Ep. 157 | What is Bipolar Disorder? Understanding Symptoms, Types and Treatment

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Welcome to Everyday Therapy, where simple and practical concepts of therapy meet your everyday life. Hosted by licensed marriage and family therapist Brett Cushing and doctor Karen Ryan, we're here to help you unlock tools and strategies you need to become the best version of yourself. Whether you're looking for guidance, inspiration, anecdotes, or actionable advice, you're in the right place.

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Let's dive into everyday therapy.

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Hello and welcome to another episode of Everyday Therapy. I'm Doctor Karen Ryan here with Brett Cushing, licensed marriage and family therapist. And today we have a really important and a meaningful topic for you, which is understanding bipolar disorder. What is it? Right. There can be a lot of misunderstandings about what bipolar is. And our hope today is to really give you some examples of what that can look like and feel like.

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So if you're somebody who has bipolar, we hope that this feels validating and helps you kind of understand yourself and helps others understand what you're experiencing. And if you don't know about it, we hope that this gives you a lens into kind of what this can look like and feel like for understanding about what bipolar disorder is. So hybrid.

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Unknown
Hey, good to be here. And I'm so glad we're talking about this because there is a lot of misconceptions about it. There's stigma that goes along with it. And one of my hope is that by the end of today, we all will have a greater understanding of this, a greater sense of compassion. If you have bipolar, my desire is that you'll be able to have a lot more compassion towards yourself.

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Unknown
And if you're living with somebody who has bipolar, the confusion is very real, and we're hoping that some of that confusion can be replaced with compassion and some very practical tips of what you can do. Absolutely. And oftentimes, you know, we will here comments or like you might hear it in the media or in post or something. We're like, oh, I'm so bipolar.

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Unknown
And that is really hard for me to hear as a therapist, right? Because oftentimes what people are referring to our emotional states or mood swings where, you know, you might have been happy and enjoying yourself in the morning and then something frustrated you and you were annoyed in the afternoon. Right? Like that is not bipolar. Those are different emotional states that you were experiencing where what bipolar is, you know, we use the DSM and we diagnose here, but this isn't about diagnosing, and this is about to give you concrete information about what bipolar is.

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Unknown
And so bipolar is when individuals experience episodes of depression. Right. So full episodes of depression which is decreased mood, decreased energy, tearful this feeling down, more fatigue, not enjoying the things you used to enjoy. So it is a clear state of, you know, weeks a week or two of clear depression. Right. And then what makes it bipolar is when the person also have periods of times of elevated mood or a heightened mood.

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Unknown
So this is when they might have increased energy. They might talk more, you have more energy, you start more projects, have difficulty finishing. Things might take some more higher risk behaviors, such as spending more or driving faster, or wanting to have more intimacy increased, kind of like talking faster, flight of ideas. And so it's when you have a real specific time of when you have experienced depression and then you experience an elevated mood.

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Unknown
And I give you a little more information because there is hypo mania, which is a form of elevated mood, which is not as intense as a full mania or manic episode. And you can talk with your provider about that. But if you've heard those two terms, that's like hypomania. Hypo means a little less not as intense of the elevated mood, where full mania is a higher, more heightened, elevated mood with some more significant symptoms that can oftentimes require some real intervention, such as hospitalization or real increased medications.

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Unknown
When we're in a full manic episode, you miss anything, Bret. Like, what are your thoughts like? I think you nailed it a lot to understand and take in here. I think just want to emphasize to with the hypomania, I'm glad you made the distinction of during those elevated times when we refer to it typically as manic and elevated times, it's not as intense, however, with the hypo mania or the type two bipolar.

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Unknown
Yeah, the depression can be just as intense. Yeah, it is exactly miss that the depression is very real, and it's just that that manic phase is less intense. And I think inherent with what you were saying, Doctor Ryan, is that notice it's really a systematic amplification of mood that has effect on energy to as well as people's actions.

