Bipolar Disorder- Episode 9

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Episode Transcript

(00:12):
Hi, I'm Daniel Bartley along withMerrimar Weeks. Welcome to psychobabel dash Me.
Before we start, we'd like toput out a disclaimer that this podcast
is in no way meant to replacemental health treatment and it may be triggering
for some. So before we start, let me once again go through some
statistics that I found when research emits. So. The World Health Organization says

(00:35):
that over forty million people in theworld diagnosed with bipolar disorder. The National
Institute of Health says in America there'sfive point seven million people eighteen and older
suffering with bipolar disorder, and itoccurs equally in men and women. It
affects all ages, races, ethnicities, and social groups. The suicide rates

(00:57):
are ten to thirty times higher forpeople who diagnosed with five polar disorder than
in the general population. Twenty percentwill complete suicide, which is a lot,
a lot, yeah, and twentyto sixty percent will attempt it.
They used to think, according tothe National Stuit of Health, that people
with bipolar two are not as highof a risk for completing suicides bipolar one,

(01:19):
but that has been disapproven. TheNational Suit of Health also says that
seventy point six percent of patients aremixed diagnoses suffering from major depression. Research
suggests that people with bipolar disorder maynot receive an accurate diagnosis for the first
five to ten years of treatment,and only twenty percent diagnosis correct within the

(01:40):
first year of sea team treatment,which is really really hot. And I'm
sure you've seen it in your practicethat people come in and they have been
put on antidepressants their whole life,diagnosed with major depression, and then when
you deal deeper in mystery. Definitely, especially because those patients are going to
their primary care when they're depressed.It's always known and said that patients don't

(02:04):
generally come in when they're manic.Yeah, they enjoy it. They enjoy
it, they love the high,the they're getting stuff done. So yeah,
definitely a lot of misdiagnosis, so, which can be dangerous whenever you
put someone on bipolar on an antidepressantmedication. So for those of you who
might be confused, bipolar bipolar disorderis what they used to call manic depression.

(02:30):
Yeah, and so basically what itmeans is what it says bipolar.
The two poles, So on theone side, you have the mania,
which is the euphoria and the highand whether you have the depression. Yeah,
and with bipolar one, you've hadto at least had one manic episode,
which then would be preceded or followedby a hope of hypomanic or major

(02:51):
depression episode. Right. So that'simportant because people say, I've only been
this way once, but that's allyou really need, yeah, to be
diagnosed with this disorder. And asDanielle said, it's important because when people
first come, they're coming and complainingabout all these depressive symptoms and they kind
of gloss over the mania and allof that. So you really have to

(03:13):
get someone who's going to ask youthe right, yeah, the right questions
and dig deeper and even go backyears, even sometimes whenever you know they're
in their twenties or and then anytimethat anybody would come in, sometimes they
present differently. I can have apatient come in with bipolar and be in
a depressed episode. I can somepeople will come in with just strictly mania

(03:36):
and some will come in with mixedepisodes, having the highs and the lows
within the same week, right,right exactly. So let's just define a
little bit what mania is. Somania is considered a distinct period of abnormal
and elevated or it can also bean irritable mood last at least one week
and most of the day every day. And that's important just because the differentiation

(03:59):
between five or one and two.With one it has to last at least
seven days, and with two it'sboarded. So you want to go over
some of the symptoms of a manicepisode. In yeah, the mania,
Oftentimes people are of normally upbeat,they're jumpy, they're wired, they have
increased energy activity, agitation. Theseare the patients that are coming in and

(04:19):
saying that they haven't slept for days. They've been up cleaning their house.
Right, are they sleep for threehours? But they have all the other
Yeah, Like, they're not tired, usually very talkative, racing thoughts,
distractability and core decision makings. Theygo on buying sprees. They you know,
money that they don't have, sexualrisk, risky behaviors, making foolish

(04:45):
investments. Peop, We're going tothe casinos, gambling money they don't have,
right, and they're more social thannormal. Sometimes these rates the thoughts
lead to what we call flight ofideas. So it's because they're like they're
talking this past and they can't getanything out and you don't even understand what
they're saying. And they got onemore thing to one other and doesn't make
any sense. I mean that's howthey talk. So it's like almost disorganized.

