A common myth about bipolar disorder is that you need to experience a depressive episode in order to be diagnosed with the illness, according to Kelli Hyland, M.D., a psychiatrist in outpatient private practice in Salt Lake City, Utah.
However, a person only needs to experience a hypomanic or manic episode, she said.
Many other myths abound – misconceptions that can jeopardize how you manage and live with the disorder. Below are three such myths.
1. Myth: The episodes of bipolar disorder are beyond your control.
Fact: According to psychotherapist Sheri Van Dijk, MSW, who specializes in treating bipolar disorder, many people believe you can’t do much to minimize the illness’s influence on your life.
In reality, while bipolar disorder is, in part, a biological illness, various behaviors and habits can trigger episodes of mania or depression. For instance, substance abuse and sleep deprivation, she said. By practicing healthy habits, you can stave off episodes or lessen their severity.
“The more people can identify their triggers and patterns — [such as] that they’re more likely to become depressed in the fall or that sleep deprivation tends to trigger mania — the more effective they’ll be at managing their illness,” Van Dijk said.
To identify triggers and patterns, Van Dijk uses a “Life Chart” with her clients. Together they review the course of their illness and document their episodes (as best as they can). This gives clients greater awareness so they can intervene. For instance, they might monitor their mood more closely in the fall, or make sure they maintain good sleep hygiene overall.
People with bipolar disorder also can learn valuable coping strategies for other symptoms they experience between episodes, such as learning breathing techniques to navigate anxiety, she said.
Other techniques can help with living a healthier life in general. For instance, in her book The Dialectical Behavior Therapy Skills Workbook for Bipolar Disorder, Van Dijk shares how readers can make better decisions.
2. Myth: Medication blunts your emotions or makes you feel like a zombie.
Fact: Individuals also mistakenly believe that medications for bipolar disorder prevent people from feeling their emotions or being artistic or prolific, Hyland said. For instance, a common concern or complaint is feeling “like a zombie.”
However, this might be a sign that someone is actually taking the wrong medication or the wrong dose of a medication, she said.
Finding the right medication takes trial and error. “We know what works for groups of people in general, under extremely rigid (research) circumstances, but I never know what’s going to work in any one individual sitting in front of me. Understanding that it’s a process and that even mistrials or struggles with meds offer us important information and direction.”
Some doctors, because they’re not specialists or don’t have time to really listen to the patient, don’t understand that a low dose of a medication might be enough for the patient, regardless of how people react as a whole, she said.
It’s also important to explore what people mean when they report feeling numb or unemotional. For instance, are they really feeling numb or are they experiencing less emotional swings because the medication is working?
“[I]t can be a real adjustment, often uncomfortable, even if they feel better in a lot of ways, to [feel] more stable emotionally than they’re used to or even might like.”
In other words, it can be tough to “tease out what’s ‘healthy’ or ‘stable’ for any one individual. Not feeling a rush of up and down and unpredictable might feel numb or unemotional to someone.”
Working with a therapist can be tremendously helpful for discussing ambivalent feelings around getting better and taking medications, she said. Also, your treatment team can help to sort out what’s going on.
According to Hyland, “medication should allow [individuals] to feel normal emotions and continue being productive, active people with a high quality of life and also help them manage emotions, behaviors and avoid emotional extremes that negatively impact function and relationships.”
3. Myth: It’s OK to stop taking medication between episodes.
Fact: Manic episodes can be far apart from one another, Hyland said. This leads to the misconception that stopping your medication isn’t problematic, she said.
“[Patients] may believe they are ‘cured,’ that they won’t have another episode or if they do, they can handle it.”
They also may forget how bad manic episodes can be, and erroneously believe they can think their way out of an episode, she noted. It’s tougher to continue taking medication when you don’t see the day-to-day effects and if they have troublesome side effects.
However, stopping your medication — without the help of your prescribing physician — can be dangerous. As psychologist John Preston, PsyD, noted in this piece: “Bipolar disorder is probably the main psychiatric disorder where medication is absolutely essential. I’ve had people ask me if there’s any way to do this without medicine. [My answer is] absolutely not.”
Bipolar disorder is a difficult illness. But with medication and psychotherapy, individuals do get better and lead healthy, fulfilling lives.