Monday, August 26, 2013

Bipolar People Breaking Bad

As a bipolar-2 person addicted to the television show Breaking Bad, I've been wondering if some bipolar people use methamphetamine and other street drugs. Online research answered my question. Of course they do.

Bipolar people are among those who seek relief from stress in alcohol and prescription drugs and then move on to illegal substances such as meth, which they can buy on the street. Street-drug use sometimes starts in college and may come before or after a bipolar diagnosis, but meth probably cannot cause bipolar disorder.

Even more effective than cocaine, meth produces a potentially addictive spike of the neurotransmitter dopamine in the brain, which at first results in a sense of well being and increased energy. But meth addiction, while perhaps seeming beneficial, can eventually lead to a stroke or psychosis.

In a bipolar person, a meth high may become a manic state that incapacitates the sufferer and leads to hospitalization. When the highs are inevitably followed by lows, bipolar people may crash into such severe depression that they cannot function. Yet when they are in their late teens and early twenties, they are not likely to attribute their dark moods to their taking drugs that at first produced feelings of well being. Psychological counseling can make that connection for them, so early intervention is key.

Some of the symptoms meth users suffer may be similar to, but more intense than, those of bipolar disorder, making bipolarity difficult to diagnose in meth users. A specialist in helping bipolar people with meth addiction is best qualified to diagnose the problem and to oversee withdrawal.

Bipolar people are especially at risk for trying to self-medicate, using mood-altering substances without consulting a physician. In fact, Nicole Gregston, a case manager at the Mental Health and Mental Retardation (MHMR), Austin, Texas, has said that “Teens and adults with bipolar disorder are the most self-medicating emotional disorder group, often turning to drugs and alcohol to quell their mood swings.”

One risk for self-medicating with meth is that it may cancel the benefits of a prescribed drug the user also takes, or the two drugs may interact in a harmful way.

Ironically, the benefits that meth delivers in new users — a sense of self-confidence, desirability, and invulnerability — are the same ones that meth takes away with continued use. Only higher and higher doses deliver the desired results and alleviate the craving, until eventually, there are no desired results, the body deteriorates, but the craving intensifies. Add bipolar symptoms to all this, and a bipolar meth addict may wander beyond a point of no return.

Even without drug addiction, bipolar people have a higher than average suicide rate. With drug addiction, the danger of suicide increases.

An online search for meth and bipolar disorder led me to discussions by bipolar drug users. These forums are obviously not scientific samplings, but the combinations of drugs people said they use or had used in order to manage their bipolar mood swings is staggering. 

In the world of Breaking Bad, it seems safe to assume that some buyers of Walter and Jesse's Blue Sky crystals were bipolar. I wonder if their stories will show up in the planned spin-off, Call Saul. Saul might be just the lawyer to handle bipolar meth users' lawsuits.

Monday, August 19, 2013

Bipolar People Are Everywhere

Bipolar disorder affects an estimated 30 million people all over the world. It strikes women and men equally, without restriction to ethnic group or class. Age, however, is a factor, and bipolar disorder tends to appear first in young adults.

Wealthy, sophisticated countries are more likely to produce studies and statistics about bipolar disorder than are poorer nations or than societies where illness is regarded as shameful and is kept secret. As a result, a completely accurate world survey of the occurrence of bipolar disorder does not yet exist. But it seems reasonable to hope that with better ways to diagnose bipolar disorder, treatment will become better and more widely available, and statistics will be more reliable.

Cancer and Alzheimer's disease are among illnesses that are less likely to disrupt the patient's life than bipolar disorder. The reason seems to be that bipolar disorder affects many more years of a person's life than do Alzheimer's and cancer.

Diagnoses of bipolar disorder have shadowy boundaries because the symptoms cover a spectrum. In Europe, half of the approximately 2% of the citizens who are bipolar are apt to have bipolar disorder 1, which is more severe than bipolar disorder 2. Of the two bipolar extremes, depression and mania, depression typically is more common, and suicide is a threat. A third category, subthreshold bipolar disorder, has also been called bipolar not otherwise specified (bipolar NOS).

The psychiatrist who diagnosed me used the term bipolar not otherwise specified. I say I am bipolar 2, but I probably shouldn't make that claim; it just seems easier than trying to explain NOS.

Statistically, bipolar disorder is more frequently diagnosed in childhood in the United States, Norway, Spain, Italy, and Turkey than in France, The Netherlands, the British Isles, or Australia. This oddity reminds me that a friend who is an expert in statistics once said that knowledgeable statisticians can prove anything they are asked to prove by designing the questions to get the desired answers. This is not, she stressed, ethical. But it does indicate that we should be skeptical of statistics.

Complicating the international bipolar issue, outlooks for bipolar patients who are diagnosed and treated in different countries can't necessarily be compared accurately, because they may be treated with different medicines or with different doses of identical medicines.

The younger a person is when diagnosed with bipolar disorder, the more likely she or he is to begin receiving treatment at the onset of the disorder. Not surprisingly, people who are not diagnosed and treated early tend to develop more severe symptoms. Early diagnosis is, then, key in treating the disorder most effectively.

Bipolar disorder is still not fully understood. For instance, United States citizens with mood disorders are more likely to marry someone with a mood disorder than those with mood disorders in other countries, but no one has successfully explained this.

We are making progress in understanding, diagnosing, and treating bipolar disorder, but much work remains to be done.

Tuesday, August 13, 2013

To Tell or Not to Tell Employers You Are Bipolar?

If you are bipolar, should you disclose the fact to an employer when you apply for a job, or after you are hired, or not at all? Under the Americans with Disabilities Act (ADA), you do not have to disclose bipolar disorder unless and until you ask for special accommodation, such as extra time off during a manic phase.

A lawyer, however, may face greater career challenges than most, according to Melody Moezzi In some states, admission to the bar includes a questionnaire that asks if you have been treated for, among other things, bipolar disorder. Lying on the questionnaire is risky, to say nothing of dishonest. Moreover, telling the truth does not necessarily prevent you from being admitted to the bar. Nonetheless, asking the bipolar question is illegal, and Moezzi says, "Call me crazy, but I think bar examiners ought to follow the law."

Moezzi isn't the only bipolar person who has recently made news related to employment. Both ABC News and PsychCentral picked up the story about The Cash Store firing Sean Reilly when Reilly asked for time off due to his bipolar disorder. Reilly had been doing well in the job and had been promoted. A judge ruled that firing him was illegal and awarded Reilly back wages plus $50,000 for pain and suffering.

According to the Job Accommodation Network (JAN), most and perhaps all bipolar people qualify as disabled under the ADA. Although not all bipolar employees will need some kind of accommodation, one JAN suggestion is to "provide space enclosures or [a] private office."

I know this can work, because even before I realized that I am bipolar, it worked for me. Years ago I was assistant to the managing editor at Cosmopolitan. My desk was in an open area outside his office and facing Editor Helen Gurley Brown's office. The traffic was constant. I got permission to put up a three-panel screen in front of my desk so that Helen's many visitors and I could not see each other, which greatly reduced the stress of my job. I just didn't want so many people looking at me all day long.

JAN also recommends allowing bipolar employees flexible hours, and again, Cosmo serves as a model. At first I worked there from nine to five. Then my boss said (with his dry sense of humor), "You're no good to any one between nine and ten in the morning. How would you like to work from ten until six?" I am not a morning person, and shifting my hours solved that problem. I can only hope that other bipolar people will be as lucky in their employers as I was at Cosmopolitan.

Whatever your situation, you may want to settle in your own mind how you want to handle disclosure or non-disclosure of your bipolar disorder to your employer, just in case it becomes an issue.