Side by side of a happy man and sad man

We all do it. Someone’s moody and we call her bipolar. Someone needs his coffee—badly—and we call him bipolar. Some people are just plain rude and we call them bipolar. If it were the politically correct way to say someone’s crazy, then why do we whisper it?

Because it is not correct.

We all have to get along and everyone who crosses our sensitivity red line is not bipolar. As it turns out, most people we unfairly label bipolar have a good reason to be moody or need their coffee or act just plain rude. Today’s hectic life breeds behavior like this.

Let’s think about this. A hundred thousand years ago, everyone woke up with the sunrise. The men then hunted-gathered and the woman took care of the children all day. Near dusk, the men brought home what they had killed; everyone participated in the family cooking, ate, got sleepy, and retired, sometimes to make more children. And sleep until the next dawn.



Today we are forced to live double lives

After sunset, there is work brought home from the office, partying, Game of Thrones catch-up, socializing, and all the other things that might interfere with one’s hunting-gathering the next day.  This creates anxiety, which must be addressed with moodiness and how we relate to others, coffee or no coffee. On top of that, we have subdivided our daily routine into two lives—the weekday life and the weekend life, which creates whole new ways to live for us.

In short, we have socially out-evolved our caveman physiologies, which still have to make all the different lives we live fit into one.


So, if moodiness and rudeness are not really bipolar depression, what exactly is bipolar depression?

There are entire books dedicated to just the classifications of the different types of bipolar depression. You wouldn’t want to read them, though, because they read like phone books. And although misbehavior might just be a case of “caveman gone bad,” some people do officially qualify for the diagnosis.


What do books tell us about it?

Bipolar depression is a mood disorder that is characterized by episodes of mania and major depressioni Mania is a significant change in mood, behavior, energy, sleep, and thinkingii.


A few words on Mania

Mania can present as an exaggerated sense of well-being or self-confidence. The manic person has racing thoughts and is easily distracted, ignores social boundaries, and acts impulsively. Before you think this is no different from drinking six beers, keep in mind you’d have to have the effect of six beers without being drunk or the need to sleep it off.



Symptoms include being very happy, but getting angry quickly, feeling like you don’t need sleep, starting lots of things and not finishing them, and making poor choices without thinking out the consequencesiii; or feeling very sad with weight gain or loss, sleeping too much, insomnia, fatigue, feeling bad about yourself or even considering self-harmiv.


How to test for it?

There is no test for bipolar disorder and although no one has pinned down the exact cause, it is felt to be a type of imbalance in the brain, which is the rationale for the medicine used for it.

Bipolar disorder used to be called “manic depression,” but that’s old school. The new diagnosis does indeed include depression, which is not the opposite of mania, but part of the full spectrum. Another part of the spectrum is “hypomania,” or—for lack of a better nickname—“mania-light.” In hypomania, a person may have exaggerated self-esteem, but won’t present with delusional grandiosity. Anxiety can rear its ugly head, too, when the depressed person frets over an inability to deal with life’s challenges because of the impairment of depression.

Bipolar disorder has been divided into “bipolar I” and “bipolar II.” Patients with bipolar II disorder have depression, a history of at least one hypomanic episode, but no major manic episodes.  Sometimes there is a blend of the two, which makes treatment tricky.


So if there really is a bipolar depression in someone, how is it treated?

Before dealing with that, the question arises: does it have to be treated? The answer is YES, because the risk of suicide is so much higher in people who suffer from it. And even those who are not suicidal—yet!—they deserve a better quality of life. Coffee won’t do it.


What type of medication can help?

It is generally accepted that if someone has an official diagnosis of bipolar disorder or bipolar depression, he or she must be treated with prescription medication and then maintained on itv. Historically, anticonvulsant and antipsychotic medicines such as Lithium, Valproate, Quetiapine, and Lamotrigine have been widely used for the initial treatment and maintenance. This is only a partial list, of course, and sometimes a mixture of medications is necessary.

A big problem is that although the medicines stay the same, the patient changes—changes in age, metabolism, diet, physiology, etc. So what might be the perfect medication at one point may be the wrong one later. It’s a shell game of sorts, and it is best played by an expert professional.  


Do you have to live on medication forever? What else can help?

Well, not necessarily, but for those who can finally do without, it won’t be for several years. Adding psychotherapy will help diminish the need for medication. But those who are treated should not think of the treatment for their bipolar depression as being sedated below their personalities; instead, they should consider it a lateral move toward a place where they can function normally. Such a mindset is not any different from taking insulin for diabetes or iron for anemia.

Omega-3 fatty acids from fish oils have been shown to improve bipolar depression when used with prescription medicationsvi. Besides the beneficial cardiac effects, anything that may decrease pure reliance on prescribed medications should be considered.


The books that list out the many forms of bipolar disorder are getting wider all the time

But medical science is becoming more knowledgeable about “chemical imbalances” in the brain, every day. It could be that there’s a blurry line between the person we call bipolar who just needs coffee or driving lessons and those who have real pathology; it could be that the chemical imbalances are a result of trying to live 21st Century lives in our caveman bodies. Regardless, everyone deserves a good quality of life, and no one should ever lose their life over a condition that is treatable.


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i(American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.)

ii(Goodwin FK, Jamison KR. Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression, 2nd edition, Oxford University Press, New York 2007.)

iii(UpToDate ®, 2017)

iv(UpToDate ®, 2017)

v(AUKessing LV, Vradi E, Andersen PK. SOBr J Psychiatry. 2014 Sep;205(3):214-20. Epub 2014 Jul 10)

vi(Omega-3 for bipolar disorder: meta-analyses of use in mania and bipolar depression. AUSarris J, Mischoulon D, Schweitzer I. SOJ Clin Psychiatry. 2012;73(1):81)

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