My Life With Bi-Polar Disorder
Hi. My name is Rita, and I am diagnosed with bi-polar disorder type II.
I missed World Mental Health Day on Monday, but since this is relevant every day for me, I might as well do a late addition.
I don’t know how much people know about bi-polar disorder, so I figured I’d talk about the illness in general, as well as what I personally have to do to live with it.
What is bi-polar disorder?
BPD is a physical and mental illness that causes biological changes in your brain that affect your mood, how you think, act, and behave, and your physical health. This occurs in waves that take you up into a state of mania/hypomania, and down into depression. It varies from person to person how high up and how far down they typically fluctuate between. This happens independently of the person’s own actions. While certain incidents or factors may cause a manic or depressive episode to occur earlier or be more intense, it will always happen eventually.
Treatment is focused on making the waves smaller. The peaks won’t be as steep, and the lows not as deep. At least ideally. The idea is that episodes will happen less often, be less intense, and not last as long, but eliminating them entirely is very unlikely. It’s a chronic illness. There is currently no known cure for BPD. So everyone has to learn to ride the waves, learn the symptoms, develop methods of mastery, and manage as best they can. Many learn how to lead a satisfactory life.
Many don’t. Bi-polar has a high risk of suicide, over 20 times as high as the regular population. While I can’t currently find a source for this, I seem to remember being told that if it is not treated the suicide rate is close to 50%. People with BPD are more often successful in their attempts.
It is also not the only danger. People with BPD are more vulnerable to heart conditions, diabetes, substance abuse, obesity, sleep disorders, eating disorders, attention disorders, and generally a stronger physical reaction to stress than most people. If you have BPD in any form, I recommend getting a complete physical check-up once a year.
If you include all sub-groups of BPD, 3-12% of the population have some variant of the illness. The number could be higher due to misdiagnosis, people refusing to seek treatment due to the personal reasons, or because of the stigma still attached to talking about mental illnesses. It’s not uncommon for people with BPD to be diagnosed with ADHD or Uni-Polar Depression at first.
Bi-Polar I and Bi-Polar II
The two biggest (most severe) variants of the illness are BPD Type I, and BPD Type II. Also known as just Bi-Polar I and Bi-Polar II. Bi-Polar I used to be called Manic-Depressive Disorder, and is the most well-known variant. Bi-Polar II is a more recent classification, and as such has not been researched as much yet.
Generally Bi-Polar I is seen as more severe than Bi-Polar II.
Bi-Polar I can get full-on mania where they become hyper-active, hyper-creative, very talkative, lose their inhibitions, don’t need much sleep, and are controlled by very strong emotions, including anger. They are more likely to do risky behaviour (such as speeding or extreme sports), they lose their sense of judgement, and often start projects they can’t finish, or spend more money than they can afford. Some can get quite aggressive if anyone tries to stop or rein them in.
Bi-Polar II has a milder variant called hypomania where they become more active and/or restless, want to be more social and/or talk more, have difficulties concentrating and focusing, higher confidence, higher sexual desire, want to buy more stuff, have less hesitation and self-control, and sleep less. I’m sure that in general that sounds pretty good, and it can feel pretty good too, but there are downsides. Less patience, more irritability, higher rate of substance abuse, and poorer judgement. Setbacks hit you harder. It’s often tied to your depression, and the higher the hypomania carries you, the lower it could slam you down afterwards.
Typical advice for people with BPD is to try to rein yourself in if you recognise you’re manic/hypomanic, and try to be more active if you recognise you’re depressed. Recognising you’re having an episode can be hard, and is a matter of practice. Having a friend, family member, or partner helping you keep track can be helpful.
Other differences between Type I and Type II is that for Type I the episodes tend to last longer, as well as being more intense. I’ve heard them say they’ve been manic or depressed for over six months or even a year or longer. They also tend to have longer normal periods between their episodes. Type II episodes rarely last longer than a few months, but I have talked to some who have been depressed or hypomanic for half a year to a year.