(05:09):
And sometimes these patients, because theygo so long without sleeping, will
end up having psychotic symptoms also,Yes, so they can become delusional,
they can start having hallucinations. Youknow, sometimes they have these huge ideas
of grandeur, like you know,they can become president, they can you
know, go to house and they'renot even nailing put a nail in the

(05:31):
wall. I mean, it's justa lot, a lot, yes,
and what the hallucinations. Oftentimes patientswill hear voices and or see things that
aren't there. Right. And thething that's important to remember is during manic
episodes, as we touched upon,patients often don't perceive that they are ill
or need of treatment. They thinkthat, you know, they feel good,

(05:56):
they're getting so much accomplished, notall of the goal directed activities.
Like some people will have an increasinggoal directed activities and will start seven things
at once and not finish. Otherpeople actually are more productive and that's why
they don't perceive it as being afille. Yes. But then whenever you
look back at some of your patientsthat are in mania, those are the

(06:17):
ones that are getting in trouble.They are, you know, one to
jail or they're cheating on her spouse. Yes, yes, relationship issues definitely
and sometimes especially I have seen inyounger individuals, like people in their twenties
and also men. Now I don'thave any any statistics to prove this,
but a lot of times instead ofthe work mood, it's an irritability.

(06:40):
Yeah. So really like a quickchange in from you're okay to you know,
I'm gonna do something if people getout of their face kind of thing.
And then the difference between mania andhypomania is that the it's it's usually
the same criteria, often not assevere, but the main point is that
it doesn't last as long, onlyfour days opposed to a seven day period

(07:02):
of of mania, And that's reallynot that important for the medication trials,
but that's the distinction that we usewhen we're diagnosymp so for both bipolar one
and bipolar two. The other sideof the coin, so to speak,
is the depressive symptoms, and peoplehave to have five of the following symptoms.

(07:26):
I'm going to review for two weeksthat differ from their normal mood and
it must include either a depressed moodor a loss of interest or pleasure.
So these are they feel depressed everyday all day, They feel sad or
hopeless, including in children. Andlike I said lots of times and teens,
that the instead of hopelessness that presentsof geared ability in hidonia, which

(07:48):
is that not enjoying anything at all, increase or decrease in weight loss,
insomnia or hypersomnia, psychomotor agitation whichis that they feel like they're moving too
fast, or retardation and that isthat they're slowed down, they feel like
they can't do things, anailability inabilityto concentrate or make decisions in a recurrent

(08:11):
thoughts of death. And when Iwent to a conference a couple of years
back, they said that that psychomotorretardation is very prominent. Often people with
bipolar foods order who most often sufferlonger in a depressive state than in the
hypomanic states. Oftentimes too, wheneverwe talk about the bipolar and Merri Moren

(08:35):
did some statistics. Suicidal thoughts andbehaviors are common among people as bipolar,
So we do want to stress theimportance of if you are having harm to
yourself or others to call nine toone one, go directly to the emergency
room and or called the nine eighteight suicide crisis line. Right. So,
then bipolar two what we as wesaid before, they meet the criteria

(08:58):
for least one hypomanic episode and majordepression, and they can never have met
the criteria for the manic episode.Patients with bipolar two usually seek treatment as
we've talked about before when in amajor depressive episode, and usually don't complain
of hypomonic signs and symptoms. Sotheir chief complaint usually results from depressive symptoms,

(09:22):
persistent and unpredictable mood changes, andit has to affect their personal and
occupational function. It's also important lotsof times because of what Danielle and I
said earlier, how people minimize oreven sometimes just forget about those up periods

(09:43):
if you can to get information fromtheir family or friends, because oftentimes they
will notice those rapid mood swings thatthe individual doesn't perceive in themselves. Yeah,
definitely, I always encourage patients ringfamily and friends and put them during
devalue. And it's so important thatyou do like dig deeper and you have

(10:03):
someone that's evaluating the patient, thatasks the right questions and definitely risk factors.
I want to just touch base on. Anytime that I'm doing a PsychEval,
you always ask any family history ofmental illness because generally, oftentimes they'll
say, well, mom has bipolar, Dad has bipolar, sister bipolar.

