Demystifying Bipolar Disorder with Olivia Callaghan and Dr Clayton Chau, MD, PhD

September 28, 2017

You've been very vocal about having gone through a lot in life that led to some serious self-image and mental health issues. Can you share some of that with us?

Liv: Of course, so I started showing signs of mental illness and extremely low self-esteem when I was 14; I literally showed signs overnight. I went from being a fairly bubbly and happy child to a miserable, secretive, manipulative and depressed teenager. I was going through an extremely hard time at school as I was struggling to keep up with assignments and couldn’t concentrate at school, and it wasn’t till I was 18 I finally sought help for my issues. Between the ages of 14 and 18 before I sought help I told no one of my problems, as I didn’t think people would believe me, and I was worried they'd presume I was just going through teenage hormones.

When were you first diagnosed with bipolar disorder and was it something you had considered that you might have? How did the diagnosis change things for you?

Liv: I was first diagnosed with bipolar disorder when I was 18 and frankly I was relieved. It meant that my pain was a result of a chemical imbalance and it wasn't normal and it wasn't something I was 'making up.' I honestly didn't consider that it was something I may have, but when the doctor described the symptoms to me, it all seemed to make a lot of sense. I felt at last that I was able to start my recovery and start living my life again. After I was diagnosed, I was put on a course of medication which didn't help and it had awful side effects. There are so many forms of medication for mental illness; it would be a miracle if I were able to find the right one for me so early on. I started having a counselor come to my house on a weekly basis, just to talk to me and see how I was doing.

What kind of treatments have you tried for your condition and what has worked the best?

Liv: I have been on several different medications, including mood stabilizers, anti-psychotics and anti-depressants. I am currently on a mixture of all three, which has really been helping me. I have had many varied experiences being on medication, including awful side effects such as dizziness, lack of sleep, severe anxiety, and nausea. Luckily the tablets I am currently on have little side effects, and I am used to them. I have also had many forms of therapy, including group therapy, which I hated. I found it very intense and hard as someone with social anxiety to talk to that many people. I was also on home treatment, which was really helpful, which involved a nurse coming to my house every day to make sure I was taking my medication and to talk with me.

As a social influencer, you had the choice to use your influence to help spread awareness and help others, what prompted you to get proactive?

Liv: I began my account back in November 2016, after a really bad episode. I was tired of feeling so lonely and so lost and feeling like I was the only one suffering, so I began the account as a way of finding other people who understood mental illness as well as I did. The response I have been getting is amazing, and I find it is helping me not only understand my own mental illness a bit better, but to manage it and create more ways to include self-care in my life. I think social media nowadays can be really tough, as you see a lot of people whose lives seem really put together, and that they don't have any problems at all! It's nice sometimes to be real and spread awareness to something that impacts 1 in 4 Americans.

You’ve talked about social anxiety, depression and thoughts of suicide, how did you learn to overcome that?

Liv: All these feelings are feelings I still deal with today, and they won't go away, but I have learned how to manage and deal with them. Depending on the severity of the situation, self-care is the best way for me to deal with the feelings. There are many forms of self-care I recommend, including taking a bath, talking to a friend, going for a walk, and reading a good book. The best way to help deal with the emotions I am feeling is to talk about it. Opening up and being honest and real about my issues was the best thing I could have done for my mental health. I often talk to my parents about my issues, as they are incredibly understanding and supportive.

What motivated you to go from hiding your issues to accepting it to embracing it?

Liv: For years I spent dealing with my issues completely on my own because of fear of ridicule and mocking. I believed that no one would understand and that I would end up more alone than ever. It wasn't until I was 17 or 18 when I finally told someone - my mom. I wrote a letter to her explaining my problems and how I was feeling, and she helped me get the help I so desperately needed. I was so young when I was going through my issues that I longed to be like everyone else, I couldn't imagine living the way I was for the rest of my life.

It wasn't until I was in recovery, getting the help I needed, that I learned to accept my issues. I learned that no one is the same, and although life would be a lot easier mental illness-free, I wouldn't change it. It's made me a stronger person, and I see the world more compassionately. As for embracing it, I'm still learning, but I realized there is absolutely nothing wrong with having a mental illness - one in four of us suffer from some form of mental issue - why on earth should I feel embarrassed or ashamed? All I want to do is help other people, realize their worth and make them understand that having a mental illness is not a bad thing.

