Living With Bipolar Disorder

WebMD Live Events Transcript

According to the National Institute of Mental Health, more than 2 million American adults have bipolar disorder, a severe brain disorder that causes unusual shifts in a person's mood, energy, and ability to function. On July 14, 2005 our guest, Kay Redfield Jamison, PhD, author of "The Unquiet Mind," shared her perspective as both a psychiatric expert in the disease and someone living with bipolar disorder.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome to WebMD Live, Dr. Jamison. Thank you for joining us today.

JAMISON:
Thank you for asking me, I'm delighted to be here.

MODERATOR:
We have a very vibrant and active bipolar community here on WebMD, especially on our message board. Several of them have questions for you so let's get started.

MEMBER QUESTION:
It is an honor to have you join us. The bipolar support group is especially tight and your books are recommended reading often for newcomers.

One thing that consistently splits us is the topic of meds versus no meds. I consider myself lucky to have found stability on lithium and an antidepressant since 1980, but others continue to struggle with med combos. A big controversy is when someone declares meds is a problem and advises others that this is a valid choice. My experience is, especially as I age, that at any given time, I am about a week away from trouble if I don't have my meds. You know, you lived it, and you've done the research. Is no meds a valid option for those with bipolar diagnosis?

JAMISON:
Very rarely. The scientific and clinical evidence is overwhelming that the best treatment for bipolar illness is medication and often medication combined with psychotherapy.

MODERATOR:
Dr. Jamison, at what point in your life did you discover that you had bipolar disorder?

JAMISON:
I was diagnosed with bipolar disorder when I was 28. I first got ill when I was 17 or 18, when I was a senior in high school. And like many people who have bipolar illness there was a long period of time between my first episode and getting diagnosed.

"There are certainly many overlapping symptoms between ADHD and bipolar illness. Sometimes people have both illnesses. Sometimes people have only bipolar illness and are misdiagnosed as having both."

MEMBER QUESTION:
I was recently diagnosed at age 21 and I cannot accept the fact that I am indeed bipolar. I know that my life isn't exactly normal but I just cannot accept this is me. What would you suggest?

JAMISON:
I think one of the hardest things to do after being diagnosed and ill with bipolar illness, is to learn to live with the reality that one has it. I think that the support group is one of the best ways to do that; other people who have similar problems are often best able to deal with how you cope with the problem. Psychotherapy is another really helpful way of learning to deal with the notions of yourself and what it means.

I think what happens over time is that you begin to realize, once you have been well long enough, that the illness doesn't have to define your notion of yourself by any means. It is part of who you are and it is part of what you have to take into consideration in your life, but it's not something that has to dominate your life.

MODERATOR:
How did you come to accept your diagnosis?

JAMISON:
With difficulty. I suppose I did several things. One is I rebelled, which was very, very unhelpful and nearly cost me my life. I went on and off my medications. I became very suicidal. I was very, very severely depressed for 18 months and after I nearly died from a suicide attempt, I realized that I was either going to die or accept my illness. But it's hard to do. It's not very consistent with the way you're brought up to believe life is going to be.

I think reading can be helpful and talking with other people can be helpful. I was fortunate in having quite a bit of understanding from friends and family, but there's no question that it is a very, very difficult sort of thing to deal with and anyone who says otherwise probably has not been there.

MODERATOR:
I don't think that you would get any argument from anyone who has bipolar disorder or the people who live with them and love them.

MEMBER QUESTION:
I am 17 and have bipolar and have ADHD. Will I have to be on the meds the rest of my life? I was diagnosed with ADHD first. Could it be that I don't have the ADHD but just have bipolar? I'd like to stop some of the meds. I'm a athlete and think the meds mess up my body.

JAMISON:
It's possible that you have only bipolar disorder, but obviously, I couldn't say. But if you have any doubts, you should get a second opinion.

There are certainly many overlapping symptoms between ADHD and bipolar illness. Sometimes people have both illnesses. Sometimes people have only bipolar illness and are misdiagnosed as having both.

I obviously couldn't say in your particular instance, but I would learn as much about both of the illnesses as I could, and I would talk to my doctor and ask as many questions as you can.

MEMBER QUESTION:
I was diagnosed with bipolar disorder in 1997. The doctors are now telling me that I have had thyroid disease all my life, and the antidepressants are making it worse. None of them ever worked -- I just kept getting worse. What do you know about the correlation between thyroid disease and bipolar symptoms? Is there a brain scan or anything yet where they can make an absolute diagnosis? I'm so tired of being called "psycho" when all I can think in my heart and my head is, this is not who I am.