(10:24):
Because there is a genetic aspect tothe bipolar disorder right as good as a
chemical imbalance in the brain, andit has been genetically proven to life.
Yeah, and people with the changesin the brain, it's so important for
them to get treatment because it's notgoing to go away exactly. And that's

(10:45):
why it's important again, like Danielleand I kind of are pounding on,
is it's important to get the rightdiagnosis because sometimes when you put someone who
is bipolar and you put them onan tidepressants and studies have shown the antidepressant
medications and I know I'm going toget backlashed from this, but they've done

(11:05):
hundreds of them, they do notrespond to antidepressions for depression. Sometimes you
put them on antidepressions for anxiety.But if you put someone who is bipolar
on an antidepressant, not always,but they can, and that can send
them into a manic episode. Andthose men stay in your system for quite
a long time. So even thoughit takes you know, four to six

(11:28):
weeks but to take effect, ittakes a long time to get them out
of your system. So then you'vejust sent someone kind of over the edge.
Yeah, it is the wrong medication. Yeah. And two, whenever
I talk about doing psychobals, it'sso important to have the patient know what
medications they have tried, because oftentimesa patient that comes in depressed and you

(11:50):
realize that they have had this maniathat no one's ever really picked up on.
You'll notice that they have been onseveral antidepressants and have failed. Whether
you know, they've listed five andeither this one caused suicidal thoughts, this
one made me worse this, youknow, So that's a big, huge
thing to look for look into,right, So anything else before we get

(12:13):
onto the meds you want to talkabout, Danielle, just know the complications
of bipolar, if it's left untreated, can result in serious problems areas like
problems related to drug and alcohol becauseoftentimes patients will use drugs and alcohol like
as a coping mechanism for them,suicide or suicide attempt, legal or financial

(12:35):
problems, damaged relationships for workers,school performance. These are some complications that
will happen with the bipolar patient ifthey are not treated. So most of
the meds that we use to treatbipolar work on the dopamine, which is
a neurotransmitter in the brain. Andwe have the first generation antipsychotics which always

(13:01):
scares people, neuro elliptics that theyused to use that aren't used so much
anymore. And then the second generation, which are the ones that you see
on the television, like the grayLarudauda, like salty right, saccris,
all of those some of them havelike if you're on cause rule, you

(13:22):
have to have labs taken and beforeyou start any of these medications, make
sure that your provider is getting labsbecause all of them can cause what we
call metabolic syndrome, which is anincrease in weight, increases your cholesterol.
Some of them can affect your heartrate, your white blood cell count.
I mean, there's just a lotof things they can do not to scare

(13:45):
people because they were these are thingsthat we want to Yeah, definitely,
and medications filter through liver can use. You want to get a baseline all
the time of the labs, right, And then we use the mood stabilizers
which are tri lepto, Lameca,tiger toll topa max right depicoat which I

(14:05):
don't really use that too much becauseit's huge weight gainer and sometimes wemen and
make sure lose your hair could causecalled the suspect of varian syndrome. So
just not that it's a bad medicine, but usually that was always last home
I list. Yeah, definitely.And then the gold standard still for cute
mania is lithium, which is anoldie budded goodie right. Yes, sometimes

(14:28):
people are very frightened about taking lithiumjust because there's a very narrow window between
where it's going to help you andit can cause serious side effects I mean
including you know, I hate tosay it, death if you can take
too much of it, yeah,get into a coma. But again,
just make sure that your provider isgoing over with what to look for if

(14:48):
you're on lithium, and that theperson that's being prescribed Tom if you're a
family member, is going to becompliant with the lab work. The lab
work, Yeah, definitely going toget your thighroid check to white count off,
and to educate patients if they haveany like diarrhea or vomiting too,
because that can also lead to toxicityexactly. So just to touch back on

(15:11):
lithium. So some of the commonside effects are increased in thirst, increased
in having to go to the bathroom. Some people gain weight acne lithium acne,
which they can give you medication forthat fatigue. Lithium goes wherever sodium
goes in the body. So that'swhy Danielle was saying that it's important to

