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Saturday, January 11, 2014

What are the symptoms of Bipolar disorder?

     A client recently told me that based on an article they read from a Facebook link, that they have Bipolar. She forwarded me the link to the article. It was from a website called, "Your Daily Dose of Health Headlines." The original articles is at this link:

I reviewed this article, but it could of been one of  more than a dozen articles that are very similar to it that you can find on the internet, usually saying the same kind of things. The original sources are usually not clear.

    The article by the sites editor Angela Ayles, may be promoting self-diagnosis - something that people should avoid doing altogether (if you have symptoms that you're concerned about, see a doctor or a mental health practitioner). I'm sure that the intentions of the editor are good; raising awareness about mental health problems is important; however, true Bipolar disorder is relatively rare, affecting only about 1-2% of the population, compared to Depression which will affect about 10% of the population, and Anxiety, which will affect about 18% of the population. Uni-polar depression is the leading cause of disability in American and in the world. 

There is an epidemic of over-diagnosis of Bipolar disorder 
in the United States; since the 1990's  the prevalence of 
Bipolar diagnosis has grown from 1.5% to nearly 5%. 

     The over-diagnosis of Bipolar is an terrible embarrassment for the field of mental health, and it is primarily caused by pharmaceutical companies marketing drugs to treat the disorder along with psychiatry's non-scientific and vague symptoms that make-up the syndrome. This issue of over-diagnosis was first seen with Schizophrenia in the 1960's and 70's, then ADHD in the 1980's to the present day, and for Bipolar, since 2000. Other disorders that have been promoted by pharmaceutical companies include Social Anxiety disorder and Seasonal Affective disorder.

You can read more about the over-diagnosis of ADHD in the New York Times, here:
and here

The DSM V (psychiatric diagnostic and statistical manual, edition five) describes a manic episode:

     "a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day [during which time at least three other symptoms are present out of seven]."

This is a very different from the description in the article: "A mood swing is characterized by high levels of positivity followed by high levels of negativity and depression or vice versa," and manic and depressive feelings are "often experienced back to back in a short period of time."

Moodiness is normal. Bipolar disorder is not "moodiness."
Bipolar is when you have had at least one Manic episode.
Alternating between Mania and Depression will 

take 7 days or longer - usually weeks or months,
not several times a day or daily.

Rapid cycling is more like a 3-month cycle.
     The problem with any written description of a mental health disorder is the difficulty conveying how someone suffering from a manic episode really looks and acts. Vague adjectives like "euphoric" to a lay person, are easily misinterpreted. For example, many people read phrases like "mood swings" and think, "oh my god, my wife is very moody," or "my daughter is so moody, I was never that bad." A phrase such as, "high levels of positivity" is so meaningless as to be useless and should be disregarded.

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Another misleading sentence from the article: "A good indication that someone is experiencing a manic episode is rapid speech. Patients will suddenly begin speaking extremely quickly for long periods of time."

Rapid speech isn't a a "good indication" of anything other than rapid speech. It is sometimes called, "pressured speech" and it if present with many other behavioral symptoms, may lead to a diagnosis of bipolar. People who talk a lot don't have bipolar. They just talk a lot. What's important is are they're talking about make sense? For example, a physicist who gets excited about String theory may talk for hours-on-end about it (it's elaborate and difficult to explain), but that's just passion. But, when Joe the plumber starts talking about how he's going to establish world peace through a letter-writing campaign, well that's pointing towards a manic episode, but it's very important to consider the context of the "symptoms" and character of the individual as well.

The article mentions, "Racing thoughts are a common manic bipolar symptom. Individuals will have a difficult time focusing on one thing and will tend to over-analyze their thoughts."

How many people do you know "over-analyze their thoughts?" Same problem as other sentences - too vague. What's missing from the description for all of these symptoms are dimensions like intensity, frequency, duration, distress, and impact of the symptom on functioning. For example, when people are anxious, they will likely have racing thoughts and feel tense; they will have trouble focusing, and they may over-analyze the worries that they are having. I often see anxiety disorders carelessly misdiagnosed as by a psychiatrist who spends five minutes with a "moody" and expressive patient complaining of racing thoughts along with rapid speech. 

From the article: "Irritation and agitation are common in both manic and depressive episodes. Sufferers are easily irritated by situations they normally wouldn't be agitated with."

Again, this symptom lacks dimensions like intensity, duration, and so on. The type or irritability in a manic episode usually persists longer than a week. It can be a reaction to someone telling the manic individual that they will never achieve their irrational goal of world peace or ending homelessness or invention a perpetual motion machine; but, for the most part, the irritability is constant and will lead to behavior problems with serious consequences, like losing friends or being arrested or hospitalized.

From the article: "When a person is experiencing a manic episode they will often have extremely high levels of energy. To help relieve the energy, sufferers often turn to physical activity. If someone suddenly feels the need to exercise excessively to exert energy, it may be an indication of a problem."

Yes, when people are manic, they will usually have lots of energy; however, the example of "feels the need to exercise excessively," is poor. In a manic episode, the energy is almost always disorganized; so the manic individual will spend lots of time pacing, walking around, maybe running around town; but, they'll be outside in pajamas, or running in a suit and tie, dress, or barefooted - in other words, they'll look out of place or seem odd. The level of energy in mania is overflowing and the individual will have difficulty directing and containing it. Sometimes the energy is used to try to achieve some grandiose goal, but the person will appear like "they have some loose screws" and someone will probably call the police or an ambulance.