PS: Your book The Unquiet Mind is amazing and I have so much respect for you that you never let it stop you from getting what you wanted out of life. You are truly one of my mentors. Light and love.

JAMISON:
Thank you very much. I appreciate that.

There certainly is a correlation between thyroid problems and mood disorders. People who have mood disorders are much more likely to have a history of thyroid illness. Some people who are put on lithium develop thyroid problems which are pretty easily treated by thyroid replacement. We know just a lot of things about what goes on in the brain and one of the things is that there is a relationship between thyroid functioning and mood disorders.

As far as antidepressants go, we also know that with certain kinds of bipolar illness, antidepressants can make the illness worse. It can precipitate mania, it can precipitate mixed states, it can make the illness more rapid cycling and more difficult to treat. That's not true for everyone who has bipolar illness but it's certainly true for many people who have bipolar illness.

MEMBER QUESTION:
Once you let people know you have bipolar disease, how do they treat you? A few people know about my disease and some treat me like I'm a "head case" even though I try very hard to control things. I'm on meds and doing well. What can I do about the way they treat me?

"I think the good thing is that people are learning a lot more about these illnesses. People are more tolerant than they used to be. They are still not nearly as tolerant as one would like, but they are more aware of what we know about the brain and research and treatment."

JAMISON:
Again, it's hard. It's hard to know when to come out, it's hard to know how to come out and it's hard to know how to deal with people once you are out.

I was actually quite delighted, in general, with the response of my colleagues. I had always told the colleagues I worked most closely with that I had bipolar illness, but I had not told most of my colleagues and they were more supportive than I really thought that they would be.

There's no question that people look at you differently and treat you differently. There's on occasion the very patronizing remark. You are, I guess, just regarded differently. I think that you can only influence other people's opinions up to a point, and the most important person's opinion that you can influence is your own.

One of the best things that you can do is really just become convinced yourself that that's not a negative, that it is part of who you are and just take strength from it. Take strength from what you learn from the adversity and just don't give other people the power to make things even more difficult. Having said that, I realize it's a lot easier said than done.

MEMBER QUESTION:
I admire you so much. I've only been diagnosed since March. Did your family accept it and help you, or did they make things worse? Mine made it worse.

JAMISON:
Well, I would say both. Basically, half of my family was incredibly supportive. They learned everything they could about it, they talked with my psychiatrist and they read what was available at that time, which was not nearly as much as there is now. Now there are a lot of good books and a lot of things to read about and there are support groups that you can talk to and be involved in.

The other two people in my family made it more difficult, not because they wanted to make it difficult for me, but because they had actually the same illness that I have and they really very much believe that medication was bad, that it was a weakness to depend upon medication, and it made it difficult for me to accept the idea. I came from a military background and a really conservative background -- not politically but socially. And it wasn't done -- to see a psychiatrist. It wasn't done to admit you had that kind of problem. So they inadvertently made life more difficult than it could be.

I think what you have to do is surround yourself with people who make it easier for you and who try to understand you. I think what you find is that many people are eager to be educated about it and to learn about it. Try and get people that are in your family to read about it, learn about it as a medical illness, learn about the treatments, learn about the consequences of not being treated and if it's appropriate, have them come in and talk to your psychiatrist or psychologist with you so that they can learn more. It's a place where education goes a long way.

MEMBER:
Yes, but I'm a jock and in my group no one sees a psychiatrist and no one has these kinds of problems or else you're just a "head case."

JAMISON:
Yes, I appreciate the problem. I think that it's probably almost certainly true that they say that and they may make you feel that way. But the odds are that some of them have problems, if not the same as your own, similar to your own.

I think the good thing is that people are learning a lot more about these illnesses. People are more tolerant than they used to be. They are still not nearly as tolerant as one would like, but they are more aware of what we know about the brain and research and treatment. And I think as the years go by, people are going to get even more tolerant as they understand more.

MEMBER QUESTION:
I'm 54 and have been living with bipolar 25 years. I take it you are med compliant. Do you feel this disease is progressive as we age?

JAMISON:
Yes, I am med compliant. As I say, I nearly died from not being compliant with my medications, and ever since then I have taken them religiously.

