An estimated 2.3 million Americans (one in five Americans) have bipolar disorder, also called manic-depressive illness. While the rate of bipolar disorder is the same among African-Americans as it is among other Americans, African-Americans are less likely to receive a diagnosis and, therefore, treatment, for this illness.
WHAT IS BIPOLAR DISORDER AKA MANIC DEPRESSION?
Bipolar disorder is a mood disorder that’s characterized by fluctuations in mood, energy, activity, and affects your ability to function optimally on a daily basis.
A person with bipolar disorder can go from feeling very, very high or euphoric (called mania) to feeling very, very low (depression and even suicidal). Many people with bipolar disorder describe their experience as if they are riding an unpredictable roller coaster of changing moods, fluctuating energy levels, and varying clarity of thought. With proper treatment, people can control these mood swings and lead fulfilling lives.
Bipolar disorder often starts in the teen years but can emerge in later life. It is a potentially life-threatening illness that a person cannot handle alone – It can often be misdiagnosed for many years and when it’s not treated properly, it can wreak havoc on a person’s financial life, their personal life, their work life, their relationships and it can be associated with an increased risk of suicide.
Tragically, 10-15% (one of five) people with bipolar disorder commits suicide.
WHAT ARE THE SYMPTOMS OF BIPOLAR DISORDER ?
People with bipolar disorder experience periods of unusually intense emotion, changes in sleep patterns and activity levels, and unusual behaviors. These distinct periods are called “mood episodes.” Mood episodes are drastically different from the moods and behaviors that are typical for the person. Extreme changes in energy, activity, and sleep go along with mood episodes.
| People having a manic episode may: | People having a depressive episode may: |
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HOW IS BIPLOAR DISORDER DIAGNOSED?
Bipolar disorder can be difficult to diagnose because mood swings can vary. It’s even harder to diagnose in children and adolescents. This age group often has greater changes in mood, behavior, and energy levels.
Talking with a doctor or other licensed mental health professional is the first step for anyone who thinks he or she may have bipolar disorder. The doctor can complete a physical exam to rule out other conditions. If the problems are not caused by other illnesses, the doctor may conduct a mental health evaluation or provide a referral to a trained mental health professional, such as a psychiatrist, who is experienced in diagnosing and treating bipolar disorder. When it is not clear if an individual has clinical symptoms of a bipolar condition, a psychiatrist may refer to a psychologist, who is experienced in diagnosing bipolar disorder.
Proper diagnosis and treatment help people with bipolar disorder lead healthy and productive lives.
WHY IS IT THAT MOST AFRICAN-AMERICANS WITH BIPOLAR DISORDER ARE GOING UNDIAGNOSED AND UNTREATED?
Most African-Americans with bipolar disorder are going undiagnosed and untreated.
Several factors have contributed to African Americans not receiving help for bipolar disorder and other mental illnesses. Some of the reasons are:
- A mistrust of health professionals, based in part on historically higher-than-average institutionalization of African Americans with mental illness; and on previous mistreatments, like such tragic events as the Tuskegee syphilis study.
- Cultural insensitivities; cultural barriers between many doctors and their patients. First, an open dialogue must be established, which can lead to understanding and trust for a person to make a connection and then discuss their symptoms and behavior concerns.
- Reliance on family and religious community, rather than (not in addition to) mental health professionals, during times of emotional distress.
- A tendency to talk about physical problems, rather than discuss mental symptoms, or to mask symptoms with substance abuse or other medical conditions.
- Socioeconomic factors which can limit access to medical and mental health care. About 25 percent of African Americans do not have health insurance.
- Continued misunderstanding and stigma about mental illness. Many individuals are suffering in silence, feeling shamed and guilt. Many are suffering alone and not getting the care and treatment that they need.\
- The myths of mental illnesses not being real. A major factor in the way it is treated and acknowledged in our society is the fact that we can’t see it, therefore, it can be perceived or even believed to be not real. However those with chronic mental illnesses like Bipolar Disorder, describe the pain to be “very real.” Some have described it as being “worse than the worst physical pain you can possibly imagine.”
