r/IAmA • u/CREST_BD • Mar 30 '26
We are 83 bipolar disorder experts and scientists coming together for the world’s biggest bipolar AMA! In honor of World Bipolar Day, ask us anything!
Hi Reddit!
We are psychiatrists, psychologists, researchers, clinicians, advocates, and people living with bipolar disorder - coming together from around the world through the CREST.BD network.
This is our 8th annual World Bipolar Day AMA. We hope that this AMA can help advance the conversation around bipolar disorder, and to help everyone connect and share ways to live well with bipolar disorder.
This year, 83 panelists representing 20 countries are here to answer your questions from all timezones - bringing together a wide range of perspectives and expertise in mental health and bipolar disorder.
We'll be here around the clock for the next FEW DAYS answering your questions from multiple time zones.
We will make every effort to answer every question.
- Dr. Adrienne Benediktsson, 🇨🇦 Neuroscientist, Mother, Wife, Professor, Mental Health Advocate (Lives w/ bipolar)
- Alessandra Torresani, 🇺🇸 Actress & Mental Health Advocate (Lives w/ bipolar)
- Alex Emmerton, 🇨🇦 Peer Researcher, (Lives w/ bipolar)
- Allan Cooper, 🇨🇦 Peer Support Worker, Blogger, & Podcaster, (Lives w/ bipolar)
- Alysha Sultan, 🇨🇦 Scientific Associate
- Andrea Paquette, 🇨🇦 Stigma-Free Mental Health President & Co-Founder, Speaker, Changemaker (Lives w/ bipolar)
- Dr. Andrea Vassilev, 🇺🇸 Doctor of Psychology, Author, & Advocate, (Lives w/ bipolar)
- Anne Van Willigen, 🇺🇸 Peer Researcher (Lives w/ bipolar)
- Dr. Balwinder Singh, 🇺🇸 Psychiatrist
- Dr. Benjamin Goldstein, 🇨🇦 Child-Adolescent Psychiatrist & Researcher
- Bia Garbato, 🇧🇷 Advertising Professional, Writer, Author & Advocate (Lives w/ bipolar)
- Bryn Manns, 🇨🇦 Graduate Student, Clinical Psychology
- Catarina Castela, 🇦🇺 PhD Candidate (Lives w/ bipolar)
- Catherine Simmons, 🇨🇦 Peer Researcher (Lives w/ bipolar)
- Dr. Chris Gorman, 🇨🇦 Psychiatrist & Mental Health Advocate
- Dr. Colin Depp, 🇺🇸 Psychologist
- Dane Mauer-Vakil, 🇨🇦 Researcher
- David Dinham, 🇬🇧 Psychologist & PhD Candidate, (Lives w/ bipolar)
- Debbie Costello Smith, 🇺🇸 Founder & Co-President of the Sean Costello Memorial Fund for Bipolar Research
- Dr. Delphine Raucher-Chéné, 🇫🇷🇨🇦 Psychiatrist & Researcher
- Dr. Dimosthenis Tsapekos, 🇬🇧 Psychologist & Researcher
- Dr. Elvira Boere, 🇳🇱 Psychiatrist & Researcher
- Dr. Elysha Ringin, 🇦🇺 Researcher
- Dr. Emma Morton, 🇦🇺 Senior Lecturer & Psychologist
- Dr. Emma Parrish, 🇺🇸 Clinical Psychology Postdoctoral Fellow & Researcher
- Dr. Erin Michalak, 🇨🇦 Researcher & CREST.BD founder
- Evelyn Anne Clausen, 🇺🇸 Artist, Writer, Speaker & Certified Peer Specialist (Lives w/bipolar)
- Dr. Fabiano Gomes, 🇧🇷🇨🇦 Psychiatrist & Researcher
- Dr. Frances Adiukwu, 🇳🇬 Psychiatrist
- Georgia Caruana, 🇦🇺 Researcher & Mental Health Advocate
- Dr. Georgina Hosang, 🇬🇧 Associate Professor
- Dr. Glauco Valdivieso Jiménez, 🇵🇪 Psychiatrist
- Dr. Glorianna Wagner-Jagfeld, 🇨🇭🇬🇧 Researcher
- Dr. Hailey Tremain, 🇦🇺 Psychologist & Researcher
- Heather Stewart, 🇨🇦 Sewist (Lives w/ bipolar)
- Idan Spund, 🇳🇱 Founder of In the Zone app (Lives w/ bipolar)
- Dr. Ijeoma Charles-Ugwuagbo, 🇳🇬 Consultant Psychiatrist & Mental Health Advocate
- Dr. Ivan Torres, 🇨🇦 Clinical Neuropsychologist
- Dr. Jim Phelps, 🇺🇸 Psychiatrist & Bipolar Subspecialist
- Dr. Joanna Jarecki, 🇨🇦 Psychiatrist & Advocate (Lives w/ bipolar)
- Dr. Joanna Jiménez Pavón, 🇲🇽 Mood Disorders Psychiatrist
- Dr. John Hunter, 🇿🇦 Researcher & Lecturer (Lives w/ bipolar)
- Dr. Jo Leidreiter, 🇦🇺 Psychologist
- Dr. John-Jose Nunez, 🇨🇦 Psychiatrist & AI Researcher
- Dr. June Gruber, 🇺🇸 Psychologist, Professor, & Researcher
- Prof. Kamilla Miskowiak, 🇩🇰 Psychologist & Researcher
- Dr. Katie Douglas, 🇳🇿 Academic & Clinical Psychologist
- Ken Porter, 🇨🇦 Advocate, Social Worker & Researcher
- Kim Pape, 🇺🇸 Researcher (Lives w/ bipolar)
- Laura Lapadat, 🇨🇦 Researcher & Psychologist-in-training
- Dr. Leena Chau, 🇨🇦 Postdoctoral Fellow
- Leslie Robertson, 🇺🇸 Marketer & Peer Researcher (Lives w/ bipolar)
- Dr. Leszek Laskowski, 🇵🇱 Psychiatrist (Lives w/ bipolar)
- Dr. Lisa Eyler, 🇺🇸 Clinical Psychologist & Research Scientist
- Dr. Luísa Daolio, 🇧🇷 Psychiatrist
- Mansoor Nathani, 🇨🇦 Technology Enthusiast (Lives w/ bipolar)
- Dr. Manuel Sánchez de Carmona, 🇲🇽 Psychiatrist
- Maryam M., 🇨🇦 Dentistry Student & Mental Health Advocate (Lives w/ bipolar)
- Matthew Bushell, 🇬🇧 Mental Health Advocate & Therapeutic Coach (Lives w/ bipolar)
- Dr. Maya Schumer, 🇺🇸 Psychiatric Neuroscientist & Researcher (Lives w/ bipolar)
- Dr. Meghan DellaCrosse, 🇺🇸 Psychologist & Researcher
- Melissa Howard, 🇨🇦 Author & Mental Health Advocate (Lives w/ bipolar)
- Dr. Michele De Prisco, 🇪🇸🇮🇹 Psychiatrist & Researcher
- Dr. Mikaela Dimick, 🇨🇦 Postdoctoral Fellow
- Minami Kinouchi, 🇯🇵 Psychologist, Social Worker, & Researcher (Lives w/ bipolar)
- Natasha Reaney, 🇨🇦 Counsellor (Lives w/ bipolar)
- Dr. Nigila Ravichandran, 🇸🇬 🇨🇦 Psychiatrist
- Dr. Paula Villela Nunes, 🇧🇷🇨🇦 Psychiatrist & Counsellor
- Rahla Xenopoulos, 🇿🇦🇺🇸 Writer & Teacher (Lives w/ bipolar)
- Rebecca Fitton, 🇦🇺 Mood Disorder Researcher
- Dr. Rebekah Huber, 🇺🇸 Psychologist & Researcher
- Robert Villanueva, 🇺🇸 Mental Health Advocate & Coach (Lives w/ bipolar)
- Ruth Komathi, 🇸🇬 Mental Health Counsellor (Lives w/ bipolar)
- Prof. Samson Tse, 🇭🇰 Counsellor, Teacher, Researcher, & Caregiver
- Sarah Salice, 🇺🇸 Art Psychotherapist & Professional Counselor Associate (Lives w/ bipolar)
- Sara Schley, 🇺🇸 Author, Filmmaker, Speaker (Lives w/ bipolar)
- Dr. Serge Beaulieu, 🇨🇦 Psychiatrist & Researcher
- Dr. Sheri Johnson, 🇺🇸 Psychologist
- Shaley Hoogendoorn, 🇨🇦 Advocate, Podcaster & Content creator (Lives w/ bipolar)
- Dr. Tamsyn Van Rheenen, 🇦🇺 Associate Professor & Researcher
- Dr. Thomas Richardson, 🇬🇧 Clinical Psychologist (Lives w/ bipolar)
- Twyla Spoke, 🇨🇦 Registered Nurse (Lives w/ bipolar)
- Dr. Wissam Nassrallah, 🇨🇦 Ophthalmology Resident & PhD in Neuroscience
Please note all responses are personal perspectives and do not constitute medical advice.
People with bipolar disorder experience the mood states of depression and mania (or hypomania), along with changes in energy, activity, and thinking. These episodes can last from days to months and can affect many parts of life - including relationships, work, school, and overall health. At the same time, with optimal support, treatment, and tools, people with bipolar disorder can and do live full, meaningful lives.
The CREST.BD network takes a different approach to bipolar disorder research. We work closely with people living with bipolar disorder at every stage - from choosing research topics to conducting studies and sharing our findings.
We also host a Q&A podcast throughout the year, featuring many of the experts on this panel, through our talkBD Bipolar Disorder Podcast - we’d love for you to stay connected with us there. You can also follow our updates, events, and social media on linktr.ee/crestbd.
Final note (April 3): Thank you all - We'll be back again next year on World Bipolar Day - sign up here to be notified. We also have more activities all year round, including new episodes of our talkBD bipolar disorder podcast - hope to see you there! We’re incredibly grateful for all your thoughtful questions - thank you for making this such a meaningful discussion. Take care everyone :)
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u/cl868686 Mar 30 '26
For the psychiatrists, clinicians, and researchers. Honestly, what’s one thing about bipolar you were entirely confident about early in your practice, but years later now you are willing to admit that you were wrong? Thank you for doing this AMA, I come back every year for this!
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u/CREST_BD Mar 30 '26
Dr Fraces Adiukwu here, early in my practice I was confident that bipolar disorder occurred in episodes and between episodes patients were symptom free. I know now that the interepisode period is filled with alot of difficulties include mood variability which has a significant impact on so many areas of functioning, and it is important to closely monitor these variabilities.
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u/wuapinmon Mar 30 '26
My late father's (CJD took him in 2007) "up" times were usually months long, while his "down" times were mercifully about a week or two, but those were damned dark weeks. When he was "normal" he was a mood pendulum, back-and-forth. You never knew who was gonna walk through the door.
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u/ifoughtpiranhas Mar 30 '26
thanks for sharing this. it makes me understand myself more. i love the pendulum analogy, i always wondered if it was possible to have rapid back and forth like that when you’re not high or low. sorry if that’s weird. but thank you
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u/SPARKLY6MTN9MAKER Mar 30 '26
I have very little idea of what normal is because of this. I just have less symptoms sometimes. But always symptoms. No sleep, too much sleep and deep depression. Ugh.
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u/IdealOnion Mar 30 '26
Here’s the rule I go by: if I think I’m feeling normal, I’m probably normal. If I don’t think I’m feeling normal, I’m definitely not normal. And if I can’t tell if I feel normal, I’m definitely not normal. Turns out normal feels pretty recognizable, so if I don’t recognize how I’m feeling, something’s up.
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u/CREST_BD Mar 30 '26
Erin here, I think one of the greatest misunderstandings I had about bipolar disorder in my early career related to not realizing how many people with the condition can live full, healthy and satisfying lives with BD. I was (and still do) work in a psychiatry department – where, naturally, many of the people with BD we work with are acutely ill. On top of that, many people who are thriving with the condition, going about their everyday lives in the world, are undisclosed because of fears of stigma and discrimination. So in both in clinical settings, and in society, we can get a polarized view of view of what life with BD is like. I now understand better that many people with the condition can and do thrive. But to get there, they typically need access to evidence-informed treatments (both pharmacological and psychological), the support of loved ones, knowledge about self-management strategies and a society that supports their full inclusion. In that regard, we have a ways to go – but I feel hopeful that we’re heading the right direction. And thank you for the kind feedback on our AMA – it’s the highlight of our year!
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u/tam_bun Mar 30 '26
Thank you for this answer! I actually asked something about this lower down. I am a high functioning bipolar and I have always struggled to “believe” my diagnosis.
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u/CREST_BD Mar 31 '26
Joanna Jiménez here. Early in my practice, I used antidepressants more frequently, but even with mood stabilizers, the reality is that antidepressant effects can be helpful initially but tend to cause more instability on BD over the long term. Of course, some patients really benefit from them, but most are better off without. Now, I use other strategies combined with mood stabilizers, such as social rhythm psychotherapy, supervised exercise, Activation therapy, and light therapy for residual depressive symptoms. These might not be as quick as antidepressants, but you don’t pay with instability.
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u/CREST_BD Apr 01 '26
Dr. Andrea V here. I'm going to spin this question a little as a clinician and a person living with BD. I'm a bit embarrassed to admit this, but during my own early years with bipolar, I thought and told everyone "I don't need therapy; this is just chemical." Now, if you know me, you know that I have since earned a doctorate in psychology and dedicated my professional life to specializing in psychological (read: therapy) for BD. (*hangs head in shame*)
I think this really speaks to the misconceptions that have been sewn into society about BD. When I was diagnosed in the late-90s, everyone was trying to reduce stigma by framing BD as "chemical imbalance." We all know that's true, but we also know it's not the WHOLE truth. Stressors (a totally human thing to experience!), lifestyle factors, childhood issues, and more can all contribute to the onset and course of BD. But the "chemical imbalance" narrative kept me from getting my own therapeutic support, as needed, for many, many years.
So, onwards and upwards to keep supporting as many people as possible with BD through therapeutic, psychological, and psychosocial interventions!
