bipolar disorder saying hurtful things

Bipolar disorder saying hurtful things

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This leaflet is for people who want to know more about bipolar disorder (sometimes called bipolar affective disorder). It is written especially for people with bipolar disorder, their friends and relatives.

This leaflet describes:

  • Signs and symptoms of bipolar disorder.
  • Some problems you may encounter.
  • Some ways of coping.
  • Evidence-based treatment.

Warning

This leaflet provides information, not advice.

The contents of this leaflet have been arranged to provide general information only. It does not constitute or is intended to constitute advice on which you should rely. It is in no way a substitute for specific advice.

Therefore, you must seek relevant professional or expert advice before taking any action or refraining from taking any action in light of the information provided in this leaflet.

Consult a doctor or other professional health care provider without delay if you have any medical questions.

Seek immediate treatment from a doctor or other professional health care provider if you think you are experiencing any health problems.

We make reasonable efforts to provide accurate and up-to-date information in our leaflets, but we never make any guarantees that the contents of the leaflets are correct, complete or up-to-date.

bipolar disorder saying hurtful things

bipolar disorder saying hurtful things

It was called ‘Manic Depressive Illness’. As the phrase implies, it involves a sudden and drastic change in your mood. In other words, severe mood swings. They usually last for several weeks or months, and are much more intense than the emotional ups and downs that people normally experience. These can be: 1

  • Low or ‘depressed mood’ — you feel intensely depressed and depressed, even losing hope.
  • High or ‘manic’ — you feel extremely happy, euphoric and very active. You may develop very grandiose and delusional ideas about yourself and your abilities.
  • Hypomanic — Your mood is high, but not as extreme as mania or mania.
  • Mixed — You have a mixture of mania and depression. For example, you may feel depressed, but you will also have restlessness and mania overactivity. bipolar disorder saying hurtful things

Let’s dive a bit deeper into the specifics of these different mood states.

bipolar disorder saying hurtful things

About 1 in 50 adults will develop bipolar disorder at some point in their lives. Typically, it kicks off somewhere between the teenage years and early twenties. This is rare after 501 years. bipolar disorder saying hurtful things

Bipolar type 1

  • You have had at least one high or manic episode, usually lasting more than a week.
  • You may only have manic episodes, although most people with bipolar 1 are deeply depressed.
  • A manic episode usually lasts 3 to 6 months if untreated.
  • Depressive episodes last longer — 6 to 12 months without treatment.

Bipolar type 2

Severe depression with multiple episodes, but few manic episodes — called ‘hypomania’.

Rapid cycling

You have four or more mood episodes in a 12-month period. It affects about 1 in 10 people with bipolar disorder and can occur with both type 1 and type 2.

Cyclothymia

Mood swings are less severe than in full-blown bipolar disorder but may be longer, which may progress to full-blown bipolar disorder over time. bipolar disorder saying hurtful things

What causes bipolar disorder?

Bipolar disorder, major depressive disorder, or schizophrenia share the same genetic risk factors. There are also environmental risk factors that may interact with genetic risk to increase or decrease the development of these diseases. bipolar disorder saying hurtful things

For example, having a genetic risk means you are more likely to develop bipolar disorder. However, if you grow up or live in a stable and positive environment, your risk of developing serious mental illness may be lower.

The most well-known risk factor for your developing a serious mental illness is having a parent with a serious mental illness (such as bipolar). 1 in 3 children is at risk of developing mental illness if either the mother or father has a severe mental illness.

When thinking about the causes of bipolar disorder, it is important to remember that many factors are involved, and no single cause is responsible.3 bipolar disorder saying hurtful things

Depression

We all suffer from depression at times.4 It can help us recognize and deal with problems in life. But in severe depression or bipolar disorder, these feelings are much more intense. 5 6 They last for a long time and make it difficult or impossible to cope with normal life problems. 5 When depressed, you may notice some or all of the following:

  • Persistent unhappiness.
  • Feelings that make you want to burst into tears for no reason.
  • Loss of interest in various subjects.
  • Not being able to enjoy anything.
  • Feeling restless and agitated.
  • Loss of confidence.
  • Feeling useless, inadequate and hopeless.
  • Having a more irritable mood than usual.
  • Suicidal thoughts.
  • bipolar disorder saying hurtful things

Difficulty thinking

  • Inability to think positively or optimistically.
  • Finding even the simplest decisions difficult.
  • Inability to concentrate properly.
  • bipolar disorder saying hurtful things

Physical Symptoms

  • Reluctance to eat and lose weight.
  • Difficulty sleeping.
  • Waking up too early and not being able to get back to sleep.
  • Feeling incredibly tired.
  • Constipation.
  • Loss of interest in sex.