The illness progresses if you don't get treated, or tends to progress -- not in everyone but in many people it does tend to get worse over time. The great advantage of treatment is that it prevents that progression and it largely prevents recurrences when the medications are working properly. That's one of the really terrific things about medication -- it can prevent the illness from getting worse over time.

MEMBER QUESTION:
You are my hero. People now come to the support board with rapid cycling. Traditionally this was defined as more than four cycles a year, but now people feel sad in the morning and then have something good happen and they say they are manic. No one will accept medication to a point they feel nothing. How do you divide up what's the disease and what's just learning to cope with life?

JAMISON:
Well, sometimes it's complicated and sometimes it's pretty straightforward. One of the reasons why psychiatry and psychology have diagnostic criteria is because those criteria allow clinicians to try and sort through what is illness and what is just a normal response to life. Sometimes it can be difficult to sort that out but generally it's more straightforward than you would think.

MODERATOR:
That can be particularly difficult when you're dealing with an adolescent who has bipolar disorder because adolescents go through so many mood swings whether they have the disease or not. They are constantly on this emotional journey towards adulthood. So sometimes it can be extremely difficult to understand what's the disease and what's teen behavior.

JAMISON:
I think that's true up to a point, but actually one of the things that's quite interesting from psychological research, most adolescent are more normal than people give them credit for being and their moods are actually more stable than most people give them credit for being. Not to say that there isn't a certain moodiness and so forth in adolescents, but it's probably been exaggerated.

I think one of the things that has been very helpful, and I could not say enough good things about good psychotherapy and enough bad things about bad psychotherapy, is that when psychotherapy is done properly, one of the things that it addresses is exactly that. How much of this is my response to other people, how much of it is my character structure, how much is my personality, how much of it is my mood disorder? Those are very complicated medical issues and existential issues; psychotherapy, in the hands of someone who is very well informed about the biological aspects of mood disorders, can be a lifesaving sort of thing.

"I'm a great believer that people should go into their doctors' offices with note pads full of questions."

MEMBER QUESTION:
Do you feel menopause plays a role in bipolar disorder?

JAMISON:
It certainly can. Any time along a woman's life where there are substantial hormonal changes can affect moods and mood disorders.

One of the reasons, for example: what we know about the postpartum period is there are so many hormonal changes that if a woman has an underlying predisposition or biological genetic predisposition to a mood disorder, that's the most likely time it's going to be triggered. So some combination of an underlying predisposition or vulnerability combined with strong hormonal changes can make a real difference.

However, what we also know about mood disorders is that their age of onset is quite young for both depression and particularly for bipolar illness. The average age of onset for bipolar illness is about 18. So, most people who have their first occurrence of mania or bipolar depression are going to have it when they are relatively young.

MEMBER QUESTION:
Since I have been on my medications I've felt flat. I have very little emotion and I'm not interested in any of my usual activities. Could one of the medications cause this?

JAMISON:
Yes and these are things that you always want to sort out if people are feeling flat, unenergetic and emotionally distant or unengaged:

  • Is it depression? Depression can certainly look that way.
  • Is it a thyroid problem? That can be treated pretty straightforwardly.
  • Is it a medication? If it's a medication, is it inevitably going to cause that reaction in that person or is it related to the dose?

These are the sorts of issues that should be brought up with the person's doctor. I'm a great believer that people should go into their doctors' offices with note pads full of questions.

MEMBER QUESTION:
Do you have any suggestions for dealing with economic stressors during periods of low functioning?

JAMISON:
Wow, not really. I think that there are some things that you can do when you're well to protect yourself.

A lot of people who have bipolar illness, for example, when they get manic, spend money in an irrational way. They can make contracts with their family members for the family to manage the majority of the money so that they don't get themselves into terrible financial problems. In terms of acute financial problems when depressed -- not really.

It's one of the most barbaric aspects of our health system; that psychiatric care is expensive and unaffordable for so many people. This is ultimately a political issue and one that the advocacy groups and support groups that I know are very actively involved in trying to do something about -- so that psychiatric illnesses are given parity with medical illnesses so people don't have that kind of financial strain. A lot of people in this country are put in the position, when they are depressed, of having to choose between not taking medication or not being able to pay their rent and that's inexcusable.

MODERATOR:
Yes, it is. Members, you may want to search on WebMD and look in our WebMD Live archives. We have done a couple of interviews with Roslyn Carter, former first lady, who is very active in this area, on mental health parity and erasing the stigma of mental health in our society.