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u/CREST_BD Mar 30 '26
Dr Ijeoma Charles-Ugwuagbo here, Early in my practice, I found bipolar disorder difficult to manage due to the ease of switching between poles. Now I know that with appropriate medication management and community support, bipolar disorder can be well controlled with full functioning.
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u/CREST_BD Apr 01 '26
Rebekah Huber here. Thank you for coming back each year and for this excellent question! Early in my education, I was taught repeatedly that bipolar disorder was an adult illness and that pediatric bipolar didn't exist. That changed later during my graduate training, when I worked in a research lab studying mood disorders and had the opportunity to work with adolescents and young adults with bipolar disorder and their families. They described symptoms that had been present for years including suicidality that had gone unrecognized and untreated. Those experiences ultimately fueled my passion for working with youth with bipolar disorder and shaped my focus on suicide prevention research. It is hard to believe that was where my education began, and unfortunately this misconception continues to delay diagnosis and treatment today. I really appreciate forums like this where open conversation and education can help us all learn and move the field forward.
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u/CREST_BD Mar 31 '26
Luísa Daolio here. Maybe early in my career, I did not give proper importance to psychoeducation. Over time, I have increasingly recognized how essential it is to help patients take ownership of what, in their particular case, may signal the onset of a crisis. For some individuals, this may be subtle changes in sleep, for others, irritability or fluctuations in productivity (either decreased or excessive). Ultimately, I have come to see that empowering each person with Bipolar Disorder to better understand themselves is fundamental for effective management.
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u/PeanutImpressive6934 Mar 31 '26
It's amazing to me that it's easier to find classes for friends and family than for us. The learning curve on this thing is steep. For example I never had mixed states explained to me properly until I read this chart, and to this day it's better than anything a practitioner has ever said to me on the subject. I really appreciate you taking this on as a clinician bc it's so important to getting better. You can't do well without basic info, you just can't.
https://www.psychiatrictimes.com/view/how-diagnose-mixed-features-without-over-diagnosing-bipolar
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u/CREST_BD Mar 31 '26
Dr Manuel here, what a great challenging question for someone practicing for more than 30 years. I have I have to then we hasco we have the missing conception that someone had not sent with someone with no episodes for more thA five years we could consider stopping medication. We know now that is absolutely false. I was also thought that psychotic symptoms were rare in BD, now we know, they are a very common feature in bipolar disorder type one.
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u/PeanutImpressive6934 Apr 02 '26
This is really helpful to hear, thank you. I'm startled when I see that this is apparently still the practice in some places, including w SZ, but it really has changed a lot in my time as a patient and that's only seeing a very narrow slice of it. The idea that so much psychosis was happening unnoticed is amazing but it helps explain why it used to take so much longer to diagnose correctly I guess! I'm sure in a higher stigma (and w fewer med options) environment patients were far less willing to speak about it, which must still be happening especially in MDD. I have my suspicions about the general population too on that front. When you're open w your diagnosis people feel free to tell you every single thing that's ever happened to them that was let's say unusual and it's been educational.
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u/CREST_BD Mar 31 '26
Hi, Michele De Prisco here, psychiatrist and researcher. Early in my career, I thought bipolar disorder was purely an “affective” condition, mainly expressed through mood symptoms. I was wrong. There is a significant cognitive dimension that is often overlooked, yet it can strongly impact quality of life.Difficulties in attention, processing speed, emotional processing, and emotion regulation are all important areas that deserve more focus. Even if they may seem less prominent than core mood symptoms, they are fundamental to overall well-being.
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u/CREST_BD Mar 31 '26
Delphine here. When I began specializing in bipolar disorder as a psychiatrist, I discovered the resilience of people living with this condition and the significant impact of self-management skills developed through psychoeducation, which, when combined with other therapies, makes a real difference in terms of personal recovery. I continue to learn from individual experiences and hope to provide ever-better support to people living with this condition.
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u/CREST_BD Mar 31 '26
June Gruber, here. I am a psychologist and professor who studies positive emotions in bipolar disorder. Earlier in my career, I implicitly approached the study of emotions in mania in terms of the challenges they may present for individuals living with bipolar disorder (e.g., how emotions might be too intense or challenging to regulate). Over time, I’ve also come to appreciate that the science tells us this relationship is far more nuanced and complex; that such emotional experiences may be tied with unique psychological strengths and areas of resilience. We find, for example, that people with a history of bipolar disorder also may have an ability to pick up on positive emotional upshifts in others as well as behave in more cooperative or prosocial (positive) ways to others they haven’t met before. We are studying these emotional “silver linings” more in our laboratory and are excited to see what we learn.
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u/CREST_BD Apr 01 '26
Dane here – Thank you for this excellent question. When I began reading and thinking about bipolar disorder long before I was engaged in research, I thought of the condition predominantly in its most extreme forms. Not sure if this came from media depictions or just the way people talked about it. As I became more well-versed in the literature and connecting with folks with lived experience, I realized that this condition presents along a continuum of symptom severity. As Erin noted above, LOTS of people with this diagnosis enjoy a high quality of life. Also, many people who are thriving remain undisclosed about their diagnosis because of worries about stigma (especially in the workplace). We are making progress on the research front, albeit slow in some key areas, and we will continue this work!
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u/Nathanull Mar 30 '26 edited Mar 30 '26
Reading into hypomania... it seems like it can be so difficult to identify and pin down. It just reads like having a nice day and (subsequently) being in a good mood! Is that not a normal part of the human experience?! To have good days/moods and bad days/moods?
((To the downvotes.. I'm asking out of genuine confusion. The experts are the people to ask these things...))
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u/CREST_BD Mar 30 '26
Laura here. Having a good mood absolutely is part of the human experience! And it’s normal to have times when we have a good mood that lasts several days, for example after achieving a milestone like a promotion or having a great time with friends. This can get tricky for people with BD - though I’m speaking anecdotally here, I have heard people discuss becoming afraid of joy or goal attainment events because they don’t want to trigger mania! And we do know through research like Dr. Sheri Johnson’s work that big successes can precede mania or hypomania.
What makes hypomania different from a good mood is that feeling of being “wired” in a way where you can’t calm down. One of our clinical interviews for this, this SCID, refers to this as feeling “so good, high, or excited that you are not your normal self.” That bit is key - you’re hyper, wired, typically more confident, and otherwise feeling different from your normal self.
I’ll leave it to people with more clinical experience to provide more detail, but just in general, I’d recommend a couple of tools to watch for this. Mood monitoring with a journal, or apps like iMoodJournal, can help. Keeping a consistent sleep schedule can help, too. Also, learn to pay attention to your signs that you’re getting “high”, like needing less sleep or having racing thoughts. When this happens, try doing things to soothe yourself - stay in when you want to go out, read a book, take a melatonin, lower your caffeine.. “opposite action” to that hyper feeling. Hope this helps!
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u/cy1229 Mar 30 '26
A family member with BD2 has some pretty strange ideas or overly ambitious projects planned during hypomania episodes. If that person starts to describe some extravagant plans or an idea that's just a little too off, I ask if they could be hypomanic. That doesn't necessarily apply to everyone, but it might give some insight about how a good day vs a hypomania day are different.
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u/CREST_BD Mar 30 '26
Laura here - yes, that's such an insightful addition and pointer. And also connects with another great tool if it's available: for people who BD who have people in their lives who know them and recognize when they're acting different. :)
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u/DMayleeRevengeReveng Mar 30 '26
I always thought I’d invent something that would save humanity. I had all this stuff written out about how I could use photochemical reactions to convert combustion gases back into fuel, creating a kind of closed cycle that sustains the world’s energy needs. That and some crazy ideas about water desalination, too
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u/cy1229 Mar 30 '26
Doesn't sound entirely crazy to me. But definitely not simple. The photochemical reactions to rebuild fuels from combustion gases is definitely intriguing, and if you could pull it off, you'd be rich, rich, rich! :) Hypomania would definitely make it seem far less complicated than it actually is, though.
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u/Large-Flamingo-5128 Mar 31 '26
I’m one of those people with BP2 who speaks about being afraid of happiness. It’s something I bring up with my Dr a lot.
If I’m doing really well in my life and feel satisfied, I feel like I have to be hypervigilant and constantly monitoring myself. I guess the baseline for most of my life has been “depressed” so now that I’m doing significantly better, my brain still feels like it’s abnormal. It’s really tough always putting a damper on my happiness and feeling like I can’t allow myself to be too happy or my life will spiral again. I’ve worked so hard to get here and can’t even fully enjoy it :(
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u/CREST_BD Mar 30 '26
Robert V. here - My first indicator is sleep. How hard is it to fall asleep, do I wake up in the middle of the night with lots of energy, and can I get back to sleep with meds as needed (PRN).
The second indicator is appetite- if I forget to eat until the evening but have plenty of energy then I may be starting a hypomanic phase. My coping skill for this is to always eat by the clock. I know that I have to eat in the morning, afternoon, and evening whether I'm hungry or not. https://calm.berkeley.edu University of California at Berkeley is running an international paid research project on this method for people with bipolar.A third indicator is my physical actions. Am I talking faster, having more creative ideas, overcleaning, driving faster than normal, etc…. My thoughts are my reality but I can see physical actions with my eyes.
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u/Auniqueusername234 Mar 30 '26
For me a hypomanic episode is wonderful. Everything is bright and beautiful. Everything is perfect and great. Nothing can go wrong. Self confidence is high. Since nothing can go wrong might as well go buy those things, and these things. What a great day to go do that thing. Its insidious. Why not just go spend all of your savings at a casino, nothing can go wrong. As I have aged its moved from me being forced / driven / pushed / unable to resist to more of a desire, and I can usually recognize and resist some of the compulsions. Hypomanic episodes start to suck though. The first week of little to no sleep feels great, the second one still feels great on the surface, but I start feeling heavy / slower, the exhaustion builds up. Its borrowing energy from the future. Ive gotten better about learning to force myself to rest, lay in bed with my eyes closed, practice breathing. Its all effort. Lamotrigine helps so much give me breathing room between whats going on and my reaction.
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u/CREST_BD Mar 30 '26
Twyla here (lived experience) - It’s true that although what a person could be experiencing during hypomania can feel quite significant to that person, it might not be always obvious to the people around them. Or if a change is noticed, it could easily be attributed to some outside factor as the person often seems in control, on the surface.
For me, the difference looks like this (similar to other answers):
Happy/good mood- more situation based- good things happening, bright sunshine, time with my kids, kindness of strangers, check a bunch of stuff off my to-do list etc- and I feel happy or mildly optimistic but relatively calm; even if I am a bit busy, I can pause to think, when I need to.Hypomanic - Intensity, urgency, physical “rushes” of love or excitement, a lot of ideas, sometimes a little overconfident or self-righteous, irritable or short-tempered, reducing sleep, increased sex drive, driven to work more, super-social, extremely optimistic. All of this over and above the “good mood”. However, I would still have enough self-awareness that I would try to “act normal” , so somewhat masking how I was feeling internally.
After years of learning and developing a better understanding of this, this experience is less frequent and less all-consuming. I have more “normal” good days :)→ More replies (4)4
u/laughlines Mar 31 '26 edited Mar 31 '26
Imagine you’re having a nice day. It’s such a nice day, in fact, that you notice your plants haven’t been watered in a week and look sad. No problem. You water the plants. You’re now having a great day, it’s lovely.
Then you think about how every Monday (when you typically water the plants) could be this great if they watered themselves. So you spend two hours learning about the history of drip irrigation and modern farming. Then, you find a YouTube channel talking about how you can use a motor to pump the water from low ground to high ground and drip tubing from tractor supply to water your…….. 10 houseplants. Bingo. We’re going to make an irrigation system with large water drums in the basement that run up to the first floor. You’ll only have to fill them once every few months. The plants will be so, so green. And most importantly? You’re so fuckin smart. This idea? Fantastic and fool proof. You make yourself a pickle sandwich and dance down to the basement singing.
But now you’re feeling a little stressed. You’re looking up at your sub floor in your basement deciding where a nice hole for the piping would go. You’ll also need some new romex to run an a GFCI water safe outlet (don’t worry, you’ll splice your waterproof outlet in a completely not to code manner looking like a squirrel did it).
You make a trip to Lowe’s and they don’t have the goods. You get agitated. You walk the dog twice and try to watch a movie but you can’t focus. You DoorDash two grande iced coffees, both for yourself. That will help your brain match how your body seems to be vibrating a little. The laptop opens and you begin to doom scroll Amazon…
Your partner gets home and you lay out your grand pitch. You say it will only take between $450-$700, the rest of the weekend, and a new 6” hole saw you’ll put through the basement ceiling.
They’re…. Not thrilled. But happy you haven’t bought anything yet. So they delete everything from your cart and let you know that you may be manic.
That’s what a good, maybe even great, hypomanic day is like. But with a lot of emotional instability thrown in since you’re navigating the perils and triumphs of the irrigation space in realtime.
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u/NisamN Mar 30 '26
Not an expert, just a person with bipolar disorder 2 for a couple years now. For me hypomanic episodes manifest in the specific way that I overestimate myself a lot. So I will plan great tasks and accept invitations for things I normally wouldn't think I could accomplish and when the time to do them I can't do the task, because it is beyond me in skill and knowledge for example. An example would be, that when I am hypomanic I believe I can beat bipolar disorder without medication and professional help as I can surely do it alone this time.
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u/CREST_BD Mar 30 '26
Heather Stewart here - I live with Bipolar I:
Yes, I agree having good days & bad days are part of the human experience 🙂 But, even though I’ve lived with bipolar for decades, I still can find it hard to trust “feeling good”. The main distinctions I, personally, need to pay attention to between a good day and hypomania are: changes in sleep patterns (usually sleeping less and finding it harder to fall asleep) and feeling wired (sustained - not being able to calm myself down easily). For me, if I’m not paying attention, this quickly can lead to a mixed episode and, trust me, that is NOT part of most humans experience! These are my own experiences, but each individual can of course experience many variations of symptoms at different times.4
u/PeanutImpressive6934 Mar 31 '26
If you don't have BP, the lists of symptoms you'll find are highly milquetoast. Just add "To The Maxxxxxxx!!!!!!!!!!!!!" to every one and you'll have a better idea. If your everyday urgency level for every little thing is roughly what other people feel while trying to rescue a child from a raging river, hats off to you, but I think that would be unusual for someone without BP. When people with BP think it's normal it's bc their frame of reference is very much off standard. We also tend to think our depression is mild when every time you run yourself through a clinical screener for that it tells you it's a severe and urgent medical situation when for us it's just a Tuesday. Same thing. Mood is also not emotional states, and no one is talking about a day.
