Imagine a mountain range. Large and encompassing, there are mountains and valleys everywhere you look. You start to climb one mountain and happiness builds within your body. Days go by and the happiness doesn’t leave you. It just gets stronger, especially when you reach the top of the mountain. But then, you descend into a valley. All of a sudden the happiness disappears and sadness takes its place. Feelings of depression swirl in your mind as you descend. Several days go by and you reach the base of another mountain, feeling nothing but apathetic loneliness. You begin to climb the next mountain and as you do, endless energy buzzes through your brain. You reach the peak and feel like you can fly off the cliffs and survive, like you are a superhuman finally coming into your full strength. And so the cycle continues, with you descending into the valleys, depressed, and ascending mountains, sometimes overwhelmed, sometimes euphoric. This is how people with bipolar disorder navigate their emotional lives.
Bipolar disorder is generally characterized by swings back and forth between depressive and manic/hypomanic stages. Similar to how panic disorders or anxiety disorders are characterized by panic attacks, bipolar disorder is characterized by extreme shifts in emotions, ranging from a sense of overwhelming buzz (manic phase) to feeling intensely down (depressive phase). Less energetic “ups,” known as hypomanic episodes, can also be part of bipolar disorder. It’s important to note that bipolar disorder isn’t just having mood swings. With bipolar disorder, changes in mood are usually very extreme. At one point you could be on top of the world, and then feel like you are down in the dumps the next. Bipolar disorder affects 2.6% of the US population, with 83% of the affected population having a severe form (NAMI). For this reason and more, it is important for people to understand how the disorder works and what steps can be taken to help people with the disorder.
A manic episode includes a feeling of immense buzz, similar to euphoria. One would experience a feeling of giddiness and feel “high”. This is not to say that a manic episode always involves a positive mood. While some experience joy during manic episodes, others may feel a rush that can influence them to conduct increasingly risky or reckless acts. They may lose touch with the gravity of a situation and reality as well as with relationships. Irritation and jumpiness, along with intrusive and uncontrollable thoughts, can also occur during a manic phase.
A depressive episode is the opposite end of the spectrum, although some symptoms may be shared. Usually, a depressive episode is accompanied by feelings of emptiness and sadness, just like for someone who experiences clinical depression. One may withdraw within a sort of psychological or mental shell. At this point, they may lose interest in conversation and the outside world and feel extremely tired (not due to physical exertion). Enjoying past pleasures or even new ones can become difficult as a depressive feeling may completely overwhelm one’s mind. This could also lead to suicidal thoughts. Many times, people have trouble concentrating and instead feel anxious, worried, and empty.
The severity and occurrence of manic and/or depressive episodes can vary based on the type of bipolar disorder one has, but all bipolar disorders share a swing between states. The difference between types of bipolar disorder is the length of time for each episode and the severity by which it impacts the individual. For some disorders, both the manic and depressive episodes may occur together. Others may experience hypomania, a less severe form of mania, instead of mania itself. Indeed, each experience of bipolar disorder is unique.
Though different types of bipolar disorder vary in severity and symptoms, the general symptoms and experience of each type do share similarities that allow us to categorize bipolar disorders into the following (NIMH):
Bipolar I Disorder
Defined by long manic and depressive episodes
Manic episodes last at least 7 days
Depressive episodes last at least 2 weeks
Symptoms may be mixed as depressive episodes and manic episodes can occur at the same time
Bipolar II Disorder
Defined by hypomanic episodes and depressive episodes
Numerous periods of hypomanic symptoms and depressive symptoms
Symptoms typically don’t qualify to be classified as depressive or manic episodes
Depressive symptoms usually last for at least 1 to 2 years, depending on the individual's age
Other unspecified forms of bipolar disorder exist, although the ones mentioned above are the most common
Bipolar disorder can be caused by a variety of factors, just like other mental illnesses. Biology, for example, can play a role. An excess or lack of certain neurotransmitters in the brain could cause mood disorders, which could lead to bipolar disorder. Loss or damage of the hippocampus (which affects mood) can also cause bipolar disorder. Similarly, damage to the limbic system could produce the same result. Another potential contribution to a bipolar disorder diagnosis is a genetic predisposition
Still, don’t lose hope! Bipolar disorder has a variety of treatments. For example, three main classes of medications are used to treat bipolar disorders: mood stabilizers, antipsychotics, and antidepressants (the use of antidepressants to treat bipolar disorder is controversial. Often used with mood stabilizers, antidepressants by themselves may increase one’s frequency and intensity of manic episodes, especially in youth). Effective psychotherapy is also part of most treatment plans. Some forms of psychological therapy that are commonly used with bipolar disorder patients include cognitive brain therapy, family-focused therapy, and more.
It’s never easy to deal with a mental health issue, much less to talk about it openly. However, we are here to support through the self-advocacy process - you are not alone! Because of the stigma around mental health and the paranoia and fear of judgment felt by millions of people every day, one may miss out on life-saving therapy and treatment plans. That shouldn’t have to be the case.
Here at Letters to Strangers, we believe that a simple letter from anyone can be immensely valuable: it proves that even a stranger cares about you and that you are not alone in the fight for mental wellbeing. Join L2S with your own letters of vulnerability, hope, and reflection - even if your words are scribbled on the paper wings of an origami bird, delivered through a friendly conversation with a stranger in another world.