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Unknown
And this is something that people who are struggling with this, it is it is a struggle for them. They are not intentionally trying to be difficult or unreasonable. They are just struggling with this. And we're going to try to unpack it a little bit more for people to understand. But I think you you captured it pretty well there.

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Unknown
And they can also have just 1.2 is they can also have some psychotic features at times too. Yeah. Yeah. So in that manic. So what happens right is when somebody in a manic state. Right. We're not sleeping as much as well. We're starting a lot of projects. We're doing a lot of things. And what happens is the body just gets run down, and when the body gets run down and our brain is trying to catch up and work hard, that's when we can have some of those psychotic symptoms.

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Unknown
And so again, it is really just because like our brain and our bodies have been overtaxed that then we can see those psychotic symptoms. Yeah. Right. Yes. And I think also within that to help people understand the mania, that overtaxed kind of sense that we have is there's such an incredible pace of thoughts that are coming. It's too much for people that actually comprehend it, make sense of it.

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Unknown
It's all coming in so fast. So it can almost feel like this incredible overstimulation going on. And how do I, I have to kind of address all these thoughts that are coming at once. And I say that just to help people understand, because in those manic phases, people can look as someone who has bipolar and think they're just they're so irresponsible.

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Unknown
And there is they're trying very hard. They're doing the very best they can. Yeah. And I think we can also be helpful is like in recognizing the different ways that bipolar can present for individuals. So each person kind of has their own experience. And so some individuals might have depression on and off for five years and then have a period of hypomania or mania once every five years, ten years.

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Unknown
Some people might experience it more where they have a couple a couple of cycles like within the year. So it might be within like a couple of months have that experience. And so it's knowing that that there isn't just that one size fits out where each person has the true like meets the criteria of those weeks of depression and then those like weak weeks of hypomania mania.

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Unknown
But it can really vary. And how often you experience both of those episodes. And with mania, what happens is, you know, it's a build. So oftentimes what will happen is people as they are coming out of depression, or they have a period where they're not depressed or hypomanic, manic, then start to experience some symptoms and then they can increase and escalate in, like Brett said.

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Unknown
Like that's when we can get into that overtaxed. Or it might start with some a little bit of like, I had one client who had starts to like irritability at work, and that's like, I'm going to tap in, I'm going to make sure I focus on sleep and I'm going to like increase my meds here. And so it's recognizing that there are sometimes and there's like a build.

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Unknown
And so that's one of the things we'll talk about today is kind of how do we recognize what some of those signs are. What does that lived experience. What does it look like to manage. Because I have so many clients who I just love, and I'm so proud of them, and they worked so hard, and they do such a wonderful job of like managing and living with their bipolar and even to a point of like can lean into like pride of like who they are and how their beautiful brains work and understanding like how they can care for themselves with bipolar.

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Unknown
And I think as we get into what it feels like, note that people who have bipolar, that's going to be different than other kind of mental health diagnoses, maybe with people who are borderline personality or PTSD, they might have fluctuating emotions within a certain day and it goes really high. It can go really low. Whereas with bipolar we're talking about more specified periods of time.

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Unknown
For instance, that bipolar one is where we have typically more than a week of either the mania or the depression, and people can kind of have a mixed episode, or they can be kind of leaning more towards mania or depression. And people who have the hypo typically will have the mania in a shorter duration less than a week, typically like four days.

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Unknown
So that's where you were talking about that. That mania is not quite as intense, doesn't last as long, but the depression still will be. So when we look at what an everyday is like for people, we, I think get a sense that, oh, okay, this is a bit defined in terms of these these swings in mood. Yeah. And I feel like one of the things that I think a lot of people will resonate if they have bipolar, right.

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Unknown
Is that it? It takes a while to figure it out. Right. And that is when you talked about compassion and grace. So if you are somebody newly diagnosed or even just reflecting on your own experience with bipolar or you have a loved one with bipolar, it's recognizing it does take a while to figure out like it is. It takes time to figure out, like, what are my signs?

