Hello! I’ve listened to you for years now and I’ve finally realized I want to learn more with bipolar. I know it’s a broad topic but can your symptoms worsen if you’re being misdiagnosed? And is bipolar disorder something you’re able to manage without medications. I’ve started therapy but I still have my moments and I don’t realize until it’s too late. I’ve always been told I have anxiety and depression but I’ve really tried to pay attention to my habits and how I act. I just feel like I’ve been trying to fix the wrong thing for years. Any advice would be great advice. Thanks again and love listening.

Hi! Great question and great topic. I think that a lot of popular media focuses on depression alone when it comes to mood disorders. Let me first briefly talk about what bipolar is. There are technically two different forms of bipolar, creatively named bipolar 1 and 2. The defining feature of bipolar 1 is mania. Essentially with bipolar 1, you alternate between periods of depression, which I’m sure you are relatively familiar with, and periods of mania.

Manic phases are a distinct period of abnormally and persistently elevated, expansive, or irritable mood. This also comes with abnormally goal-oriented behavior or energy. It has to last at least one week and be present for most of the day nearly every day. People who are manic tend to have inflated self-esteem or grandiosity, decreased need for sleep, pressured speech, flight of ideas, distractibility, increased goal-oriented activity, or excessive involvement in risky activities. You don’t have to have all of those criteria and mania can look a bit different depending on the person. Some people have very strange thoughts and even delusions when they become manic. Other people are just very agitated and have a lot of pent-up internal energy. I’ve had people call old friends at 2am just to talk. I’ve had people leave their families to go pursue an affair that is completely imaginary/one-sided.

Now bipolar 2 is a little different. You still get the depression, but rather than full mania, you have what are called hypomanic phases. Hypomania is really what it sounds like – a less severe form of mania. Basically, you can have many of the same symptoms, although irritability is possibly more common. Unlike full mania, hypomania is not significant enough to cause a significant disruption to your functioning or cause hospitalization on its own. And if you have psychosis, that automatically counts as full mania.

I will say that bipolar 2 is not necessarily less severe than bipolar 1. Less obvious, for sure. But to me it’s sort of like people on the autism spectrum. Autistic people with “higher functioning” autism does not mean that it’s less severe. I’ve had a number of close friends like this and it’s just as pervasive and impactful, it’s just less obvious to other people. So that’s a little primer on bipolar. Let’s get to your actual questions.

The first one is can your symptoms worsen if you’re being misdiagnosed? I’m not totally sure what you mean by that – whether you mean if you have bipolar but are diagnosed with something else or if you are diagnosed with bipolar but you don’t have it. In the first circumstance – if you are diagnosed with something like clinical depression, but you actually have bipolar, you can run into some interesting things. I think for many people, they are first diagnosed with depression because you don’t know that it’s bipolar until a manic phase happens. In many cases, manic phases are so different from normal behavior that they are easy to spot. Sometimes they are misattributed to things like a medication side effect or a psychotic break. But you usually can tell that something is not right. In many cases, if you give someone with bipolar antidepressants without adding a mood-stabilizing medication (there are a variety), that can throw them into a manic phase. So in that way, their symptoms would certainly get worse.

If it’s simply bipolar that isn’t caught, I wouldn’t say that the symptoms are necessarily going to get worse, because it’s not like a progressive medical condition. How severe mental health issues are depends on many factors. But you can definitely see an increase in the impact and how difficult they are to deal with. For instance, if someone is living with severe bipolar 1, but their family doesn’t notice they might get themselves in debt, have debilitating health conditions due to risky behaviors, could get in trouble with substances or the law, or may simply have a very very hard time operating within the world.

If you were diagnosed with bipolar and it was actually something else, that’s obviously problematic, but in some cases it could turn out alright. It just depends on what the actual situation is. For instance, people with borderline personality disorder are often misdiagnosed as having bipolar. Same with people who have psychotic disorders like schizophrenia. In these cases, there is a lot of medication and treatment overlap that could still be helpful. Now let’s say that someone was diagnosed with bipolar but it was actually a temporary state of delirium from a medical procedure or an infection. That could be bad news since they might be labelled inappropriate and treated inappropriately. You really don’t want to be on mood stabilizers unless you actually need them.