(15:33):
tell your provider if you have diarrheor vomiting because that changes the fluid balance
in your system and you can easilybecome toxic. If you're on lithium and
you start to get flurred vision,you find that you're unfordinated, you can't
think clearly. That is a signthat you might be toxic, and you
need to go and get your labwork drawn. Once people are stabilized on

(15:54):
the medication, then they'll probably doa lithium level like once a month and
an app that it's like every sixmonths if you're okay, it's just getting
to the right dostage and then gettingthe right level for you, and that
sometimes can be kind of burdensome,but it's you need to do it.
But again, like I said,it's the best thing for people who are

(16:15):
manic and having respond to The goodthing is now we have one drug for
everything, right, Yes, soyeah, ray Lar will treat both the
manic and the depressive episodes. Yeah. The only problem is that the insurance
companies often don't. Yeah. Yeah, and they make you jump through hoops
and take some of the older drugsbefore they let you take that. But

(16:37):
I've had patients on ray Lari.It's like the golden standard in my practice
because I've had multiple patients call meand just tell me it is changed their
lives and how wonderful they're doing.And then that, you know, in
a sense, makes you feel somuch better because these your patients are drawn
better. So to talk about likesome coping and support. It can be

(17:02):
very challenging for family, friends,even the patient with bipolar. So one
thing you want to do is learnabout your bipolar you know which you have
with symptoms make sure that your familykind of knows what you're going through,
get them on board, stay focusedon your goals. I don't know how
many times I can say that apatient will start feeling better and stop their

(17:22):
medications, which should never ever stopyour medications unless you're contacting your healthcare provider.
Yeah, this is a lifelong chronicillness. It is for the rest
of your life. Join a supportgroup often. I think in our location
we have gnomy that a lot ofpeople will be involved with. Find healthy

(17:45):
outlets such as hobbies, exercise,stress techniques which could be yoga, meditating,
relaxation techniques can help. Also tocoupled with I anytime that I have
a patient and I suggest that theyall should be in therapy. Also definitely
learning coping skills because along with bipolarbecomes you have anxiety, you have not

(18:11):
sleeping, the depression sometimes, thedrug abuse, yes, and sometimes if
you you know you come from afamily of it, you have all those
issues of you know mom or dador bipolar and it's just a it's a
complicated diagnosis, it is. Sojust make sure that you're thicken with your
treatment and being open and honest withyour provider. Calling if you have any

(18:34):
problems, questions, or concerns.Right, and we're going to have a
special guest join us here after thisbrief commercial. Hello everyone, we'd like
to welcome to the program Shannon.She's a woman who suffers with bipolar disorder.
High Shannon, Hi, how areyou this afternoon? We're good?
Thanks. So we just start atthe beginning, like when did when did

(18:59):
you first know that you were havingsome sort of mood swings or were like,
what was the first thing that struckyou? I can remember feeling what
now I recognize as depression, butthen kind of sadness an insecurity as a
really young child, probably in middleschool, but it wasn't really talked about

(19:22):
or discussed back then. But that'swhen I first noticed it, and it
really the depression really kind of becamepervasive throughout my entire life. So when
you were first diagnosed to the diagnosedyou with depression as opposed to a bipolar
disorder. Yeah, so I'm diagnosedwith depression finally, probably in my early

(19:44):
twenties, as unipolar depression. Itwasn't until probably almost fifteen years later that
I was diagnosed with bipolar iiO.Right, So that's interesting because that's one
of the statistics that I had atthe start of the show that I I
said that it was. I can'tremember the number, but most people go
up to ten to fifteen years withoutgetting a proper diagnosis. So when says

(20:08):
that's your bipolar two, did youhave a full blowd manic episode or what
happened? Well, you know,when I look back at young adulthood in
my twenties, I was very anadrenaline junkie, and I thought high risk
behaviors more from a sports perspective,extreme sports, and I needed that that

(20:33):
is rental and fixed, I think, to kind of pull my brain almost
but I still have a depression.But looking back in those early years,
I can remember being terribly depressed andat the same time, you know,
I'm a very social person, soat the same time I still had to
be still had to be the lifeof the party. I couldn't miss a