Type II also tend to have more depression episodes than hypomania, and it’s generally estimated that someone with Bi-Polar II is in some state of depression 70% of the time, even if it’s not a full episode.
Even if you have as many manic/hypomanic episodes as you do depressive, the depressive ones tend to last longer. You might also experience mixed episodes where the symptoms fluctuate back and forth, or come in unusual combinations.
By the time the illness is fully manifested, Bi-Polar I tend to have no more one episode per year, while Bi-Polar II can have one to three.
1 in 8 with Bi-Polar have Rapid Cycling BPD, with four or more episodes per year. They can be as short as a few hours or just a day, or last for weeks. People with Rapid Cycling rarely have very long episodes, only more frequent. You are more likely to get Rapid Cycling if it takes too long to get adequate treatment. This is my variant of BPD.
Before I was fully diagnosed and started the correct treatment, I was on a pretty constant cycle of 2 weeks depressed, 2 weeks normal/hypomanic/mixed, rinse and repeat.
How is Bi-Polar Depression Different From Uni-Polar Depression?
They share a lot of similarities, and can in general be talked about in the same terms, but there are some differences. Again I state that this varies from person to person, but people with bi-polar depression have generally described their episodes as being more about lacking energy and motivation, while people with uni-polar depression have put more emphasis on feeling bad/sad and struggling with dark thoughts. These things occur for both kinds of depression, and it’s far from a fixed rule, but there seems to be general difference in how they’re affected the most.
There is also the issue that Bi-Polar depression does not necessarily need any sort of trigger. While triggers can hasten the onset of an episode, the wave keeps rolling regardless, and eventually it will happen no matter how well you’ve been doing.
Causes, Triggers and Progression
Research seems to indicate that Bi-Polar Disorder has more to do with biological factors than environmental ones. You need a certain biological weakness/predisposition to develop BPD, and while the genes have yet to be fully mapped, it’s been proven that they can be passed down hereditary. If one or more of your parents or siblings has BPD, the risk that you could also develop it is much higher.
However, having it in your genes is not a guarantee that you’ll get BPD. It’s a vulnerability, not a certainty.
For the illness to develop it usually takes some sort of trigger. Common ones being long-term stress, substance abuse, long-term highly irregular sleep pattern, and major life events. Even positive events can be a trigger.
If the vulnerability is triggered you get your first episode. After this it could be quite a while before your next one, but as the illness progresses, you will get shorter and shorter normal periods between episodes. The longer you go undiagnosed and untreated, the worse it gets, and the harder it is to recover. Unfortunately it often takes about 10 years from the first signs/symptoms of the illness, to being correctly diagnosed and getting adequate treatment started.
While you can develop BPD at any point in your life, the risk is greatest between the ages of 15 and 25. It is rare that it develops after you’re 35.
I wasn’t diagnosed until I was 31, but looking back I think I had my first episode when I was 24 or 25, brought on by a lot of small stress factors piling up over a long period of time.
I should also mention that people with BPD often also have: Anxiety disorders, sleep disorders, problems with substance abuse, attention disorders, migraines, eating disorders, and/or personality disorders.
Treatment of BPD tends to be a combination of medication, therapy, and life-style changes.
Let’s talk medication first, as it is probably the most essential part. It is a matter of trial and error, as different medication will work for different people.
In general anti-depressants are not the first choice to treat BPD. While it can have good effect with some, BPD patients have often reported little or bad effect, and/or more side-effects than usual. There is also the risk that anti-depressants could trigger mania/hypomania, so it needs to followed up on closely.
The main category of BPD medication is called mood-stabilisers, with the aim being to flatten out the waves, reduce the impact of episodes, and extend the normal periods to as long as possible. Several of the mood stabilisers are classed as anti-epileptic or anti-psychotic medication. There is also a weighing of the scales in that the quicker a medication starts to have effect, the more side-effects it is likely to produce.
