From Homeland to Silver Linings Playbook, Francis Ford Coppola to Selena Gomez, the media and entertainment landscape is rich with representations of people and characters living with bipolar disorder. With World Bipolar Awareness Day coming up on March 30, we thought we’d get to the bottom of what bipolar actually is – and isn’t – with the help of Casey Wolf, MD, medical director at WellPower.
Here’s our Q&A interview with Dr. Wolf. By the time you get to the end, we think you might be surprised by something – we sure were.
Q: First off, what exactly is bipolar disorder?
Dr. Wolf: When people have bipolar disorder they experience really big changes in mood corresponding with two opposite extremes, or “poles” (hence the name bipolar, meaning two poles) that really impair their lives.
One end is what we call “mania” – feeling euphoric and energetic but also irritable, not being to sleep as much, racing thoughts, talking fast, coming up with grand plans about the world that you hadn’t thought of before that might not make sense to other people. Many people with bipolar disorder find themselves doing things out of the ordinary, especially in high-risk situations, like spending money, maybe using substances in a different way, meeting up with strangers in a way they haven’t done before. When this happens, it really impairs what you’d normally be doing in your life, such as going to work or school, or taking care of your family. Manic episodes can last a few days to a week or longer, and those are followed by an episode on the other end: depression.
The other extreme is a lasting depression – what we call “major depression” to distinguish it from the common feelings we all experience. Hallmark symptoms of major depression are lower mood, feeling sad or irritable, feeling tired, sleeping more, not wanting to get out of bed, feeling hopeless, having thoughts about not wanting to live anymore, all of which last for an extended period of time. Like the manic episode, the depressive state can significantly impair someone’s ability to function at work, school and with family.
What I hear from people living with bipolar disorder is that the times of mania – feeling more energetic, euphoric, motivated, goal-directed – can feel really good. People feel like they accomplish a lot, and that feels good internally. Then on the flip side, those times of depression are really significant and people can feel really low. It takes a long time to recover from depression: it can come on fast and can take a long time to recover from.
In between these episodes people might feel more in the middle. As people with bipolar disorder get older, their symptoms tend more towards depression, with more depressive episodes and fewer manic episodes.
For people with bipolar disorder, it can be difficult to maintain relationships because the extreme emotional states are often really hard on friends and family. This is especially challenging because relationships are really important to us as people. Isolation fuels depression, so if it’s hard to maintain relationships, more isolation makes it even harder.
Q: Are there different kinds of bipolar disorder?
Dr. Wolf: Yes, there are two types: bipolar-1 and bipolar-2. The first type – bipolar-1 – is what we talked about earlier, with very high “highs” and very low “lows.” With bipolar-2, on the other hand, the manic episodes are not as pronounced – what we refer to as “hypo-manic,” where there are still the experiences of elevated or irritable mood, racing thoughts, decreased sleep, but it’s not nearly as extreme as bipolar-1, and the person is less likely to end up in the hospital or have significant psychosocial impact. The major depressive states are still there, though.
Only 1% of the worldwide population has bipolar-1. And the depressive phase of bipolar-1 disorder is the mental health diagnosis with the highest rate of death by suicide of all mental health diagnoses.
Q: What causes bipolar disorder?
Dr. Wolf: We don’t have a direct genetic cause, but we know that there is a genetic predisposition. If someone has a parent with bipolar disorder, they’re more likely also to experience it. We don’t know exactly why it emerges in the first place, though. Like schizophrenia, we have lots of theories but nothing definitive yet. And unlike other mental health experiences, bipolar disorder onset is not associated with a traumatic event.
Q: When do bipolar disorder symptoms usually start?
Dr. Wolf: Typical age of onset is late teens into a person’s 20s. It’s usually a little later for women. As a psychiatrist at WellPower, I work with teenage youth and young adults, so it’s always something I’m curious about when I meet with people with significant mood symptoms. It can be challenging to tell what’s typical teen and young adult experiences in learning how to regulate rapidly changing emotions through that time of life with lots of other changes happening – when we experience distress that would be expected from life circumstances versus what might be something that points to bipolar disorder.
