A Therapist’s Thoughts on Bipolar Disorder Inside and Outside the Therapy Room

As a therapist I have had many clients who were diagnosed with or in the process of being identified as having Bipolar I Disorder. Similarly, I recognize experiences with acquaintances whose personalities seemed to dramatically change over time. Before learning more about bipolar disorder, I wondered what had caused these changes, was it me, them, or had our relationships simply changed.

Bipolar I Disorder was once called manic depression because a person with this diagnosis often swings from extreme highs and lows as part of mania and depression phases. Typically, mania involves extreme increases in energy levels and reduced sleep needs, risky and impulsive behaviors, poor decision making, restlessness, and irritability among other symptoms. During a manic episode, a person may feel invincible, on top of the world, and as though nothing can stand in the way of success.

And after, depression occurs as part of a cycle—what goes up, must come down. As good as the mania feels, the depression feels equally bad, including extreme symptoms of sadness, emptiness, and hopelessness/helplessness. Both mania and depression symptoms may occur for several days as part of a repeated cycle. A person can become psychotic during each phase, seeing, hearing, or smelling things that are not there. Likewise, a person may experience suicidal ideation during each phase of bipolar disorder, wanting to end their cycle of pain, poor decision making, and confusion about what happened.

Without treatment a person with Bipolar I Disorder can cycle more regularly between mania and depression, also experiencing more extreme symptoms of each. Examples could be a person quitting their job, filing for divorce, or trying to end their life. Bipolar I Disorder can be difficult to diagnose. This is because mood swings may look different for different people. Additionally, symptoms of mania, including jumpiness, anxiety, and restlessness, may be confused with a generalized anxiety disorder. Distractibility can be confused with ADHD. Depression can look like a simple depressive disorder.

Diagnosis and treatment for a bipolar disorder may not occur until a trained mental health professional observes the significant and long-lasting symptoms of mania and depression as part of a recurrent cycle. Likewise, obtaining a history of similar symptoms among family members can be critical for making a bipolar diagnosis. Additionally, knowing a history of recent trauma as potentially triggering the beginning of the mania/depression cycle might be helpful.

The good news is that there is help to better regulate mood swings and return to a more stable lifestyle. As with any other medical condition, taking medications has proven beneficial for feeling more in control of mania/depression symptoms. Mental health therapy, including individual therapy, couples/marital therapy, and family therapy, has been proven helpful for understanding the impact of having bipolar symptoms, including how we perceive ourselves and are perceived by others.

Supportive therapy can help people with a bipolar diagnosis learn how to create balances between working excessively, staying up late, doing drugs, drinking too much alcohol, and building financial safeguards for preventing overspending. Establishing a supportive circle of friends, professionals, and community resources is usually part of feeling better about self and the world. Keeping mood diaries through various apps can help people monitor potential mood swings.

I look at the world today as being more humane and supportive of people with a mental illness like Bipolar I or II. However, it remains essential that a person with manic/depression symptoms recognize the advancements in treatment of this disorder and reach out for help.

The Counseling and Wellness Center of Pittsburgh is here to help if you are experiencing symptoms of bipolar disorder. Please contact us at 412-322-2129 if you need support.

Written by: Stephanie Davis, MEd, LPC at the Counseling and Wellness Center of Pittsburgh.