JAMISON:
She has been terrific and also very active on the other side of the aisle is Senator Pete Domenici, whose daughter has schizophrenia; he's been a very active participant. And of course the late Paul Wellstone -- more than anyone in the United States Senate -- he and Senator Domenici worked together very closely to try to do something about parity. The problem is it actually tends to pass the Senate, and then gets bottled up in a very small subcommittee of the House of Representatives. That has to do with insurance companies.

MODERATOR:
Yes, that's exactly what Mrs. Carter said.

JAMISON:
She has been great, of course. She and her husband both -- she has been just fabulous.

"My experience with support groups is that they have more ideas than anybody, both more practical and more invested in trying to help other people with similar problems."

MODERATOR:
She spent over 30 years trying to get people to understand that mental illness is an illness -- just as diabetes or kidney disease and that people need to be allowed to have their dignity and receive treatment.

JAMISON:
Yes, she has been terrific.

MEMBER QUESTION:
I'm 58, recently divorced, on a medical assistance program and just diagnosed as suffering from bipolar disorder. I can't find a psychiatrist who will accept medical assistance. I really need to speak to someone soon.

MODERATOR:
Unfortunately her situation is not terribly unusual.

JAMISON:
No, it's not. Again, I think going to one of the support groups or the advocacy groups like the Depression and Bipolar Support Alliance or the National Alliance for the Mentally Ill and asking some other members of groups what their suggestions are in the local community might help.

MEMBER QUESTION:
I am a nurse and having so much trouble with the constant ups and downs. My employer, where I review records, is threatening to fire me. What can I do? My psychiatric doctor wanted to put me in day treatment but my boss said that if I went out he would not hold my job. I am just going through a divorce of 33 years of marriage. I have problems concentrating. I tried Lamictal but broke out in a rash. Now I am starting on an emotional roller coaster again. I don't want to die but it crosses my mind so often.

JAMISON:
I would talk to your doctor long and hard about what to do. I mean, there are legal considerations, certainly with the Americans with Disabilities Act, which may or may not be helpful in this particular circumstance. Certainly it's something that you should really discuss with your doctor and again, with the support groups. My experience with support groups is that they have more ideas than anybody, both more practical and more invested in trying to help other people with similar problems.

MEMBER QUESTION:
My daughter has recently experienced severe mood swings, since the school year ended and about the same time her OB/Gyn prescribed Yasmin 28. She is 16 years old. Her psychiatrist has prescribed another medication to aid in smoothing out her mood swings. It appears to be helping but I have seen a terrible swing in her moods recently. I called the OB/Gyn and asked him to look into another drug. I hope that as an expert on bipolar you may have recommendations or suggestions related to drug interaction concerns.

JAMISON:
I don't. I think that's something that she really needs to talk about with her doctors and again go in with questions, go in with concerns and ask away.

MEMBER QUESTION:
I was diagnosed two years ago and my 16-year-old was diagnosed a few months ago. As I try to help her, I find that her pain triggered depression for me. How do we function living together without triggering each other with our mood swings?

JAMISON:
I think this is a place, again, where psychotherapy, two or three or four sessions together with a psychologist or psychiatrist, to sit down and talk about what are the best ways, what are the things that set one another off and what are the things that are helpful. Do it when both people are feeling good so that it's not an emotionally charged environment and figure out the best ways of coping. Sometimes it just takes somebody else to help kind of untie some of those issues.

MEMBER QUESTION:
We have people come to the message board seriously ready to take their own lives. It's hard. What should we say to them besides trying to get them to call a crisis line?

JAMISON:
Going to an emergency room is probably the single best thing that people can do if they are suicidal. If they don't have a doctor themselves, hopefully they could get a family member or friend to take them to help them make an appointment to see someone or to take them to an emergency room. But it's certainly something that is best dealt with directly and quickly.

"I think what happens over time is that you begin to realize, once you have been well long enough, that the illness doesn't have to define your notion of yourself by any means. It is part of who you are and it is part of what you have to take into consideration in your life, but it's not something that has to dominate your life."

MODERATOR:
Dr. Jamison, I know you're just about out of time. Before we wrap things up for today, do you have any final comments for us?

JAMISON:
I think it's great that you have a support group that's good and helpful. Godspeed and my heart goes with you.

MODERATOR:
Thank you so much. Can we have you come back and visit with us again sometime?

JAMISON:
Sure.

MODERATOR:
We'd love that. Thanks for joining us today. For more information, please read The Unquiet Mind .



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