Behavior

  • Difficulty starting or finishing a task — even everyday tasks.
  • Crying a lot, or feeling like you want to cry but can’t.
  • Avoiding other people.
  • bipolar disorder saying hurtful things

Mania

You feel intensely good, energetic, and optimistic — so much so that it affects your thinking and judgment. Strange beliefs arise about oneself. Can make bad decisions. Embarrassing, harmful and sometimes risky behavior.

As with depression, daily living can become difficult or impossible. Mania can adversely affect both your relationships and work.If it is not severe, it is called ‘hypomania’. It can still affect your judgment and interactions with other people1. bipolar disorder saying hurtful things

In a manic state you may notice several things in yourself:

Emotional

  • Very happy and excited.
  • Very irritable (this is because you often can’t convince people of your unusual positivity, or get people to do what you say).
  • Feeling more important than usual.
  • bipolar disorder saying hurtful things

Way of Thinking

  • Full of new and exciting ideas.
  • Changing ideas quickly, and forgetting or being unable to explain what is being thought or meant to be said.
  • Hearing voices that no one else can hear.

The Physical

  • Strong energy and more active than usual.
  • Unable or unwilling to sleep.
  • May be more interested in sex.
  • bipolar disorder saying hurtful things

Conduct and behavior

  • Making grandiose and unrealistic plans.
  • Being very active and moving very fast.
  • Behaving differently than usual.
  • Talking too fast — so fast that it may be difficult for others to understand what you are saying.
  • Making spur-of-the-moment decisions that sometimes lead to disastrous consequences.
  • Spending money recklessly.
  • Being overly close to other people or uncritically critical of them.
  • Being less restrained than usual.

The first time you have a manic episode, everything may seem normal, but your friends and family can usually tell that something is up. You may get annoyed if someone tries to show you this. You lose awareness of daily life and other people’s feelings. bipolar disorder saying hurtful things bipolar disorder saying hurtful things

Psychological symptoms

If a manic episode or depression is severe, you may develop delusions1.

  • In a manic episode — you develop a superstitious belief in yourself that you are up to something important or that you have special abilities or skills.
  • In a depressive episode — you may feel that you are the only one to blame and that you are worse than everyone else, or that you don’t even exist.

In addition to these unusual beliefs, you may have hallucinations — you hear sounds, smell, feel, or see things, but can’t locate their source around you. bipolar disorder saying hurtful things

In between episodes

Some people with bipolar disorder feel that they are calm and stable between mood swings, but for many this is not true. You may feel depressed and have trouble thinking, even though others may think you are healthier than before.

An episode of bipolar disorder may require you to stop driving for a period of time. You must tell the Driver and Vehicle Licensing Agency, or DVLA if you have bipolar disorder. You can discover details about this on the DVLA website.

Who do I go to?

You may want to see your GP first, especially if you have had a depressive episode. If you are diagnosed with bipolar disorder, he will refer you to a psychiatrist. According to NICE guidelines, only a specialist7 can prescribe mood stabilizers, even if you are subsequently under the care of a GP. bipolar disorder saying hurtful things

You will also meet other members of the Community Mental Health Team (CMHT) when you see a psychiatrist. They can help with emotional support, information and psychological interventions, and assist in sorting out practical issues.

Your GP can take almost full responsibility if your medication seems to be working, although he will usually want you to keep in regular contact with a psychiatrist and CMHT.

Medications for bipolar disorder

There are things that can help keep mood swings under control so they don’t turn into manic episodes or depression. These are mentioned below. However, the reasons why medicine may be needed are:

  • To stabilize your mood (prophylaxis)
  • To treat manic or depressive episodes.

Mood stabilizers

There are several mood stabilizers, some of which are used to treat epilepsy or schizophrenia8. Your psychiatrist may use several medications to effectively control mood swings. 9 bipolar disorder saying hurtful things

Lithium

Lithium has been used as a mood stabilizer for decades, but how it works is still not clear. It is still the first choice for long-term treatment of bipolar disorder and can be used to treat manic and depressive episodes.

