S1E3 – Diagnosis through the lens of bipolar disorder

Original podcast aired on 8th May 2019

**Quick content warning: we are going to be discussing mental-health and may discuss suicide and other content that may alarm you.**

Welcome! 

In Stephs head this week 

I am actually having a really positive week! I’m having a good time with mental health work and  meditation, feeling on an even keel and just in general quite nice ALTHOUGH… something happened that wasn’t the greatest…

So, I’m trying to be more assertive, trying to be more honest with how I’m feeling and being able to say no; everyday I try to get out of the office and have my lunch in nature and listen to a meditation to ground myself outside of work. 

On this particular day I set myself up with a meditation on the Headspace app and hit play JUST as a colleague walked into the park. Usually, I am pretty antisocial on lunch breaks anyway. So this lovely colleague asked if she could sit with me, so I said “Look I am actually just about to do a meditation sorry so I won’t be much company!” so off the colleague goes off and finds her own spot to sit. Point one for Stephs assertiveness! Except… when I get back to the office I find out that it is actually the lovely colleagues’ BIRTHDAY! Doh!! 

And in Ems head this week.

I am totally overwhelmed with everything at the moment, even having a panic attack before work once this week. The only thing bringing me happiness is the podcast! I actually decided this week to defer from uni to focus more on my mental health for a while. I have mixed emotions about this, I am feeling down on myself and like I am failing and wasting time, but at the same time I think; better to do that and recognise I’m not ok at the moment so I can look after myself and uni will be there when I am ready. 

So! What are we talking about today? DIAGNOSIS! Is a diagnosis always a good thing? We are going to try to break it down a bit. When talking about diagnosis, for a physical illness it is a doctor trying to assess your symptoms, usually with tests like x ray, blood samples etc. However when diagnosing mental health it can get trickier, it starts with talking and trying to rule out symptoms, like a process of elimination. Assuming you find the correct diagnosis, this can be positive as you can understand your symptoms, give yourself some relief around blame, get effective treatment and find some sense of belonging. Finding a diagnosis can also be distressing, create an unhealthy obsession or preoccupation with the illness. It is generally how you use your diagnosis and move forward that makes the difference.

Em finds her diagnosis (depression) liberating, useful and comforting, whereas Steph feels locked in and put in a box by her diagnosis (health anxiety) and finds herself often questioning: does the diagnosis control you or the other way around?

So, to unpack this topic a little we are talking to someone very special to me, my iddy biddy baby sister Sarah. Over the last 10 years, Sarah has struggled and fought damn hard for her life, and just a short time before we created this podcast at the young age of 23 she was diagnosed with bipolar disorder type 1. I think she is pretty inspirational; she has come up against some massive challenges and has done so with the stubborn toughness that anyone who knows Sarah will recognise. Although if you asked her, she would probably say she didn’t really do anything at all, everything is owed to the people around her, but isn’t that so classic? We never give ourselves the credit we are due!

Sarah, left, aged 3 and Em, right, aged 5

We welcomed Sarah to our virtual studio and began by asking her, what’s in her head today? Well, she has been giving up smoking so that’s about all she has room for she said.

We wanted to know; what is her current formal diagnosis? Sarah explained that she has been diagnosed with bipolar disorder, and that while there are many different types of bipolar disorder, type 1 is her specific diagnosis. For Sarah that means generally long episodes of depression, and then in between those episodes, periods of mania, or sometimes hypomania (similar to mania but without the more psychotic symptoms). Sarah is 23 now, and the first time she saw a mental health professional she was 13, however the diagnosis of bipolar didn’t come around until around 5 years ago. 

On asking her if she remembered the first time she felt like her brain worked a little differently, she said the first time she had suicidal thoughts was when she was around 12 years old which definitely felt weird at the time, she remembers feeling as though there was something wrong with her brain. Steph followed on by asking; Was that a time when it flagged in her mind that there was something mental health related going on, or was there perhaps things leading up to the suicidal thoughts, even that she couldn’t quite put her finger on. Sarah said that yes, while that was the first time she felt that she had a problem regardless of other warning signs or precursors there may have been, but she wasn’t ready to talk about it yet. 

