You Can Know if You Suffer From Bipolar II Disorder
and What You and Your Doctor Can Do About It
Clara is a 27-year-old artist whose talent has opened opportunities for her she never dreamed possible. She’s published books of her original poetry and children’s stories she wrote and illustrated herself. She paints watercolors of children playing amid lovely floral backgrounds … and sells them through a local gallery.
Clara’s light-hearted artistry belies her deeply analytical and moody personality. She says she paints the world the way she wishes it was, rather than the way she sees it.
She experiences long periods of sorrow…self-criticism…shame. Then sometimes, out of the blue, she’ll feel more normal again — and she’ll rush around to buy groceries, clean up her place, and have lunch with friends…until that brief “normal” period is replaced by that all-too-familiar sinking feeling again.
Clara was diagnosed with bipolar II disorder. Most of the time she labors under the leaded blanket of bipolar depression…and occasionally she’ll feel better for a few days. Her “hypomanic” periods are really just about what “normal” would be like for someone who wasn’t ill.
She can’t believe this isn’t just depression.
The Good Times Roll…and Then They Plunge…
Then, there’s Ben. He’s 33 and works in the IT department of a large hardware company. He’s been promoted regularly due to his innate ability to problem-solve software “puzzles.” Ben finds that there are periods when he’s particularly astute, and can work long hours relishing in the challenges before him. At these times, he gets by on little sleep — and feels fine with only 4-5 hours a night.
He loves to get with co-workers for a beer after 16 straight hours of fighting a problem together. He buys drinks for everyone, along with appetizers for the team. Then after a few hours of shut-eye, he’s ready to jump back in again.
However, those times come and go.
After a period of almost spectacular productivity, it’s as if someone blew out the candle. He begins to slow down…really slow down…more and more until it’s hard to rub two thoughts together. During these times he feels heavy, sluggish. He manages to go to work, but once there, he feels dull. And he chows down on chips, cookies, cokes, and pasta. Before long, he can no longer button his pants.
It’s so humiliating. His coworkers – the ones he bought rounds of drinks for 2 weeks ago – poke at him. Tease him. They really like him but don’t understand that he’s powerless to be different right now, and the aggressive ribbing just make his shame more intense.
He just wishes he could go to bed and sleep. He feels overwhelmed at his own failure. He’s convicted of his complete worthlessness.
His boss starts pushing, getting annoyed with his poor performance. Ben feels helpless. Powerless. And ashamed. Worthless.
Then, after a few months, just before his boss is about to lay him off, his energy comes back. Suddenly, he’s brilliant again, and in two weeks makes up for all the down time when he was so depressed.
Ben sees a psychiatrist for his condition, but the treatment hasn’t helped. The doctor diagnosed Ben with bipolar II disorder.
No One Understands: Their Lovable Friend Retreats in Pain
Kelsey is 29 and has a job as a lab tech in the community hospital. She’s fast and efficient in her job and loves it. She has a bright and sparkling personality most of the time. Her coworkers love socializing with her outside of work.
They all want to be her best friend.
But sometimes she withdraws…calls in sick for several days…and avoids answering the phone. She thinks she has the flu from all the aching in her back, arms, and legs. And being home in bed is a welcome relief from the pressures and chaos of the office. She needs rest, she tells herself, and she’ll be ok.
After a week of reprieve, she steels herself to face it all again, and is back at work on Monday morning. But she decides to see her doctor when she realizes she’s still not herself a week later.
After a thorough examination, and lots of questions, her family doctor tells her he believes she’s suffering from Major Depressive Disorder (or unipolar depression, as some call it), and prescribes an antidepressant to help her feel better.
The antidepressant is a SNRI (serotonin norepinephrine reuptake inhibitor) and he expects it to relieve the aching she experiences during these “down” times.
It takes a couple of months, but Kelsey does begin to feel better. She wakes up with more and more hope each day… feels less need to withdraw … and the aches and pains subside. Finally.
The Solution Becomes the Problem
But then something weird happens. About 5 weeks after beginning the SNRI, Kelsey notices herself talking more at work — and at social gatherings, too.
After she goes home she thinks back and realizes she did most of the talking herself…like a veritable Chatty Cathy. It’s embarrassing… what’s wrong with her? She dominated the entire evening! groan…
But she still has the energy for work again and that’s a great relief.
The next week, she deposits her paycheck, and goes shopping. First she decides on new sheets … then she thinks it would be nice to make all her linens match, so she chooses bright cheerful sheets, pillows, duvet cover, towels, bathmats.
The bag is humongous so she takes it to the car then goes back into the department store.
The store is having a sale, and it’s so exciting that she just happens to be there — what great deals! She spots dishes that match her bed and bath linens, then pots and pans.
On her way out she notices those shoes she’d seen in a haute couture magazine…and buys them! She works hard. This is her special reward.
Oh boy! she says to herself, How beautiful and cheerful my whole apartment will be with everything matching. She pulls out her debit card and pays for a full set of dishes complete with matching serving bowls and the matching set of cookware.
The clerk suggests she bring her car to the door so they can help her load it all up.