Next of your questions – is bipolar something that can be managed without medication. That depends. First, it depends on how severe the symptoms are. Bipolar is one of the mental health conditions that tends to be more reliant on medication than others. There are a lot of changes that you can make to effectively treat anxiety or depression. Unfortunately, there are not a lot of good techniques to make mania go away without medication. You CAN learn how to better deal with mania when it happens, though. There are many people that know their warning signs well and are good at avoiding triggers around their sensitive periods so that they rarely run into mania and even if they do, they are able to plan and mitigate the damage from it.

Meds definitely do make things easier, though. A lot of people have mixed feelings about them, but the fact of the matter is that mood stabilizers truly help to reduce the frequency and severity of mania. Ideally, someone is able to intervene on multiple levels. Medication management, therapy, and changes to the social/physical environment. It’s okay to be curious and experimental. You can try going without meds, especially if you have a good support network and you know you are going to be safe in the event of mania. If it’s becoming just too disruptive to your life to bear, then you can elevate the care and talk to your psychiatrist about medication options. If you haven’t seen a psychiatrist or you don’t feel like your therapist has done a thorough evaluation with you, that might be something to pursue. We can assess for these things and help you figure out exactly what is going on.

Hopefully these thoughts were helpful to you. It sounds like you’re trying really hard, so I’m proud of you for that. Take care!

So I have exams coming up and I just can’t get started with studying. I’m behind on every subject, so I really need to put some effort in. If I open a book I just can’t concentrate or I quit after a few minutes. I really don’t wanna fail them but I don’t seem to care enough to start studying.

I struggle with self discipline for quite some time now but it has definitely gotten worse since covid. I lay 18-22 hours a day in my bed and sleep about 10-12 because I just like being asleep. I neglect myself quite bad. I have tried several times to change, but nothing works. Today I noticed that my muscles are wasting because I lost all power in them when I took a 15 min walk. So I really want to change but I don’t know how because I never follow through with my plans. Do you have any tips on how I can get myself to study or basically do anything outside of my bed without quitting after 5 minutes?

Hey there and thank you for the question. I’m sorry that you’ve been having such a hard time with this. I know it sucks to want to do something, but you just can’t bring yourself to get the energy or true desire to get it done. And then it gets worse because it’s lingering and harder to get started. Blech. So I want to be super real and honest with you here. This does not sound like you are just an unmotivated person or that you’re being lazy. This sounds like you are depressed. Any depressed person who was listening to this question was probably thinking the same thing.

Hypersomnia is what we call sleeping excessively and that’s a super common symptom of depression. In fact, let me read through the criteria for you so you can think about how they might match up to your experience:

• Depressed mood most of the day nearly every day
• diminished interest in activities
• significant weight loss or gain when not intentionally trying to change weight
• slowing of thought and reduction of physical movement
• fatigue or loss of energy
• feelings of worthlessness or excessive guilt
• diminished ability to think or concentrate
• suicidal ideation

So, I want you to think honestly about your situation and consider whether this fits for you. I’m definitely hearing changes in fatigue/energy, interest in activities, possibly weight loss, and diminished ability to focus. The defining factor for any mental health disorder is that it significantly interferes with life. That is absolutely the case for you here. Being unable to function well in school counts as that disruption. I think it’s time for you to get some help. You’re trying to push through this all on your own, which I think is admirable. You clearly have fight in you and a strong will, but the depression is getting in the way of that.

It’s not your fault that you feel like you can’t get your shit together. That’s how depression works. So let’s do something about this before it gets even more out of hand. If your school has counseling services, that could be a good place to start. You can also talk to your doctor or health services. The research indicates that depression is treatable, so there is hope that you won’t be in this spot forever. Hopefully, as we continue to work our way out of the pandemic that helps as well. But let’s not ignore this.

Reach out to someone. If you can’t bring yourself to make an appointment, maybe you can reach out to a family member or a friend to start with. let them know that you think you are depressed and you need to figure out some way to get help. I can hear that your instincts are good in terms of doing things that would help. That’s great. Sometimes you just need a little boost to help you get there. There are many different forms of therapy, there are many different medications, there are many different lifestyle changes you could pursue. You have a lot of options.

You might also want to start learning more about depression and coping strategies on your own. I’ve covered a lot of information related to depression on the podcast before, just go to the website and search depression. I also have an entire book on the topic. There are other podcasts, books, blogs, youtube channels, etc. Start educating yourself and drag this nasty beast out into the light so that we can do something about it.

I believe in you and I don’t blame you for being where you are at right now. You got this.