Monday, October 21, 2013

Bipolar and Violent?

Complicating the problem of bipolar disorder and violence is the fact that victims of abuse, especially domestic abuse, are more apt to develop mental problems, including bipolar disorder, than are non-victims. While bipolar women are more often victims of domestic violence than are bipolar men, both are more often victims than are those without a mental disorder.

While the question of whether abuse can cause bipolar disorder has yet to be answered, there is some evidence that as many as half of all bipolar people experienced physical, sexual, and emotional trauma as children.

Nonetheless, most bipolar people are not abusive. A bipolar person who does become violent is probably in a manic or mixed state, although these do not always lead to violence. Bipolar violence can be addressed with psychiatric help that includes bipolar medications and will probably put an end to violent episodes. When all else fails, a bipolar person experiencing extreme mania, whether or not violence occurs, may have to be admitted to a locked psychiatric ward until the mania ends.

If you have a relationship with a violent person, bipolar or not, you should seek professional counseling about how to leave. Unfortunately, just walking away from a violent partner can put you at risk for his or her following you and continuing the abuse, because violence is a lack of impulse control. A good counselor should help you escape safely.

Bipolar people in a severe manic or depressed state may be at risk for violence against themselves as well as for violence against others. They may start cutting themselves, even to the point of bleeding to death, or they may turn to other suicidal methods. They should not be left alone, although practically speaking, providing someone to keep an eye on them may be tricky. On the one hand, a companion may not be available, and on the other hand, the bipolar person may insist on solitude.

Bipolar men of low socio-economic status are more likely than other bipolar people to become violent, because they have less of a support system. This suggests that efforts should be made to reach economically disadvantaged communities with bipolar counseling and support.
When a violent bipolar person first seeks treatment, the result is not necessarily immediate. There will probably be a period during which the doctor and patient try different medications until they find the most effective ones. Moreover, some medications for bipolar disorder can take over a week to show results. After the correct bipolar meds kick in, however, any violence should subside.

Monday, October 14, 2013

Bipolar and Pregnant (Part 1)

Even if you are not bipolar, deciding to have a baby is a major life event. But at least bipolar women are not told categorically that they must not become pregnant, which is what happened until a decade or so ago.

When I got pregnant I didn't know I am bipolar. But I had a trouble-free pregnancy with no morning sickness, and I felt terrific until I went into labor. My natural delivery with no anesthetic was naturally painful, and in retrospect, I wish I'd had a spinal. But all in all, I was lucky.

If you are a bipolar woman who wants to have a baby, consult your psychiatrist and obstetrician about medication options. Ideally, of course, years earlier you will have got medical advice on how being bipolar factors into your contraception decisions.

If the prospective father is the one who is bipolar, he and his wife would be wise to discuss with his psychiatrist how fatherhood may affect him. If both people in a couple are bipolar, they should both consult their doctors, perhaps together.

Pregnancy has never been restricted to those who choose it. Bipolar women who accidentally become pregnant had better continue to take their usual meds and consult with their doctors and the prospective father about whether to continue with the pregnancy.

If you are bipolar and pregnant or planning to become pregnant and you plan to take bipolar medications before and during pregnancy, make certain the meds have not been shown to cause birth defects. And if you do not want to continue taking meds while pregnant, be alert to the risk of self-medicating with alcohol and tobacco, which also can cause birth defects. 

A further risk is that if a bipolar woman takes no medication and becomes depressed during pregnancy, her depression can have a negative impact on the baby. Yet another key factor is that statistically, a bipolar woman who ceases taking her meds before and during pregnancy is at risk for the return of symptoms.

There is no one answer that fits all bipolar expectant mothers and their medications. Consultations with your psychiatrist and OB-GYN can help with a decision about what, if any, meds to take while pregnant.

I was surprised to read that electroshock therapy may be safer for a pregnant bipolar woman than drugs. Of course, electroshock should only be administered by a doctor knowledgeable about bipolar disorder and pregnancy.

Given the emotional nature of pregnancy even for women who are not bipolar, bipolar women can help themselves and their baby by having talk therapy regularly with a professional they like and trust. If you are one of these women, you might want to discuss with your therapist whether the baby's father should join you in at least some of the sessions.

It is a good idea to arrange well in advance of the birth to have someone who can take care of the baby if you are unable to do so until your postpartum bipolar disorder stabilizes, because a bipolar woman who is pregnant or has just given birth is at increased risk for a manic episode that may require hospitalization, whether or not she has been taking her meds.