HOW IS BIPOLAR DISORDER TREATED?
Bipolar Disorder is a lifelong condition. Although there is not currently a cure, there are treatments than can effectively manage the condition’s symptoms so individuals can live optimal lifestyles. There is hope. People with bipolar disorder can be helped by treatment which can include:
Medication – Doctors may recommend one or more medicines to find what works best.
Counseling – Often, psychotherapy or other forms of counseling are used in combination with medication therapy.
Peer Support – The advice and support of others who have bipolar disorder can aid recovery. This support can be found in “Group Therapy.”
Complementary Care – Some people benefit from exercise, healthy eating, stress reduction classes and other activities to complement their treatment and help them manage their illness. I.e. yoga, meditation, prayer, etc.
ECT, or electroconvulsive therapy – This is used as a last resort to treat severe bouts of depression and suicidal thoughts. It’s only considered when medication and therapy haven’t worked.
KANYE WEST HAS BEEN OPEN ABOUT HIS STRUGGLE WITH BIPOLAR DISORDER. HE SAYS HE’S OPTED FOR USING “ALTERNATIVE TREATMENT METHODS.” WHAT DOES THAT LOOK LIKE AND IS IT EFFECTIVE?
Some people with bipolar disorder have reported that using alternative treatments provides relief from symptoms. Scientific evidence supports many of the benefits in treating depression. But the effectiveness in treating bipolar disorder requires more research.
Always check with your doctor before starting any alternative treatments. Supplements and therapies may interact with your medication and cause unintended side effects. Alternative treatments shouldn’t replace traditional treatments or medications. Some people have reported feeling increased benefits when combining the two together.
- Fish Oil
- Rhodiola rosea (arctic root or golden root)
- S-adenosylmethionine (SAM)
- N-acetylcysteine
- Choline
- Inositol
- St. John’s wort
- Calming techniques (massage, yoga, acupuncture, meditation, prayer)
- Interpersonal and social rhythm therapy (IPSRT)
- Lifestyle changes (structured routines with exercise, sleep and healthy eating)
IF YOU DON’T HAVE HEALTH INSURANCE TO COVER TREATMENT, ARE THERE ANY OPTIONS AVAILABLE?
Community health centers / free clinics provide care to people who cannot otherwise afford it. There are no qualifications and no application processes. Generally, you pay what you can. Depending on the clinic, they may offer everything from family practice and pharmacy services to dental health care.
Some also offer counseling. What services they provide depend on what staff and resources are available. To find one near you, you can either do a search for your location and “community health center” or “free clinic” or you can visit http://findahealthcenter.hrsa.gov/. For additional resources, click here: https://www.mentalhealthamerica.net/paying-care
WHAT’S THE DIFFERENCE BETWEEN DEPRESSION AND BIPOLAR DISORDER?
Bipolar disorder is easily confused with depression because it can include depressive episodes. The main difference between the two is that depression is unipolar, meaning that there is no “up” period, but bipolar disorder includes symptoms of mania (and depression).
IF UNTREATED, CAN THE SYMPTOMS GET WORSE?
When left untreated, the symptoms of Bipolar Disorder will often increase in severity. It can lead to damaging consequences in different areas of life and may lead to suicide; there is a high suicide rate for people with the disorder.
The risks of untreated bipolar disorders can include:
- Severe challenges at work or school and difficulty holding down responsibilities
- Increased financial burdens with limited personal power to address them
- Greater stress in social situations
- Strained interpersonal relationships and perhaps loneliness and isolation
- Heightened depression or anxiety
- Suicidal thoughts and attempts
- Substance abuse issues that can lead to unchecked and destructive consequences
Many people with bipolar disorder describe their experience as if they are riding an unpredictable roller coaster of changing moods, fluctuating energy levels, and varying clarity of thought. While there are effective and reliable treatment options available, without treatment, it is as if there really is no way off of this devastating ride.
