It takes courage to recover from bipolar disorder. Clients must often contend with the unwelcome side effects of medication. More importantly, they face the stigma that society places on having a severe mental illness. A young woman with bipolar disorder wrote on the nami.org website:
Your expectations must be realistic: it will be slow and gradual, there will be highs and lows, setbacks and leaps forward, and there will always be people in your life who just don’t get it, but with the right assistance and support you can lead a wholly satisfying, fulfilling existence.
An insightful therapist can help you understand your own symptoms, so you can get help if you begin to approach the edges of depression or mania. A therapist will also help you negotiate some of the social and workplace minefields associated with having a serious mental illness. It is important to build coping skills that will enable you to manage your illness and the stigma that comes with it. Your therapist will help you take ownership of your treatment and recovery. A compassionate therapist can provide emotional support when you find it too difficult to discuss your situation with people "who just don't understand."
Recovery from a serious mental illness is a journey. There is no cure, but while much of your journey will be uncertain, you can achieve many goals and dreams despite having bipolar disorder.
Dual diagnosis, also known as co-occurring disorders, is the concurrent presence of a mental illness and a substance abuse disorder. People with a mental illness often use alcohol or drugs to self-medicate in the absence of effective psychiatric treatment. In 2014, 7.9 million people in the U.S. suffered from a dual diagnosis. Half of them were men.
Substance abuse worsens mental illness over the long run and can interfere with treatment. The idea that a mental illness cannot be treated until a person is sober is outdated. Both issues need to be addressed. Sometimes, this involves being detoxed from alcohol and/or drugs followed by a period of inpatient rehabilitation.
Psychotherapy and psychiatric medicine are a large part of treatment. Unfortunately, many substance abuse treatment centers are not fully qualified to treat the most difficult cases of mental illness. Further, members of some support groups, including 12 Step groups, may claim the use of any medication is "not being sober." While this is contradicted in 12 Step literature, people with mental illness may be dismayed at the lack of understanding. It is critical to "stay close" to your psychiatric treatment team, including your doctor and therapist, as you begin to rebuild your life.
Bipolar I disorder features severe mania, which usually alternates with episodes of depression. However, an episode of major depression is not required for a diagnosis of bipolar 1 disorder. Mania usually lasts at least a week and can include feelings of invincibility, extreme irritability, a marked increase in energy, and little to no need for sleep. During a manic episode, individuals can behave in risky ways, make impulsive decisions, and spend money frivolously. In some people with bipolar 1 disorder, mania escalates into hallucinations or delusions (psychosis). Depressive symptoms usually outnumber manic symptoms 3 to 1.
In bipolar II disorder, mania is a less severe form known as hypomania. It usually involves at least one episode of major depression. Hypomania is similar to mania but functioning is not as impaired. Many people who experience hypomania enjoy the increased energy and sense of self-confidence, making compliance with medication difficult. Research suggests that untreated bipolar II illness is likely to develop a pattern of more severe episodes of depression with a decreased likelihood of returning to a normal state over time. It is therefore important that people with bipolar II disorder maintain a regimen of effective treatment; it is not less severe overall than bipolar I disorder. Depressive symptoms generally outnumber manic symptoms 40 to 1. Because hypomania may be infrequent or short-lived, patients with bipolar II disorder are often diagnosed as suffering from unipolar depression.
Cyclothymia (sometimes called "bipolar III disorder") is a relatively mild mood disorder with short periods of non-major depression alternating with hypomania. In most people, the pattern of these mood swings is unpredictable. People with the disorder generally seek help when they are depressed, but cyclothymia frequently goes undiagnosed and untreated because people do not look for help. It affects up to 1% of the U.S. population. Up to half of people with cyclothymia may also have a problem with alcohol or drug abuse.
Some people experience a manic state and depressive symptoms, or a depressed state with manic symptoms, at the same time. Approximately 40% of people with bipolar disorder will experience a mixed state at least once.
Most people with bipolar disorder alternate between manic and depressive episodes once or twice a year. Others will experience rapid swings with no set pattern. These can occur monthly, weekly, or even hourly. Rapid cycling is associated with the more difficult to treat bipolar 1 disorder, and is itself difficult to treat. Hypothyroidism, a long history of antidepressant use, and PMS are associated with rapid cycling. Although difficult to treat, rapid cycling can be tamed with the correct combination of medications in many people.