Bipolar Disorder: What you Need to Know

8 Myths About Bipolar Disorder
Bipolar disorder is on the rise, yet myths persist. Experts separate the facts from the fiction.
By Kathleen Doheny

FeatureReviewed by Brunilda Nazario, MDBecause of increased awareness and diagnosis, more people than ever before have a basic understanding of bipolar disorder, the condition formally known as manic depression.

Yet myths persist about this mental disorder that causes mood shifts from depression to mania and affects a person's energy and ability to function.

WebMD asked five bipolar disorder experts to help unravel what's myth and what's fact. Read on for the eight common myths about bipolar they often hear from patients and the public.

(What myths have you had to deal with while living with bipolar disorder? Talk with others on WebMD's Bipolar Disorder: Support Group board.)

Bipolar Myth No. 1: Bipolar disorder is a rare condition.
Not so, according to statistics and research. In a given year, bipolar disorder affects about 5.7 million American adults, or about 2.6% of the U.S. population 18 and older, according to the National Institute of Mental Health.

Estimates for children and teens vary widely, partly because there is debate about the criteria for diagnosis, say Thomas E. Smith, MD, a research scientist at the New York State Psychiatric Institute and an associate professor of clinical psychiatry at Columbia University College of Physicians and Surgeons in New York.

But the Child and Adolescent Bipolar Foundation estimates that at least three quarters of a million American children and teens may suffer from bipolar disorder, although many are not diagnosed. A recent study by researchers from Columbia University and elsewhere showed the diagnosis of bipolar disorder is up dramatically in children and teens and is also on the rise in adults.

When the researchers looked at the number of office visits with a bipolar disorder diagnosis in 1994-1995 and 2002-2003 in the U.S., they found that the number of office-based visits increased 40-fold for children and nearly doubled for adults from the first time period to the second.

Bipolar Myth No. 2: Bipolar disorder is just another name for mood swings.
Not so. The mood swings associated with bipolar disorder are very different than those of people without the condition, says Matthew Rudorfer, MD, associate director of treatment research in the division of services and intervention research at the National Institute of Mental Health in Bethesda, Md.

"The mood swings of bipolar [disorder] are more severe, longer lasting, and maybe most significant of all, they interfere with some important aspect of functioning, such as ability to work at one's job, or manage one's home, or be a successful student," he says.

The mood swings of a person with bipolar disorder, experts agree, are far more severe than, say, a person without bipolar disorder being bummed out because rain spoiled the weekend plans or weight loss efforts aren't showing the desired results.
Bipolar Myth No. 3: People with bipolar disorder shift back and forth from depression to mania very often.
The Jekyll-Hyde personality, the type that can turn on a dime from sad to euphoric, is a myth about bipolar, says Gary Sachs, MD, director of the Bipolar Clinic and Research Program at Massachusetts General Hospital in Boston and associate professor of psychiatry at Harvard Medical School. ''The average bipolar patient will be depressed more often [than manic]," he says.

There are people with bipolar who will shift back and forth more quickly than others, Sachs says. But that's not the typical pattern, he says. "For the most part what is typical is to have an abnormal mood state colored by a predominance of high or low.''

What's an abnormal mood state? Something intense or unexpected in relation to a situation, such as giggling instead of crying when you find out your home will be foreclosed, Sachs says.

Bipolar Myth No. 4: When they're in the manic phase, people with bipolar disorder are often very happy.
True for some, experts tell WebMD, but not for others. And a person with bipolar disorder may enter the manic phase happy but not stay that way. "The hallmark of mania is a euphoric or elevated mood," Smith says.

But, he says, "a significant number of people become edgy and irritable as the mania progresses."

"Many people are actually frightened when they go into mania," says Sue Bergeson, CEO of the Depression and Bipolar Support Alliance in Chicago, a patient-run mental health organization. "When you are moving into mania, you are losing control of your actions and thoughts," she says. Patients often complain they can't sleep, too.

A person in a manic phase may go on spending sprees, use poor judgment, abuse drugs or alcohol, and have difficulty concentrating. Sexual drive can be increased and behavior can be "off" or out of character for what is normal for them.

It's crucial, Smith says, to treat a manic phase (typically with mood-stabilizing drugs). If untreated, it can progress from an elevated mood to euphoria to extreme disorganization and other common signs of mania -- lack of sleep, increased energy, and disorganized behavior that interferes with relationships, he says.