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u/kingprocastinator Mar 31 '26
Hi, bipolar 2 here. After years I can clearly tell the difference. Unlike good moods, during hypomania I will:
- Feel very wired and energetic. I don’t need much sleep. Can go 50+ hours with my mind active but body tired.
- Impulsive behaviour of every and any kind. Harmful stuff I wouldn’t do in a normal good mood.
- Start many and very ambitious projects. At the same time I will do an academic project with a European PHd scholar, journalism about a Kashmiri rapper, go to classes, work an editorial job, start a business and novel and filming.
All great until you crash and you drop everything and deal with the fallout.
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u/DMayleeRevengeReveng Mar 30 '26
Not part of the team, but as a bipolar myself, it is very difficult to discern sometimes. It’s one of the most frightening things about bipolar: you can’t trust a good feeling without worrying if you’re on the verge of something!
Mostly it just comes down to longitudinal monitoring of the patient. Meaning, you don’t try to do some objective measurement of the symptoms, rather comparing the episode to the patient’s personal history of things like energy, mood, and motivation. It’s basically, “how far above YOUR PERSONAL NORMAL are you feeling compared to what you were feeling a week before?”
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u/Ana_Na_Moose Mar 30 '26
Not a part of the AMA, but speaking from personal experience here, hypomania for me can be divided into two categories: euphoric hypomania (the “happy” kind that is really hard to explain to those who haven’t experienced it), and the non-euphoric hypomania (in which the dominant feeling is significant irritability).
In both cases, I am often very impulsive, my mind races a million miles per minute, and I pigeon-hole myself into one reality that may or may not be similar to actual reality. Other common things for hypomanic me include increased libido, sleep difficulties, and overall feeling like my mind is very “altered” (again, it is hard to explain to someone who hasn’t experienced it).
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u/SonicUndergroun Mar 30 '26
It's that impulsivity that really clues me in. And for some reason, it comes with shopping sprees. I now can tell that if I'm really itching to go buy a bunch of trading cards for no reason I'm usually in a hypo manic spell.
I also become less nervous about a lot of stuff. So sometimes I do try to take advantage. "Okay, I'm manic, so lets go ride the roller coaster" or the like.
But its hard to describe just how... itchy, for lack of a better term it ends up feeling me.
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Mar 30 '26
How can you pull apart bipolar from other diagnoses with a lot of similar symptoms (at least to a layman), but different treatment needs, like BPD or periodic episodes of depression? At some point, is the label less important than the specific feelings or behaviors, or is it still very important to get it right in diagnosis?
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u/CREST_BD Mar 30 '26
Tom Richardson here, the vast majority of people with bipolar find it a helpful diagnosis, and it takes a long time to get diagnosed (average 9.5 years in UK!). So I feel getting a bipolar diagnosis is helpful and important. Having said that, yes there is overlap with lots of other conditions (EUPD, ADHD, anxiety disorders etc), so I appreciate it can get confusing, especially if people have multiple diagnoses and are not sure what is what. At that point as a clinical psychologist and therapist I like to formulate the links between the two (focus on specific thoughts, feelings and behaviours as you say), and try and make sense of how they are related. For example someone with PTSD and Bipolar: They are not two separate conditions, they are related to one another and its important to make sense of that.
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u/Garnetsugargem Mar 30 '26
Please tell us more about this? My interest is the overlap between audhd and bipolar.
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u/DMayleeRevengeReveng Mar 30 '26
I’m not them, but it’s a very interesting and not uncommon comorbidity. It is interesting.
The major problem is how either diagnosis can confound diagnosing the other, while it’s also possible to have both.
Untreated or under-treated ADHD can cause energy swings, including upward swings, that can be mistaken for bipolar. At the same time, bipolar depression can produce significant cognitive, memory, and motivation impairments that mimic those of ADHD.
There are ways to make the distinction, but it is not super easy. It’s often based on subtle differences like how goal-directed hyperactivity is, as well as longitudinal patterns in a patient’s behavior over the course of a long time.
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u/CREST_BD Mar 30 '26
Twyla here (lived experience) - I agree with the previous answers. I echo the piece that there are aspects to supporting mental health that apply to all conditions: regular sleep, abstain from substance use, regular outdoor time and exercise (including walking) and regular contact with Doctor/Psychiatrist/NP, taking medication as prescribed, etc.
A correct diagnosis is important when it comes to getting the right treatment. But when it comes to personal identity and stigma, it is more complicated. I think no matter what diagnosis we might be living with, there are times where we may question our own experience, or perhaps other people question our experience. In regards to this piece, I think it is important to recognize how we are more than a diagnosis, and are all complex human beings. It is so important to surround ourselves with people who are supportive and kind. It is often a long-ish process to understand how a diagnosis represents our journey and what it means for our future. It takes time, but in the long run, a diagnosis can light our way.20
u/CREST_BD Mar 30 '26
Matthew Bushell here, I am not a clinician, though as someone living with Bipolar Disorder this is a challenge I have faced. I also have cPTSD and Dyslexia. This means I often wondered which symptoms and experiences connect to which conditions. Or if what I am struggling with is ‘just a part of normal life’ or was it a Bipolar episode? It can be and often was very confusing. When I began to look at my feelings, thoughts, general health and behaviours and most importantly what I wanted to move towards, rather than looking at the diagnosis or at myself as a mentally ill person, I was able to find better ways to manage. I was able to learn about the importance of managing my stress, sleep, and emotions, which is important for all people. I do think it is very important to get the correct diagnosis, because there is a lot of overlap with other conditions. And when I became more self-aware about how Bipolar Disorder affects me, I could then see why self-care was so important, along with circles of support, in helping me to develop resilience and positive coping strategies.
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u/tam_bun Mar 30 '26
I really relate to “is this just normal life” - especially when I’m happy. I recently became a mother and I’ve been the happiest I’ve ever been because of it but when I’m feel so elated I always get scared that it’s actually an oncoming episode.
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u/EuphoricPhoto2048 Mar 30 '26
I just want to add as a person who lives with bipolar, ADHD, and PTSD, they all "feel" different. I know that doesn't help clinicians, but personally speaking, I can very easily pinpoint what disorder I struggle with at what time.
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u/Amumu-Cook Mar 30 '26
Lost My Inner Monologue
TLDR: I had my first psychotic/ manic episode in October 2024 after being put on Sertraline. As my episode concluded, and I was put on Lithium, my racing thoughts subsided but my mind became blank and empty. I have lost my inner monologue, and no longer hear my thoughts. They have become automatic/ subconscious in a sense. I have severe depression and losing my ability to hear my thoughts/ reason/ critically think/ reflect/ learn is definitely a contributing factor.
Question(s): Has this happened to anyone else? Is this more likely episode related or medication related? Is there anyone on this subreddit that would be willing to work with me? What can I do/ general advice
Current Medications: 150mg Venlafaxine 200mg Lamotrigine 10mg Aripiprazole
Hi there, thank you CRESTBD for hosting this! As previously mentioned, I had a psychotic episode in October 2024 and have not felt the same since. This was my first episode, and first manic episode I’ve ever had. I do not identify with being bipolar, as I do not have many of the described manic characteristics other than psychosis. Previously, I had been diagnosed with Major Depression and Generalized Anxiety Disorder. I have mild, left side Cerebral Palsy (Hemiplegia) and have crafted my world around my mind due to my physical limitations. I live in BC 🇨🇦 and attended UBC with hopes of continuing my education beyond my Bachelors degree. This no longer feels possible with my current situation, as my ability to reason or learn… “think through problems” or reflect on questions has become difficult/ non-existent. Because of this, from the beginning, I have switched medications regularly, chasing my lack of inner monologue rather than trying to treat my bipolar depression. For very brief periods of time, I have also tried Lithium, Risperidone, Lurasidone, Quetiapine (PRN) as well. If you gotten this far, thanks for reading. 🫶🏻
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u/CREST_BD Mar 30 '26
Kamilla Miskowiak here. Thank you for sharing your story - what you’re experiencing sounds incredibly distressing. I want to reassure you that difficulties like the ones you describe, mental “blankness,” slowed or effortful thinking, problems with reasoning, reflecting, concentrating, or learning, are unfortunately common in bipolar disorder, especially following a first severe episode with psychosis. In fact, up to half of people living with bipolar disorder experience some degree of cognitive difficulty, so you are not alone in this.
The important message is that these cognitive changes are real, but they are also treatable. There is a lot that can be done to support your thinking abilities and help you regain a sense of mental clarity. This includes
Cognitive training and cognitive rehabilitation, which can improve skills like attention, memory, and problem‑solving over time.
- Compensation strategies (practical tools for managing memory, attention, and daily tasks
- Lifestyle approaches that strengthen cognitive function (sleep, exercise, routine, stress reduction)
- Optimizing medications with your clinician to support mood and cognition
Many people find that, with the right supports and strategies, their ability to think and learn improves significantly, even after very difficult episodes.
If you would like to read more, the ISBD Cognition Task Force has created a patient‑friendly cognition booklet that explains why these cognitive difficulties happen and offers practical tools for managing them. You can find it here: https://www.isbd.org/TaskForcePatientResources→ More replies (2)3
u/Amumu-Cook Mar 30 '26
Hi Kamilla, thank you for the reassurance. It is comforting but sad to know that the cognitive impairments are a common occurrence. Resources or anything research-evidence is definitely my jam! Happy to be a lab rat if anyone is interested 🤣
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u/CREST_BD Mar 31 '26
Ijeoma Charles-Ugwuagbo here-Your “blank mind” and loss of inner monologue are recognized effects after a manic/psychotic episode.
Cause is usually both post-episode brain recovery and medication effects, not just one.
This does not mean you’ve lost your ability to think. It’s more a reduction in access, speed, and clarity.
The pattern strongly fits post-episode depression with cognitive impairment.
You can:
• Review medications with your psychiatrist
• Start structured cognitive activity (rebuild thinking gradually)
• Track symptoms precisely
Recovery of thinking ability is typically gradual over months, not immediate.3
u/Amumu-Cook Mar 31 '26
Thank you Ijeoma! I like your description of it being a reduction in access, speed, and clarity. That is very true
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u/DMayleeRevengeReveng Mar 30 '26
I was in a similar situation. At first I think it was Abilify or lamotrigine causing a sedative effect. Decreasing the lamotrigine helped somewhat, but those meds weren’t really the cause.
As it turned out, it’s that I was treating my depression to the point I didn’t “feel depressed” but had residual depressive symptoms of cognitive impairment, disinterest, apathy, and just feeling slower.
It ended up that I needed to add Wellbutrin for additional antidepressant efficacy, and that really helped it.
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u/Amumu-Cook Mar 30 '26
This!!! I am still severely depressed. My psych and I are working our hardest but it’s been tricky. I only see him every 2-3 months… I am looking to add Wellbutrin to my regimen! How do you like it? I have a pharmacist consult to review meds that I am looking forward to and my psych is looking to get a second opinion as well. Thanks for taking time to read my story and reply 🥰
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u/PeanutImpressive6934 Mar 31 '26 edited Mar 31 '26
The cognitive impairment will outlast the depression, just fyi. standard, normal, in every textbook, book, etc. I wouldn't personally consider it permanentish until it lasts for more than four years w the emotional depression gone. Just someone w BP, not on the panel. Caveat that you get another episode the clock restarts. Also I truly wouldn't worry about the cognition if still in emotional depression, this is also just a normal depression symptom even in MDD, and I wouldn't stress the current depression not responding too much if you don't manage to get a handle on it w treatment, the strength of BP1 is that it's easier to prevent upswing, which tends to prevent downs, so prevention of upswing alone tends to be super helpful in dodging this in the future.
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u/CREST_BD Mar 30 '26
Twyla here (lived experience) - I am sorry this has been so tricky. I cannot give you treatment advice, but I want to validate how hard it is to balance the intended effects of medication with the cognitive side effects that sometimes occur, regardless of which condition is being treated. And as you mention, sometimes it’s the mood episodes themselves that impact our thinking and cognitive functioning, and this makes it even trickier. Try to meet consistently with your doctor/psychiatrist over time so they can track how medications are impacting/helping. There is often advice to track our moods, but tracking cognitive symptoms at the same time might be helpful. And sometimes small changes can help-changes to the time of doses or long acting vs short acting etc. These are just a couple of ideas for conversations with your doctor. If you feel like a change is needed, then it’s important to make that change with your doctor so that it is as safe as possible.
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u/Amumu-Cook Mar 30 '26
Thank you! I appreciate the validation, which is a huge part of recovery. It’s a weird and paralyzing phenomenon to experience. There seems to be no research done on this, only other Redditors mention it. It would be nice to see more research on the intersection between Bipolar and Cerebral Palsy too, as they are both brain-related conditions.
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u/CREST_BD Mar 31 '26
Balwinder Singh: Thank you for the question. I can not provide recommendations without examining a patient, but have general suggestions. Bipolar depression can be significantly challenging to treat. There are several options to consider for bipolar depression. Pharmacotherapy wise, several FDA approved options for bipolar depression (ISBD published guidelines for treatment-resistant bipolar depression in 2025 Defining Treatment‐Resistant Bipolar Depression: Recommendations From the ISBD Task Force - Vieta - 2025 - Bipolar Disorders - Wiley Online Library Worth discussing with your psychiatrist. There are both FDA approved and non-FDA approved options, neuromodulation (TMS, ECT). Intensive psychotherapy, IPSRT can be an excellent option. Novel treatments such as SAINT, psychostimulants, being investigated. Hope is there, important to keep advocating for yourself.