Treatment with lithium should not be started without the advice of a psychiatrist. It’s very important to take the right amount of lithium — too little won’t work, too much can hurt you. So, you’ll need to have regular blood tests for the first few weeks to make sure you’re getting the right dose. 10 If the dose stabilizes, your GP can prescribe lithium and arrange for you to have regular blood tests for a longer period of time. bipolar disorder saying hurtful things

It is very important to have the right amount of water in the body compared to lithium in the blood. Dehydration will increase the level of lithium in your blood, and you may experience toxic side effects.1 So, remember:

  • Drink plenty of water — more in hot weather or when being physically active.
  • Be careful with tea and coffee — they increase the amount of water you pass with your urine.

It may take three months or longer for lithium to work properly. During this time it is best to continue taking the medication even if your mood swings continue.

Side Effects

Side effects may occur during the first few weeks after starting lithium treatment. They may feel annoying and unpleasant, but they go away quickly or get better with time. bipolar disorder saying hurtful things

Side effects include:

  • Thirst.
  • Urinating more and more frequently than usual.
  • Weight gain.

Less common side effects are:

  • Blurred vision.
  • Slight muscle weakness.
  • Occasional diarrhea.
  • Mild tremors in hands.
  • Feeling mildly ill.

These usually get better by reducing the dose of lithium.

The following symptoms indicate that the level of lithium in your body is too high. If you notice these, tell your doctor immediately:

  • Feeling very thirsty.
  • Severe diarrhea or vomiting.
  • Trembling hands and feet.
  • Muscle twitching.
  • bipolar disorder saying hurtful things

• Feeling confused.

Blood and urine tests

First you need to have blood tests every few weeks to make sure you have the right level of lithium in your blood. You will need these tests as long as you take lithium. But after the first few months the level of testing will gradually decrease.

Long-term use of lithium can affect the kidneys or thyroid gland. You should have blood and urine tests every few months to make sure these organs are working properly. If any problems occur, you should stop lithium and discuss alternatives with your doctor.

Taking care of yourself

  • Eat a balanced diet.
  • Drink unsweetened fluids regularly. It helps maintain salt and fluid balance in your body. Avoid drinking colas and soft drinks, as they contain a lot of sugar.
  • Eat regular meals — this will also help maintain fluid balance in your body. bipolar disorder saying hurtful things

• Beware of tea, coffee, or cola containing caffeine. Caffeine causes increased urination, which can alter the levels of lithium in your body.

Other mood stabilizers

Medications other than lithium may also work. The prescribing of these drugs depends on a number of factors, such as whether it is being prescribed for a manic or depressive episode and whether the person is already taking an antidepressant.

Epilepsy drugs / Anticonvulsants :

Sodium valproate is an anticonvulsant that probably works like lithium, but we don’t have enough evidence to be sure yet. It may harm an unborn baby if consumed during pregnancy, so it should not be recommended to anyone who may be pregnant.

Carbamazepine and lamotrigine are also effective for many. bipolar disorder saying hurtful things

• Medications like haloperidol, olanzapine, quetiapine, and risperidone are some of the options to address certain mental health concerns.

When to start mood stabilizers

It is difficult to predict the likelihood that you will have another episode after just one episode. Many people do not want to start mood stabilizers at this stage, but manic episodes can be intense and very troublesome.

If you have a second episode, there is a good chance that you will have more episodes in the future, so taking a mood stabilizer is strongly recommended in this situation. bipolar disorder saying hurtful things

How long to take mood stabilizer medication?

At least for:

  • Up to two years after an episode of bipolar disorder.
  • Up to five years in cases:
  • Repeated worsening after previously improving condition
  • If psychotic episode
  • Excessive alcohol or drug consumption
  • If you are constantly stressed at home or at work.

If you decide to stop your medication, discuss this with your doctor. It is best to see your psychiatrist for 2 years after stopping medication for bipolar disorder, so they can check you for signs of relapse.

You may need to continue the medication for a longer period of time if problematic mood episodes persist. bipolar disorder saying hurtful things

What is the most effective medication for me?

You’ll need to discuss this with your doctor, but there are some general guidelines.

  • Lithium is usually the first choice of doctors; Sodium valproate is the second choice, although it may be given in combination with lithium. Olanzapine may be tried if lithium and sodium valproate do not work.
  • Quetiapine may also be used, especially if someone is depressed between manic episodes.8
  • You may be prescribed lamotrigine for bipolar 2 disorder or bipolar depression, but not for mania.
  • In certain situations, it’s helpful to mix different medications. bipolar disorder saying hurtful things

Which medicine you are advised to take depends on how well you are benefiting from a particular medicine. A drug that is useful for one person may not be useful or applicable for another.

What can happen if you don’t take medicine?