IS IT TRUE THAT BIPOLAR DISORDER OFTEN GETS MISDIAGNOSED?
It has been shown repeatedly that, contrary to earlier beliefs, bipolar persons of African ancestry may well demonstrate similar prevalence rates for bipolar disorder when compared with bipolar persons of non‐African ancestry. Yet some researchers believe that bipolar persons of African ancestry are frequently misdiagnosed as being chronic undifferentiated schizophrenics and treated with major tranquilizers when lithium is the drug of choice. This contention is supported by case histories and some institutional dynamics that cause this form of misdiagnosis to continue to prey upon African ancestry psychiatric patients.
Furthermore, published data (evidence-based research) shows that bipolar persons of African ancestry, compared with bipolar persons of non‐African ancestry, are more often misdiagnosed with a disease other than bipolar disorder (i.e. schizophrenia). Additionally, studies show that there are disparities in recruiting patients of African ancestry to participate in important genomic studies. This gap in biological research in this underrepresented minority may represent a missed opportunity to address potential racial differences in the risk and course of bipolar illness.
WHEN SHOULD A PERSON SEEK TREATMENT?
Often in bipolar disorder, people with hypomania may not realize it’s a problem. They may even enjoy it, finding it to be a productive time. Or they may fear that taking medicine will make them depressed and they’ll miss feeling good. Others struggle with depression, not getting the help that could relieve their suffering.
After understanding how some of the symptoms of Bipolar Disorder can present, if you think that you (or someone you know) has these symptoms, speak immediately with your primary care physician and/or faith leader (someone you or the person you know, trusts.) However, only a mental health professional can tell if a person has bipolar disorder and properly treat it. Once in treatment, it is important that the person receive the support and understanding of friends and family. Many people also find strength and support through their religious and spiritual affiliations.
WHAT’S THE DIFFERENCE BETWEEN BIPOLAR I AND BIPOLAR II?
There are four basic types of bipolar disorder; all of them involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, and energized behavior (known as manic episodes) to very sad, “down,” or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.
- Bipolar I Disorder— defined by manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depression and manic symptoms at the same time) are also possible.
- Bipolar II Disorder— defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes described above.
- Cyclothymic Disorder (also called cyclothymia)— defined by numerous periods of hypomanic symptoms as well numerous periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.
- Other Specified and Unspecified Bipolar and Related Disorders— defined by bipolar disorder symptoms that do not match the three categories listed above.
WHAT CAUSES BIPOLAR DISORDER?
It is uncertain what causes bipolar disorder. But its causes may involve/include:
Brain chemistry – There are chemical changes or imbalances in the brain during both extremes of behavior (mania and depression).
Genetics – Close relatives of people with bipolar disorder are 10 to 20 times more likely to get depression or bipolar disorder than others.
Drug and alcohol abuse – More than half of the people diagnosed with bipolar disorder have histories of substance abuse. In some cases, substance abuse precedes the development of the problem; in others, alcohol or other drugs may be used as a form of self-medication.
Stressful or disturbing events – Both can cause mood swings
IS BIPOLAR DISORDER HEREDITARY?
Your risk further increases if the family member with the condition is a close relative. That means if your parent has bipolar disorder, you have a greater chance of developing it than someone whose great-uncle has the condition. Genetic factors account for about 60 to 80 percent of the cause of bipolar disorder.
SOME PEOPLE MAY HAVE VIOLENT BIPOLAR MOOD SWINGS, HOW SHOULD A FAMILY MEMBER OR CARETAKER REACT TO THIS BEHAVIOR?
Some people find that living with a person with a chronic mental health condition like bipolar disorder can be difficult. Negative or even aggressive behaviors exhibited by someone who is manic are often focused on those closest to them.