(20:57):
social event, but felt like,you know, had these like constant suicidal
ideations the entire time. It wasnow when I look back, I think
that was the start of the truebipolar symptoms. So probably in my early
twenty right, So you almost hadlike a mixed episode what we call so

(21:17):
you would have both the hypomania depressionoccurring within the same time period. Yeah,
with what I now have had diagnosedis ultra rapid cycling, right and
see existed, Yeah, exactly atthe same time, but it was but
my mood would still switch to liketotally depressed and then totally happy and kind

(21:40):
of manic throughout the day right overenergetic like impulsive behaviors things like that.
Definitely, right. So, fifteenyears with misdiagnosies and then did you ever
find that the medicines they put youon made it worse? Absolutely? And

(22:04):
I went through a number of differentmedications and nothing really felt you know,
because my mood wasn't being addressed asboth you know, from a bipolar perspective.
Sometimes I felt like the depression wouldbe treated a little bit. But
I feel like had I been ona more appropriate medication regimen, that my

(22:30):
depression wouldn't have become as debilitating asas it was at sometimes, right,
Yeah, because antidepressants don't work realwell on people who have bipolar disorder.
Do you want to kind of tellus the like, did your family or
friends or you know, boyfriends relationships, did they notice or say anything about

(22:52):
your mood swings. You know,I think sometimes from from depression perspective,
you know, I also can bekind of pipers, So I think that
my friendships and those in my circlealways just saw me as this like high
energy person and I would talk prettyfast and continually thinking of new ideas and

(23:18):
way to execute them, which reallyended up being quite a strength in my
career. But I would say thatmy close friends did often notice that behavior.
I think everybody knew that I definitelysuffered from depression, but I did
a pretty good job of hiding it. And I think, to my detriment,

(23:45):
I was always able to kind ofrationalize things in my head. I
research everything, and I'm in themedical profession, so I'm very good at
researching everything. But that also canbe to a detriment of not truly admitting
that I needed help, that Ifelt kind of out of control. But

(24:07):
it wasn't until it wasn't until oneparticular episode that I that I knew that
something was terribly wrong. I really, I think I knew that I had
bipolar disorder, but it finally sunkin enough that I knew that I needed
to seek treatment. And you know, once I kind of got through my

(24:29):
extreme sport on young twenties days andI ended up you know where I am
now in my career. I neverreally felt totally fulfilled in my career,
and that I ended up landing ajob in kind of the same role that
I am now twenty three years later. That was highly intellectual. It was

(24:51):
I work in under R and Dkind of umbrella and medical affairs with big
pharma company in big medical device companies, and I can remember sitting in kind
of a first R and D updateand it was highly scientific and highly intellectual,
and I had tears streaming down myface because I was home and it

(25:15):
was like, this is what I'msupposed to do, and that kind of
feeling of I got here despite allof the challenges that I've had. And
at that exact same moment, Iwas feeling very depressed. I had those
those you know, I'm a fraudtype of feelings imposter syndrome, which I

(25:36):
know can be really common. Andso at the same time, I'm ecstatic
and I'm listening and I feel likeI found my way home. I'm imagining
I'm imagining, you know, asuicidal I had suicidal ideations that were really
pervasive, and they are occurring atthe exact same time with kind of the

(25:57):
hypo mania, you know, ranticnote taking and frantic ideas and all of
that. And it was at thatexact moment I knew that I needed to
figure out what was wrong and figureout how to get control of it so
that it didn't ruin my career.So is that what you're talking about is

(26:18):
that the Aha moment you had thisparticular wouldn't realize that there was something beyond
depression or was it something else?Yeah? No, I think I had
earlier Aha moments, but that therewasn't really a chance of affecting what was
going to be a lifetime career choicefor example, So the stakes weren't as

(26:41):
high. I didn't have kids yet. It was really that realization of you
know, kind of adulthood. AndI was in my thirties, so I
wasn't a young adult, but thatstakes are high kind of feeling where if
I don't figure this out and getit, get control of bit, that
it may affect my ability to bea mom and my relationship and my career