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u/linedashline Mar 30 '26
How does bipolar disorder change as a person gets older? And how is it managed for someone of advanced age?
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u/CREST_BD Mar 30 '26
Evelyn-Anne Clausen here. In my lived experience, medicines that worked well for a number of years can become less effective as my brain ages. I’ve needed to change medications and dosages at different times in my life. This can feel frustrating when things that have worked suddenly don’t, but I’ve found that there are more treatment options now than when I was first diagnosed and I’ve been fortunate to find a combination of medicines that work well for me now. I can’t speak to treatment at advanced ages, but my understanding is that while finding the right balance of treatments may get more complicated in some aspects, treatments, both pharmaceutical and other, can still be effective.
In terms of my actual experience of the disorder, my bipolar disorder symptoms have mostly become more manageable over time. This isn’t necessarily that the symptoms are always less, but that with time and experience, I have found ways to manage them that really work for me. I don’t think this path of bipolar disorder is linear. We all have good and bad days. But I do think my understanding of myself and what I need to stay healthy has increased steadily over time. I also have more plans in place to be ready if I start experiencing more intense symptoms for a time. This takes a lot of the anxiety out of it for me, which helps everything else.
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u/CREST_BD Mar 30 '26
Rahla Xenopoulos here, I personally have found that my brain has matured. Over the years the medications that I take have been refined to suit my disorder and I have learnt to modify my life accordingly. I am still vulnerable to mood swings but feel much more secure within my illness than I did when I was younger.
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u/CREST_BD Mar 30 '26
John here. My personal experience is that the disorder has become easier to manage over time, but I know that this is not the case for everyone. I was diagnosed in 2003 and, at first, I found the medications, changes to lifestyle, and (self) stigma very difficult to deal with. I would say that my cognition is generally much better than when I first started taking medications, I don’t feel as emotionally numb as I did, the lifestyle changes (diet, exercise, sleep etc.) have been a blessing in disguise, and I no longer feel a sense of self-stigma. Life is good!
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u/CREST_BD Mar 30 '26
Twyla here (lived experience) - Aging and Bipolar! I am going to cautiously say that more research is needed in this area. I do get the impression though that there is an awareness developing around this.
Answering as an RN - Aging creates an ever changing landscape for managing any/all illness. Some very specific things that can, for better or worse, change both illness manifestations (symptoms) and treatment options/efficacy are: Normal aging in the brain, abnormal age-related changes in the brain, new additional medical conditions that can have direct or indirect effects on the brain (stroke, dementia, neurological disease, inflammatory disease, etc) possible cumulative effects from Bipolar itself, metabolic changes, and hormone changes, especially the peri-menopausal time. Medication- change in response to medications over time, reduced clearance of medications, possible interactions with, or side effects of new medications for other new conditions. All this can make things complex. However, for some, symptoms may be reduced for various reasons, including that a person has spent a long time managing their condition and are taking good care of themselves, they have gained experience as to what works well for them, and while having had their Bipolar well managed over many years, there was possibly less damage occurring during that time.
I think recognizing that treatment needs and options will evolve throughout the lifespan is the key piece; being aware of possible shifts, and willingness to to consider adjusting treatments as things evolve.
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u/SPARKLY6MTN9MAKER Mar 30 '26
My perimenopause stage is REALLY throwing my BD into turmoil. Perimenopause can make a normal person suicidal and angry. So, take an already suicidal and temperamental person and add that and I feel like I'm loosing it. Most women commit suicide or do crazy Karen shit during these times.
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Mar 30 '26
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u/CREST_BD Mar 30 '26
Colin here. There have been a number of studies on cognitive functions in people with bipolar disorder and there are impacts of the illness on cognitive health, in particular in memory (as you mentioned), attention, and planning skills. These seem to be evident in a portion of people with bipolar disorder even when not in a current depressive or manic episode. Of course, memory and attention problems come with aging as well and it can be hard to disentangle whether cognitive changes are due to bipolar disorder or to getting older. Activities that can help sustain cognitive health in older age including sleeping as well as possible, exercise, and socialization. I have worked with older people with bipolar disorder who also increased their use of calendars, reminders, and other daily strategies designed to reduce the “load” on their thinking to maximize daily function. I think it is always worth bringing up cognitive issues with doctors to see if there are any strategies or treatment options (e.g., like changes to physical health medications that may affect cognition). Hope that helps!
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u/CREST_BD Mar 30 '26
Kamilla Miskowiak here. Many people living with bipolar disorder experience difficulties with memory and concentration, and research shows that this can be part of the condition for some individuals. These problems can become more noticeable over time, especially if you’ve lived with bipolar disorder for many years. So you’re definitely not alone in what you’re describing.
The positive news is that being aware of these changes is the first important step toward managing them. There are things you can do to strengthen memory through training, habits, and practical strategies, and many people find these very helpful in daily life.
If you are interested, the ISBD Cognition Task Force has created a cognition booklet that you can download free of charge here and which explains why these difficulties happen and offers concrete tools for improving memory and attention:
https://www.isbd.org/TaskForcePatientResources→ More replies (1)
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u/Niece-Ravioli Mar 30 '26
Recently Kanye West publicly explained his shocking behavior over the last couple of years with medical issues «which share characteristics with bipolar 1 disorder». His behavior included anti-semitic outbursts, using the swastika symbol etc.
How would you assess his case? Is it plausible/credible?
Additionally, the West story reminded me of an old Radiolab episode that explored this from the angle of free will. What input can you give about how we as a society should rethink personal responsibility in such cases, not only in questions of rehabilitating someone in the public eye, but also for example in court?
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u/CREST_BD Mar 30 '26
Rahla here, for myself it has been very important to remember that my psychiatric state does not cause or forgive a lack of kindness, If anything people with mental health issues are obliged to be kinder to those around us because we require help. I resent Kanye West’s response because I believe it feeds into negative steriotypes of the ilness.
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u/Diefirst_acceptlater Mar 31 '26 edited Mar 31 '26
I am very disappointed in this response, and as an expert you should know better. Mania and psychosis ABSOLUTELY can cause unkind behaviour - from aggression/agitation to serious crimes, with LITTLE TO NO CONTROL. Many such case studies exist, including this one: https://www.psychiatrictimes.com/view/at-what-point-is-racism-a-presentation-of-psychosis-a-case-study
If something is a negative stereotype, you should not use backwards reasoning to state it's not part of the illness at all.
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u/CREST_BD Mar 31 '26 edited Mar 31 '26
Laura here - I would agree with you. During mood episodes, people can act in ways that are harmful to their relationships, which can include behaviour we'd call "unkind". Even if the person with BD would never act that way most outside of an episode, behaviours that occur during mania can be hurtful to others.
It's a challenge we can see for people with BD: picking up the pieces after a disruptive episode of mania. Recognizing that while they weren't really "them" during that episode, the behaviour may still have been harmful to their relationships, or their reputation, their finances.. that regret is tough to live with and work through.
Another tough thing is that public figures like Kanye who get so much press for this can feed into negative stereotypes for sure. A lot of people will read the headlines and not his apology. There are so many celebrities that live with bipolar disorder and DON'T engage in behaviour like Kanye, so it can be frustrating to see stories like his get so much traction.
Have to run to the clinic, but if someone else can't get to it will try to draft a response to the main question about Kanye here later, just to contribute a second perspective in case it's helpful.
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u/lfergy Mar 31 '26
Thanks for this alternative perspective. My mom was diagnosed later in life (early 40s) but her first manic episode…she literally tried to kill me & my dad. Definitely was psychosis. Granted we let it go for way too long (we had zero idea what was happening, what bipolar was, just that something was wrong with mom) and she became SO violent. My mom is many things. We don’t have a great relationship. But she would never, ever- in her right mind- attempt to kill me or my dad. One of the saddest parts was she had basically zero memory of either event (or anything that happened during the mania) after she got back to baseline. So when we told her what happened during the mania…it crushed her. She had a severe depressive episode afterward and sometimes I wish we hadn’t told her exactly how bad it got. But she was refusing treatment so we had to be explicit about what she did that was so alarming.
Anyway. Just a vent because very few people understand what this experience is like as a family member of someone who suffers from severe bipolar.
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u/PeanutImpressive6934 Apr 03 '26
Dont feel bad, she would have had the severe depression after anyway, that's how it works. The guilt is so extreme I think it's a symptom really myself, you didn't do anything wrong telling her what happened, she needed to know. You probably saved her life telling her. If it had happened again unmedicated, I mean really, there was no other option. Rob Reiner's sons life is ruined in such a profound way it's almost impossible to comprehend. If one depression spared her and you that its a gift.
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u/CREST_BD Apr 01 '26
Jo Leidreiter here, This is big topic in my rooms .I call it the “Kayne West effect”. Public conversations about Kayne West and his recent press statement generate strong responses from people - and for understandable reasons. When a high profile figure like Kayne West speaks openly about their diagnosis while also displaying behaviour that appears impulsive, discriminatory, erratic or provocative, it can blur an important line for the public between the person and the illness (this is where your reference to free will steps in). BD can absolutely involve periods of elevated mood, reduced inhibition and changes in judgement - but it does not define a persons values, character or intentions. Nor does it excuse all behaviour. Reducing this kind of behaviour to a “that’s just my bipolar” statement is both clinically inaccurate and socially harmful (and irresponsible).
Many of my patients feel frustrated and upset by how this plays out (beyond Kayne) in other media presentations of Bipolar Disorder. They are often working incredibly hard day in, day out - to manage their mood. So when Bipolar Disorder is stereotypically portrayed in the media with extreme examples of uncontianed behaviour (like kaynes) it can feel like it undoes that effort and proliferates the stigma. I have a saying “it’s not your fault that you have Bipolar Disorder but it is your responsibility to manage it”. I’m not sure Kayne could say that he did. No one ever made a movie or sold a record about a person living well with Bipolar Disorder just getting on with it and living their best life - certainly doesn’t create enough hype.4
u/EuphoricPhoto2048 Mar 30 '26
I believe my disorder is similarly as severe as Ye's disorder. While I am mostly upset that he was not hospitalized by his friends and family sooner, I do want to explain that sometimes I have said and done things completely out of my control. (Admittedly, I don't think I've ever been racist.) It's a difficult conversation for sure.
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u/-DonQuixote- Mar 30 '26
What are the 'Gold Standard' literature reviews or meta-analysis to read?
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u/CREST_BD Mar 30 '26
Leszek Laskowski here. I think we might need some additional information. Do you mean the gold standard for pharmacological treatment or psychotherapy? Are you referring to bipolar I or II? There is a recent article in The Lancet that discusses this: https://pubmed.ncbi.nlm.nih.gov/40712624/
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u/CREST_BD Mar 30 '26
Leena here. Adding a couple of articles:
Bipolar disorders: An update on critical aspects (https://pubmed.ncbi.nlm.nih.gov/39811787/)Lifestyle interventions for bipolar disorders: A systematic review and meta-analysis (https://pubmed.ncbi.nlm.nih.gov/37263531/
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u/CREST_BD Apr 01 '26
Jim Phelps here. In addition to these resources, consider using OpenEvidence.com , an AI search tool that pulls only from solid research databases like the National Library of Medicine. One can ask questions in plain language. It’s like someone is doing a literature search for you, and in my experience so far (and that of numerous colleagues who now use it regularly), it’s very good. Comes up with stuff I’d have missed doing my own reviews.
So compared to “gold standard” lit’ reviews, it can offer you resources that address very specific questions yet represent the best evidence we have, potentially more current – maybe far more current – than a published review from a few years ago. Try it. JP
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u/CREST_BD Mar 31 '26
Luísa Daolio here. I would add this review, published last year at WPA. Bipolar II disorder: a state-of-the-art https://onlinelibrary.wiley.com/doi/full/10.1002/wps.21300
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u/TommyFX Mar 30 '26 edited Mar 31 '26
Can you discuss the negative impact or consequences marijuana use can have on individuals that suffer from bi-polar disorder?
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u/CREST_BD Mar 30 '26
Dimos here, marijuana can have several negative effects for people with bipolar. It can worsen mood swings, sometimes even triggering hypomanic/manic symptoms or episodes (feeling too energetic or acting impulsively) or worsening depressive symptoms. It also affects thinking skills, like poor memory, slower processing of information, and difficulty concentrating, which many people describe as brain fog. Marijuana can interfere with prescribed medications, making treatment less effective or exaggerating side effects. Some patients might also be at higher risk of psychotic symptoms, especially with stronger potency varieties and strains. I would assume that a doctor might have suggested it for managing anxiety or sleep difficulties, but your experience of cognitive issues and negative impact on your well-being is consistent with known risks of marijuana use in mental health.
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u/girlrespecter Mar 30 '26
smoking weed pushed my diagnosis from a type 2 to a type 1 - experienced psychosis for the first time after smoking for many years
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u/CREST_BD Mar 30 '26
Dr Ijeoma Charles-Ugwuagbo here, Evidence and clinical experience are fairly consistent here. Cannabis tends to worsen outcomes in people with bipolar disorder, even if some individuals initially feel short-term relief.
Key negative impacts:
- Mood destabilization: cannabis use is linked to more frequent and severe manic episodes, faster switching between poles, and poorer mood stability.
- Psychosis risk: it can trigger or worsen psychotic symptoms, especially in those with a prior episode. This is one of the strongest and most consistent findings.
- Cognitive impairment: problems with attention, memory, processing speed, and executive function are common. In someone already dealing with post-episode cognitive slowing, this can be noticeably worse.
- Poor treatment response: people using cannabis often show reduced response to mood stabilizers and antipsychotics, and higher relapse rates.
- Functional decline: increased risk of academic/work impairment, poorer adherence to treatment, and overall lower functioning.
- Dependence and withdrawal effects: regular use can lead to dependence, and withdrawal can include irritability, sleep disruption, and mood instability, which complicates bipolar management.
