Myths vs. Facts: Bipolar Disorder

Five myths and facts about bipolar disorder from Prechter Program team member, Christine Ribbens Grimm, M.S.N.

#1 People living with bipolar disorder are constantly feeling either “up” or “down.”

It is a misperception that all people with a mood disorder, like bipolar disorder, experience constant mood swings, shifting between dramatic highs and deep lows. While the “highs” (mania or hypomania) and the “lows” (depression) are the key symptoms for diagnosing bipolar disorder, the mood episodes look and last differently from person to person. Some people living with bipolar disorder spend most of their time feeling either revved up or depressed, while others with the diagnosis may have disruptive mood episodes that influence their day-to-day lives for shorter periods of time.

#2 It’s nearly impossible to prevent manic or depressive symptoms from occurring.

Just as individual variability exists in symptom intensity and duration, there is a range of reported experiences when it comes to symptom management and prevention. Some people living with bipolar disorder may start to become aware of their “early warning signs” for mood shifts and episodes. Behaviors like increased talkativeness and needing less sleep could indicate a manic episode for some, or withdrawing from family, friends, or hobbies might suggest a depressive episode for others.

As individuals become experts on their own condition, some can start to effectively identify what works for them to prevent minor symptoms from escalating into a full mood episode. For example, they may notify their trusted therapist who can fit them in for an additional therapy session. Or, they may work with their psychiatrist to add a sleep medication to assure that they do not go too many nights with disrupted sleep.

The support of family and friends is also very important. Episodes of depression, mania, and hypomania can occur suddenly, and close friends or family members can help identify problems so that they can be addressed as quickly as possible. Finally, adding in other self-care measures to reduce stress like exercise and engaging in activities that contribute to a sense of wellbeing may help with preventing mood shifts.

#3 Once a person’s treatment for bipolar disorder has been set, it won’t change

Most people living with bipolar disorder benefit from a long-term treatment strategy that typically includes medication, therapy, and lifestyle changes. Finding an effective treatment strategy for bipolar disorder can take time, and may look different from person to person. However, it’s important to understand that treatments, like medications, may need to be changed over time.

In fact, thoughtful adjustments to an individual’s treatment plan often represent an effective approach to caring for bipolar disorder. There are various times when consideration for a medication change may be warranted. For example, medication adjustments may be considered following a destabilizing mood episode that led to an inpatient hospitalization or as a person ages and there are changes in the way the medication is being metabolized.

#4 Alcohol and cannabis are effective ways to regulate mood in bipolar disorder

While substances like alcohol, cannabis, and other drugs might offer temporary relief by reducing anxiety or helping with sleep, regular use can harm the long-term management of bipolar disorder symptoms. Recent research from the Prechter Program analyzed ten years of data from nearly 600 individuals with bipolar disorder and found that alcohol consumption can intensify manic or depressive symptoms over a six-month period. Another study from the Prechter Program revealed that more frequent cannabis use, along with increased substance and alcohol impairment, was associated with heightened suicidal thoughts over the following six months.

#5 If a loved one is showing signs of concerning mood changes, a psychiatry referral is the first and only appointment that is needed.

While it may seem logical to send an individual suffering with mood challenges directly to a psychiatrist, that is not the only consideration to be made. It is also critical to have the person connected with a primary care provider (PCP). The PCP serves two important roles. First, the PCP will evaluate any treatable physical causes for your loved one’s mood changes such as a low thyroid level or insufficient vitamin D level. Second, the PCP can be a valuable connection point for coordinating your loved one’s care. Whether they need to be evaluated by neurology, psychiatry, or require a referral to be seen by a particular therapist, the PCP can assist with making sure they gain access to the specialized care necessary to thrive.