Lithium reduces your chance of relapse by 30–40%8, but the more manic episodes you’ve had, the more likely you are to have another manic episode.

The risk of having a subsequent episode remains the same as you get older. Even if you’ve been healthy for a long time, you’re still at risk of having another episode. bipolar disorder saying hurtful things

Pregnancy and the treatment of bipolar disorder

You should discuss pregnancy planning with your psychiatrist. You can plan with your psychiatrist to manage your mood during pregnancy and in the first few months after childbirth. Lithium and sodium valproate should not be used if you are pregnant or planning to become pregnant.

If you become pregnant while taking lithium, talk to your psychiatrist about whether you should stop using lithium. Lithium is safer than other mood stabilizers during pregnancy, but it carries a substantial risk of heart disease in the baby. This risk needs to be weighed against your risk of becoming depressed or going into a manic episode.

The highest risk comes during the initial three months of pregnancy. Lithium is safe after the 26th week of pregnancy, although you should not breastfeed your baby if you take lithium, as it can be toxic to your baby.12 bipolar disorder saying hurtful things

It would be best for you to discuss the possibility of starting the aforementioned psychological treatment.

Obstetricians, midwives, health visitors, GPs, psychiatrists and community psychiatric nurses all need to be in close and regular contact with each other during pregnancy.

Psychological treatment for bipolar disorder

Psychotherapy may be helpful during a depressive episode or between a mania and a depressive episode. 1 5 11 May include:

  • Mental health education — learning and knowing more about bipolar disorder
  • Mood monitoring — learning to quickly recognize when your mood starts to fluctuate
  • To help develop general coping skills
  • Cognitive behavioral therapy (CBT) for periods between such episodes, including depressive episodes (this treatment usually involves about 16 to 20 hour sessions over a period of 3 to 4 months).
  • Interpersonal Therapy (IPT)
  • Couple (couple) therapy
  • Family meetings.
  • bipolar disorder saying hurtful things

Depressive Episode

If your depression is at least somewhat severe, your doctor may recommend:

 Olanzapine (an antipsychotic drug that acts as a mood stabilizer) with fluoxetine (an SSRI antidepressant)

Quetiapine

If the previous treatment doesn’t work, there are other alternatives to explore.

  • Adding quetiapine may be helpful if you are already taking lithium or sodium valproate.
  • Antidepressants can trigger manic swings if you’ve had a recent manic episode or rapid-cycling disorder. It may be safe to increase the dose of a mood stabilizer without an antidepressant.
  • Antidepressants may take two to six weeks to improve your mood, but sleep and appetite usually improve initially. Antidepressants should be continued for four weeks after improvement in depression. Your doctor will then discuss with you whether you will be given no medication or talking therapy (treatment through talking sessions). If you need to stop taking an antidepressant, taper off slowly before stopping completely.
  • If you have recurrent depressive episodes, but never progress to mania as a result of taking an antidepressant, you can continue with both the mood stabilizer and the antidepressant to prevent further episodes.
  • You should not take antidepressants long-term if you have manic episodes.

Manic and depressive episodes

Any antidepressants should be discontinued. Haloperidol, olanzapine, quetiapine or risperidone may be used to treat manic episodes. Lithium can be added if these do not work well.

Symptoms usually improve within a few days of starting treatment, but full recovery may take several weeks. If you want to drive while taking this type of medicine, consult your doctor first. bipolar disorder saying hurtful things

Other help

Your mental health team can help you mediate with your bank or creditors if you’ve spent too much money while sick. If this is the case, you may consider choosing a carer or a relative as your representative.

Manage your mood swings

Self-Monitoring

Know the signs that your mood is spiraling out of control so you can get help quickly. By doing so, you may be able to avoid both full-blown episodes and hospitalization. In a diary, you can write down what things in life are good for you and what are not good for you.

The Knowledge

Learn about your illness and what help is available to treat it. There are further references at the end of this leaflet. Check out some of the support groups and organizations below. bipolar disorder saying hurtful things

Stress

Try to avoid particularly stressful situations — stress can trigger your manic or depressive episodes. Not all stressors can be avoided, so learn ways to deal with them wisely. You can start stress reduction training online or via CD or DVD on your TV or computer, join a relaxation group, or consult a clinical psychologist.

Relationship

Depression and mania can put a lot of stress on friends and family — you may need to rebuild some relationships after an episode. bipolar disorder saying hurtful things

Having at least one person to trust and rely on makes the job easier. Explain your illness to those close to you while you are healthy. They need to know what’s going on with you and what they can do for you.

