"I don't want to feel numbed out. I don't feel like me when I'm on meds."
Bipolar disorder is a mood disorder with really low lows (depression), and really high highs (mania). People with bipolar want to get rid of the lows, but the highs can actually feel pretty good. A lot of people with bipolar are extremely creative and highly productive during their manic periods. A number of artists and high level executives use their manic periods to drive their careers. Is it any surprise, then, that some people with bipolar don't want to take medication for fear of loosing their creativity or productivity?
In the award winning musical Next to Normal, bipolar wife and mother Diana sings about her grief over loosing her mania:
Diana compares her manic episodes to the thrill of running across mountains and soaring above it all. I hear that same thing echoed by my clients who have stabilized their mood swings through medications and therapy. There's a profound grief that can come after the manic highs are reduced or gone. You can even loose your ability to outperform everybody else at work, as you become just a regular human again without the super-speed lent to you by mania. It's like a friend has died, or a part of you is missing. You feel like a different person and you aren't at all sure that you like it.
It's clear why people who are in the depressive phase would want treatment, but why would anyone want to give up mania?
Well, there's a downside to mania and it's a pretty big one. During a manic episode you are impulsive and your actions are extreme. That means some pretty extreme consequences can follow. Here are some real life examples of manic behaviors:
- During a meeting at work a man mouthed off to the CEO saying he could do better and making jokes at the CEO's expense. He was fired.
- A woman took her car into a dealer to get the oil changed. While waiting she bought a sports car that she couldn't afford.
- A woman went on a business trip out of the country. She met a man in a park and went with him to his home in the middle of nowhere for a one night stand. She was lucky and didn't get hurt, diseased, abducted or worse.
- A man went to a wedding with his wife. He proceeded to take pictures of guests' breasts during the reception. They were later shunned by their former friends.
- Following a breakup, a woman took a massive dose of sleeping medication. She was manic and impulsive, not depressed at the time. Luckily she survived.
To be clear, just because someone acts impulsively or irrationally, like in the examples above, doesn't mean they are bipolar. However, people who have bipolar and are in a manic episode experience these kinds of things as a rule rather than as an exception. 25-50% of people with bipolar attempt suicide at least once. People usually correlate suicide with depression, but the extreme impulsivity that occurs during a manic episode can lead to a suicide attempt. More people succeed at suicide while in a manic episode than in a depression.
Stabilizing bipolar mood swings is an art form. It takes time, trial and error and a good psychiatrist to find the right balance. Research has shown that the manic and depressive episodes that happen during the course of bipolar disorder are progressive. That means that each episode becomes more difficult to stabilize. If you take a medication and it works, then go off it and have an episode, you can't just start back up on the same medication and have the same effect. If you miss the highs and are thinking about stopping your meds, please consider this thoroughly and work closely with your doctor to make informed decisions.
So what's the good news?
Bipolar disorder is a highly treatable disease and treatment is effective in 80% of cases. The best course of treatment includes medication along with psychotherapy. Medication is highly recommended for bipolar, but it's not the only way to stabilize moods. There are CBT and DBT techniques that a psychotherapist can teach you that will help along with the medication. For more discussion on non-medication approaches to bipolar see my blog post 5 Ways to Manage Bipolar with Lifestyle Changes.
For more information about bipolar disorder, feel free to contact me.
Online Resources for Bipolar Disorder: