Trigger warning:
depression, mania, substance abuse, self-harm, suicidal ideation
In my life, I am fairly open about my manic depression. My
loved ones tend to keep an eye out for signs of a manic or depressive episode,
which I really appreciate. However, sometimes I can’t express routine mood
fluctuations such as excitement or disappointment without someone wondering if
I need to be heavily monitored or checked on repeatedly. Let me repeat, I
really do appreciate the support of those who take action when they have concerns.
Don’t get me wrong, sometimes with mental illness, the slope of excitement to
mania is a slippery one and feeling any type of extreme emotion can trigger a (hypo)manic
or depressive episode.
I’d like to break down some of the ways that people who have
loved ones with bipolar disorder might be able to differentiate these nuances
in behavior. I truly believe as a person who suffers from manic depression and
who has suicidal ideations, the over-monitoring is beneficial to me because I
am a point in my disease where I consider myself unstable. However, many people
with this mental illness are at a place where they find themselves to be stable
and feel safe within the realm of routine mood fluctuations – they may not want
to be watched over so closely as it is exhausting work to get yourself to a
good place. Having someone there to check in can be comforting, but it can also
be ostracizing because it feels like no one else has to have someone play this
role. The best way to help a loved one is to listen. Please keep in mind that
everyone experiences BP differently, and these are cases that I have
experienced personally. In fact, most people with a bipolar diagnosis do not
experience rapid phase cycling in the same way that I do (rapid phase cycling
is more common in women and children, particularly with bipolar II), and these
cycles can be transient (2).
Excited versus Manic
- Hypomania typically lasts 4+ days (mania
typically lasts 7+ days), so if I seem overly excitatory for longer periods of
time, then it is appropriate for loved ones to start asking questions and
checking in more frequently. If I receive good news and I am excited for the
rest of the day, and present no signs of recklessness, I am just excited like
any neuro-typical person when they receive good news. Excitement may include: irritability,
anger, paranoia, and joy.
- Manic episodes tend to be presented as excess.
What I mean by this is, my friends were never concerned if I had a couple of
alcoholic drinks before my diagnosis, nor were they concerned if I had 6 of
them. Now that I have received a diagnosis, if I have a single drink there is
immediate concern and pressing questions. People who struggle with manic
depression do fall more easily to addictive behaviors – I have abused alcohol
in the past. What I want people to know is: please only be concerned that I am
having an episode if you see me indulge in more than 2 drinks in one sitting
and this amount will vary from person to person. This behavior also involves
other types of substance abuse and acts of a sexual nature, for those who are
wondering what to look for in their own friends and family with mental
illnesses. Keep an eye out for
self-indulgence and self-sabotaging behaviors.
- Similar to the excessive tendencies that I am
known to display when manic described above, I also have a marked increase in
confidence (which plummets during a depressive episode). I have racing
thoughts, all of which I thoroughly believe are fantastic ideas that I need to
carry out immediately. I’ll often make a bold statement about what I need to do, whether someone will join me
or not – imagine; me insisting my friends help me spray paint the building on
campus that stood for patriarchy (what campus takes donations from a man who is
forced to retire because of sexual assault and harassment cases against his
female employees???) and having no idea why no one else thinks the idea is
fantastic.
Sad versus Depressed
- One of the ways my psychologist determined I had
bipolar disorder II, as opposed to bipolar disorder I, was the duration of my
hypomanic episodes (around 4-5 days) and the severity and longevity of my
depressive episodes (usually at least 2 weeks at a time). With both of these
disorders, the phase shift between mania and depression is important. For
example, if I am in a manic or hypomanic state for a few days and suddenly
begin sleeping for excessive amounts of time or cannot get out bed (or any
subset of depression symptoms) suddenly, I have likely experienced a phase
shift and am entering a depressive state. However, if I receive some bad news
or am just having a rough day (maybe I overslept or maybe traffic was awful), I
am allowed to experience sadness as any other human would. Before questioning
your loved one, consider the circumstances and try to imagine how you might be
feeling in the same situation. My neuro-typical partner is just as easily
frustrated by traffic as I am, so seeing my repeated eye-rolls and heavy sighs
is not a sign for him to be particularly watchful over me no matter how
irritable I may get.
- Similar to the examples above for mania, assess
the risk-associated behaviors, the length of time that symptoms of possible
depression are occurring, and see if these symptoms are in excess. Oversleeping
one day before work is not a sign that I am experiencing major depression;
sleeping for 14 hours several days in a row is a sign that I am experiencing
major depression and I would appreciate it if someone reaches out.
Remind your friend or family member that episodes of sadness
can become episodes of depression, and that you are only asking because you
care. Sometimes I don’t want to acknowledge that the sadness I experienced when
learning my grandfather has lung cancer triggered a depressive episode. It
became obvious that I phase-shifted when I lost the desire to do anything
pleasurable, stopped taking care of myself (bathing regularly, washing my
clothes, exercise), and began experiencing more frequent suicidal ideation. I
knew it was a trigger, but I didn’t want people to dismiss my genuine sadness
over the situation as “just another depressive episode.”
Another confusing aspect of dealing with bipolar disorder
(from the first person point of view or as a loved one) is the existence of
mixed episodes – now called mixed features according to DSM-5 (1). The most
basic explanation of this term is that it is used to describe to either a manic
episode with depressive features, or vice versa. To me, mixed features are
typically noticeable by my level of anxiety. I have much higher anxiety during
bouts of mixed features than I do otherwise. When I am manic, I feel
indestructible and care-free. When I am depressed, I feel numb and empty. When
I am experiencing mixed features, I am usually hypomanic with simultaneous
anxiety due to my desire to essentially go out and be reckless but incapable of
feeling pleasure from doing so or being unable to do anything at all. I also am
most likely to dissociate during a mixed feature.
Whew, self-awareness
is exhausting.
You can help by just taking the time to listen to someone who
has mental health struggles, but if there is someone you are close to, buy them
a pack of cool pens and a workbook appropriate to their diagnosis – I have a
CBT/DBT Bipolar II workbook. It is likely that the workbook will include a list
of symptoms to look out for, and my book in particular has a section where I
filled out what my triggers are, what early warning signs of a manic or
depressive episode look like for me specifically, and general behaviors that I
should look out for. If the person you are concerned about is comfortable
enough, they can share some of these pages with you (I shared with my partner
because sometimes I like to ignore these triggers and early warning signs).
It is common that changes in a person’s schedule,
particularly sleep, or stressful life events can trigger a phase shift.
While the above examples work for MY illness, they aren’t universal to everyone with bipolar disorder. The biggest tell that someone is in crisis or unstable is a change in behavior, especially radical or sudden changes. If you suspect that someone is in crisis or suicidal, my personal belief is to reach out – even if you have to explain your concern at the risk of frustrating your loved one, it is always better to be there when you aren’t needed than to not be there when you are needed.
If anyone would like to reach out with further questions, I
can be found at:
References:
- American Psychiatric Association
- Very Well Mind
