The Problem with Defining Bipolar as Mood Swings

I was diagnosed in 1990 at age 17. The definition was a little different back then. The only diagnostic measurement of bipolar was “responds to Lithium.” The DSM has changed the definition and clinicians have changed the usage, and currently, apparently only about 40% of those diagnosed with bipolar mood disorder respond well to Lithium. Since it’s all based on symptoms rather than etiology, I suspect they have rewritten the definition of bipolar in such a way that includes other conditions. I hope the progress they are making in understanding the working of the brain, brain scanning techniques, and genetics, that we will eventually move toward more of an intrinsic understanding of mental illnesses. We will do a more effective job of medicating them once that happens.

The mood swings associated with bipolar are anywhere from months to years long. They can be mostly upswings or a balance, but most people with bipolar have mostly downswings. I am fortunate that my father was diagnosed first, so by the time my symptoms showed up in late puberty, we had an idea of what the problem might be and what the outlook was. My symptoms included risky, compulsive behavior, like driving too fast, difficulty sleeping (one of my earliest symptoms), and talking way too fast, such that people couldn’t understand me although I could understand myself fine. There was also the typical grandiose thinking and occasionally doing without sleep, during manic phases. My depressive phases are different than ordinary depression due to circumstances, which I also sometimes experience. The bipolar depression, for me, is more like just not having energy. I sleep a lot; I don’t have motivation to do anything; I seem extremely heavy to myself, like lifting a finger or getting out of bed will take more effort than I am capable of. The world seems like an extremely dreary place. I’m not particularly sad. I just have no energy and can’t get out of bed. With meds, I can rarely tell where I would be in terms of bipolar mood. I mostly feel like a normal person, perhaps a bit less organized, although I don’t know how much of that is mental illness and how much of it is the effects of childhood trauma. Only when my stress levels get extreme, like when the pandemic started, does my sleep pattern and energy level change enough to be noticeable. I am fortunate to have always been bipolar 2, no psychotic episodes, and to respond well to a combination of Gabapentin and Zoloft. I took Lithium until the side effects got so bad I couldn’t anymore. I was a zombie on Desyrel. I am also fortunate that I tend to react to meds the same as my father, so we would talk about our meds and occasionally help each other avoid a bad one or find a good one that way. This was also hugely helpful when my father developed Alzheimer’s. The memory clinic staff had certain meds they were used to prescribing but I was able to advocate for my father and tell them which ones would work and which ones wouldn’t. The problem was that each time he went to a new facility for any reason, they would take him off his meds and he would go haywire until I managed to get them to listen to me again. Alzheimer’s is a tough one. If it runs in your family, have a pre-signed power of medical attorney you can file in case someone starts going downhill, because it hamstrings efforts to get them help if they are their own medical decision maker and they also have dementia. I did some genetic testing and I carry one of the gene mutations for it, so I plan to set this up with my husband while we’re still fairly young. Bipolar is also known for the symptom of hypersexuality, which I have. I think this is part of why I ended up a sex addict in college. I had known people who had been through drug, alcohol, and tobacco addictions and rehab, so I was savvy about those and never got into them. I had no idea what healthy sexuality or relationships looked like, and certainly you can’t learn that from watching movies or TV, so I fell right into compulsive sexual behavior with no warning signals I recognized. I have been in recovery for sex addiction for over 25 years; I credit 12-step and therapy with the fact that I am still alive, let alone functioning fairly well. I am more likely to admit to co-workers or other acquaintances that I have OCD or ADHD than I am to admit to the bipolar. They will usually see the symptoms of the first two every so often and think I am weird if I don’t explain (sometimes even if I do explain), but if I mention bipolar, people tend to expect me to be violent or out-of-control, which I don’t think is fair or accurate of most people with bipolar. Yes, bipolar 1s in the midst of a psychotic break may be violent, although not necessarily, and some people are prone to being violent based on their upbringing, not their mental illness, but I don’t associate violence with bipolar. I am fortunate to have had several friends over the years who have bipolar 1 or 2 diagnoses, and the only one I knew with a violence problem had been severely sexually abused as a child and her violence was directed at herself. When things got bad and she hallucinated, she was a suicide risk. The stigma attached to bipolar is partly due to media misunderstanding and misrepresenting the disorder. Yes, people with bipolar may experience lability of mood, which is rapid changes of mood from one moment to the next, but that is not what the bipolar mood swings are. Some other disorders, like borderline personality, are far more associated with lability of mood. Quick story: My husband and I were in couples counseling and while I had been calm, happy, and joking a moment before, my husband said something that ticked me off and suddenly I was angry and fired off a retort, and the counselor said “That’s chemistry!” We both looked at him like he was insane. I’m guessing he thought was an example of a bipolar mood swing, but it was more lability of mood, and intense sensitivity / over-reactions to stimuli.

I, too, am bipolar. I have reached stability; however, we know that stability can be fleeting. People with brain disorders tend to be extremely intelligent and that makes it easy for others to look at us and say or think, “why doesn’t she just snap out of it”. My family included. My kids, on the other hand, know what I (We) are dealing with and are super supportive. Even though it gets tiring, they hang in there. I went through a year of horrible nonfunctioning depression, again, I am stable now and I am trying my best to keep my stressors (triggers) at bay and stay on course. I wish all the best to the bipolar population that deals with this disorder.

I think the most important things to stay on an even keel are 1) Good sleep habits
2) Take prescribed meds religiously
3) Avoud substance abuse ( even caffeine)