From the article: "Sometimes, people suffering from bipolar disorder will turn to drugs and alcohol. Careless use of these substances may be a warning sign of deeper issues."

Again, the example for this issue is poor. Alcohol abuse is common during a manic episode for several reasons, but mainly to get a handle on the over-flowing energy. Many people with mania have prior problems with alcohol or drug use. In fact, many drug and alcohol abusers are misdiagnosed with Bipolar when in fact they are suffering from the effects of chronic or excessive substance use. The factors that lead to substance abuse are many and complicated. It is important to understand that Bipolar disorder should only be diagnosed if a person has a manic episode after at least 6 months of no drug use of any kind, or perhaps a year of sobriety for someone who has been a chronic drug user.

From the article: "As previously noted, manic episodes often involve large bursts of energy and euphoria. These symptoms can make it incredibly difficult to sleep. An individual experiencing this symptom will require less sleep but won’t necessarily feel tired or exhausted."

When someone has a manic episode, they usually don't want to sleep. They're may be times during the day when they sleep for a 2-3 hours, but they will usually be up and about, going from one unrealistic goal to another.The lack of interest or need for sleep will last at least 7 days, but usually much longer. It's very important to understand that all of the symptoms of mania or bipolar disorder must occur in the complete absence of any substance use, including prescription drugs like anti-depressants, ADD drugs, or even anti-anxiety drugs like Xanax, all of which are known to cause manic and depressive episodes.

From the article: "Individuals experiencing other symptoms on the list, along with chronic pain with no known cause, may be suffering from bipolar disorder. This pain can present itself throughout many parts of the body including, but not limited to, severe headaches."

Pain is not a real symptom or criteria for diagnosing bipolar disorder. There are far too many factors that can cause pain and contribute to pain. If you have "severe" headaches, whatever that means, then you should see your primary care doctor immediately. If that's your only symptom, don't worry that it could be bipolar disorder.

Mental health in America is highly prone to diagnostic fads which usually coincide with the marketing of new drugs. This happened with Schizophrenia, Depression, and it continues with ADHD, and more recently Bipolar. The fact is that there are no effective long-term drug treatments for any of these problems without serious and even life threatening side effects. Pharmaceutical corporations want you to engage in self-diagnosis so that you'll visit your doctor and ask them to prescribe the precise medication that is being marketed. Most people trust that pharmaceutical corporations to be doing the "right thing," but the record is undeniably clear: pharma corporations only care about their shareholders at the cost of your health. These companies have had many criminal charges filed against them and they have shelled out billions of dollars in fines for misleading doctors and the public. The problem continues to this day. Since 2004, the FDA no longer works for the American people, it considers corporations to be their client and receives millions of dollars in fees from them. This information is public record. Let the buyer beware.

Further recommended reading:
Bad Pharma (all the schemes that drug companies use to get ineffective and dangerous drugs on the market and get you to take them).
The Emperor's New Drugs (how and why anti-depressants are placebos).
Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America.
Mad in America (the history psychiatric interventions - a must-read for any consumer or provider of mental health).
Your Drug May Be Your Problem: How and Why to Stop Taking Psychiatric Medications.

Links to additional posts about Bipolar disorder:

If you think that you or someone you know really has "bipolar" disorder, take a step back from labeling the problems and instead schedule an appointment with a licensed mental health provider for an evaluation. Keep in mind that if you visit a psychiatrist, you're likely to be treated with pills. You may want to consider starting with a Licensed Clinical Social Worker or LCPC first. If they feel that you would benefit from drug therapy, then they will refer you to a psychiatrist of other medical doctor. 

Mental Health Advice Disclaimer: The information included in this post and blog are for educational purposes only. It is not intended nor implied to be a substitute for professional mental health treatment or medical advice. The reader should always consult his or her mental health provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a mental health or medical condition or treatment plan. Reading the information on this website does not create a therapist-patient relationship.


  1. mainstream medication are to time costing for Bipolar Disorder Treatment . any thing new should be introduce to us

    1. If you really were correctly diagnosed with Bipolar I, you probably need a mood stabilizer, but anti-psychotics or neuroleptics like Risperdal, Zyprexa, Seroquel, Abilify, or others are probably not necessary and long-term very dangerous.Finding long-term, safe and effective meds is challenging. Depakote seems like the best for long-term prevention of manic episodes.

  2. Depression is most common symptoms of bipolar disorder.Lifelong treatment is required for people who are suffering from this disorder and people needs care and support during this problem.

    1. Be careful not to over-simplify and over-generalize. Probably close to 50% of people diagnosed with are misdiagnosed but never try to confirm the diagnosis with another provider-type. For example, the range of behaviors that qualify for manic are far too broad; too many people coming out of depression are seen as "hypomanic" when they are just happier; "moodiness" is seen as a symptom by laypeople when it is not; one symptom becomes the entire disorder for laypeople; many providers do not assess for substance abuse and many patients will lie about their substance abuse (you can't be dx with bipolar if you've recently taken substances). Also, the idea of lifelong treatment may be true for some, but not all, and the type of lifelong treatment needed is not clear.

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