World Bipolar Day – we may have a diagnosis of BPD but why do we all experience it so differently?!
Updated: Jan 29, 2022
Bipolar disorder, formerly known as manic depression, is a mental illness in which the sufferer experiences extremes of mood that are beyond the normal highs and lows of the average person. But it is way more complicated than just labelling someone as having ‘bipolar’ because there are so many different types and subcategories.
I wrote about these differences in a previous post, but since then I’ve revisited the current medical literature on bipolar disorder and there now appears to be six distinct categories which are:
Bipolar I - Mania and Major Depression
Bipolar II - Hypomania and Major Depression
Bipolar III - Cyclothymia
Bipolar IV - Antidepressant-Induced Hypo/mania
Bipolar V - Major Depression with a family history of Bipolar Disorder
Bipolar VI - Unipolar Mania
If that’s not confusing enough then there are also subcategories within depression and mania, and many patients either rapid cycle between them or get distinct episodes with stretches of ‘normal’ mood in between.
The different subcategories are:
Depression with flight of ideas
Mania without psychotic symptoms
Mania with psychotic symptoms
Other manic episodes (some clarity on this one would be nice!)
Manic episode, unspecified (this one’s particularly helpful!)
Then there’s also a ‘mixed state’ where the sufferer gets manic racing thoughts but in a negative way, struggles to sleep, and is basically all over the place like I have been over the last four years.
Have I confused you yet?! To illustrate all of these categories I’ll explain my own experience and that of my friends in an attempt to add some much needed clarity.
Like many others, my diagnosis has changed over the years because unfortunately the medications themselves have created huge problems, new symptoms and in truth worsened my condition.
Traditional antidepressants gave me symptoms of panic, fear and anxiety - which I now identify as mixed state BPD, antipsychotics did nothing to alleviate any of my symptoms, and ketamine sent me wildly manic.
My episodes are at the extreme with full blown manias coming rarely but lasting three months, and then deep suicidal depression which can last up to 18 months at a time. In between all of this there are sporadic periods of stable-ish mood.
My diagnosis is obviously Bipolar I but then within it there are so many other states because after the ketamine fiasco I was rapid cycling between simple, mixed and agitated depression, which was absolutely horrific and quite frankly, not survivable.
My friend Cordelia (author of the excellent ‘In Bloom’ who I wrote about a couple of weeks ago), experiences the illness in a very different way. She tells me that she cycles between hypomania and depression in a regular pattern which consists of 4 months of depression followed by 5 months of hypomania with no period of ‘stable’ mood in between.
Another friend of mine Jack, who I met in hospital, has long full-blown manias but is never depressed. It doesn’t make any sense to me to call his illness ‘bipolar’ because he only experiences the manic ‘pole’ so he’s unipolar, but they call depressives unipolar, so I suppose that’s why there’s now a bipolar VI category – it’s just so confusing!
Jack also reports irritability and sometimes aggression in manic phases which I can relate to as well. In my first manic episode the police came to the house, overpowered me and put me in handcuffs which propelled me into a manic rage, and I was impossibly rude and vulgar to everyone that came near me.
This is so out of character for me but that’s what mania does – it turns you into somebody that you don’t recognise, and it can be horrific for those that support us. Early intervention is vital to prevent full blown mania, however, this hardly ever happens because the mental health teams are always so slow to respond, or they have been in my experience.
My friend Mark has episodes of both depression and mania but in a lesser way than me so I’m guessing that’s bipolar II, but over the years they’ve changed his diagnosis from psychosis to schizophrenia to schizoaffective disorder to bipolar!
He reports that the drugs have played a role in worsening his symptoms which I can relate to so completely. We’re both still on an antipsychotic drug that we only take because we can’t now sleep at all without it – the side effects from coming off these drugs are often quite frightening with all sorts of symptoms appearing which you never had to contend with before.
Recently, a young guy in his twenties messaged me and told me that he’d gone manic on antidepressants and was having a really hard time coming to terms with the fact that he’s now got a diagnosis of bipolar disorder.
For every 23 patients given an antidepressant one of them becomes bipolar – we are generating, feeding and creating mental illnesses! I suppose he would fall in the bipolar VI category now, because they’ve had to invent a category for people who go manic on the drugs! You could argue that I’m in this group as well since the ‘antidepressant’ ketamine sent me wildly and dangerously manic and traditional antidepressants instigated a frightening mixed state too.
The categories still don’t represent everyone’s experience though because I have another friend who only ever experiences mixed state rather than depression or mania, and I have no idea which category she would fall into.
The other thing about bipolar disorder is that we all experience the episodes differently too.
For me, manic episodes consist of extreme euphoria where I can’t stop talking and the mind is constantly jumping from topic to topic. I also go extremely godly and religious and believe that I’m some kind of blessed prophet or disciple!
When I reach full blown mania, I become a spiritual medium, receiving ‘messages’ through colours, songs and even the weather. In my last mania I ‘spoke’ to all sorts of people from George Michael to Mother Theresa, and I even touched God’s outstretched hand through a cloud as well!
The other friends I’ve spoken to seem to report increased sex drive with promiscuous and dangerous sexual encounters. They also tell me that they spend ridiculous amounts of money and have ‘grandiose delusions’ where they believe that they are better born and more privileged.
I don’t seem to get any of those elements, I just get the abnormal devotion to Jesus Christ and random delusions like being Jane Austen reincarnated which is what happened in the first mania! In the ketamine induced mania I thought I could speed dial the Queen through my thoughts so that’s probably even classed as mania with psychotic symptoms!
All of the friends that I have mentioned are still experiencing periods of hypomania, mania and/or depression even though they are on medication. They all seem to be taking something different too which means that there is no unified approach to treatment.
The only one who has managed get off the roller coaster and reach full remission is me, and that’s thanks to the amazing treatment I had with Dr Andy Zamar at The London Psychiatry Centre. I now take a high dose of thyroxine in combination with rTMS (repetitive transcranial magnetic stimulation) and by doing my own therapy and working really hard at getting my confidence back, the relentless up’s and down’s are completely gone – hopefully for good!
I hope to be able to raise awareness of this treatment because even though it has been shown to be incredibly effective, the psychiatrists are still not unified in their thoughts about how to treat bipolar disorder and they are all still doing different things!
This makes the ‘bipolar journey’ unbelievably complicated, distressing and quite frankly terrifying for the patient because we’re all being subjected to a barrage of different drugs until we find something that works.
I would love to know if my friends with their different presentations of the disorder would benefit from the treatment in the same way as I have. With 50% of BPD sufferers making an attempt at taking their own lives, and 17% dying from suicide, the need for successful and side-effect-free treatments and medications cannot be over emphasised.
Hopefully, I will be able to get enough of a following that I can really publicise my journey of survival, to recovery, to full remission as we never seem to hear success stories. It’s about time that we did though, and I’m hoping to provide a huge amount of hope around an otherwise complicated and misunderstood disorder, so please help me by spreading the word!
Thanks for reading,
Speak to you soon,