If you are depressed or have been depressed, ask yourself the following questions: Are there times when you feel really good? Is your basic disposition one of endless driven energy? Is your basic disposition one of constant change? Do you have trouble maintaining relationships? Do you have trouble keeping a job? Have you been in trouble with the law? Do people walk on eggshells around you? Are you depressed but also have a lot of energy and can’t sleep? Do you habitually count things? Do you drink to calm your mind or to fall asleep? Have you been on three or more antidepressants? Have you gotten better quickly on an antidepressant only to find that it soon stops working? Has an antidepressant ever made you nervous? Did you have your first episode of depression as a child or teenager? Have you ever attempted suicide? Do you have family members who are bipolar? Do you have a family history of mental problems? If you can answer “yes” to any of these questions, and you are or have been depressed, it is possible that you have bipolar disorder.
In recent years, doctors have discovered that much of what has been seen as general depression is actually bipolar depression. Although superficially they may appear to be the same thing, bipolar depression is different. Its onset is sudden, rather than gradual. It feels like emptiness more than sadness. It is deeper, more barren, more exhausting and more terrifying than general depression.
People with bipolar disorder spend much more time depressed than manic. Usually, they alternate between this bipolar depression and shorter periods of mania, during which they are exuberant, reckless and impulsive. They can be manic and depressed at the same time, exhibiting symptoms of agitation, anxiety, restlessness and irritability. The mood instability of bipolar disorder can disrupt every aspect of a person’s life, leading to alcoholism and drug abuse, job loss and damaged relationships. Bipolar disorder has the highest mortality rate of any mental illness, with one out of every five cases ending in suicide.
The typical age of onset of bipolar disorder is 15. Sometimes it occurs in children, often masked as ADHD. Sometimes it shows up in the elderly. The economic cost of this disease has been estimated at $44 billion. For the individual, this disease accounts for an average 9-year loss of productivity and 10-year reduction in life expectancy. Yet bipolar disorder has been overlooked, ignored and underestimated by the medical community. Seventy percent of people with bipolar disorder have been misdiagnosed. The treatment they have received, if any, has at best not helped them, and at worst made them sicker.
However, bipolar disorder is recognizable. Medications have been developed that stabilize mood and resources exist that offer support to those challenged by this disease. Doctors have discovered that there is a whole spectrum of bipolar illness. Some is characterized by the classic manic episodes most people think of when they think of bipolar disorder, but most of the time for most people it is not like that at all. It is bipolar depression.
Twenty years ago, our knowledge of depression blossomed in such a way as to lift it out of psychiatrists' textbooks and into the mainstream culture. Depression became unveiled, and with this new recognition came awareness, empathy, acceptance and help for the many afflicted, not only with depressive illness, but also with its stigma. Now we find that this knowledge is not enough, that some of this depression was another kind of depression, the depression associated with bipolar disorder. The authors of this book look forward to the time when bipolar disorder is also understood and destigmatized and those afflicted with it receive the same empathy, acceptance and care.