Em asks, what was the progression of Sarah’s illness? When Sarah was 12, that was the first suicidal thoughts and jarring indication something might be a bit off, this is also when she began to self harm. Around about a year later when Sarah (and Em’s!) parents realised what was going on, this is when professional help was sought. She was put on antidepressants, which she was on for around 10 years (until just recently). Her diagnosis until she was around 18 was anxiety and depression, however when she was 18 and started seeing a new psychiatrist things changed a little, and she was diagnosed with bipolar disorder type 2. Pretty recently she had a manic episode which has meant her diagnosis has been updated to bipolar disorder type 2.

Steph wanted to know, how did it feel having so many different diagnoses floating around the place? Sarah said it got really confusing, she explained that even as recently as a year ago she saw a different psychiatrist again who misdiagnosed her with borderline personality disorder, which really threw her through a loop for a while, it was so different to anything she had ever heard before. She further explains how frustrating it is to have so many incorrect diagnoses floating around, and she does say she wished she had the correct diagnosis sooner so she could have got onto the correct medication and treatment. On this topic Em asks if there were things that were directly bad for Sarah in having the incorrect diagnosis, or is it just a matter of “lost time”? Sarah explains that the anti-depressants she was on for around 10 years are really bad for people with bipolar disorder, especially type 1, as they can actually induce mania in those with bipolar disorder. In fact, recently when Sarah had her first manic episode was right after she started taking her antidepressants again. She hadn’t been taking them and when she started again all of a sudden she found herself in the middle of her first truly manic episode. 

We wanted to know; why did her diagnosis take so long and why was she misdiagnosed a few times? Sarah points out that one indicator of bipolar disorder is depressive episodes, and especially for her, the depressive episodes tend to be a lot longer and more frequent than her manic or hypomanic episodes, so for this reason it is quite easy for bipolar to be misdiagnosed as depression. Anxiety is something that Sarah has on top of the bipolar disorder, so this is not a misdiagnosis however it probably led to the correct diagnosis being even more difficult (just a note on this, people with bipolar disorder and obsessive compulsive disorder are actually at high risk of suffering an anxiety disorder such as generalized anxiety disorder, social phobia, or panic disorder!). She said she thought bipolar has a lot of symptoms that are shared with other disorders, making it quite difficult to pin down. She says that most people she met in psychiatric wards did have more than one diagnosis (medically known as “comorbid diagnoses”) making it more difficult and less efficient to get a correct diagnosis and therefore correct treatment, especially when you are a child or a teenager.

Sarah goes on to explain that medical professionals are hesitant to diagnose patients with anything such as bipolar disorder while people are in their adolescence. We discuss whether this is a positive or a negative, and Sarah believes this is a positive. She clarifies by saying she is not a professional, however hormones can often get in the way of a correct diagnosis, and symptoms of puberty can present as signs of a mental illness.

Em asks a little about support from family, friends but also from the government and mental health services. Sarah responds that she had great family support, but what she would say about government funded mental health support is that unfortunately, unless you present a danger to yourself or the community, you don’t get the support. She expands that this is mostly because they are extremely underfunded, understaffed, and under resourced. Sarah says however that she currently has a really great mental health team provided by a government service who are really helpful and have more resources that they share with her (however Em notes this is only following the diagnosis of bipolar type 1 which is prioritised a little higher by these services, it took a lot for Sarah to be provided with this support!).