Honest discussions with your loved one while they’re not having a manic episode, as well as counseling, may be helpful. But if you’re having trouble handling your loved one’s behavior, be sure to reach out for help. Talk to your loved one’s doctor for information, contact family and friends for support, and consider joining a support group.
Often, fear is the reason for not seeing a doctor. That’s especially true if there is a family history of emotional problems. People in denial are protected from their worst fears. They can stay comfortable in their everyday routines — even though relationships and careers can be at stake.
If you’re concerned about a loved one who could have bipolar disorder, talk to him or her about seeing a doctor. Sometimes, simply suggesting a health checkup is the best approach. With other people, it works best to be direct about your concern regarding a mood disorder. Include these points in the discussion:
- It’s not your fault.You have not caused this disorder. Genetics and stressful life events put people at greater vulnerability for bipolar disorder.
- Millions of Americans have bipolar disorder. It can develop at any point in a person’s life — though it usually develops in young adulthood — and is responsible for enormous suffering.
- Bipolar disorder is a real disease. Just like heart disease or diabetes, it requires medical treatment.
- There’s a medical explanation for bipolar disorder. Disruptions in brain chemistry and nerve cell pathways are involved. The brain circuits — those that control emotion — are not working the way they should. Because of this, people experience certain moods and energy levels more intensely, for longer periods of time, and more frequently.
- Good treatments are available. These treatments have been tested and found to be effective for many, many people with bipolar disorder. Medications can help stabilize your moods. Through therapy, you can discuss feelings, thoughts, and behaviors that cause problems in your social and work life. You can learn how to master these so you can function better and live a more satisfying life.
- By not getting treatment, you risk having worse mood episodes— and even becoming suicidal when depressed. You risk damaging your relationships with friends and family. You could put your job at risk. And your long-term physical health can also be affected, since emotional disturbances affect other systems in the body. This is very serious.
Trust is crucial in shaking someone’s denial and in motivating him or her to get help. Trust is also important once treatment for bipolar disorder starts. Through the eyes of a trustworthy friend or family member, a person with bipolar disorder can know when treatment is working — when things are getting better, and when they’re not. If your interest is sincere, you can be of great help to your friend or family member.
Dr. Brown answers your ‘Text Tom’ questions below:
If you are newly dating someone, how can you detect if the person is bipolar if they don’t reveal it?
Unless a person has severe manic symptoms, the signs / symptoms of bipolar disorder can be difficult to notice. A person who is bipolar (untreated) is more likely to reveal depressive symptoms most of the time vs manic symptoms. Decreased concentration and drive, poor energy, poor sleep and appetite hygiene, decreased interests may be observed when a person is in a depressive state.
However, a “depressive state” is typically the first “phase” that occurs in someone who may have bipolar disorder. What is key, is to recognize the “pattern” of symptoms a person reveals. Do their moods often fluctuate like a roller coaster-up one minute and down the next? Are they feeling down over a 2-week period and then this unusually changes to them not sleeping for a number of days and they appear to have so much energy, it is difficult for them to control it?
To address the second part of your question, depending on its severity, it will be challenging for a person with bipolar disorder to not reveal their symptoms since this is a condition that occurs outside of one’s control. However, individuals with hypomania (a lesser form of mania), may feel more energized than usual, more confident and full of ideas, and able to get by on less sleep. These are symptoms that hardly anyone complains about because they are not as severe and may not be interfering with a person’s functioning.
Furthermore, an individual who has bipolar is more likely to seek help if they are depressed (vs when they are manic), but their doctor may not observe the manic side of their symptoms at that time, due to them being in a “depressed” phase. This can make it rather challenging to know if someone has Unipolar (depression) vs. Bipolar (Depressive AND manic phases.) It is also important that doctors obtain a good, solid history from the patient and his/her family, to distinguish if a person has unipolar vs bipolar disorder, since the treatment can be different.
What causes manic depression?