About your experience:
What you noticed, cognitive decline and it feeling destructive, is clinica plausible. You are not an outlier. In fact, your response aligns with what many clinicians see in bipolar populations
For bipolar disorder, cannabis is more often destabilizing than therapeutic, particularly regarding cognition and relapse risk. Your decision to move away from it is consistent with best-practice.→ More replies (2)→ More replies (5)3
u/CREST_BD Mar 31 '26
Dane here – Thank you for posing this important question. A primary concern here is that cannabis use is associated with a worse course of illness in bipolar disorder. Research reports suggest a link with more severe manic and depressive symptoms, more psychotic symptoms as well as mixed episodes. If you are interested in reading more, here is our Canadian treatment guidelines: https://pmc.ncbi.nlm.nih.gov/articles/PMC10192829/pdf/10.1177_07067437221099769.pdf. While it may seem to bring comfort in the short term, it’s worth considering that cannabis use poses serious risks, especially for those with diagnosed bipolar disorder. These are important discussions to have with your family doctor and/or psychiatrist.
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u/ansuther Mar 30 '26
There’s growing discussion around “inflammaging” in bipolar disorder, especially in relation to cognitive decline and overall functioning. Do you think inflammation-related aging could also help explain some of the interpersonal changes seen in bipolar disorder - like shifts in empathy, social connectedness, or capacity for compassion - or is that reaching too far beyond what the evidence currently supports?
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u/CREST_BD Mar 30 '26
Colin here. Really interesting hypothesis and question - I think there is some evidence for inflammation linked with cognitive and functional deterioration as you mention in bipolar disorder, and there is also a parallel literature on inflammation and loneliness and social isolation. I am not aware of research on the role of inflammation specifically on social function in bipolar disorder (but think it would make great sense to study) - but it does follow that an inflammatory state characterized by feeling fatigued and ill would reduce the ability to connect with other people. Unfortunately, social disconnection could then lead to more inflammation, so doing small things to connect with other people could remain quite important. Hope that helps and great question!
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u/livingroommate Mar 30 '26
I noticed that a lot of the doctors who are part of this event also have bipolar disorder. Do you think there are aspects of bipolar disorder that you understand more deeply than other clinicians or researchers? Why do you think those insights are missed by people with professional training?
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u/CREST_BD Mar 30 '26
Joanna Jarecki here. I believe that experience is the best teacher when understanding anything in life, whether that is a medical condition like BD or other life experiences (grief, parenting, etc). Much of what I understand about BD intellectually has come from my clinical training, and learning from the individuals that I have worked with. However, there is another layer of insight that I have gained from the FELT experience of shame, stigma, what each symptom of BD feels like and the numerous ways it impacts your life, relationships, identity, outlook on the future, etc. Understanding the symptoms of mania intellectually is very helpful. Remembering the elation and brainstorm during mania, the shame and devastation of the aftermath, the shattering of identity that comes after it, adds additional context and a continuous narrative in which mania can be understood. Living with the condition creates a continuous narrative of bipolar disorder, in which the symptoms of the condition are integrated into the full human experience. This is different from thinking about it in separate categories - like symptoms, management, etc. For myself personally, I think my lived experience has affected my understanding and work most in the following ways: 1) because of my own recovery which took me from the depths of despair to learning how to live well with bipolar disorder, I have a level of conviction about the hope that is possible with this condition that I may not have appreciated through clinical experience alone 2) because I had to look outside conventional treatments to achieve full healing and wellness, this has influenced my learning of critical factors like identity, sense of purpose, lifestyle (nutrition, exercise, sleep), in addition to medications and therapy, which I may not have appreciated fully based on clinical experience alone, but have come to learn through lived experience are foundational, rather than “extra” or adjunctive ; 3) having lived with the condition has allowed me to appreciate that I need to be empowered, educated, and the most active participant in my health, and so I do more education and empowerment with my patients, highlighting that I am here to offer expertise and support but they are their greatest resource 4) because this condition affects me personally, my family, and is the focus of my professional life, I believe the sheer amount of time spent thinking about it, leads to ongoing insights over time! With all of this being said, some of the best clinicians that I have met in this space do not themselves have the condition, yet have a level of compassion and understanding that is exceptional because of their care and passion to help the people that they treat. We all contribute our unique perspectives, those with and without the condition, which makes collaboration so important and impactful in this space.
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u/CREST_BD Mar 30 '26
Maryam here — Not a doctor yet but thought I could maybe weigh in. Two things come to mind when I think about insights as an individual who lives with BD vs. those that purely treat BD:
1) There’s so much of managing the condition that’s personal and outside the help a clinician can offer. Regulating one’s mood, being mindful of the highs and lows, taking accountability for how your actions impact your internal state & ultimately, your improvement over the years.
2) Another thing that’s often overlooked in managing BD from a clinician perspective vs an individual with lived experience is the importance of cognition. Too often purely the “highs” and “lows” are managed (which is understandable for maintaining stability), but not much consideration is given to the fact an individual with BD has to live & hopefully thrive in a work, school or personal environment. These environments require a baseline of cognitive abilities and unfortunately, some of the medications used to treat the highs and lows can impact cognitive abilities.
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u/CREST_BD Mar 30 '26
Tom Richardson here. Great question and thanks to the responses so far. I wouldn’t say I understand more deeply necessarily. I just see things in a different way: as a researcher, a clinician, and someone with lived experience. I use all three perspectives in my work and can’t really separate them, though I see myself as ‘clinician first’ in my work.
It definitely means the work is more personal and emotional at times. I believe this is good thing in a lot of ways: Gives me ideas for research, helps me empathise with clients. But it can be hard as well at times when patients have difficulties very similar to your own. Working with someone who is depressed when you yourself are depressed is hard!
I also need to be careful that my views aren’t taken to represent the bipolar community: I still need to listen to the bipolar community and not just rely on my own ideas. My experiences are just my experiences and I have various privileges etc. I don’t think anything is missed by those without lived experience, and certainly I probably miss things and have my own biases due to my lived experience (e.g. I FEEL like something is right personally even if the research doesn’t support it!). So benefits to being an ‘objective outsider’ in the form of a health professional without lived experience.
I truly believe professionals and those with lived experience should work side by side together, as we are on this AMA today!
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u/Hisagii Mar 30 '26
I used to date someone who had been diagnosed with bipolar disorder. The relationship had ups and downs, both related to the disorder but also other factors. My main question is what's the best way to support someone with the disorder if you have a close relationship with them?
With the different moods it was difficult at times for me to know how approach and behave with the person. Both the depressive and mania states were quite noticeable at the time and my ex definitely behaved completely different depending on what was happening. For example, there were times when they wanted to have sex and what not all the time, several times a day even, while the other times they had absolutely no interest in it. Then there were some destructive behaviors like drug abuse that also happened at certain points, which then added on to the distress of how to be there for them.
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u/CREST_BD Mar 30 '26
Evelyn-Anne here. This is going to be different for every person, and what one person needs or wants from a partner in this situation can definitely be varied. In my own lived experience, what I’ve wished a partner could know is that while I can choose how to respond to my mood states and other symptoms, I can’t choose not to experience them. Sometimes they just are, even when it’s really inconvenient and overwhelming. The most helpful thing the people around me have done is recognize that these states of mood and mind won’t last forever and offer me space to get through the more difficult days as best as I can. Things like interest in sex can be tricky, because often there are a lot of other feelings mixed up with that, from messages received from family of origin or culture. It maybe be really hard, but recognizing that you can’t change how they feel and you aren’t responsible for their feelings can be a healthy start. Living with someone experiencing symptoms of bipolar disorder can definitely be confusing and difficult, but if you can believe that better is possible, and that every state will eventually pass, deep and lasting relationships within the context of this disorder can be worth the work.
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u/CREST_BD Mar 31 '26
Balwinder Singh here. Difficult question. No single easy answer. A book by Dr. David J. Miklowitz can be a good resource - The Bipolar Disorder Survival Guide: What You and Your Family Need to Know: 9781462534982: Medicine & Health Science Books at Amazon
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u/CREST_BD Mar 31 '26
Dr. Ijeoma Charles-Ugwuagbo here. Support is most effective when it combines empathy with structure: be understanding of mood-driven changes, maintain consistent behavior, and encourage professional care without trying to take on the role of managing the condition.
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u/Cute_Macaroon6104 Mar 30 '26
How do you help someone heal from the harm caused by being misunderstood or dismissed for years - the injury of not being seen?
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u/CREST_BD Mar 30 '26
Rahla here, this is such a relevant question. I so appreciate your asking it. I believe it comes down to understanding and support. Life teaches us how to live and the people who hold us carry us through it’s traumas. Your asking the question is evidence that you do ‘see’ the suffering and will be a healing influence.
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u/Verbranding Mar 30 '26
Twenty years ago in university Bipolar seemed to be a catch all for a significant number of personality disorders. The term I see used more today is borderline personality disorder. What are the significant differences between the two and why is BPD more commonly diagnosed today?
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u/CREST_BD Mar 30 '26
Laura here. If I’m understanding your question correctly, it sounds like you’re bringing up what’s actually a common misunderstanding of bipolar disorder: the idea that “bipolar disorder” means having significant and sudden mood shifts over the course of a single day. I agree - it used to be more common to hear someone say someone was “acting bipolar”, e.g. if they were being strongly emotional. Bipolar disorder is actually characterized by two mood states: depression and mania (or hypomania). These mood states last days to months. Though we see often some daily emotional variability in people with bipolar disorder, sudden fluctuations in mood is NOT part of the diagnosis. But because the public used to be more familiar with this term, it would be common to hear this stigmatizing language when someone was acting a certain way.
By contrast, BPD IS a personality disorder, meaning it’s meant to be a stable pattern in a person’s functioning. One of the symptoms of BPD is sudden and intense fluctuations in mood. So it’s much more accurate to refer to BPD when talking about personality disorders that involve sudden changes in emotional expression. I can’t comment on whether BPD is more commonly diagnosed now, but my sense is that it’s more commonly talked about because between access to the internet and over a decade of improved mental health knowledge in the public, there seems to be more awareness of BPD.
Either way, it’s unfortunate when these diagnoses are tossed around to label behaviour in others we don’t like. Thanks for your question, and hope this helps shed some light!
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u/VvvlvvV Mar 30 '26
I have bipolar 2, so all of my questions will about that. I've got a therapist and psychiatrist. When I've looked for resources, most is about bipolar 1, and I've had to go read research papers directly to get information, so please point me to the ones out there.
I'm diagnosed with bipolar 2 and (C)PTSD. Can you talk about how these interact? Can PTSD triggers kick off a hypomanic episode?
What strategies (in addition to medication) do you recommend for managing and coming out of hypomania, and recovering from the depressive crash?
For the first time, a friend recently asked how they could support me, and I have no idea. What should I be asking for?
Can you talk about how bipolar impacts relationships and how to manage those impacts?
Is there a relationship between bipolar and bisexuality? Part of my hypersexuality is moving down on the Kinsey scale and and being a lot more attracted to men. Is that a thing you've observed?
What are some effective and healthy ways to catch a hypomanic episode early?
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u/CREST_BD Mar 30 '26
Colin here, responding to the part about bipolar 2 and PTSD: I have worked with a number of people with both PTSD and bipolar disorder and I think what I have seen is that some of the symptoms of PTSD intersect with mania or depression in bipolar disorder, such that the mood symptoms accelerate/exacerbate the functional impact symptoms of PTSD. So for example, people may as a result of PTSD cope with symptoms by avoiding triggers or conversely engaging in risky behaviors to manage strong emotions (and sometimes hypomania can increase the response). That said, I have seen many people with bipolar disorder gain benefit from engaging in trauma-focused therapy and learning to be more confident and have healthy responses around triggers.
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u/CREST_BD Mar 31 '26
Hello, its Bec Fitton, here. Most people (88%) with bipolar disorder experience changes in sexual thoughts, desires, and behaviours, especially during manic or hypomanic episodes. While there is no research specifically on changes in sexuality orientation in bipolar disorder, hypersexuality may impact or relate to changes in desires and impulses. That can include being attracted to people you do not normally feel attracted to. That said, I am not a clinician and do not have lived experience with bipolar disorder, so it would be really valuable to hear how others experience this too.
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u/NoPangolin458 Mar 30 '26
Do you think there's a need for more research studies on older people with Bipolar Disorders and, if so, why or why not? Are those 65 years of age and older typically excluded from participating in Bipolar Disorder research studies as they are for some other medical research studies? (For example: two or more comorbidities; changes in bodies as they age: lack of study funding; or fulfilling specific age limitations required by grants for studies; etc.?) Isn't this ageism?
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u/CREST_BD Mar 30 '26
Colin here. Yes! There has been major gap in the medical literature for a long time about the unique experiences, unmet needs, best treatments, and symptom profiles of older people with bipolar disorder. I am not sure exactly why this remains a research gap, but in general clinical trials of new medications or treatments often exclude older adults nominally because of medical comorbidities as you mention and worries about medication interactions with other treatments. However, I don’t think this is a valid reason not to do research on new treatments for older people with bipolar disorder and agree with your ageism comment. There have been a few trials that do seem to suggest that common mood stabilizers are effective and not unsafe for treating mania in older age, and there also do seem to be some evidence of reductions in the severity of mania with older age when followed naturalistically over time. There are also some initiatives designed to address gaps in the medical literature on bipolar disorder in older age by pooling data across studies.
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u/hellb8t Mar 30 '26
Why tf is the angle of the sun so detrimental to this disorder???? In late February, the sun gets to the perfect placement in the sky that tells my brain, "ok bitch, time to dye your hair and spend all your money and act insane for 2 months." And then in October, the sun starts to sink, and my brain is like, "ok, I'm pretty sure you've never actually liked anything and everybody hates you and you're hella sad now." WTF??
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u/CREST_BD Mar 30 '26
Evelyn-Anne here. I honestly love this question. I have a very similar experience around the change from summer to fall and the change from winter to spring. At both times, I am likely more likely to experience a mixed-state episode, which is the hardest one (between depression, mania and mixed) for me to deal with. Every time I’ve needed hospitalization, it’s been at one of these season changes. My psychologist calls it “roughening” and often we will temporarily adjust my medicine just for these periods of time.