Research indicates that bipolar disorder can be genetic, have you learned of anyone else in your family with the condition?

Liv: As far as I am aware, none of my immediate family suffer from mental illness; however, on my dad's side there are traces of mental illness. My aunt suffered from self-harm and bulimia in her teens, which led to a diagnosis of depression, but I am unsure if she was diagnosed with bipolar disorder, but it is extremely likely.

What advice would you give anyone, especially young people, living with bipolar disorder?

Liv: I have lots of advice for young people dealing with mental illness, but my top advice would be to open up and talk to someone. I spent years bottling it all in, which was damaging to my health and affected all my relationships within my family and friends. It can be incredibly scary to open up at first, as there is so much stigma behind mental illness, but once you get past the fear it opens up a whole new world. Don't be afraid to show emotion, don't be afraid to be yourself, and don't forget you are wonderful and amazing just the way you are.

Next we chatted with Clayton Chau, MD, PhD, the Regional Executive Medical Director for mental health and wellness for Providence St. Joseph Health.

We asked Dr. Chau to provide his perspective on bipolar disorder:

What is bipolar disorder?

Bipolar disorder, also known as manic-depression, is a treatable, serious chronic brain disorder that causes dramatic shifts in mood (mood swing), energy level and the ability to think clearly and to carry out daily living activities. People living with bipolar disorder typically have high and low moods also known as mania and depression, which is different from the typical ups and downs most people experience.

What are the symptoms?

An individual living with bipolar disorder may have distinct manic or depressed states, some have overlapping states and others may also have psychotic symptoms such as hallucinations or delusions. Usually, the psychosis mirrors a person's extreme mood. To be diagnosed as bipolar, a person must have experienced mania or hypomania, a less severe form of mania.

Manic symptoms include:

  • Feeling very “up,” “high,” or elated
  • Feeling “jumpy” or “wired”
  • Having a lot of energy becoming more active than usual
  • Having increased activity levels
  • Having trouble sleeping
  • Talking really fast about a lot of different things
  • Feeling like their thoughts are going very fast
  • Being agitated, irritable, or “touchy”
  • Doing risky things, like spend a lot of money or have reckless sex

Depressive symptoms include:

  • Feeling very sad, down, empty, or hopeless
  • Feeling like they can’t enjoy anything
  • Feeling worried and empty
  • Having very little energy
  • Having decreased activity levels
  • Having trouble sleeping, they may sleep too little or too much
  • Having trouble concentrating
  • Forgetting things
  • Eating too much or too little
  • Feeling tired or “slowed down”
  • Thinking about death or suicide

During a hypomanic episode, an individual may feel very good, be highly productive, and function well. The person may not feel that anything is wrong, but family and friends may recognize the mood swings and changes in activity levels as signs of bipolar disorder. Without proper treatment, people with hypomania may develop severe mania or depression.

Who gets bipolar disorder?

It effects men and women equally.  It occurs among all ages, races, ethnic groups, and social classes.

What causes bipolar disorder?

Many researchers have and continue to look at possible causes of this illness. However, to date, most agree that there is not a single cause. Furthermore, it is most likely that multiple factors are contributing to the increased risk of developing the illness.

  • Genetics. The chances of developing bipolar disorder are increased if a child’s parents or siblings have the disorder. But the role of genetics is not absolute. Most people from a family with a history of bipolar disorder may never develop the disorder. And studies of identical twins have found that even if one twin develops the disorder, the other may not. 
  • Stress. A stressful event such as a death in the family, an illness, a difficult relationship or financial problems can trigger the first bipolar episode. Thus, an individual’s style of handling stress may also play a role in the development of the illness. In some cases, drug abuse can trigger bipolar disorder.
  • Brain structure. At this time, brain scans cannot diagnose bipolar disorder in an individual. Researchers have identified subtle differences in the average size or activation of some brain structures in people with bipolar disorder. While brain structure alone may not cause it, there are some conditions in which damaged brain tissue can predispose a person. In some cases, concussions and traumatic head injuries can increase the risk of developing bipolar disorder.

