Just as you’re thinking about how sweet, upbeat and loving your partner is, the mood switches. Suddenly, he’s in a funk, depressed, moody and irritable.
The cycles are up and down and repeated over weeks. It makes you wonder: Could my loved one have bipolar disorder?
Previously known as manic-depressive disorder, bipolar disorder can be difficult to diagnose — even for medical doctors. What people may suspect is bipolar disorder may only be the extremes of moodiness that still fall into the normal range, says psychiatrist Michael Gitlin, MD, director of the Adult Division and the Mood Disorders Clinic at the UCLA Neuropsychiatric Hospital and professor of clinical psychiatry at UCLA School of Medicine.
On the other hand, Gitlin says, what you pass off as normal behavior may actually be bipolar disorder. Estimates vary greatly, but experts say the disorder affects 5 to 10 million people in the U.S. today.
While only a physician can diagnose this complex disease, there are ways to figure out whether you should be concerned about your loved one and encourage him or her to be evaluated for bipolar disorder.
Identify Episodes of Highs and Lows
Knowing a bit about bipolar disorder can help. The disorder is characterized by episodes of highs (i.e., mania) followed by lows (i.e., depression). “The hallmark of bipolar disorder is the presence of these highs or hypomanias,” Gitlin says. “In some, the hypomanias are milder, and these people have a slightly different version of the disease.” Unlike full-fledged manic episodes, the hypomanic episodes may harder to spot.
Bipolar disorder has two main categories: types I and II. Depression is present in both types. What clearly differentiates them is the intensity of the manias.
“Those who have bipolar I have full-blown mania,” Gitlin says. “Those who have bipolar II have only the milder mania.” For both types, a mix of genetic and environmental factors is at play. Gitlin explains that, although bipolar disorder can come on at any time, it typically appears in the late teens or early 20s.
Suspecting Bipolar Disorder
Beware: What you think is bipolar may be extreme moodiness, but still fall within normal bounds, Gitlin says. The behavior might also indicate another mental health condition, such as Attention Deficit Disorder.
“There are a lot of people who are moody in the general sense of the term,” Gitlin says. For instance, they may become excited about a work project, then become irritable when it drags on. That doesn’t mean someone is bipolar.
Some people cycle through these different episodes a couple of times a year. Others have four or more manic, hypomanic or depressive episodes in a year, which is considered more rapid cycling, but that’s not the end of the spectrum. Some people are what Gitlin calls “ultradian cyclers”: In the course of a single day, they’re up, they’re down, they’re back up, etc.
What if a meeting at work goes well and you’re on top of the world, then, on the way home, traffic is bad and the world suddenly seems to be full of hateful jerks? You aren’t necessarily bipolar; you could normal, or simply be moody — everyone has a bad day — or have other mental health issues.
In many cases, those with bipolar disorder will remain in either the “high” or “low” phase for days, weeks or even months, which is tough on their family members and caregivers.
Not everyone with bipolar disorder has mania, and sometimes drug abuse can be confused for the mania of bipolar disorder, but mania is a big tip-off. Episodes can build. Initially, those having mania may be very creative and productive, suddenly getting to projects they’ve put off or cleaning the house at midnight. “As people get more and more manic, though, their judgment goes down,” he says. They feel invincible, spend too much money, abuse drugs or alcohol, or repeatedly mouth off to the boss and get fired.
Listen to your gut: “If someone has bipolar I, full-blown mania would never be confused with normal behavior,” Gitlin says. In most cases, a person with bipolar disorder II experiences much more depression than mania.
- If you suspect a loved one has bipolar disorder, recommend getting an evaluation by a physician familiar with the disorder (usually a psychiatrist). Be prepared with a detailed history; doctors also have tools such as a mood disorders questionnaire to help make the right diagnosis.
- Often, a doctor requires vital input from a family member or friends to get the total picture. The doctor may also may also suggest the patient attend weekly support group meetings.
- Treatment can lead to a reduction in episodes, even dropping from a dozen manic or depressive episodes per year to one episode every six months or so.
Loved ones with bipolar disorder are emotionally challenged by their condition – and emotionally challenging to their caregivers.
- Be good company. If you’ve already suggested your loved one get evaluated, offer to go along and take notes, or simply offer companionship. There’s no cure for bipolar disorder, but treatment can improve lives tremendously, Gitlin says. A combination of mood-stabilizing medications and talk therapy is best for both of you, he adds.
- Take care of yourself. Join a support group or plan stress-relieving activities, such as exercising or going to a movie. Caregivers also should feel free to seek professional support to help manage their relationships and keep caregiver stress under control. And if you are a caregiver with bipolar disorder yourself, make sure you are getting all the help you need, both for yourself and for your loved one.