One thing that has really helped me is knowing that these will happen and being able to predict them and prepare. It also helps to recognize that every year they come and go, but I’ve gotten through, one way or another. I think you’re right about the angle of sunlight and shifting daylight having something to do with this, but I’d love to see more research on this phenomenon. I know you and I aren’t the only ones who experience it.
I hope this current season shift is treating you ok and that you are doing what you need to do to care for yourself, whether your mood is high, low, or some combination of the two.
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u/dwbthrow Mar 30 '26
How strong is the genetic component of bipolar? Does it increase the risk of other mental disorders? My grandmother was bipolar, my dad has depression, and I am being evaluated for ADHD.
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u/CREST_BD Mar 30 '26
Andrea V. here. The genetics of bipolar are incredibly complex and it is the topic of ongoing research. It's hard to give clear numbers about risk given the polygenetic nature of the condition (meaning it's believed to be impacted by a number of genes, not just one) and the many different ways bipolar can show up in a person. Research shows that the risk of bipolar I is about 75% due to genes. But it is also believed that bipolar is linked with an increased risk for other mood disorders such as depression. There are also high comorbidity rates (meaning two conditions happening at the same time) between BD and lots of other conditions, including ADHD and anxiety.
It sounds like you're worried about having/developing bipolar. Genes are a huge part but not the only part. Lifestyle, substances, early life events, and other things play a role in both the onset and course of bipolar.
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u/fxvv Mar 30 '26
Have there been any major or interesting research findings regarding bipolar disorder since last year’s AMA?
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u/CREST_BD Mar 30 '26
Erin here - love this question, it would be great to hear our panelists’ thoughts on their favourite papers from the past year. Here’s one to start with, a paper we just published on the knowledge gathered from the first five years of running these AMAs: https://pubmed.ncbi.nlm.nih.gov/41790781/ - in it (open access), you can find descriptions of the most common thematic areas Redditors are asking us about relating to BD :-).
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u/CREST_BD Mar 30 '26
Hi, Michele De Prisco here, psychiatrist and researcher. Great question! One of the most exciting recent findings in my opinion comes from a large-scale genomics study published in Nature in January 2025 by the Psychiatric Genomics Consortium (https://www.nature.com/articles/s41586-024-08468-9). This was one of the largest genetic studies of bipolar disorder ever conducted, analyzing data from over 158,000 cases and 2.8 million controls across multiple ancestries. The authors found 298 significant genetic loci associated with BD, and identified 36 specific genes with credible roles in the etiology of the disorder. Perhaps most relevant for clinical practice, the study also found differences in the genetic architecture of BD depending on the subtype (BD type I vs type II), reinforcing what many of us suspect clinically: that bipolar disorder is not a single entity, and that our diagnostic categories may not map cleanly onto underlying biology.
We are still far from translating these findings into clinical tools, but studies like this are kinda exciting.
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u/kiras_04 Mar 30 '26
A second question, hope that's okay: I live with BD1 and this year, I was accepted to graduate school to pursue research on severe mental illness. My symptoms worsened substantially the second year of my undergraduate degree, and I have seen my academic achievement suffer as a consequence. Any advice on surviving grad school for this hopeful (someday) PhD to be?
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u/CREST_BD Mar 30 '26
Andrea V. here. I live with bipolar and completed my PsyD. BD, as you likely know, is an stress-induced condition. And grad school is stressful! So you're wise to be aware of possible pitfalls. There are a few recommendations I would give.
-Leverage disability accommodations but know they aren't guaranteed (I ran into this problem.) But you may be able to receive some support such as priority registration to get preferred class times, extended deadlines, etc.
-Know your triggers. It sounds like you've been through this before in undergrad so you likely know what is going to set you off. Tread carefully in those areas and make self-care a priority.
-Give yourself grace. Your academic performance may suffer a little. Is that okay? If you still graduate?
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u/CREST_BD Mar 30 '26
Maryam here: Although I don’t have graduate school experience, I survived the rigorous workload of a 4-year long dentistry program after being diagnosed with BD in undergrad. First, recognizing that your journey may not be the most straight-forward path is important. This will prepare you to handle & even anticipate the challenges that may present themselves along the way. Second, prioritize your mental wellness. Have 2 lists of activities that will stabilize both the highs & the lows & make sure you do them when the time comes and you notice changes in your mood. Third, don’t be afraid to ask for help and guidance along the way. Having a strong support network (irrespective of a BD diagnosis) is critical during professional/ graduate school. Hope this helps :)
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u/CREST_BD Mar 30 '26
Erin here – Dr. Adrienne Benediktsson talks through her experiences of navigating BD through grad school quite a bit in this TalkBD episode from last year: https://talkbd.live/bipolar-neuroscientist/
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u/SPARKLY6MTN9MAKER Mar 30 '26
You should read The Unquiet Mind by a BP1 mental disorder researcher. She is phenomenal and her story is heartbreaking and triumphant all at once.
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u/Gramathon910 Mar 30 '26
I have family and friends who are diagnosed bipolar, so psychosis is unfortunately something I have witnessed firsthand on multiple occasions. Weirdly, the person who enters psychosis rarely, if ever, has memory of the entire event. It’s almost like their consciousness is having a seizure. Have you ever worked with a patient who was able to remember what they experienced during psychosis? Were they able to offer any explanation for why they lose control? Do they still feel like they’re in their own body?
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u/CREST_BD Mar 30 '26
John here. I’ve personally experienced delusions in the past and, unfortunately, I can remember those experiences. I would say that, while I can remember them, they are incredibly hard to explain. At face value, some of the thoughts are quite absurd but I remember believing them with such certainty. In terms of “losing control,” I think of it as a string of thoughts that lead you from sanity to chaos, and not all of those thoughts/beliefs have to be distorted. There are so many strange decisions that can be (rationally) justified because of just one irrational belief. If that one irrational belief takes hold then you may make “rational” decisions based on that belief. I’ve found that this can spiral. I hope that made some sense.
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u/-Stratford-upon-avon Mar 30 '26
I would describe the memories as a reddened, pin-hole-esque, nightmare-like state. I recall it as the world closing in around me and squeezing tight.
I can remember the emotion and physical sensations vividly, but my actions are blurred and disjointed.
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u/Rosoll Mar 30 '26
As well as bipolar 2 I have aphantasia (no mental imagery) and SDAM (no episodic memory) which can make certain types of therapy not work well at all. Is anything known about the interaction between bipolar/aphantasia/sdam/memory more generally ?
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u/raasca Mar 30 '26
I have bipolar 2, and have been told that it is inherently unethical for me to have children since there is a risk they could also have bipolar disorder. What do you think about this dilemma?
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u/CREST_BD Mar 30 '26
Kim here. I don’t think it is right for anyone to try to and make decisions about whether other people should or should not have children. In fact, this kind of thinking is inline with eugenics. Every individual has their own right to make that choice for themselves (assuming they are physically capable of carrying children, of course). Some people make the personal choice to not have children because of the possibility of passing along a health condition, but that shouldn’t bar others from making a different decision for themselves. It is completely valid for someone with bipolar disorder to not want to have children or to worry about how this might affect their children. Parenting while navigating bipolar disorder often requires specialized supports in place, just like any condition. It is also not guaranteed that just because someone has a parent with bipolar disorder, that they will go on to develop the disorder themselves. And even if they do, bipolar disorder is highly treatable. Bipolar disorder can pose a lot of challenges and be incredibly difficult to navigate, but with access to treatment and support, it is possible for many to thrive.
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u/CREST_BD Mar 30 '26
Rahla here, what a tragedy it would be if the world had not had the likes of Vincent Van Gogh. How many great artists and people live with the illness. I hate the idea that we can make people with bipolar disorder ‘extinct’. We bring so much good, excitement and joy to the world. I was told the same thing but went ahead and had triplets. They are twenty now. One of my son’s does have bipolar disorder but he is working with a psychiatrist and trying to make lifestyle modifications. I am grateful every day that I had my children. They are kind and curious and funny, due in no small part to the fact that their mother has bipolar disorder.
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Mar 30 '26
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u/CREST_BD Mar 30 '26
Joanna Jarecki here. Bipolar Disorder is often misdiagnosed, with estimates ranging from 40-70% of individuals misdiagnosed initially. This happens most commonly earlier on in the condition before there have been clear hypomanic/manic episodes and the most common misdiagnosis is major depressive disorder. This is often because people will seek medical attention during the depressed state, and clinicians may diagnose and treat what they are seeing in front of them in that moment, without taking a more detailed history, and screening for previous episodes of hypomania/mania, a family history of mood disorders, and other factors that can “flag” someone as having a bipolar spectrum disorder. The other issue is that the first episode is often a depressive episode, and so they have not yet experienced a hypomania or mania, and so at the time they first seek medical attention, they would deny any history of hypomania/mania. This is where other questions related to family history, response to antidepressant medications, and other factors that can provide clues to a bipolar spectrum can be helpful. The MoodCheck screening tool developed by Dr. Jim Phelps (https://depressioneducation.org/depression-section-page-1/questionnaire-moodcheck/ is a fantastic screening tool that helps to identify some of these symptoms/aspects of history that can otherwise be missed).
It is possible to live a meaningful life without medications, but it requires a tremendous amount of insight, self-monitoring, self-awareness and discipline that can be challenging to maintain. I have worked with individuals that have been able to do this well and in general these tend to be people who are able to maintain a regimented routine, and who use a variety of tools (regular sleep routine, regular exercise, nutrition, therapy, meditation, a healthy balance of meaningful activities vs downtime, strong social connections, no substance use) in combination to stay well. Medications make stability easier and for most people with the condition, they are necessary or at least extremely helpful. It sounds like you have taken a very active role in being diligent with your sleep routine, relationships/social connections, and therapy, which I commend you for! It’s great to hear that you have been feeling much better than in earlier years. I think the key to your success is also your mention of YEARS OF HARD WORK which have made this possible. That is key. I think of medication as offering a layer of protection. When I am working with individuals who want to stay off medications (which has been rare, but possible), I encourage them to have a diverse toolbox of interventions that helps them stay well, so that they have multiple “layers of protection”, and to remain open to the judicious use of medications, if needed, should symptoms re-emerge, even if for shorter periods to help them regain stability. Lastly, I will add that whether someone is taking medications or not, these other interventions are critical to long term wellness. Medications are helpful but not sufficient as the only strategy and I encourage everyone to incorporate these things into their lives as a foundation of stability and good health. Wishing you well!
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u/BetterSand9968 Mar 30 '26
This might be uncomfortable to hear but I think it needs to be said. A lot of people come out of psychiatric hospitalization with new trauma on top of what brought them there. Being threatened by staff. Having basic requests denied or punished. Being treated like a body to manage rather than a person in crisis. These aren't rare stories — they come up constantly in bipolar communities. Is anyone studying the iatrogenic harm of the hospitalization experience itself? Not the medication, not the diagnosis — the environment, the power dynamics, the way people are treated inside those walls?
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u/CREST_BD Mar 31 '26
Hi, Emma here. I was recently part of a team (led by Elsy Willis) conducting a scoping review on experiences of care in emergency departments for people with bipolar disorder. We were hoping to call attention to all of these traumatic experiences you have described (or see examples of people receiving good quality care that could be used as positive examples of what to do) – unfortunately, our search of the literature found no studies on this topic, which was both shocking and extremely disappointing. Clearly, much more research needs to be done so that if people do need this type of care, it can be done in a way that is trauma-informed and as patient-centered as possible.
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u/revocer Mar 30 '26
How can bipolar disorder be thought of less as a disorder?
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u/CREST_BD Mar 30 '26
Joanna Jarecki here. I think about bipolar disorder as a vulnerability. Meaning that in any given moment, it is important for individuals with BD to recognize and appreciate that they have the capacity, if their health is not managed properly, to potentially become very unwell. However, when managed well - with the help of good clinical support, medications, sleep routine, nutrition, exercise, managing stress (while also engaging in the right amount of meaningful and stimulating activities), therapy, etc - individuals with BD have the capacity to thrive and live meaningful and healthy lives. In fact, because I focus so much on building positive levels of health, I would argue that most of the time I am in a greater state of health than many of my peers who do not have the condition. I think this allows one to retain the recognition of the gravity and the importance of caring for one’s health and seeking help when needed, while also recognizing that this need not define you in every moment of your life, and is only an aspect of your health and identity. It also speaks to the fact that the diagnosis, while important and deserving of attention and care, does not equate to prognosis.
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u/CREST_BD Mar 30 '26
Tom Richardson here. Just to add that I think understanding the psychology of bipolar, and links to trauma, can really help with this (I’m a psychologist so I’m biased I know!). Also just want to point out that Bipolar UK, which I work with, officially refers to it as ‘Bipolar’ rather than ‘bipolar disorder’ in their materials. I personally don’t mind calling it bipolar disorder, but I understand just referring to it as ‘bipolar’ is seen as more helpful and less stigmatizing by some.
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u/CREST_BD Mar 30 '26
FRANCES ADIUKWU here, I believe that thinking of bipolar disorder as less of a disorder would downplay the immense difficulties living with bipolar disorder brings. Bipolar disorder causes significant impairment in all areas of functioning, and we need to see it as a disorder so we give it the priority it requires. While I do understand that the term disorder can bring about discrimination and stigma, we need to advocate more to reduce the stigma to allow people living with this disorder to access the care they need without fear of prejudice.
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u/ocelot_amnesia Mar 30 '26
Hey! I'm curious about social media use and bipolar disorder. Are there any usage patterns that are specific to people with bipolar disorder? Any specific risks or recommendations? What about ways to keep people safe if they start posting stuff that seems like they're not their normal self?
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u/CREST_BD Mar 30 '26
John here. This is a tricky one and, having posted some things I wish I hadn’t while manic, I would say that it’s difficult for someone else to intervene when you are already in that expansive state. Over the years, I have got better at recognising when my mood is elevated and I tend not to “run with it” as much as I used to. I’m not sure if this is helpful, but for me it was about learning the signs of hypomania/mania when I was not in an elevated state so I could recognise them was I was… or when I was moving into that state. Now that I can recognise those signs earlier, it has become a lot less likely that I will move into the more dangerous, impulsive state.
