisis because life has gotten way out of whack, they need time to recover, rest, and breathe.  But when the fires are put out, and the dust clears, the brain begins to crave the excitement.

Again, this really means the medication is working, and they will quit, yet again, starting the cycle all over again.

So, what can a caretaker, a parent, a spouse, or a friend do?  Likely any attempt at supervision or intervention will be met with anger, avoidance or outright denial.

Bipolar CaosAs bipolar disorder, and schizophrenia most often emerges in the late teens or early adulthood, is should be predictable that they do not want supervision.  They do not want to be told that someone else knows best.

When confronted or even questioned, the bipolar will almost always say that everything is OK – even if it is far from OK.  In short, they will lie.

Again, what can a caretaker, a parent, a spouse, or a friend do?  In short, especially in the newly diagnosed (and for a bipolar or schizophrenic the definition of newly would be likely less than 10 years), there will be no opportunity for supervision.  They will be secretive and untruthful.  You must wait for the crash and be there to assist with the crisis and recovery – only to repeat it again in a few months or years.

The good news is that eventually, the periods between “the crashes” will likely lengthen. When they are thinking clearly, when the medication is working – ask them why they do it.  Encourage them to participate in therapy, join a bipolar or mental disorder group. Realize they may not always go.

Over a period of years, perhaps decades – the patient may eventually become to accept that they truly do need the medication.  Likely they will never be completely compliant but one can always hope.

A caregiver, a parent, a spouse, a friend can look for signs – if you are close, you may be able to keep track of their medication, physician visits, refills but you may not be able to.  You should prepare yourself when you see signs: a developing increase in communication, vivacity, anger – likely followed by erratic behavior and hiding.

Intervene as much as you can but know that your may not be able to stop them.  They quit medication when it is working because it makes them….normal.

Melissa Lind

Suicide in Depression

Why does treatment for depression increase the risk of suicide?

Whether you are bipolar or suffer from major depressive disorder – when you start taking medication for depression, your risk of suicide actually goes up for a short period of time.

The risk of suicide in depression

Every time an advertisement for a medication for depressive disorder or bipolar depression comes on the television, one thing that seems to stick out is the warning that states “May increase the risk of suicide“.  This is often an arguing point for people who are opposed to psychiatric medications.  If it is supposed to improve your mood, why does the risk of suicide go up?  Shouldn’t the opposite be true?

How do antidepressants work?

Antidepressant medications work by increasing the activity of neurotransmitters in the mood centers of the brain.  Nerve cell signals are transmitted by the release of chemicals known as neurotransmitters.  These include naturally occurring chemicals such as serotonin, norepinephrine and dopamine.  The neurotransmitter is released from one cell which signals the next cell to react.  The same cell then “gathers up” the neurotransmitter to be used again later.

Most antidepressants specifically work by blocking the “reuptake” of neurotransmitters so that they are in the synapses or spaces between the nerve cells for a longer period of time.  This increases the likelihood that the neurotransmitter will send a “happy” signal to the next cell – sooner.

Why do antidepressants increase the risk of suicide?

Suicide and DepressionThe problem with depression and how long it takes to recover is twofold, because depression involves both mood and energy levels.  In a person with depression, the mood state is lowered because there are often not enough neurotransmitters available.  This leads to the mental effects of depression causing sadness and an inability to enjoy normal activities.  There is also a corresponding drop in energy levels making the victim lethargic and sleepy.

When antidepressants are prescribed, most healthcare practitioners make it pretty clear that the mood state will not really begin to get noticeably better for at least 2 to 3 weeks. What is not always made clear is that energy levels actually begin to improve before the mood level is increased.

Once this person with low mood level and low energy level begins to take antidepressant medication, their energy levels go up fairly quickly.  The mood level, however, stays depressed – sad and unable to see the light at the end of the tunnel.

If patients had been thinking of suicide as part of their depression, they may not have had the energy to make actual plans or to carry them out.  Once their energy levels are boosted – they may find themselves still having the same thoughts, but this time – able to act.

Are the newer medications worse?

This increased risk of suicide is not new, despite what the media has portrayed.  It is not specific to a certain medication or even a certain kind of medication.  It is a fact, a well-known risk that has existed since the beginnings of treatment of depression.

Suicide and MedicationOur medications, today, are really much less dangerous than medications of old.  Thirty years ago, your choices for the treatment of depression included only tricyclics such as Elavil and Tofranil or MAO inhibitors such as Parnate.  Both of these medication types carried a lot of very debilitating side effects (dry mouth, constipation, excessive sweating, dizziness, and food intolerances) as well as the increased risk of suicide.  While they were effective, they were also quite dangerous in the event of an overdose – possibly resulting in death.

We now have more advanced medications – the SSRIs or Serotonin specific reuptake inhibitors, Norepinephrine reuptake inhibitors (NRIs) and newer MAO inhibitors that have much fewer side effects and are less likely to result in a serious overdose – but they have not been able to eliminate the actual risk of suicide.  This is inherent in the treatment of depression because the energy improves before the mood.

