I’m not a weatherman or -woman, but as a psychiatrist I certainly know bipolar behavior when I see it. At the risk of being accused of anthropomorphizing, I must say our weather is demonstrating bipolar tendencies. It’s winter, and here in the northeast we have 50 degrees Fahrenheit one minute and 10 degrees the next. In the past, it would get cold and stay that way for a few months, and then get hot and stay hot throughout the summer.
Scientists tell us it’s due to pollution, global warming, polar vortexes, and/or deforesting. Whatever is going on, we’re uncomfortable with the constant changes. People with bipolar disorder are usually uncomfortable as well with all the mood shifts they endure. When they’re up, psychiatrists call it manic — they may spend too much money, have indiscriminate sex, are insomniacs. It may sound like fun, but being manic for too long leads to negative consequences. The manic person may be irritable, may fly into a rage for no reason, and can strike out at others or him or herself. I had one patient who attempted to swim across the lake in Central Park because he felt so powerful. Needless to say, he hurt himself badly and suffered hypothermia. He was all cut up from cans and other debris floating in the lake. He had to be hospitalized.
Depression, the other pole of bipolar disorder, is also unpleasant and dangerous. Most patients can’t function normally. They may oversleep or don’t sleep. They may overeat or can’t eat. Their mood is blue. Winston Churchill said: “The black dog trailed him wherever he went.” He was referring to his depression. The worst consequence could be suicide. It is thought that 25 percent of all suicides may be due to untreated bipolar disorder.
It is important to recognize bipolar disorder (often termed manic-depression) and treat it. Here are some tips on how to distinguish this serious condition from everyday ups and downs (from the DSM-5):
1) A person must have ups and downs. If just one state or the other is experienced, it’s not bipolar disorder.
2) For an up or manic episode, a person must experience an elevated mood for at least a week. Usually there is a feeling of grandiosity, an inflated sense of self-esteem, in which the person feels glorified and able to do anything. I had one patient who began directing traffic in Times Square. (Of course, he wasn’t a traffic cop and knew nothing about what he was doing. The traffic that day was an absolute mess!) There’s a decreased need for sleep. The person will be excessively talkative with a flight of ideas. He or she could be distracted easily and get into trouble, e.g., sexual indiscretions, gambling, buying sprees. All of this manic behavior cannot be drug-induced, for example, from cocaine, which can cause similar behavior.
3) In a down or depressed mood, the state must be present for at least two weeks and he/she has to feel sad, empty, or hopeless nearly every day. There is usually a decrease in the ability to feel pleasure. There could be weight gain or weight loss and insomnia or “hypersomnia” (increased sleep). Other symptoms are fatigue, guilt, decreased concentration, suicidal ideation.
4) There is usually a family history. We believe a genetic component is responsible, but we haven’t figured out the details yet.
5) Bipolar disorder usually begins in the late teenage years or in the early 20s, although children can be diagnosed or late onset could occur in one’s 60s or 70s.
6) A person can have a mixed episode of mania and depression and swing back and forth from one pole to the other. During mania, people often do not feel that anything is wrong with them.
If you find that you or a loved one has these symptoms, please get advice from a psychiatrist. There are many treatments for bipolar disorder, including drug therapy, behavioral therapy, or a combination thereof. We may not be able to do anything about the weather, but with an effective plan in place, doctors and their patients can certainly do a lot to treat bipolar disorder.
This article first appeared on the Huffington Post on 9 February, 2014.