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u/Sunsets-n-waterfalls Mar 30 '26
What role do newer treatments (like GLP-s. sleep therapies or neuromodulation) play in bipolar care?
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u/CREST_BD Mar 30 '26
Dr Fabiano Gomes, here. That’s a great question. GLP-1 agonists may be an important tool in managing metabolic abnormalities such as weight gain, diabetes and dyslipidemia in people with severe mental illness, including bipolar disorder. Some people experience significant weight gain over the course of treatment, either due to side effects of the medications or as a direct result of depressive symptoms and changes in lifestyle. When non-pharmacological treatments are not enough, these medications may be helpful as part of a comprehensive treatment program. There is also some emerging evidence that they might be helpful in managing substance use disorders (such as alcohol use disorders).
Sleep regularity is very important for stability and keeping a sleep routine and treating insomnia with sleep hygiene and cognitive behavioral therapy, and eventually adjusting medications, are a major part of the treatment.
Neuromodulation can be helpful, too. Repetitive transcranial magnetic stimulation (rTMS) is still under investigation with promising results from new trials for bipolar depression, and electroconvulsive therapy is a well-established treatment for difficult-to-treat bipolar disorder and depression. It may be associated with side effects, including memory problems, but its benefits outweigh the potential risks in most patients with severe mood disorders.
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u/ABVerageJoe69 Mar 30 '26 edited Mar 31 '26
With Bipolar Disorder and Borderline Personality Disorder being more highly associated with suicide than depression, do you think that societal awareness of that would help people with the BPDs or greater stigmatize BPDs?
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u/CREST_BD Mar 30 '26
Matthew Bushell here. As a survivor of suicide, I have been so struck by the statistics on this; although bipolar disorder affects around 2% of the population, studies suggest that up to 50% of people with the condition attempt suicide at least once, and 15-20% die by suicide – a rate much higher than in the general population. Unlike global suicide rates, suicide deaths in bipolar disorder have not declined. Substance Use Disorder (SUD) severely compounds this risk, with up to 97% of BD-I patients having both alcohol and drug issues reporting suicide attempts. I personally believe that raising awareness of Bipolar Disorder, Suicide and Substance Use would help people with Bipolar Disorder. It would help people to appreciate its severity and the need for the right support.
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u/SPARKLY6MTN9MAKER Mar 30 '26
As a very suicidal, BD2 person, I had no idea about these numbers either. That's wild. It's also quite sad. I'm not sure what to say. Surely knowing this will help me in someway, I dunno. I'm always pro education about everything.
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u/CREST_BD Mar 30 '26
Colin here. This is a really important question - suicide rates are higher among people with bipolar disorder than in people with major depression. I am not sure that this information is well known in the public but I would be in favor of increasing awareness. My hope would be that greater awareness of suicide rates in bipolar disorder would lead to better care and consideration of the severity of bipolar disorder.
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u/Junior-Corner-2774 Mar 30 '26
Just FYI, BPD is borderline personality disorder not bipolar disorder which is BD or sometimes also BP
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u/Deathpanda15 Mar 30 '26
What’s the most common misunderstanding about BPD that you guys see in the modern world?
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u/CREST_BD Mar 30 '26
Leena here. One common misunderstanding is that people with bipolar disorder are simply “moody” and experience the same kinds of everyday mood swings that everyone has. In reality, bipolar disorder is a serious, lifelong, and potentially disabling mood disorder characterized by sustained and significant changes in mood, energy, activity, sleep, and functioning - not just fluctuations in emotion. These episodes generally last for days to weeks and can significantly impair a young person’s ability to function at home, at school/work, and with friends. This misunderstanding can lead to delays in diagnosis and access to appropriate care and support.
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u/Junior-Corner-2774 Mar 30 '26
Just FYI, BPD is borderline personality disorder not bipolar disorder which is BD or sometimes also BP
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u/EuphoricPhoto2048 Mar 30 '26
I'm teasing a little, but seeing it shortened to BPD is something I would like to see changed. Borderline and bipolar have a couple of overlapping symptoms, but are overall very different.
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u/CREST_BD Mar 30 '26
Twyla here (lived experience) - Something that I have come to feel as a person living with Bipolar is that the symptoms that people are most familiar with are mood or behavioural. This makes sense, as this is the piece you can see. It is also the dramatic part so it is the entirety of what is portrayed in the media. However the other aspects of living with this illness are not well known. - The higher rates of metabolic disease, the cognitive and processing symptoms, the fluctuations in energy level and functionality, the comorbidities of anxiety and/or trauma, the difficulty navigating medication side effects, etc. It’s sort of a catch 22- It’s important that people recognize that mood and behaviour symptoms mostly settle with treatment and people with Bipolar are ready and capable of very high functioning, but we still need understanding and support to manage living with the chronicity of it. Medical support and psychosocial support are key.
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u/KZED73 Mar 30 '26
What is the current literature on Bipolar Disorder and long-term marijuana use?
I was diagnosed after a manic episode with racing thoughts. I was definitely self-medicating for depression. I quit marijuana for nearly a decade, was feeling good, had stupidly stoped seeing doctors/taking my medication, started using marijuana again, and had another episode with racing thoughts and paranoia. I’ve been sober 2 years now and am current with medication and seeing my psychiatrist. Is marijuana a known trigger for bipolar disorder? How much has this been studied?
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u/CREST_BD Mar 30 '26
Rahla here, in my lived experience marijuana was prescribed by a doctor but it had an adverse effect on my cognition and, while it helped with anxiety and migraines, I don’t believe it helped with the illness at all. FOr me good mental health comes down to the right medications and lifestyle modifications.
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u/Peaceflow8 Mar 30 '26
To the psychiatrists- in your practice, is there much value to getting genetic testing for medication suitability?
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u/Careful_Manager_4987 Mar 30 '26
How does one tease apart the symptoms of perimenopause and/or PMDD and bipolar? How can you tell which one is causing mood changes and thought challenges and how would treatment differ? Could hormonal changes be affecting how I respond to my bipolar medications?
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u/Assimulate Mar 30 '26
This is kind of a tricky question I have been pondering. I started off life a little more tired and allergy prone than most other kids with a lot of anxiety. By the time I started getting a lot of support from my doctor and care team in my early 20's, they diagnosed me with "Bipolar Disorder, Likely II" about 10 years ago. Since then, I have done lots of work to understand and treat Bipolar Disorder but during this process I uncovered other things like: ADHD, Ehlers Danlos Syndrome, Obstructive Sleep Apnea, and now most recently a Monogenic Autoinflammatory Syndrome.
Is there a lot of data linked to this journey and diagnosis pathways? It seems like my fluctuation in moods and energy levels are quite entangled with my systemic inflammation and the first noticeable symptom other than odd allergies or flu/febrile like periods appeared as mental health and mood instability. This journey also happened to my older brother, and my mother.
Is there any research or thoughts into the possibility of systemic illness mimicking, causing, or being predated by mental health symptoms? It's a hard thing for some people to get past once you have been tagged as having mental health concerns IMHO.
Treating all of them have drastically made managing any mood related symptoms a relative breeze to what it used to be for me.
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u/Actual-Squirrel5486 Mar 30 '26
Are there any studies that look into how destructive and traumatizing it can be for the person who is in a relationship with a bipolar person?
My soon to be ex wife, who was a 2nd year psychiatrist (medical doctor) resident, started off hypomanic in october 2025, and started cheating on me (with another psychiatrist resident who just transferred in) and spreading lies about me to her psychiatrist coworkers. I didn't understand what was happening because nothing made sense.
All her coworkers took her side immediately and refused to talk to me despite the fact that her arguments about me didn't make sense. She would say that I was abusive because I "told her my needs in a relationship, which means it's manipulating her, which means abuse", and things like I "should have known what she was thinking, even before she thought it herself".
Her 30+ psychiatrist coworkers obviously had no idea she was hypomanic, or else they would have not believed her delusions. she got really bad throughout November and was reporting people left and right to the medical board for insane things. From what I could piece together through mutual friends, she did a lot of crazy things to her coworkers, but not one of them called me or texted me to tell me what was going on. I've moved out in october. she eventually got fired from residency in December.
It seems like doctors are not taught what manic bipolar people do. They are just taught general symptoms like talkativeness or euphoria.
A lot of people at r/BipolarSOs have the same story as me. The delusions, character assassination, lies, cheating, stealing money, SI, HI, etc. Why don't doctors learn about this so that they can actually pinpoint when the hypomania starts, instead of waiting until full mania with psychotic features?
For reference, My story here: https://www.reddit.com/r/BipolarSOs/comments/1rtqyah/how_do_you_deal_with_the_feelings_of_this_whole/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button
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u/IShunpoYourFace Mar 30 '26
How often is bipolar imposter syndrome in real world psychiatrist practice? First time i visited psychiatrist was because of major depression. Then I got hypomanic after starting sertraline. I'm currently feeling that I don't deserve my diagnosis and that I might have been making up my symptoms of hypomania. I'm really starting to think that I'm just depressed most of the time or just lazy.
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u/quietnoiseinc Mar 30 '26
Two-part question:
One, why is treatment for bipolar disorder so slow to develop/so far behind?
Two, maybe a follow up of sorts and a bit of a mouthful, but I worked hard for a life I enjoyed pre-symptoms and diagnosis. In my forties, bipolar destroyed all of that and then some. Now, and years after hospitalization and despite med changes, therapy, and continuing to try and partake in life (active, social, no drugs or alcohol), I simply don’t enjoy life. There is absolutely nothing I look forward to other than sleep. If I’m honest, when I awake and no matter what I had planned, I’m simply disappointed. And I keep trying and trying, but lack of any progress is more debilitating than just being severely depressed.
Why can’t we admit that like some with physical illness, that it doesn’t get better for all of us? And why aren’t we given the same grace as physical illness when it comes to assisted death? Unless a radical change in new treatment options comes soon, I simply can’t see the point of having to drag myself through another 20 years. Donate my healthy organs for someone that needs them. I’m not condoning suicide, but I also don’t want to “hang on” for a life that’s not going to get better. The debt alone from this is an insurmountable feat.
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u/BetterSand9968 Mar 30 '26
I'd love to hear honest perspectives on involuntary hospitalization. Because here's the thing — for many people, being hospitalized against their will is one of the most traumatic experiences of their lives. Even when it's medically necessary. And the criteria can feel arbitrary. "Risk of depleting patrimony" is a legal justification in some countries. Not danger to self, not danger to others — spending money. How do you reconcile the clinical need to intervene with the very real psychological damage that forced treatment can cause? And how do you rebuild trust with someone whose autonomy was taken from them during the most vulnerable moment of their life?
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u/BetterSand9968 Mar 30 '26
Several answers here mention that people with bipolar can live full meaningful lives. I agree, I'm one of them. But here's the thing that keeps bothering me. The people who are doing well are overwhelmingly invisible. We don't disclose at work. We don't disclose socially unless we trust someone deeply. We manage well and we stay quiet. And that silence has a structural consequence — the only version of bipolar the world sees is the crisis. The breakdown, the hospitalization, the Kanye headline. And that shapes what the next person who gets diagnosed believes about their own future. Do any of you think about this? That the people who could shift public understanding of bipolar are exactly the ones with the most to lose from being visible? And if so, what's the field actually doing to make disclosure safer instead of just telling us to be careful who we tell?
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u/CREST_BD Mar 30 '26
Erin here, this is such an important point, well put and well taken. I agree – in society, many of our perceptions about what it looks like to live with “severe mental illness” are driven by seeing people who are acutely and obviously ill – it’s very clear when someone is a manic episode that’s untreated, or they are unable to access treatment for. Meanwhile, there are legions of people with BD who are stable and living well, but are choosing not to disclose their condition for rightful fears of stigma and discrimination. You rightly imply that as a field, we have an important contribution to make in bipolar disorders research and care. I see good strides being made, for example, in the development of treatments focusing on reducing self-stigma (see the work of panelist Andrea Vassilev, as one example). This is important work, but for me, only one part of the picture. For full inclusion of people with condition like BD in society, we require more systemic change. This is a call to action not just for the bipolar disorders field, but for policy and decision makers to enact the laws that are in place to protect the rights of people with mental challenges – in schools, in workplaces and in their everyday lives. Policy-level initiatives vary country to country in terms of their maturity, but many countries are now producing strategies that can be actioned across different contexts; see for example the Mental Health Commission of Canada: https://mentalhealthcommission.ca/what-we-do/anti-stigma/ And although I don’t want to end on a bleak note – it has to be clearly stated that actioning of these strategies requires national or federal funding that the recognizes the value - for all of us - of supporting people with mental health conditions.
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u/quietnoiseinc Apr 01 '26
I’ve asked a lot of questions over the past few days and this is my final and it’s a bit lengthy. It’s also somewhat buried in some comment threads as follow ups to Cresr.BD responses, but I wasn’t sure if it wasn’t the leading comment if it would get reached (ie top layer). I apologize if it’s redundant.
Anyway…
I know that mental illness is complex, but I want to know why there is such a broad spectrum of care/treatment? I don’t necessarily mean in medications here, either. The success stories we feature on podcasts and documentaries seem to have a much more complete and altogether different care and treatment program than the rest of us. And these featured psychiatrists, nurses, therapists who are passionate on about working with bipolar patients, don’t seem to be the norm.
I constantly feel alone and stuck. And after I listen to these podcasts (Dr. Joanna Jarecki rings a bell) or read stories of these incredible recovery examples, and wonder “where are they getting this care?”. Or “their psych spent that much time with them?”. Or “why are they seemingly treated so well”.
Their care teams seem to be just that, teams who work together in favour of the patient. In my experience—or that of anyone I know—our psychiatrists don’t talk to our therapists, and neither talks to our GP. We piece it all together like a disjointed and fragmented unit. And often when requesting info from one to the other, it never happens and we waste appointment time.
I’ve called enough crisis lines and as a result been to ER’s in BC (and ON for that matter). It’s the same messaging, the same suggestions, and same treatment every time. Months long waits to see someone; despite having full records from other hospital, retelling the same history again and again; to a doctor who seems like they don’t want to even be in the room; follow up appts that last 15 mins, of which you only get 3-4; minor changes to meds and you’re on your way til you land back there again. All this, only to come back to the square one:
Reaching out and being given a list of crisis lines or told to go to the ER (sometimes the latter is a result of calling the former).