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Unknown
Like what? How do I recognize when I'm getting outside of that threshold? And what is like for me? Like, when am I thriving, right? And when am I having positive energy? Because that's one thing I've experienced with clients, is when they have become really skillful and are really working hard to watch for hypomania or mania. It's giving themselves permission to have fun days and get excitement and like, what's excitement versus what's hypomania?

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Unknown
And so I just again want to reinforce like that compassion of it takes effort. And it is absolutely something that we can figure out. And you work with your provider to identify. But it takes time, right. Like and patience. Yes. Patients with yourself or your loved one, someone you care about that takes a lot of patience and time.

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Unknown
I'm glad you mentioned that. Maybe we can share what it's like. I'd like to share a little bit of what it's like, maybe with somebody with type two, with the hypo mania, and so notice it. It's there's kind of a build up kind of a the up phase. And maybe day one, the person gets up at like 4:45 in the morning.

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Unknown
They're not groggy, they're wide awake and they're thinking, you know, I should sleep more, but hey, I'm ready. Let's start the day. I feel good. And so it feels great because they have all sorts of new ideas, they have new eye plans that they're going to do, and they're actually able to make connections of things in their mind, perhaps, that they weren't able to do before.

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Unknown
And so they get out of bed. Don't even need coffee today. Right. They're having this now. I'm going to do it anyway. You know, I stick with my routine, but they probably don't need it. And so now their thoughts are flying and it's only 7:00. And so then they've mapped out. By then they've mapped out a new business idea and planned they've cleaned part of the house they've spent or sent three long, enthusiastic messages to people that they haven't talked to in months because they have all of this energy.

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Unknown
So they're talking faster than usual, they're interrupting a bit, and yet it feels like they're being incredibly efficient. So what that comes a great sense of confidence more than normal. And they're feeling sharp and they're very persuasive. And then by the evening they're still not tired. They have a lot more energy. And they're reorganizing things their closet, their schedule, their finances.

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Unknown
And they decide, this is the week I'm going to finally get everything done. And so they take on maybe a monumental task, and they go to bed at midnight and they're still not really tired. And then from there, things tend to escalate in like days 4 to 6, things aren't escalating even more. They still feel good, but there's an edge.

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Unknown
They're slightly irritable, they're frustrated, and they're thinking becomes even more ambitious but slightly unrealistic. And they spend more money than usual, and they tend to take on commitments they can't sustain. And they feel unusually driven to fix everything in their life all at once. And someone might even say, hey, are you doing okay? You seem a little different.

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Unknown
And their reaction internally would be, no, I'm actually I'm finally doing well. And then the shift comes days 7 to 10. There's that shift over to the depression where people feel overwhelmed. What did I get myself into? Why did I make these purchases? And you have that sense of depression and the body just going to that other extreme, and then other people notice, wow.

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Unknown
There is what is going on and you might not even know yourself. So that's kind of the Reader's Digest version example of what what happens here? What do you think? What am I missing here? Yeah. No, I really like that example. And I think what what can be hard right. Is that at first like when you go like, especially if you've been experiencing depression.

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Unknown
Right. Like depression is hard. It's not an enjoyable experience. Right. It's just hard to do things. It's like living through a little bit of sludge. Right. And then when you first start to experience hypomania, right, like it feels good, like there's energy, there's this positive energy and motivation and drive and you highlight it well. What happens is like it starts with that energy and then it becomes overwhelming.

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Unknown
And then it starts to be like, you can't stay on top of it. And then it becomes like distressing. And so there's still this like activation. And then like most people will experience kind of a crash or a comedown. Right. And that's really hard. And we know. Right. The more things that we have kind of set up or the more behaviors that we have done while we're in the hypomanic state, then lead to more things.

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Unknown
We have to kind of take care of or fix or clean up afterwards. So is that like returning items? Is that like repairing any relationships? Is that kind of backing away from certain things? Is it kind of like that recognition of like, oh, I was excited to start these projects and it's okay now that I'm not doing them.