There’s also lithium. Lithium is a salt, it’s cheap, and it usually either has great effect, or no effect at all. It’s fast-acting, and toxic in high amounts, so it requires frequent blood tests to monitor the amount.
I am on Lamictal (Lamotrigine), which is a slow-acting medication. It can take six months or maybe even longer for it to reach full effect, but in exchange it does not have a lot of side-effects. The biggest issue is that it can cause a fatal skin disease in a very small amount of people, which is why they up the dosage slowly over several months to be able to monitor whether or not that happens.
Personally I’ve been lucky to avoid any noticeable side-effects, and it helps me retain more control of my life.
Therapy is another component, to help BPD patients gain a better handle on things. Everyone’s needs are different. For me it was airing my thoughts, gaining a perspective on things via saying things out loud and getting feedback, and learning how to self-analyse myself better through having to explain my condition to someone else.
I also entered group therapy for a year, and attended a course about BPD, both places where I got to meet other people in tough/similar situations, and communicate on a more equal level. Being able to talk to someone who understands what you’re saying, who speaks the same language, can make a huge difference. You don’t have to explain, you can just say, and you can trade coping mechanisms and life-style tips.
Life-style changes is a more complicated topic. Again, different things work for different people. We have different coping mechanics and counter-measures. BPD makes it extra difficult because you need different methods depending on what state you’re in.
For instance: in general it’s good to get more physical activity and being outside for at least half an hour a day. But when you’re manic/hypomanic, physical activity can cause over-stimulation that makes things worse.
Eating well is another general tip, but there is no recommended diet for BPD. It’s something you have to figure out on your own.
Having a good sleep pattern is very important though, at least for me. You should try to go to bed, and get up, at the same time every day (easier said than done). When you’re manic/hypomanic the issue is to sleep long enough. When you’re depressed the issue is to not sleep too long.
Generally: Try to calm down and rein it in when you’re up. Try to force yourself to be more active when you’re down.
All of that is much easier said than done. You will likely fail more than once. Please don’t be too hard on yourself for it.
Source: A course I took on BPD last year, and the information in the binder I kept afterwards. I don’t know about any online sources, I’m afraid. Especially not any English ones.
I have come to realise (resentfully) that I have to structure my entire life around this illness and the counter-measures to it in order to make a gradual recovery. I have been really low and really ill, but I feel like I’m slowly doing better.
I also have anxiety and a high level of introversion to consider, but through a long process of self-analysis, observation, trial, and error, I have reached a mostly stable life. So long as I don’t do anything drastic or too life-changing. With the right amount of preparation I am slowly discovering that being social, even with groups of people, going on trips, and going out more are all possible so long as I don’t overdo it. It’s going to take practice and patience to get back to what I would consider a “normal” level, but I am in a comfortable enough position right now that I don’t feel like I need to rush it. I can do this. It will take years, but I can do this.
First off I need to consider my personal energy levels. This is less about physical energy/stamina, and more about emotional and mental energy/stamina. Think of it as a phone battery. As an introvert, my main source of recharging that energy is being alone and administering self-care. Going somewhere, working, and being social all drain that battery, to various degrees. The more I enjoy being with someone, and the more relaxed I feel around them, the slower the drain. But it always drains.
I still have a need and desire to be with others, just not as often or as much as other people do. I just have to take care to not exhaust myself too much. I have learned the hard way that if I get too tired, my sense of judgement weakens and I have a harder time resisting my self-destructive urges. I start to sabotage my own sleep schedule, it’s harder to get myself outside to go on walks, and I don’t eat properly. Which makes things worse in the long run.
I have generally figured out through experimentation and experience how long I can spend with various people and family members before it’s time to retreat. For instance, with my parents the limit is 3 hours, maybe 4 if I’m in a good period. And then I preferably need two weeks before I see them or anyone else again. But I have other people I’d like to see, and other things I want to spend my energy on, so I don’t see my parents every other week. I believe in time I’ll gain more endurance for these things, but for now I’m not putting anyone ahead of my own health.