"I don't think people look forward to manic episodes," Smith says. "When you are not manic, you can look back and see how disruptive your life became."

Smith advises bipolar disorder patients to know their early signs of a manic or depressive episode so they can get additional treatment promptly.
Bipolar Myth No. 5: There is a bipolar test.
Not true. In early 2008, an at-home bipolar test, sold over the Internet, made headlines. But the test only tells users whether their genetic makeup puts them at higher risk of having or getting bipolar disorder.

The bipolar test evaluates saliva samples for two mutations in a gene called GRK3, associated with the disorder. But it can't tell users for sure.

Today, a diagnosis of bipolar disorder depends on a doctor taking a careful patient history, asking about symptoms over time. A family history of the disorder increases a person's chances of getting it.

Bipolar Myth No. 6: Bipolar disorder can't be diagnosed until age 18.
Not true, says Sachs. But it is true that it's more difficult to diagnose it in some people than in others, because of varying patterns of the disorder.

And typical childhood behavior -- such as having a tantrum and recovering quickly to go to a birthday party -- can also make it difficult to diagnose the condition in children.

"There are clearly cases of children who have classic presentation in the early childhood years," he says. But if a child does not have a classic pattern, it's usually more difficult to make the diagnosis.

Even so, the disorder may be present but not diagnosed until later, he says. According to the National Institute of Mental Health, the median age of onset for bipolar disorder is 25 years old (half are older, half are younger).

But Sachs says many adult patients report having symptoms before age 18, whether they were officially diagnosed or not.

Bipolar Myth No. 7: People with bipolar disorder should not take antidepressants.
Not true, says Smith, who explains where the myth originated. "There's a concern, and it's valid, that some people who are depressed and bipolar, if they take antidepressants ... could flip into a mania."

The thinking, however skewed, is that the mood will be elevated too much and mania will result. Although the concern has some validity, Smith says, "that does not mean you should always avoid antidepressants." Sometimes, he says, people need the drugs, especially if the depression persists.

In a study published in The New England Journal of Medicine, Sachs and his colleagues randomly assigned 366 patients with bipolar disorder to a treatment of mood stabilizer drugs and placebo or to mood stabilizer drugs and an antidepressant, following them for up to 26 weeks.

They found no differences in adverse effects, including a shift from depression to mania, between the two groups.

Bipolar Myth No. 8: Aside from taking medication and engaging in psychotherapy or "talk therapy," a person with bipolar disorder has few options for controlling the condition.
Not true. "Medication and therapy are important," says Ken Duckworth, MD, medical director of the National Alliance on Mental Illness. But paying attention to lifestyle can help, too, he says.

"Active" strategies, such as getting regular aerobic exercise, keeping a regular bedtime, eating a healthful diet, and paying attention to personal warning signs that a shift to depression or mania is coming can all help a person manage bipolar disorder, he tells WebMD.

"If people know their warning signs, they can stave off disaster," Duckworth says. For instance: If a person with bipolar knows he starts to wake up at 4 a.m. when he is shifting to mania, he can pay attention to that pattern, Duckworth says, and promptly seek medical help.

Sources:

Ken Duckworth, MD, medical director, National Alliance on Mental Illness, Arlington, Va.

Matthew Rudorfer, MD, associate director of treatment research, division of services and intervention research, National Institute of Mental Health of the National Institutes of Health, Bethesda, Md.

Gary Sachs, MD, associate professor of psychiatry, Harvard Medical School; director of the Bipolar Clinic and Research Program, Massachusetts General Hospital, Boston.

Thomas E. Smith, MD, research scientist, New York State Psychiatric Institute; associate professor of clinical psychiatry, Columbia University College of Physicians and Surgeons, New York.

Sue Bergeson, CEO, Depression and Bipolar support Alliance, Chicago.

National Alliance on Mental Illness: "True or False? The top 10 Myths About Bipolar Disorder."

National Institute of Mental Health: "Bipolar Disorder."

WebMD Feature: "At-Home Bipolar Disorder Test: Help or Hindrance?"

Child and Adolescent Bipolar Foundation: "Pediatric Bipolar Disorder Fact Sheet."

Reviewed on August 01, 2008