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Unknown
And so that's what's hard about it, is it can be hard because at first it feels really motivating. And that's when it can feel like I don't need my meds or I'm going to stop taking my meds. And medication for bipolar is different than what we typically people have for depression. We tend to have people use a mood stabilizer, which is really helpful.

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Unknown
Then and again mood stabilizer to help prevent by the hypomania, but also treat the depression because if somebody tends to be again, we're not medication providers, so we're not going to give any medication advice. But why people who have bipolar just typically aren't on a straight anti-depressant is because that can lead to more hypomania or mania. So really, being with a med provider who understands bipolar and can can treat you for that is tends to be really helpful.

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Unknown
But what? You're not alone. If you have had troubles like staying on or getting on medication because at first like that hypomania just it feels it is positive, right? It feels it's motivating, it feels good. And so it can be hard to recognize when it's hypomania or to remember in that moment what might come next. Because I think, Brett, you had a really good example of that, of like why it can be hard in that moment to recognize when we're in hypomania.

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Unknown
Right? Like you'd be like, how do you not know? And it's well, there's some really good neurobiological reasons. There are, there are. And one of them, that something that's helped me a lot with compassion is this idea of Anna, where the frontal lobe for people, they're in this manic phase. There's something called Anna that helps us understand why people go off their meds when they're doing well.

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Unknown
And it's really important. I think if you're living with somebody who goes through this, because I've seen it as a therapist, they're doing well. They might be in this manic phase. I don't need my meds, and I'm so frustrated for them because I know they're going to regret that later. But what's actually happening is part of the frontal lobe shuts down, where there's an inability to actually know and assess.

00;17;20;04 - 00;17;51;01
Unknown
I'm in danger and I'm vulnerable right now. So the only example I can think of is when I'm driving once down the mountains in Sierras and just driving along, and suddenly I'm going 93 miles an hour down a mountain. And I think we can all relate to that. Like, oh, we had no idea. And that what happens for people with bipolar is they get this in that phase of mania where they don't realize, but they, they don't have a speedometer to even look at and read.

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Unknown
And so they are really vulnerable and they can't help that. Yeah, I think they're going 60, but they're really going 110. Right. Yeah, yeah. And I think it's so important to remember that when you experience hypomania or mania, it is there is absolutely nothing connected to willpower to work ethic, to being a responsible person. None of those characteristics that we like think of as like defining like a good person.

00;18;18;10 - 00;18;36;02
Unknown
Those don't. That is not what is happening here, right? This is a neural biological like I don't love the word disease, but it is disorder, right? Like it is a disorder because it is not something that you can just control, right? It's not something that you cause and it's not something that you can just like make go away.

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Unknown
It truly is something to like, manage and that like I say that and hopefully in an empowered way of like, I can learn to manage this. And if I can think of it as like, I have a team and I'm going to manage this versus like, what's wrong with me? There's something wrong with me. I'm not doing enough.

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Unknown
That is not what is happening with bipolar. Very important reminder. I think for all of us there is there are elements that are definitely out of our control, and there are some elements that are certainly within our control. And maybe we can shift to that. And as we wrap up our time, begin to focus on what do you do and how do you help yourself?

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Unknown
How do you help somebody you care about? One of the things I think about you touched on is the medication. It is something that medication, those mood stabilizers typically are the go to medications for this and can be highly effective for people. Lithium is probably the most popular one I hear about. And when people take that, it helps because like you said, it's a disorder.

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Unknown
And think about that word. It might have a negative connotation, but when you strip that away, things are just out of order in our brain that, like you said, I don't have a whole lot of control over. And the mood stabilizers do just that. They help stabilize things so that I'm not so high. I'm not so low all the time.

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Unknown
Yeah. And what I find. Right. So, you know, there's and there's many different medications for it now too, which is great as they're doing research for mood stabilizers. And what I find is when people work with their medication provider, like it is such a wonderful way to be empowered to know exactly how to take your meds to. And so, like I alluded to this earlier, having clients who know, okay, and here's the med that I can take or I can increase a little when I have these symptoms and having those regular check ins.