Proper sleep is one of the most important things. Personally I need 6-8 hours to make it through a day in decent shape, and it needs to be at night. If it’s less than that, I am at high risk of not being able to boot up properly, and any more tends to leave me lethargic. The tip I was given was to set alarms so I know to go to bed, and to get up, at the same time every day. After doing that for several months, combined with getting more exercise, I no longer need the alarms. Unless my sleep schedule has been disrupted in some way, and I have to take steps to correct it.
I also have sleep medication on hand for those nights where I just can’t fall asleep. Depending on where I am on my cycle there’s a marked difference in how easy it is to fall asleep. I have accepted that I will never achieve 100% consistency with this illness. The medication helps, both in actual use, and for some extra peace of mind simply from the fact that I know I have it. Due to fear of having a really bad episode some day I made sure to ask for medication that I can not lethally overdose with. The worst that can happen is that I sleep for several days.
Then there is my anxiety medication that is also on a “take as needed” prescription. It’s pretty powerful stuff. It slows me down, evens my breathing, calms my thoughts, and makes me feel more in control. I can easily see how someone might get addicted to it, because I do find myself missing that feeling sometimes, even when I’m doing fairly well. So I take it as a point of pride that I’ve been trusted to self-regulate it, and I have not abused that.
Physical activity has been another important factor, which I also resent a little. It is really hard for me to pay attention and stay committed to something I’m not especially interested in, even when I know it’s good for me. Pokemon Go was what made me finally get serious about going outside regularly. Getting outside for at least an hour 4-6 times a week has made a real difference, which has made it more annoying that I had such a hard time getting regular exercise without it.
Now I am not going to make any lofty claim that I carefully watch what I eat. I cook my own food regularly, but it’s hardly the healthiest recipes. I do my best to pick healthier versions of ingredients, so long as they’re not too expensive. I take vitamin supplements to make sure my body gets what it needs, paying particular attention to Omega-3 and Vitamin D. And I make sure to eat every day. Breakfast and dinner. I don’t always get a third meal in, but I do sometimes remember to have a light lunch.
There is also the tip from Deadly Premonition: Give yourself one little reward per day. I have noticed that when I stick to that, I have gradually lost interest in/forgotten to buy snacks as much. It happened so gradually that it took me a while to notice, but more and more that one reward fulfilled most of my need for unhealthy things, and now I only rarely remember/feel the need to buy chocolate or crisps, and I’ve cut out soda altogether. I still drink juice and ice tea though, so I’m not going to claim I’ve gotten super healthy.
I have always been one to overthink things. As I realised I got ill I turned that inwards, and started to scrutinise myself. I have been gradually learning to recognise where I am on the never-ending cycle of this illness, and what counter-measures to employ. What to avoid, and what to make sure I do. A whole heap of little things, a lot of which have become more or less automatic.
I’m not going to lie, it’s really tiring. Being in a daily state of such self-awareness is very exhausting.
My Words To My Fellow Sufferers
I have realised that there’s no point in getting too hung up on how things should be or how you wish they were. You have to work with how things are. Accept what works, and what doesn’t. Now I’m not saying to just leave things as they are. On the contrary. Keep testing yourself. Determine what is useful and what isn’t. Use any tool you can, anything that works, to improve your life and your health. Don’t feel any shame in needing medication, therapy, or other help. It’s okay. It is okay. Your needs are unique to you, and discovering what they are is the important thing.
Then you can set your goals realistically, and work towards them. They don’t have to be big goals. Take any victory you can get, big or small. Learning to cherish the small ones might be hardest, but I believe that’s important.
Self-care is not just about what you want to do, but also doing what you know is good for you.
Accepting that you will fail sometimes has also been important. It’s an illness. Sometimes it will overwhelm you. Sometimes the best you can do is damage mitigation. Sometimes the best you can do is not enough. That is okay. It’s okay. It is not your fault. You get tired. You will get tired. That’s not your fault. It’s okay.
Some days will be write-offs, and you don’t have to feel bad about that.
I love you, and believe in you.