(27:07):
and you know, all of thosethings I think add to our to our
self esteem, and I finally feltlike, I can't, you know,
I can't sacrifice other people in mylife that i'm you know, that I'm
responsible for, and I certainly Ican't sacrifice and and fail at a career
that I loved so much and andthose that was the important aha moment was

(27:29):
in my probably my mid thirty Sothat's when you went back to whoever was
rescribing your menth and are like,this isn't what's you know? Something else
is going on and worked it out. Yes, yes, And it took.
It took a very difficult conversation forme. You know, I'm I'm
kind of that that overly intellectual thinker. I've got, you know, big

(27:52):
vocabulary, and and I think Ialways was able to kind of come up
with what I needed to say tosound kind of educated in in what my
issues were. And it wasn't untilI really knew that I had to drop
that card and be candid and honestwith my practitioner and honest with myself that

(28:17):
I finally was able to get thediagnosis. But personally, I think I
think it was should have been painfullyobvious to my practitioners that he should have
ruled out bipolar when medications for unipolardepressions weren't working. But that's what I
finally said, this is life isn'tworking for me here right now. I

(28:38):
need to figure out what's wrong right, And that's what Danielle and I talked
about at the start of the show, that it's important because oftentimes providers,
you know, most people who arebipolar only seek help win are depressed.
And unless your provider is asking theright questions, and it should have been
a light bulb moment, you know, after minimum or maximum medication, Yeah,

(29:00):
that can fail. That you failed, that there was something more going
on, and unfortunately that happens alltoo often and on a system today.
So but now you go ahead.I'm sorry. I was just going to
say. I think also if Ihad been more open to saying a therapist
throughout that you know, depression process, I felt like I could handle everything

(29:22):
on my own. So I didn'tgo to a therapist. And I think
had I established that kind of relationship, that probably I would have been diagnosed
earlier. So I'm my fault.Yeah, well I'm not your fault,
but yes, I mean, again, as Danielle and I have mentioned,
had nauseum on our program that werecommend therapy for therapy for everyone. I

(29:45):
mean, anyone can benefit from therapyand that should also always go far and
far when you're on any sort ofpsychotropic medications just to help with coviting.
Yeah, so, but now you'regood, and what you don't mind sharing,
like what medication does they finally findit helps you? Interestingly, right

(30:07):
now, I'm only on one medication, which is le Mitchel. I'm on
a really high dose. I havea fantastic psychiatrist, and I think he's
fantastic because I view him as aphysician scientist. He is current on medications.

(30:27):
He truly understands, you know,dosing and metabolism and all of the
things that I understand are important havingworked in the pharmaceutical industry for all this
time. But he was willing totry different things. And when I said,
you know, these doses aren't workingand I feel like I metabolize it

(30:49):
and it doesn't work long enough forme, and you know, even before
twenty four hours is up, Ican feel that it's not working. Or
if I miss my medication, Ifeel almost out of control and very strange
before I take it again, andso he ordered a genetic test and it
actually came back that I was arapid metabolizer, and so so he prescribed

(31:14):
you know, higher for off labelnoses and I finally hit that sweet spot.
I can still tell if I ifI'm off by four or six hours,
but this does for me completely keepsmy life balance and my mood balance,
my self esteemed balance, and allowsme to function at a really high

(31:37):
level at work. Great. That'sfantastic, Shannon. Anything you want to
ask for Danielle, No, no, okay, all right, Well Shannon
and I appreciate you coming on theshow and sharing your story and all the
best to you. Well, thankyou so much for having me. Have

(32:00):
a wonderful rest your day YouTube,bye bye, all right, mahor Mary
that's speaker. She was very informativeand touched on a lot of the things
that we had talked about and educatedpatients about, especially about medications and treatment
misdiagnosis. Yes, definitely. Sothis is going to be our last episode

(32:21):
until after the holidays. We willcome back in January, right, and
we'd really really appreciate some email.Just let us know what you think,
any questions you have, topics youwant us to cover anything at all,
just email us at psychobabb with meall one word E S y C H
O b A d v l Fat yahoo dot com. And we just

(32:45):
want to let you know that you'renot alone. Thank you, take care, Bye MHM