How common is it?

Every year, 2.9% of the US population is diagnosed with bipolar disorder, about 83% of cases are classified as severe. There are more than 5 million people in the US who are living with bipolar disorder

How is it diagnosed?

Bipolar disorder can be difficult to diagnose. To diagnose bipolar disorder, a doctor may perform a physical examination, conduct an interview and order lab tests. While bipolar disorder cannot be identified through a blood test or body scan, these tests can help rule out other illnesses that can resemble the disorder, such as hyperthyroidism. If no other illnesses (or other medicines such as steroids) are causing the symptoms, the doctor may recommend the person see a psychiatrist. A mood diary to keep track of the daily mood changes and sleep patterns can be very helpful to aid in determining the diagnosis. To be diagnosed with bipolar illness, a person has to have had at least one episode of mania or hypomania. 

Some bipolar disorder symptoms are similar to other illnesses, which can make it hard for a doctor to make a diagnosis. Also, many people have bipolar disorder along with another illness such as anxiety disorder, substance abuse, or an eating disorder. People with bipolar disorder are also at higher risk for thyroid disease, migraine headaches, heart disease, diabetes, obesity, and other physical illnesses.

People who have hypomania may feel more energized than usual, more confident and full of ideas, and able to get by on less sleep. These are things that hardly anyone complains about. People are more likely to seek help if they’re depressed, but the doctor may not observe the hypomanic side then.

When does it typically present?

It usually begins in late adolescence (often appearing as depression during the teen years), although it can start in early childhood or later in life.

What are the treatments? 

If left untreated, the symptoms usually get worse. With a lifestyle that includes self-management, healthy, holistic with a solid treatment plan and medical/community support, many people live well with this condition.

Bipolar disorder is treated and managed in several ways:

  • Medications, such as mood stabilizers, antipsychotic medications and antidepressants
  • Psychotherapy, such as cognitive behavioral therapy and family-focused therapy
  • Support groups
  • Electroconvulsive therapy (ECT)
  • Self-management strategies and education
  • Complementary health approaches such as meditation, faith and prayer

Are there levels of the disorder?

There are several diagnosable types of bipolar disorder.

  • Bipolar I is characterized by one or more episode of mania or mixed symptoms. Its hallmark is the extreme manic episodes.
  • Bipolar II is characterized by one or more depressive episode and at least one episode of hypomania.
  • Cyclothymic disorder is characterized by at least two years (for children, a full year) of both hypomanic and depressive periods without having full range of symptoms for mania, hypomania or depression.
  • Bipolar disorder specified or unspecified is characterized by the recognition that many individuals, particularly children, to a lesser extent, adolescents, experience bipolar-like phenomena that do not meet criteria for bipolar I, bipolar II or cyclothymic disorder.
  • Certain medical conditions such as stroke, brain injuries, Cushing's disease and multiple sclerosis can cause a bipolar manic or hypomanic condition.
  • Likewise, certain medications such as steroids, methylphenidate, immunosuppressants, as well as drugs such as cocaine, can cause a bipolar manic or hypomanic condition.

Why is the connection between bipolar and suicide so high?

Bipolar symptoms are so severe that they can damage relationships and make it hard to go to school or keep a job. They can also be dangerous. Some people with bipolar disorder try to hurt themselves or attempt suicide. The lifetime risk of suicide in individuals living with bipolar disorder is estimated to be at least 15 times that of the general population.  Bipolar disorder may account for one-quarter of all completed suicides.

What are the signs people should look for?

The common seven signs of mania are:

  1. Feeling overly happy or "high" for long periods of time
  2. Having a decreased need for sleep
  3. Talking very fast, often with racing thoughts
  4. Feeling extremely restless or impulsive
  5. Becoming easily distracted
  6. Having overconfidence in your abilities
  7. Engaging in risky behavior, such as having impulsive sex, gambling with life savings, or going on big spending sprees

Providence St. Joseph would like to thank Olivia for being a paid partner with us on this important topic. 

Providence is pleased to share the stories of great people who have overcome health conditions. As part of our population health program, we want to share insights and stories that help bring awareness to common health conditions. Not all the people featured in our stories are Providence patients.

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