Another key consideration after giving birth is whether or not to breast feed your baby, and if you do breast feed, whether to take medications, and if you do take medications, which ones are safe for your child? Again, find a doctor well versed in answering such questions.

Whatever you decide about having a baby, I wish you all the best. With the support of your partner, your families, and your doctors, you and your baby, if you choose to give birth, can be off to the best possible start.

Monday, October 7, 2013

Bipolar Disorder Is a Family Affair

Because bipolar disorder has a genetic component, it tends to run in families. As a result, a family with one bipolar member is likely to have other bipolar members in various generations. There also may be two bipolar members in a single nuclear family, which can't be easy for any of them.

If a family member with bipolar disorder is an identical twin, the other twin is more apt to develop the disorder than are other siblings. A non-identical twin is more likely to develop bipolar disorder than a non-twin sibling is but less likely than an identical twin.

More children of a bipolar 1 or bipolar 2 parents are bipolar 2 than bipolar 1. And first-degree relatives of bipolar people have an increased likelihood of suffering serious depression even if they are not bipolar. They are, unfortunately, also at risk for schizophrenia, alcohol abuse, and drug addiction.

A study at Stanford University concluded that children of bipolar 1 and bipolar 2 parents have a 51 percent likelihood of having a psychiatric disorder like depression or attention deficit hyperactivity disorder (ADHD). Surprisingly (at least to me) children diagnosed with ADHD more often, as adults, have bipolar children than children with ADHD.

I am bipolar NOS (not otherwise specified), a diagnosis for those of us with bipolar symptoms that don't quite fit the bipolar 1 or 2 category. I have not seen any studies that factor bipolar NOS into possible genetic connections, but I feel quite certain that others in my family were bipolar in years before diagnosis and treatment were available. 

Bipolar disorder originates primarily in the brain as a result of faulty neurotransmitters. A bipolar episode can be triggered in vulnerable people by events in their lives. Without treatment, a bipolar person may attempt to self-medicate with alcohol, recreational drugs, large doses of caffeine, promiscuous sex, and even to try to end suffering with suicide.

As we come to understand more about our brains and how they work, we can hope to see new approaches to dealing with bipolar disorder in individuals and in families.

Tuesday, October 1, 2013

Bipolar Sex

Bipolar disorder expresses itself in such a wide variety of ways that some bipolar people who have never had any sexual desire find their medication stimulates it, while others are on medication that dampens or kills their sex drive as a side effect. Having to sacrifice sex for sanity seems unfair, but that is a situation in which some bipolar people find themselves. On the other hand, adjusting medications may be a happier solution.

Hypersexuality, which is a problem for some bipolar people, is an intense, abnormal need for sexual gratification that may accompany a bipolar manic or hypomanic (mildly manic) state. The risks include having many sexual partners chosen at random, some of whom may be dangerous, and exposure to sexually transmitted diseases. Symptoms may also include thinking and talking about sex constantly and attraction to pornography. A manic episode of hypersexuality is potentially devastating for a couple.

Whether or not sexual addiction exists can be controversial, but a bipolar person whose desire for sex is out of control can find stopping is difficult or impossible without help. Psychiatrists trained in bipolar disorder provide both talk therapy and an adjustment of medications to help patients rein in out-of-control sexuality. Electroshock therapy for bipolar-1 people can sometimes eliminate or reduce sexual and other problems.

Good bipolar lovers are very good because of their intensity. Intensity can, however, be terrifying for some partners who are not bipolar. And a bipolar lover who is attempting to find relief from depression in sex is not going to be very good company out of bed. Bipolar people sometimes use sex to regulate dopamine in their brains, but the last thing a manic bipolar person needs is more dopamine making them more wired.

Bipolar depression that obliterates a sufferer's sexual desire can, like promiscuity, injure or destroy a long-term relationship. Again, adjustment of medications and talk therapy may provide relief.

Even bipolar people who are not experiencing extreme moods or any other serious dysfunction sometimes find it difficult to form a committed relationship. Lack of self-confidence and low self-esteem are possible contributing factors.

For bipolar people who have a partner, mood swings may be obstacles to creating a family. In fact, some people with bipolar-1 disorder (more severe than bipolar 2 or bipolar NOS, which means not otherwise specified) who marry choose not to have children, especially if their mood swings are frequent and intense, perhaps requiring periods in a locked psychiatric ward.

A bipolar lover or spouse, whatever the degree of their disorder, is not for everyone but can give life extra dimension for those who meet the challenge.