Activities

Disorder

Try to balance your life, work, leisure, and relationships with your family and friends. Being too busy can trigger your manic episode. bipolar disorder saying hurtful things

Make sure you have enough time to rest so you can calm down. Consider taking a course if you’re unemployed, or even consider volunteering that isn’t related to mental illness.

Exercise

Moderate vigorous exercise for 20 minutes three times a week improves mood.

Joy

Do something regularly that you enjoy and that gives your life meaning.

Continue your medication.

You may want to stop your medication before your doctor thinks it’s safe, but that could cause you to start another mood swing. Talk to your doctor and family about it while you’re healthy. bipolar disorder saying hurtful things

Comment on your treatment for bipolar disorder

If you are hospitalized for bipolar disorder, you may want to discuss with your doctor and family in writing:

  • An ‘advance statement’ — to set out how you want to be treated if you become ill again (this may include any information important to your health or care)
  • An ‘advance decision’ — a specific treatment that you do not want to receive.

What can I expect from my GP? (England and Wales only)

Your GP is expected to give you an annual physical health check if you are taking lithium or any other medicine for your bipolar disorder. This test will include:

  • Blood pressure.
  • Weight and Body Mass Index (BMI).
  • Smoking and alcohol use.
  • Blood sugar levels.
  • Lipid levels (for all patients above 40 years of age)

What you will need if you are taking lithium:

Check lithium levels every 3–6 months.

Get a blood check for thyroid and kidney function every half-year to keep tabs on your health. You may need to have these blood tests more often if there are any problems. Information for family and friends Mania or depression can be distressing and exhausting for family and friends.

Depression

Navigating a conversation with someone experiencing deep depression can be challenging; finding the right words may not always be easy. They see everything negatively and may not be able to say what they want from you. They can be aloof and irritable, (bipolar disorder saying hurtful things) but at the same time, they need your help and support. They may be anxious unwilling or unable to accept advice. Show all the patience and understanding you can muster

Mania

At the beginning of the manic mood swings the person will be happy, energetic, and sociable, and will be the ‘middleman’ of any event or heated discussion bipolar disorder saying hurtful things. But the tension of such a situation will drive their tempers to extremes. So, try to keep them away from such situations. You can encourage them to seek help or give them some information about the illness and self-help.

Practical help is very important and very effective. Make sure your relative or friend is able to look after themselves properly and don’t forget to do everyday practical tasks like paying bills.

Helping your loved one stay well

Learn more about bipolar disorder between mood episodes. It can be helpful to accompany your friend or loved one to any appointments with the GP or psychiatrist. Local mental health services can provide your family with support, family meetings, and information about bipolar disorder.

Be yourself

Give yourself space and time to refresh. Set aside some time for yourself or to spend with trusted friends who will provide you with useful support. If your relative or friend has to go to the hospital, share it with someone else. Being well-rested will enable you to provide even better support for your friend or family member. bipolar disorder saying hurtful things

Dealing with emergencies

  • In severe mania a person may become hostile, suspicious, and verbally or physically aggressive.
  • A person with severe depression may begin to have suicidal thoughts.
  • If you find someone who:
  • Neglecting himself by avoiding food and water
  • Behaving in a manner that puts himself or others at risk
  • Talking about self-harm or suicide

Get medical attention immediately. A mental health trust or emergency team may have a crisis number for times of crisis. A psychiatrist is available 24 hours a day in the emergency department.

Keep the name and telephone number of a trusted professional whom you can call in any such emergency. Sometimes a short hospital admission may be required. bipolar disorder saying hurtful things

Caring for children while you have bipolar disorder

If you become manic or depressed, you may not be able to look after your children properly for some time. Have your partner or other family member do this while you are sick. It can be helpful to plan ahead while you are healthy. bipolar disorder saying hurtful things

If you are not healthy, your child may feel anxious and confused. Unable to verbalize their distress, young children can become clingy and difficult to handle. Older children will express it in other ways.

Children will benefit if the adults around them are sensitive and insightful and can respond to their difficulties and questions in a calm, supportive, and consistent manner. An adult can explain to them why their parent is behaving differently. Questions should be answered calmly and matter-of-factly and in a language they can understand. They will feel better if they can go about their normal daily routine. bipolar disorder saying hurtful things

Explaining bipolar disorder to children

Older children sometimes worry that their parents are sick because of them. They need to be reassured that it is not their fault, but they should be given time and support. When an older child has to care for a sick parent, they will need special understanding and practical support.

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