After loading, she calls a friend to meet her for lunch at the nearby Italian bistro, and off she goes feeling exhilarated.
Following a yummy lunch with her friend and lots of lively chatter, the waiter brings the check. Kelsey pulls out her debit card and offers it to the waiter. In short order the waiter returns.
“Ma’am, this card was declined… do you have another we can try?”
OH NO. In Kelsey’s enthusiasm, she didn’t think to subtract her purchases from her balance. She had spent her entire paycheck without even noticing.
She asks her friend to cover lunch with promises she would pay her right back. What choice did her friend have…? Kelsey knew her friend wouldn’t look at her the same way again. She was devastated…confused… her face flushed and she tried to hide it.
She also knew she should probably return all the stuff she bought. But she just didn’t want to.
Bipolar II Disorder Can Hide For Awhile
Sometimes, a person who’s diagnosed with unipolar depression can take an antidepressant … and manic symptoms emerge.
Kelsey’s relief from depression and physical pain led to a phenomenon that sometimes happens with persons who are depressed and take antidepressants.
Kelsey actually suffers from bipolar disorder, but was mistakenly diagnosed with unipolar depression and treated with an antidepressant because she had not had a manic episode at that point.
The antidepressant either triggered hypomania in Kelsey… or… this was her first hypomanic episode.
Either way, she unwittingly plunged into a crisis.
Many doctors call this Bipolar 3 Disorder, which isn’t a real diagnostic term…but more a nickname for the condition when someone with depression who’s never exhibited bipolar symptoms suddenly does upon beginning an antidepressant.
If you’re old enough, you may remember the popular talk show host, Jane Pauley from the Today Show. This was her experience. And in a televised interview, she referred to her condition as “bipolar III.”
Aside from labels, Kelsey needs to be watched carefully by her doctor who’ll cautiously treat the symptoms as they present themselves, evaluating her condition going forward. But that’s another article for another day.
Treatment for all the variations of mood disorders doesn’t line up in black and white categories, but in combinations and shades of gray and it’s important to find the one that best helps you personally.
Bipolar Disorder is a Spectrum Disorder
So, we’ve mentioned three people who share a bipolar diagnosis, but whose symptoms are not that much alike. The point is that bipolar disorder is a spectrum disorder and its diagnosis relies on the patient’s – and their family’s – observations and descriptions of symptoms.
When you suffer from bipolar I, the upswing symptoms tend to be more severe … harder to ignore…and the diagnosis is less difficult.
The distractibility is clear, the recklessness and impulsivity are OBVIOUS, the high energy and lack of sleep and grandiosity can slip quickly down a slippery slope. It’s mania through and through, and it can dig you into a hole, fast.
But bipolar II is more complicated to diagnose because your symptoms land in a variety of places on a symptom spectrum. And sometimes even the symptoms you expect to see aren’t really there… yet. And may never be.
The better you understand your symptoms and recognize them, the more you and your family can help your doctor arrive at the correct diagnosis and the best treatment for you.
How to Understand a Spectrum Disorder
In his book, Why Am I Still Depressed? Recognizing and Managing the Ups and Downs of Bipolar II and Soft Bipolar Disorder, Jim Phelps stresses the importance of gauging symptoms on a continuum, rather than checking them off an arbitrary list.
Because we’re human, and everyone has a little of something that can be a symptom in someone else.
You may know someone who has milder insomnia but somewhat pressured speech and …severe irritability. They tell you they have bipolar disorder. So you think that’s what bipolar looks like.
In your case, you may feel confident and clever at times, even at times engaging everyone at a dinner party. Still, behind closed doors you have periods of extreme agitation and impulsivity. Or maybe risky behaviors like spending sprees, speeding, or intense sexual behavior that isn’t your norm…?
It’s tempting to say things like, “Maria doesn’t have bipolar disorder. It must be something else causing her problems. Because my daughter has bipolar disorder, and Maria and my daughter don’t act the same way at all!”
Each Person is Unique – So Psychiatric Disorders Are Unique in Each Person
But the fact is that there aren’t absolutes, but rather varying degrees of various symptoms that interfere with a productive and fulfilling life. And that’s why we seek to treat these symptoms…because they interfere with your life and the way you want to live it.
At Innovative Psychiatry, we see people with bipolar disorder in all its varieties every day. And we work with you to help you feel better. Not to just improve, but to feel so much better you can finally live and enjoy the things that are important to you. You can build and strengthen your relationships. You can focus again to read what you want to read and do things you enjoy. And you can show up when and where you’re needed.
And if you’ve tried other treatments for your bipolar diagnosis that haven’t helped much at all, don’t give up. Chances are that ketamine treatment may be just what you need to feel balanced, motivated, and able to relax and enjoy the moments of your life.
The beauty of it in bipolar disorder is that it lifts depressive episodes quickly — so you can avoid the risks of switching into hypomania or mania that come with using an antidepressant for weeks … or months.
That is so worth it.
The Concept of Spectrum Disorders
Because every person is different, and responds to medicines differently than every one else, there are no absolute guarantees. But given our success rate, chances are ketamine treatment can turn your life into one you enjoy living.
To the emerging of your best self,
Lori Calabrese, MD