Q: Is there treatment for bipolar?
Dr. Wolf: Yes – treatment consists of some combination of talk therapy, medications and other interventions that contribute to well-being like body movement, social activities and helping people identify personal goals. Unfortunately, the medicines we have right now have side effects that can make people feel flat and numb. It’s common for people to cycle through medication utilization – taking their medication for a while, then stopping due to the side effects, then starting back up again when their symptoms worsen. I completely understand the impact of side effects. It’s hard as a clinician to talk to someone about their medication making them not feel good, because one of our core goals is to help people feel better.
I’m a huge proponent of therapy, especially on the depression side, using approaches like CBT [cognitive behavioral therapy], and skill-based tools like DBT [dialectical behavioral therapy] to build emotional regulation, mindfulness and interpersonal skills. Many people also have histories of trauma, so specialized therapy for trauma like trauma focused CBT and eye movement desensitization and reprocessing (EMDR). In addition, activities to increase body movement – exercise, dance, yoga, even meditation – are really helpful. Groups are another effective aspect for many people – group therapy and even things like engaging with a faith-based group can help to further social connections.
Q: What about a cure?
Dr. Wolf: We don’t have a cure, unfortunately. We really do our best to help with the symptoms that people are experiencing with the goal of having the person experiencing bipolar disorder to achieve their goals – whatever they are. For example, if the person’s goal is to never have to go to a hospital again because of their symptoms, that might mean taking medication for a longer period of time. If it’s keeping their job, family and housing – we work with them to accomplish that.
Q: What is the most common misconception you hear about bipolar disorder?
Dr. Wolf: The most common misconception is that people think bipolar disorder is like flickering a light switch on and off, with wild mood swings happening quickly. That’s not it. We all have mood changes, experience stress and get angry at times. For the vast majority of people, shifts in mood or emotions are not indicative of bipolar disorder – they’re a common human experience. In these cases, we work with people on how to better manage their emotional regulation and get more control over how they handle their response to stress. Bipolar disorder involves long-lasting episodes of mania and depression, rather than these mood changes everyone experiences. So instead of a light switch, it’s more like the relationship between day and night – two opposites that each take quite a bit of time (in the case of bipolar disorder, it’s several days to several weeks or more for each episode).
Q: What prevents people from seeking care?
Dr. Wolf: There are a lot of barriers to mental health treatment, including for bipolar disorder. As a society we’re still dealing with a lot of stigma around mental health, and fears about being labeled as “crazy.” People are often hesitant to have a label of a mental health diagnosis.
Many people also might not understand what’s going on with their symptoms – it can be disorienting or scary, and sometimes people aren’t even aware that something out of the ordinary is happening because it’s what they’ve known as “normal” for a long time. In these cases, it can be friends or family who encourage them to seek mental health care. Then there is the perennial challenge of health insurance. (WellPower welcomes people with Medicaid coverage, as well as a number of Medicare and commercial insurance plans.)
Q: How do we treat bipolar at WellPower?
Dr. Wolf: At WellPower we’re really all about meeting people right where they are and helping them accomplish their goals. As we talked about earlier, a big part of treating bipolar disorder in general is helping people identify what matters most to them and then bringing in therapy, medications, group experiences, vocational rehabilitation, supported education, housing and others that help them accomplish that.
We are particularly good at this here at WellPower because of our focus on community. For example, our NextChapter program is part of our vocational rehab. It’s really person-centered and tries to bring together lots of options for building the skills each person needs to accomplish their goals.
How to Get Help with Bipolar Disorder
If you or someone you know needs urgent support, call, text or chat 988, the Mental Health Lifeline. In Colorado, you can also visit a walk-in center for immediate, in-person help in a crisis. Denver’s walk-in center (operated by WellPower) is at 4353 E. Colfax Ave. Find another Colorado location closest to you here.
Ready to explore ongoing mental health support for yourself or a loved one? Click here to learn about services at WellPower or give us a call at (303) 504-7900. We gladly welcome Medicaid members, and we accept a range of Medicare and commercial insurance plans.
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