00;20;23;11 - 00;20;44;01
Unknown
So then you can watch for kind of when we're getting outside of the bounds of what feels actually healthy or in the best space for you. And so that that can be a helpful piece. Well, there's also something for the depressive episodes, because I think people maybe misunderstand that it's it's not full blown depression because it's an episode.

00;20;44;01 - 00;21;07;06
Unknown
And in addition to the medication, we want to be able to treat it as much as we would any other kind of depression. Now your clinic offers, what's your big chair that you have here? Your transcranial TMS. TMS. Thank you. Yes. Can you explain that a little bit? Because I think that's there's a lot of evidence that that's really helpful with bipolar.

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Unknown
Well, the challenge is, is TMS we're only treating for people with depression and so we don't. Yeah. For bipolar. Nope. I did not know that. Yeah. Yep. And so that's one of those times where it's, I think where research might take us there. But in the meantime, that's one of those times where, you know, providers and certain services.

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Unknown
But we're careful to make sure we don't do anything that would lead to that person to go into a hypomanic or a manic. That's that's an excellent point. Yeah. Yeah. And so TMS, which is very we can talk about some other time, but it's essentially sending signals to increase the activation of your neurotransmitters. And with bipolar. Right. Like we're trying to balance out neurotransmitters, not just increase them.

00;21;48;02 - 00;22;23;04
Unknown
And so that's when that one might be contraindicated. And so that leads me into something to be careful about. We always hear a lot about exercise. And so when people are heading into kind of a manic episode, exercise is kind of what people here oh, just exercise. Exercise. And yet there's a vulnerability. We have to be careful if people are heading into that manic episode, if they're doing high intensity kind of workouts, that can lead to a full blown manic episode, which is, I think, kind of what you were just alluding to with trans magnetic stimulation.

00;22;23;05 - 00;22;41;16
Unknown
Yeah. So, yeah. And so some of the things. Yeah, that are really helpful. Right, are focusing on like just the really the day to day self-care thing. So making sure that you have as close to a sleep schedule as you can. So being aware of like, oh, I feel the need for less sleep. Right. We do that with depression of like we're sleeping too much.

00;22;41;18 - 00;23;09;09
Unknown
Like how do we kind of get activated and go same sort of thing. Like, am I not getting enough sleep? Right? So really taking meds at the same time, having a consistent bedtime, being thoughtful about like breaks from work and when work is done and taking time to relax. I'm watching for irritability, watching for like the increase, like spending, watching for like, am I all of a sudden like more socially involved, right.

00;23;09;10 - 00;23;26;12
Unknown
And again, social engagement is good. And like is this a shift or a change. And so those are some early signs and like irritability if I didn't say that like that's another key one. What are your thoughts. I think you touched on sleep. And sleep is one of the top indicators of I'm going to be vulnerable. It's a trigger for us.

00;23;26;13 - 00;23;50;02
Unknown
And so when our circadian rhythm gets off and our sleep is really deprived, our brain is working very hard and we may not think it or realize it. And we need to be aware if we have bipolar, if we know somebody who is. Sleep disturbances is a considerable trigger to getting into manic going into depressive phases. So we want to be careful with that.

00;23;50;02 - 00;24;17;23
Unknown
And what can be very helpful that we provide here is CBT. So cognitive behavioral therapy dealing with insomnia. And we've had Doctor Rick Blackburn many times on the podcast talking about our behavioral medicine sleep medicine that we do. So keep that in mind. Extremely important. Can't emphasize the the sleep aspect enough. Yeah. And so it's literally like I don't feel like and I don't really want to go to bed until two.

00;24;17;23 - 00;24;49;12
Unknown
But you know what? I'm gonna, like do my skills and get myself to bed at 11. Right. And like, those things can get you back on track. Yeah. I also think of nutrition. Super important. So I think of three things we touched on meds, sleep and nutrition. So we want to obviously try to avoid sugar and carbs, things that are going to cause inflammation, but specifically omegas, the omegas and the like fish, salmon, really good walnuts, things like that.

