I mean, sure, if you asked me would I want to sleep only 3 hours a night without feeling tired, finish my first novel in 10 ten days, start training for a half Iron Man with no ill effects, and ramp up my personality until I was the scintillating center of every social moment, I’d definitely consider answering in the affirmative. Really, who wouldn’t? (Maybe Snow White’s little friend Dopey, I suppose, but I don’t take answers to hypothetical questions from cartoon dwarves–everyone must have their standards.)
But as surely as night follows day, research and experience show that, for a bipolar person, a manic or hypomanic episode, improperly treated and managed, will be followed by a depressive one, and, from what I’ve seen, it’s simply not worth it. For this illness, following prescribed treatment is essential, as much as you may not like it, as much as it may be unpleasant, as much as you feel you lose. Because if you don’t follow treatment, you surely lose more.
As surely as night follows day, mania leads to depression
I work with one superlative psychiatrist who tells our patients, “If you don’t have mood stability, you don’t have anything. Anything.”
He responds to their protests, “But I feel great,” “But I need the energy to. . .,” “But I miss my personality,” with a blank stare, and a Herman Munster-like repeat of the same words he’s just spoken, that are his own personal mantra: “If you don’t have mood stability, you don’t have anything.” He’s the unmovable object–and with him, often even my most treatment resistant patients can start to improve.
For the sad truth of bipolar disorder is the following: Depression is by far the dominant disordered mood state. In fact, the ratio of time spent in depressive episodes to time spent in manic or hypomanic ones is basically an unhappy three to one–if you approach the question with rose-colored glasses.
In an incredibly un-subtly titled article, called–I really couldn’t make this up–”Three Times More Days Depressed Than Manic or Hypomanic in Both Bipolar I and Bipolar II Disorder,” RW Kupka et all from the Altrecht Institute for Mental Health Care in The Netherlands share the research behind the unpleasant facts. [If you'd like to check it out, it's in the August 2007 edition of Bipolar Disorders. Read it for yourself if you don't believe it--it's important that you, if you are suffering from bipolar and are attached to your "highs," understand what every "high" brings in its wake.]
Don’t like that study? Still think your manic episodes aren’t dangerous? Okay, there’s a 2002 study by Lewis L. Judd at al from University of California at San Diego in the Archives of General Psychiatry with the exact same statistic on bipolar I–but they claim that in bipolar II it’s a ratio of 1:40. It’s getting ugly.
Still displeased with the information, still hoping to wish the unpleasant facts of mania’s promised damage away?Just take a look anywhere, in any research journal, or, heck, take a look on the web, head off to about.com if that’s where you find your in-depth information on topic (and, yes, we’ve all done it, just like we’ve all–and this is embarrassing–used Wikipedia at one point or another). I encourage you, if you’re still resisting the facts in the above studies, because there you’ll find the following: “depression is three times more common than mania in bipolar I disorder, and . . .over the natural course of bipolar II disorder, the amount of time spent in depression [is] up to 39 times more common than the time spent in hypomania.”
I’m sorry–I really am–but it’s a truth worth holding on to when you pine for your high, that you’re just setting yourself up for a far-longer low.
To add bad news on to worse, the more cycles you go through, the more likely you are to cycle again. In a term borrowed from epilepsy, this is called kindling, wherein episodes–without treatment–both increase in frequency and worsen in degree over time.
I have more than a handful of patients who have gone off their medication–sometimes more than once–and an even larger number who continue to mourn their “highs” while being medically compliant.
But you allow yourself to experience your mania to the serious detriment of your emotional outlook.
Later posts will address some things you can do to assist your healing from bipolar–aside from the obvious consistent use of appropriate medication–but for now, just recall the mantra.
“If you don’t have mood stability, you don’t have anything.”
Articles:
- Enjoy a behind-the-scenes look at the bipolar character who inspired Claire Danes’ performance on “Homeland.” She realizes the connection between sleep and manic episodes. See http://www.nytimes.com/2012/01/18/opinion/my-so-called-bipolar-life.html?_r=1&nl=todaysheadlines&emc=tha212
- ‘Kindling Effect’ on Bipolar Disorder (http://www.bipolarcentral.com/articles/articles-117-1-Kindling-Effect-on-Bipolar-Disorder.html)
- Mood Disorders (http://www.surgeongeneral.gov/library/mentalhealth/chapter4/sec3.html)
- Crash Course in Bipolar Disorder–Some useful resources depicting what life is like inside the bipolar world, at http://sashakildare.wordpress.com/2012/01/27/crash-course-in-bipolar-disorder/
Rita Felker
March 18, 2012
Dr. Abrahamson, I find your articles here on your site VERY interesting, as I am a wife of a bipolar type II. My husband had his first “crisis” in 1981, shortly after he graduated from dental school and set up his practice from scratch, about 2 years before we were married. He was monitored on Lithium, 300 mg. daily until his annual visit to his M.D. in 2005, where he influenced his Dr to take him off the meds and fabricate a letter to the effect that he no longer has a need or shows symptoms for BPDisorder. As a result, he has not been taking Lithium or any drugs for this condition since that 2005 visit, and he has become very unmanageable, eliciting numerous “episodes” for the past 5 or so years. The longer he goes without the Lithium it seems the longer his highs last. I want to get him medical help but he is in denial and no doctor will make me an appointment for him unless he complies. I am going to try the glutathione/NAC regimen, but not sure if all the other Herbals and supplements he takes will conflict. Do you have a suggestion?
Candida Abrahamson PhD
March 18, 2012
Untreated bipolar depression is a no-fooling-around matter. Of course, it’s bad for your husband’s brain, as you’ve already noticed. However, no one can tell another person what to do; you can only decide what you will do. Are you prepared to leave the marriage if he does not seek treatment? I recommend your getting help for yourself from a professional familiar with the ravages of the disease.
sashakildare
April 24, 2012
Someone not open to treatment is akin to an addict in active addiction. In a word, denial. I think it is excellent advice to focus on taking care of yourself, which could lead to more clarity as to your options. Also, I’m amazed that a doctor would prescribe 300 mg of lithium, which is a low dose that probably causes minimal side effects. Your husband is very lucky if he responded to that dose.
Candida Abrahamson PhD
April 24, 2012
Must be some confusion on the comments. My husband takes no psychotropics–and I generally try to spare him his privacy in my blog. Must be somebody else’s signficant other on that miniscule dose, and I, too, am glad for him that he responded.
sashakildare
April 24, 2012
Mourning lost highs is not the only reason some diagnosed bipolar do not want to take medication. Unpleasant side effects such as uncomfortably low blood pressure, impaired speech and coordination, rashes, and inability to dream are only a handful of such side effects. I think attitude is the most important thing though when it comes to medication compliance. Having an all or nothing attitude by patient or physician is likely to lead to relapse, because the nature of the illness is cyclical and chronic and can be triggered by various stressors. If both the patient and physician are open-minded about doses, various prescriptions, medication holidays, lifestyle accommodations, addressing addiction if it is a factor, and complementary remedies, I believe that patients can continue to improve their health and quality of life.
Candida Abrahamson PhD
April 24, 2012
You make a very good point about the challenge of working through side effects. They are manifold–even more than you list. Sounds like you’ve had some good experiences with a flexibile psychiatrist. Fantastic.