With older medications, the psychiatrist would often only prescribe a few days’ worth of medication at a time because the old medications could be dangerous if too many were taken and lead to overdose by someone trying to commit suicide.  This often meant that the patient was seen once a week or more often during the first month.

Now that overdose is not such a risk, physicians often prescribe an entire months’ worth of meds at once, and no one keeps track of the patient during this dangerous period  – giving them plenty of time to plan and act.  Generally the newer medications cannot be used as a suicide tool but it does not stop patients from finding other tools.

What can help decrease the risk?

The solution is to know your patient – know your friends, know your family.  If you have a friend or relative who has been depressed and is placed on medication, be aware.Check on them frequently. Drag them around to social activities, out to eat, to outdoor events. Note any changes or patterns that indicate they may be considering suicide.  Help them through the funk.  You may get on their nerves, but you may also save their life.

A little effort and toleration of irritating friends is way better than going to a funeral and wishing you had done something.

 

Newer medications used for prevention of suicide in depression are much less dangerous than medications of old.

Understanding Mental Illness and Diagnosis

Many people are confused by mental illness and many will claim that they simply do not exist.

Mental Illness - Sad TeenagerThey mean that such conditions are caused by the persons experiencing it. However, every day there are counselors who are diagnosing people as having a mental illness conditions. The disease is difficult to determine because of this, whether or not a diagnosis is correct. Also because of this, there are many controversies surrounding these conditions.

Mental health is essential for everyday life. Most people are fit to go through life without glitches in their mental activity, but others seem to have constant interruptions. It`s these interruptions that show us that there is something going wrong in the brain of these individuals and that there is an existing problem.

To understand interruptions that occur in the brain we need to look at different diagnoses and symptoms. We could use bipolar depression for this example. Bipolarity is one of the most common disorders diagnosed in today`s society. In fact, you probably know someone with bipolar depression you just don`t know that they have it. Bipolar disorder is extremely common, but many people do not fully understand the condition.

Bipolar is a chemical imbalance in the brain. Meaning; the brain is denied of vital nutrients that it needs to maintain a stable mindset. Since lots of people are diagnosed bipolar, they do not have their whole life experiences taken into consideration; this can be an enormous problem for them.

We all experience stress, trauma and excitement in our lives. However, not everybody deals with these stressors the same way as somebody else would do. No one should be expected to cope with such stressors the same way as everybody else would do. There is a process that takes place that brings on the condition of bipolar depression.

The first thing we must consider is that all have some “triggers” in life. That triggers might be traumatic events that occur in one’s life. Now, everybody deals with these differently.

Some people will react negatively, and others ignore. Those individuals who ignore these issues are generally not hearing the messages in between. This is how we can separate a mentally ill mind from a so called “normal” way of thinking.

The mentally ill mind tends to consume everything in life that is said. They get it all, and they fell all of that process in their heads until this begins to cause confusion. The “normal” mind tends to listen only to what it wants to listen to, and they do not have these conflicting thoughts to cause the mental confusion.

To better understand this process, it helps also to understand cognitive mental health disorders and how these are related to the confusion that occurs in the mind.

Roots of Mental Health Issues

Some of the Basics of Mental Health Issues

Mental health Delirium Tremens Fantasy

There are several different types of mental illnesses, and they all have some essence that prompts them to manifest somewhere in a person’s life. There are various conditions that people may suffer from including:

Adjustment disorders are common when a person has a hard time adapting to stress in their life.  Bipolar is another common disorder diagnosed in individuals, but this condition can easily be misconstrued and can be misdiagnosed. Bipolar or manic depression affects individuals and often includes symptoms such as:

In just a matter of minutes, these individuals seem to suffer from extreme highs to extreme lows.

They can literally drive a person crazy, and they should get immediate treatment for their mental health problems. These Delirium Tremens Dreamindividuals often threaten suicide, although many are just looking for attention and never attempt suicide. Conditions like this have a direct link to a chemical imbalance in the brain, and the problem is more neurological than physiological.

This problem is likely to be passed on in a family and has also been linked to genetics.

Some patients diagnosed as bipolar, have a family history of similar behavior with mood swings. Several of these chemical disorders are usually happening in their childhood, and trauma that the person sustained never received treatment.

Bipolar symptoms will occur if the trauma allows festering and the person never has to accept and deal with it.

Sexual disorders also occur in a similar way. These mental disorders are different from bipolar and other adjustment disorders. Sexual deviation is often linked to abuse, although not always. Pornography and other types of negative sexual behaviors are not necessarily abuse related.

However, recent studies have proved serial killers, and sociopathic behaviors are genetic. Some studies have linked these conditions to child abuse, and this may be the case in some instances, but not necessary all instances. Sexual disorders are mental, and there have been links of psychological impairments that cause interruptions in the brain`s processes which cause this Dementiabehavior to manifest itself.

Dementia and delirium are brain disorders that tend to manifest themselves in older individuals.

These cause memory loss and confusion.

If the patient is in a developing face, memory loss and confusion might be difficult to determine since the condition could be caused by other mental health illnesses in young individuals.