00;24;49;12 - 00;25;08;22
Unknown
And just eating good balanced meals and not kind of going on major binges with eating, but staying in a good, healthy, balanced nutritional diet. So it really is a lifestyle all in all. Yeah, almost like kind of sometimes living by the clock, I'll call it. So bedtime at this time I'm going to eat a breakfast, I'm going to eat lunch, I'm gonna eat dinner.

00;25;08;22 - 00;25;27;05
Unknown
And so just like helping yourself, because sometimes those internal cues get off. Like, sometimes we can really live by internal cues, and sometimes we're gonna, we're going to use the clock a little bit to remind us of what will be helpful. So consistency consistent consistency day by day. And we talked about in the previous podcast about boundaries with work.

00;25;27;05 - 00;25;50;00
Unknown
We need to have very clear boundaries and consistency with managing medication, nutrition, appropriate exercise and sleep. Yeah. And if you have a loved one who has, you know, bipolar, sometimes it's helping just like talk through so non-judgmental, you know, and really pulling in like love and logic. Right. So reminding them if they're like, well, I don't need my meds.

00;25;50;01 - 00;26;06;25
Unknown
Like that's when you can like, do you remember, like last time, you know, you had felt like you wish you would have like, let's just keep taking them every day because we know that's going to help you long term, right? Or helping that person just try and like say, hey, I'm concerned because I noticed you didn't sleep at all last night.

00;26;06;28 - 00;26;22;25
Unknown
Like, hey, do you want to watch a movie and kind of wind down together to get some good sleep tonight? So it's not making judgments, but it's stating facts of like what you're observing, because sometimes it can be hard to notice that. And it can be hard not to just jump in and tell them what they need to do.

00;26;22;26 - 00;26;41;12
Unknown
Yes. And because you've seen it and you see this, the train coming and you're like, oh, let's get off the tracks, you need to move. And you know what could be coming for you too. And yet, what's going to be more effective is to lead with a lot of listening first and trying to validate that, wow, this is really hard for you.

00;26;41;12 - 00;27;13;10
Unknown
I get that. And again, inherent with what you said, Karen, is a we approach how what are we going to do and try not to lead with fixing it for them because you suddenly become their adversary then. And that's just going to come back and not be effective. Yeah. And then what you can do to is kind of proactively or at a time when it you're both calm or somebody isn't in, you know, depression or hypomania mania is have a conversation about like, how can I support you?

00;27;13;15 - 00;27;34;19
Unknown
What would be helpful and literally sometimes writing it down. Right. So then that you can able to like let's look at it together. Remember we like we wrote this together. You wrote this. This is what you wanted me to help you remember or those sort of things. Because then it's that person's like empowered where they're doing it with them for themselves, on a team, with you versus being told what to do.

00;27;34;19 - 00;27;56;28
Unknown
So kind of laying out that foundation can be, can be really helpful. There's so much to be said. We wish we could keep going longer about it. And one thing I hope that people do take away is a greater sense of compassion. Nobody likes to feel out of control. It's really one thing universal in the human condition. Yes, we do not do well feeling out of control.

00;27;57;01 - 00;28;22;09
Unknown
Covid is a great example of that too. And so just try to remember, for those of you that are struggling with this or know somebody that they're feeling out of control, and you might be too, as someone who's a partner, for instance. And so try to keep remembering these things and apply these practical tips. The goal is not to eliminate the emotion, but it's to build a life that isn't controlled by it.

00;28;22;11 - 00;28;35;07
Unknown
Yeah. Were you experiencing a range of emotions that feel safe right. And within your control? Right. Yeah, exactly. Well, thanks for joining us. We look forward to sharing with you next time. Take care all.

00;28;35;10 - 00;28;53;03
Unknown
thank you for listening to this episode of Everyday Therapy. We hope you're inspired to apply today's insights to your own life. Don't forget to subscribe so you never miss an episode! If you found this podcast helpful, please leave us a review. It helps others discover the show and join our community. See you next session!

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