Steph inquires, as someone who isn’t as savvy on bipolar disorder, what is the difference between manic and depressive episodes? For Sarah, depressive episodes last a lot longer than manic episodes, and these are characterised by really low energy/motivation, low confidence and self esteem, and low mood. Sarah has only had 1 manic episode, in the past she would have hypomanic episodes, which includes being hyperactive, talkative, high mood, high confidence, high energy and these last around a month-6 weeks for her. Is mania and hypomania a good thing when coming out of a depressive episode though? Sarah says it is definitely something to look forward to after experiencing a depressive episode for a year or so which is typically how long Sarah’s depressive episodes last. It feels good for the person in the manic or hypomanic state, however it is the people around them who are often quite uncomfortable and/or concerned about this behaviour. She also stipulates that hypomania and mania are quite different, however yes, these higher moods can be enjoyable but can make the person “annoying” (Sarah’s words, not ours!). The other thing can be that people do things they regret, that don’t  necessarily line-up with who they are as a person. During hypomania and more commonly, mania, infidelity is really common, overspending is common, just generally acting as though you are invincible and above risk, which can be quite damaging to the person going through it in the long run. 

Steph then wants to know how having this disorder has affected Sarah’s relationships, and Sarah describes having a very supportive family, and partner. She says she honestly doesn’t think it has changed these relationships too much at all except that her family and partner are often worrying about her, sometimes that isn’t so fun… When she was in high school however it was a bit of a different story. She explains that she would go from the person who would ignore all her friends and not talk to them for a long time, to jumping around, writing on people with pens and being a tad overbearing. It is hard to put this much strain on your friendships, especially at this age, and it is hard for people to stand by someone through all of that without knowing exactly what is going on, and Sarah understands that.

Coming back to the actual diagnosis, we asked Sarah how it felt to have arrived at seemingly the correct diagnosis, how has it been for her getting the correct treatment and what was it like to receive this diagnosis? She says she is really glad to have this diagnosis that feels right and means she can get the correct treatment. She can look back at her past behaviours and see that this diagnosis fits, and she can trust in the people who gave her this diagnosis, and trust that she will now get better treatment and have a better prognosis. It’s a relief! Bipolar disorder is often very easy to treat once you are on the correct medications and therapies available to you, and you can go on to live a relatively normal life. 

Em asks what IS important to Sarah’s treatment that may be more unique to people with bipolar disorder. Sarah responds that the number 1 thing is for her to take her medication. She explains that there are stories of people overcoming their bipolar disorder without medication, which is fantastic, however a lot of the time the one thing that makes the biggest difference with bipolar disorder is taking the correct medication, so this is Sarah’s number one focus at the moment. Sarah also says mood tracking is such a helpful thing for bipolar disorder. Once you have tracked your thoughts, feelings, energy levels etc for a while you can start to notice the patterns that come along with bipolar disorder and you can nip any issues in the bud as they come up. There are a lot of great mood tracking apps, or you can go for a traditional paper and pen!

We then discuss a YouTube video by Dr Tracey Marks about a phenomenon called imposter syndrome (see episode 7 of season 1 for more on this topic!) and whether this is another reason to mood journal. Sarah explains that yes, legitimising your behaviours by being able to see them written down by you is so important, as well as being able to see what actually lead up to the episode, it didn’t come from nowhere, there were probably red flags that you missed to get to that stage, so discovering these insights is important!

Steph then asks, what are some of the biggest misconceptions about bipolar disorder? Sarah says that she thinks the biggest misconception about bipolar disorder is that if you are somebody who flies off the handle easily, or if in one day you are happy, then sad, then angry, then happy again, that you must be bipolar, but this is not what bipolar disorder is. It doesn’t necessarily mean there is nothing wrong if this is what you are going through, but bipolar really is long term episodic mood changes.

So then, to the last question… if we could wave a magic wand and Sarah could wish for one thing for the future of mental health, what would the wish be? Sarah says she would really like to see more funding, so that people can get help before they get to the critical stages where they are hurting themselves or other people.

We are NOT medical professionals, so what we discuss in our episodes cannot be taken as medical advice, if you ever need to reach out for support, please do so;

**And if you are ever in immediate danger please call 000, or the emergency number in your country**

Beyond Blue – 1300 22 46 36

https://www.beyondblue.org.au/

Lifeline – 13 11 14

https://www.lifeline.org.au/

Mind Australia

https://www.mindaustralia.org.au

Sane Australia

https://www.sane.org/

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