I’m familiar with sadness that makes your bones cold. For years, I thought it was just severe depression. Since I was a teen, it came in waves, up until this past winter, when I entered an especially dark place: In my Brooklyn apartment, rocked by miserable weather and a seemingly never-ending pandemic, I really didn’t want to live anymore.
I’d been prescribed a popular antidepressant in 2019 to help with anxiety and depression. But in 2021, after reaching the maximum dosage, it was clear that something had to give. I turned to my psychiatrist. We had noticed ups and downs in my mood in the past, but hadn’t really dug into them.
After a few months of mood tracking, I was diagnosed with bipolar II — a subtype of bipolar disorder I never knew existed. The massive mood swings are a key element of the disorder, and part of why “regular” depression is also called “unipolar.” While bipolar I is characterized by intense, euphoric manic episodes that can send people to the hospital, people with bipolar II experience more severe depression and short “hypomanic” episodes.
While both types of mania can make sufferers feel “like the Energizer Bunny,” says Dr. Daniel Kimmel, a Manhattan-based psychiatrist, neuroscientist and professor at Columbia University, the difference is in “how interfering it is.”
“People having a hypomanic episode — it will affect them, but they’re able to keep going on with their lives, with work, they’re able to see their friends, they’re able to do hobbies,” he says.
It’s likely why I never suspected I had bipolar disorder. I’ve always been a bit of a neurotic overachiever, my life marked by periods of elevated productivity, impulsivity and creativity, speckled with harrowing, dampening depression. I often made a lot of grand plans, only to not necessarily follow through once the depression came around. Everything made sense once I was able to name it.
Experts estimate that at least 5.7 million Americans know they have bipolar disorder. I’m telling my story because one, people get silent when I bring it up, and two, misconceptions about the illness can delay treatment — which can make an already deadly condition deadlier.
“By no means is it a morbid sentence,” Kimmel says.“It’s a controllable, livable disorder.”
The ‘B’ Word
When I realized I may be bipolar, first, I was ashamed. No one wants to ever say the “B” word.
When it appears in movies or TV shows, bipolar disorder is often highly exaggerated, depicting people who are dangerous or dysfunctional.
That’s not to say the disorder can’t be debilitating; it absolutely can be. But it’s not always so black and white. These portraits of the mood disorder can mislead people, including me, about its symptoms.
In one 2005 public knowledge survey, although 8 out of 10 adults claimed to know what bipolar disorder is, fewer than two-thirds could correctly identify it from a list of mental illness descriptions.
People around the world have experienced the ups and downs of bipolar disorder (albeit by other names, many of them damaging) for centuries. Fortunately, medical providers have come a long way in understanding how it functions.
In 1960, the National Institute of Mental Health looked at data from its hospitalizations and split a group of patients into three categories: patients who experienced depression, patients who experienced major depression and mania, and patients who experienced depression and mild mania (or hypomania).
While the first two groups were recognized as unipolar and bipolar depression, the third was simply categorized as “atypical bipolar.” It wasn’t until 1980 that bipolar disorder finally made it into the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). Bipolar II, “atypical bipolar,” didn’t make it in until 1994, when the DSM-IV was published.
Due to some overlap with other mental illnesses, like unipolar depression, schizophrenia or ADHD, bipolar disorder, especially bipolar II, remains underdiagnosed.
“People with bipolar II often come in not because they’re hypomanic — in fact, that doesn’t seem like a problem to them — but rather because they’re depressed,” says Kimmel. “What the challenge is is that the doctor doesn’t know if they’re depressed because they have bipolar II or whether they have the more classic major depressive disorder. The depressive periods look identical.”
In fact, nearly 69 percent of patients with bipolar disorder are misdiagnosed initially. And one study reports it typically takes five to 10 years to receive a correct bipolar diagnosis after the initial request for help. This quickly enters dangerous territory.
When I realized I had bipolar, I was also scared. Of all the mental illnesses, bipolar disorder is one of the most fatal. If you have it, you’re 28 times more likely to die by suicide than the general population.
“Depression is the dominant pole of bipolar disorder, with bipolar individuals spending on average three times as much time depressed as manic/hypomanic,” says Dr. Michael Gitlin, director of the Mood Disorders Clinic at UCLA. Kimmel reiterates that bipolar depression can be incredibly difficult to treat. “It’s not peachy,” he adds.
Misdiagnoses can be dangerous because the treatments for unipolar and bipolar depression are fundamentally different. While both can be treated with psychotherapy, typical depression is often treated with selective serotonin reuptake inhibitors (SSRIs), which can actually worsen manic/hypomanic episodes or create mixed episodes (a combination of depression and mania) in people with bipolar disorder.
To treat bipolar disorder, psychiatrists often prescribe a mix of mood stabilizers, to reduce mood swings and prevent relapses into depression or mania, and antipsychotics, which can help control delusional thoughts in people with bipolar I. At times, a psychiatrist might add an antidepressant into the mix, but more for someone living with bipolar II than I. It can take some time to find the right treatment; in one survey of people with Bipolar I, 54 percent had tried 5 or more different medications to find the right treatment plan.
I personally was prescribed a mood stabilizer, to go along with my antidepressant, in December 2021. Luckily, I haven’t experienced side effects, and it’s drastically changed my life for the better. Before, I lived on a roller coaster that I couldn’t always control; now I’m able to roll with the punches more. I’m so grateful that I have the resources to get the treatment I need.
Due to stigma, funding issues and misdiagnoses, fewer than 40 percent of people with bipolar disorder receive “minimally adequate treatment.” Yet silence about bipolar disorder only prevents those living with it from enjoying the lives they deserve — and can, with already available help, have.