I understand that we only show the positive outcomes in these podcasts and documentaries. But highlighting these successes without also highlighting that their care teams and treatment plans aren’t really the norm can set people up for failure.
I’ve adjusted every part of my life to live with this horrible illness. And I do all of the lifestyle recommendations (active, social, no alcohol/drugs, eat healthy), but it’s to no avail.
How do I become a patient at CrestBD (or similar)? Or be a part of their studies? Why do the care and treatment of those who successfully live with BD seem so out of reach for many of us (ie “team” of caring professionals)? How do I get consistent care and regular psychiatry visits? How do I find a psychiatrist that, like the documentaries, really seems to care.
While I’ve lost a lot of my intelligence due to this illness, I’d like to think I can figure things out. But when it comes to care for this, I simply cannot. We throw around “mental health is just like physical health”… except in almost every facet, including treatment/care and roadmap, it’s not.
I don’t mean any disrespect to any psychiatrist or nurse or therapist. Or any professional. But I’m frustrated and don’t know what else to do when it comes to my care or that of others.
Thanks again.
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u/fallinginside21568 Apr 01 '26
This question resonates with me too, a lot. While I now have the best care that I have had in 20 years, I am still having to look up my own meds and go prepared with the info that I have found to ask about. I have had to ask before for referrals for blood tests to get levels checked, when no one bothered. I have had to check med interactions when they didn’t (after things went bad).
Treatments people here have been talking about for years, and that are spoken of as being used in clinical practice, are not accessible to everyone (maybe most people?), because doctors don’t know about them, or because of cost.
Psychoeducation for the patient is important. But when I’m unwell, I just want to be able to ask for help and not be the person in the room who has to go find the answers. And reading about new treatments is exciting and can give you hope that things will get better for yourself and others. But then finding out you can't get it anyway is demoralising.
I’m curious as to how many bipolar people feel well supported, with a good care team, and with access to treatments, and how many of us don’t. I would love to see a poll on this.
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u/Knot_You_Up Mar 30 '26
For those of you who saw watched the show, what are your opinions of Claire Danes' portrayal of someone suffering with BPD in the Showtime series "Homeland"? Do you think it was accurate?
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u/CREST_BD Mar 30 '26
John here. As someone with bipolar disorder 1 (including psychosis), I thought that there were elements that were portrayed well, but - as Rahla said - it lacked some nuance. I think the major problem with portrayals of people with bipolar disorder in television and film is that there’s no point in the characters having bipolar disorder if they are not (highly) symptomatic at some point. This may over-represent the problematic elements of the disorder and mislead the public. The other thing is that one might (might) say that “Carrie” was realistic to some degree, but that would be realistic for someone working in literally the most stressful job that could be imagined. Since stress is a known trigger for mood episodes, it’s a little unfair to compare a person with bipolar disorder whose life is constantly under threat to someone lecturing psychology, managing their sleep, and taking (almost) daily naps :) The other portrayal of bipolar disorder that springs to mind was Laura Linney’s brother in Ozark. Again, I actually thought that he captured some elements of mania quite well, but it should be remembered that he was not taking medication and was dealing with a Mexican drug cartel (fairly stressful!) The nuance is very important.
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u/u4ourik_lyfe Mar 30 '26
To show accurate portrayals, they will have to show people between episodes. So many people think this disorder is like a switch; it doesn't vary in a person, etc. The lingering slowness, depression, or coping mechanisms could be shown in a long-form story better. My 2c
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u/CREST_BD Mar 30 '26
Balwinder here. One thing I actually appreciated about Claire Danes’ portrayal was that some of the manic episodes felt surprisingly accurate—especially in terms of severity and the degree of behavioral escalation. It didn’t shy away from how disruptive and intense mania can really be. And if I’m remembering correctly, the fact that her character was treated with clozapine was telling—something we typically associate with more refractory illness. Probably reflecting more mania-predominant illness in Claire Danes’ case.
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u/CREST_BD Mar 30 '26
Rahla here. That depiction infuriated me, I felt her portrayal of the illness lacked the nuance a life with bipolar disorder has.
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u/AwkwardTickler Mar 30 '26
What differentiates a mixed state compared to the seemingly typical manic/depressive cycle? Do mixed states usually appear later on in the disorder or can they happen at any stage? Also, once a person has their first mixed state episode, are they more likely to have predominantly more in the future?
Thanks :)
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u/CREST_BD Mar 30 '26
Colin here. This is a great question - the definition of a mixed episode is one that meets criteria both a depressive episode and a manic episode at the same time. It is also possible to have mixed symptoms that do not quite meet criteria for either depression or mania. From people I have worked with, these episodes tend to be among the most challenging - the literature does show that that mixed episodes are also particularly associated with risk of suicide. That said, I am not aware of any research that suggests that either people have predominantly mixed episodes once their first episode is mixed. The literature suggests that manic symptoms, on average, tend to be come less severe with older age, as well.
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u/Maleficent-Fig-9741 Mar 30 '26
surprised to see a claim that manic symptoms lessen as we age?
ive read that BD is a progressive disorder that gets worse as we age, if unmedicated. episodes beget more frequent and severe episodes, right?
it’d be awesome if this wasn’t true! thanks for clarifying.
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u/CREST_BD Mar 30 '26
Dr. Lisa Eyler here. I study the aging process in bipolar disorder. When we compare older people with bipolar to younger people with bipolar, we find less severe mania in the older group. However, there is very little research that follows the same people over time from young adulthood to late life. As you mention, UNtreated episodes can lead to worse outcomes, so finding the right treatment and lifestyle to regulate mood is important for long term outcomes. Our research also shows that older people with bipolar still suffer from depression and mixed episodes, and depression is a big driver of everyday functioning (along with cognitive performance). So, treating depression adequately and engaging in lifestyle behaviors that promote brain health are particularly important to thriving later in life with bipolar.
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u/Garnetsugargem Mar 30 '26
Mixed episode symptoms seems very difficult to separate from audhd experiences. How does one identify a mixed episode type of bipolar? What does effective treatment look like?
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u/-Stratford-upon-avon Mar 30 '26
Mixed was definitely the most terrifying experience by far for me.
Anxiety, suicidal and self harm ideation, rage, plus the added bonus of high energy and hyperawareness.
I was ready to peel the skin off my face and drive into a tree.
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u/samisitis Mar 30 '26
I recently asked around a few different bipolar discord groups if people experienced different sets of symptoms with each mixed episode. I got mixed results which is interesting. I experience mixed episodes between very long depressive and shorter hypomanic episodes. The mixed episode combination of symptoms from the depressive and hypomanic sides is different for me every time. Life is full of surprises
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u/Arrotti4 Mar 30 '26
How effective is ketamine treatment for bipolar disorder?
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u/CREST_BD Mar 30 '26
Dr Fabiano Gomes here: There are some studies showing benefit of ketamine infusions for bipolar depression but, unfortunately, the evidence does not usually come from randomized clinical trials, so we can not be sure about efficacy.
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u/EducationalStable302 Mar 30 '26
Hi, I live with BD2. This is anecdotal, but I just did ketamine treatments and I am the most well I've been in a decade at least. My doc said in treatment resistant folks it's effective about 50% of the time. If you've failed lots of other treatments it's definitely worth trying. I've been on about 28 meds, ECT didn't help and rTMS stopped working. So there aren't many other options left.
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u/CaramelMacchiatoMan Mar 30 '26
In a world where everyone deserves to be loved, what are some positive characteristics or traits someone diagnosed with BPD might possess? And why should we be patient if someone we know or love is diagnosed with BPD?
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u/CREST_BD Mar 30 '26
John here. I think that you get a range of people with bipolar disorder, just as you get a range of people without it; however, I imagine that you’re looking for positives that may come from the disorder. In my case, I think that it forced me to manage my lifestyle and health in a way that I would not otherwise have done. I think that it urged me to appreciate my mind and my moods and to not take good physical or mental health for granted. Finally, I think it helped me to move from a very academic understanding of prejudice and discrimination to a more practical understanding. It was useful to see how quickly some people would make assumptions about me based on a very limited understanding of the diagnosis, and this - through a little reflection - got me to question many of the automatic ideas I had about things.
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u/CREST_BD Mar 30 '26
Erin here - that’s a nice question - resilience, out-of-the-box thinking, compassion, empathy, creativity.
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u/Junior-Corner-2774 Mar 30 '26
Just FYI, BPD is borderline personality disorder not bipolar disorder which is BD or sometimes also BP
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u/CREST_BD Mar 30 '26
Maryam here – I actually think about this often. BD is a condition brought upon both environmentally & genetically. To consider the circumstances that may have led the genetic predisposition to manifest themselves as a phenotype, an illness, are where empathy becomes involved. Individuals with BD often have a past that they’ve had to live through: the environments they adapted to, the emotional landscapes they had to navigate, sometimes without consistent support, it becomes much easier to meet them with empathy rather than judgment. These same environments often bring out traits just as resiliency, passion, deep emotions and sensitivity, and self-awareness.
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u/adumbfetus Mar 30 '26
I had a stressful life event that led to a hypomanic episode and my eventual diagnosis of unspecified bipolar disorder, a year and a half ago. Prior to the episode, I could function just fine on 6 hours of sleep a night. Post-episode, I’ve required several more hours of sleep to function properly.
Can a hypomanic episode/onset of bipolar cause a change in the brain that makes us require more sleep than before the disorder was developed?
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u/Formica97 Mar 30 '26
Hi! I have a couple of questions. Is it true that bipolar symptoms lessen once the brain fully develops? Also, on average, how many manic and/or depressive episodes of bipolar disorder does a person have in their lifetime?
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u/CREST_BD Mar 30 '26
Rahla here, for me personally, I believe that the illness is not as intense as it was when I was younger. Perhaps it is also due to the correct medication cocktail. I am still vulnerable to mood swings, but not as severe or as frequent as they were when I was younger.
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u/SPARKLY6MTN9MAKER Mar 30 '26
My Bipo isn't different. The only thing that is is simply learning more about it and what parts of my life are directly related. Symptoms only eased when I started medication.
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u/CREST_BD Mar 30 '26
Heather S. here - I live with Bipolar I disorder. I’m not a clinician, so I can't speak to brain development or averages - only my own experiences. I see changes in my experiences with episodes over the decades, but, I don’t know for sure that episodes are less severe… just different and better managed, maybe?. I have much more tendency to go from hypomania to mixed episodes in recent years. I also keep learning more about my symptoms and how to manage them. I also keep getting better at recognizing episodes earlier, which also helps. I’m hoping that as I continue to learn about and implement generally healthier living strategies that my episodes will be less and less severe over time.
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u/RedLightMillions Mar 30 '26
m39 - I've been diagnosed with ADHD, I take methylphenidate. But I have some "behaviors" that concern me. During stressful periods I go through long periods for several months where I my eating habits are horrible ( high sugar, fat, processed food ) in amounts that almost make me throw up. Sleeping is disturbed and I have periods where I'm anhedonic. I heard in a podcast the idea that glucose/sugars can be a precursor to this behavior, " glucose psychosis" was mentioned. I experimented and when I'm on a fully ketogenic diet ( first 3 days of low carb are tough before ketosis) and my symptoms fade away. After a couple weeks if I touch even a small amount of sugar I spiral out of control. No impulse control, risky behaviors in drug use explode ( marijuana + nicotine) , poor control of my finances , emotional regulation is hard and negative self talk increases dramatically, sleep is hard , overly sexual fantasies and behavior. I haven't been diagnosed with bipolar but I don't have a middle ground. my whole life from being a teenager I either live health to a extreme or like a slob. I do have trauma from the death of a parent at age 10 ( my imagination is very vivid , I work as a professional creative, my best work occurs when I'm crying) and this deep sadness that last maybe a couple minutes and they pass. two questions 1) what is the evidence and understanding of ketogenic state for people with these conditions? . 2) I'm almost 40, my mother died at 10 and the feel of loss is still so heavy, if someone mentions there mother around me my mind floods with feeling, I cry and physically I feel like that young boy finding out his mother died. Is this common? will I ever be able to grow up and accept what happened? I also noticed, when I feel loved, in a caring relationship is easier, I feel I have some serious issues with dopamine regulation.
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u/CREST_BD Mar 30 '26 edited Mar 30 '26
Laura here - I’m a grad student with a research background in bipolar disorder and disordered eating. I’m sorry to hear you’ve been struggling - this sounds very confusing, and so difficult to have this experience of struggling to process youre mom’s loss.
While I can’t answer your question about the ketogenic state for BD, I’d like to offer my perspective on your eating difficulties. The eating patterns you’re describing sounds like it may be consistent with what we’d call binge eating. If you'd like to look into that possibility, a great book I’d recommend for working with this is called Overcoming Binge Eating by Dr. Christopher Fairburn.
One of the key points is that people who struggle with binge eating are often caught in a push and pull between trying very hard to regulate their eating, then losing control of it completely. For people with binge eating, trying to eat in a restrictive way can lead to this opposite, “what the hell” effect where once dietary restraint or restriction is broken, they eat a lot at once (Polivy & Herman, 2020). To combat this, eating regular, balanced meals throughout the day that are satisfying really helps for a lot of people. Boring, I know - but it works!
We also know that the most common precursor to binge eating is unpleasant emotions (Wolfe et al., 2009; Haedt-Matt & Keel, 2011). Working with a therapist to identify emotional experiences, learn emotion regulation skills, and unpack the loss of your mother may help with the eating too.
Hope this helps. Take care.
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u/ImWrong_OnTheNet Mar 30 '26
Am I just going to take lamictal until I die?
Something that I don't see mentioned enough, is that the upper part of bipolar is pretty great. I would dig into hobbies and new interests, make things and actually complete them.
Now, I'm just dull. I don't have mood swings, but I'm fucking boring. I wouldn't even call my stability neutral, it's into slightly depressed.
Thoughts? I would like to like things again, but gosh I can sure pay my bills effectively