It is uncertain what causes bipolar disorder. But its causes may involve/include:
- Brain chemistry – There are chemical changes or imbalances in the brain during both extremes of behavior (mania and depression).
- Genetics – Close relatives of people with bipolar disorder are 10 to 20 times more likely to get depression or bipolar disorder than others.
- Drug and alcohol abuse – More than half of the people diagnosed with bipolar disorder have histories of substance abuse. In some cases, substance abuse precedes the development of the problem; in others, alcohol or other drugs may be used as a form of self-medication.
- Stressful or disturbing events – Both can cause mood swings
I have two questions: Is complex post-traumatic stress ever confused with bipolar disorder? Do Black people suffer from complex post-traumatic stress disorder secondary to European racism?
Individuals with bipolar disorder have been found to be at high risk for developing several other mental health disorders (co-morbidities). One such disorder that co-occurs with bipolar disorder at high rates is post-traumatic stress disorder (PTSD). PTSD is an anxiety disorder that can develop after a person experiences a traumatic event. However, a doctor may diagnose complex PTSD if a person has experienced prolonged or repeated trauma over a period of months or years.
Complex PTSD can be confused with Bipolar Disorder, especially since both conditions can include symptoms of moderate to severe mood fluctuations. It is important for individuals with either or both of these conditions to complete a comprehensive mental and physical health evaluation by a trained mental health provider.
If the act of racism is a prolonged and repeated behavior against an individual, it is very likely that a person could be at risk for developing symptoms of complex post-traumatic stress.
Is bipolar disorder a lack of self-control?
Individuals with bipolar disorder, when in manic phases, often lack full self-control; they can have moderate to severe impulsivity. They can display erratic behaviors and poor judgment which can lead to severe consequences: relationship conflicts, increase risk for abusing substances, job losses, increased risk for sexual promiscuity, spending money excessively, and increase risk for contemplating suicide or succeeding in suicide.
WHERE CAN LISTENERS FIND YOU? DO YOU HAVE A PODCAST OR UPCOMING SPEAKING ENGAGEMENTS?
I offer 1:1 mental health consultations and can be found on my website: www.DrDawnPsychMD.com. I am also located on all social media platforms, using the tag @DrDawnPsychMD. (FB, IG, Twitter, LinkedIn, You tube)
I have two private practice locations in Houston, TX and offer virtual appointments to families who live in Texas and Illinois. You can locate more information on my practice website: www.adhdwellnesscenter.com
My Podacast, “From ADHD to Amaze-Ability” is now available on Pandora! It is also accessible on iTunes, Google Play and Spotify. Subscribe today! “From ADHD to Amaze-Ability” Podcast Show
Register for The FAB Gathering Summit taking place on August 17th in Memphis, Tennessee. I’ll be speaking on a panel called Mental Health Myths: Fact Versus Fiction. We will be chatting about removing the shame and stigma of mental illness, how living with a chronic illness affects the mood, and more! 💥 Use code TJMS for a special discount! Click here to get your ticket to this unique women’s wellness experience at ▶️ www.TheFabGathering.com
Resources:
National Medical Association
(for a list of African-American doctors)
(888) 662-7497
Black Psychiatrists of America
(510) 834-7103
American Association of Pastoral Counselors
(703) 385-6967
Depression and Bipolar Support Alliance (DBSA)
730 N. Franklin Street, Suite 501
Chicago, IL 60610-7204
Phone Number: (312) 642-0049
Toll-Free Number: (800) 826-3632
Fax Number: (312) 642-7243
Website URL: http://www.dbsalliance.org
American Psychiatric Association
1000 Wilson Blvd, Suite 1825
Arlington, VA 22209-3901
Phone Number: (703) 907-7300
Email Address: apa@psych.org
Website URL: www.psych.org
References:
https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=24
https://www.mentalhealthamerica.net/african-american-mental-health
https://www.nami.org/find-support/diverse-communities/african-americans
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