Living with Bipolar Disorder
Frequently Asked Questions

I Got Diagnosed in Less than Two Hours.
What Kind of Bipolar Diagnosis is That!

When I was told I was manic depressive, the psychiatrist took about an hour to do so. I never trusted him after that. According to one person who wrote me - "the doctor was either a genius or a quack."

I had been going to a therapist for a few months to deal with my problems in everyday life, never thinking I was manic depressive. It was only after a bout of mild depression that I asked to be referred to a psychiatrist so I could get drugs temporarily cope. I certainly never expected to be diagnosed as manic depressive.

I was shellshocked. I don't think anyone wants to hear the diagnosis that they are mentally ill. I certainly didn't.

But I think that caution in accepting a diagnosis of being bipolar is a healthy thing to do. If someone tells you that the rest of your life is about to be changed there is every reason to be skeptical.

They could be right, of course. But before I accept the diagnosis, I would want a bit more evidence than a one or two-hour interview with a psychiatrist. I want to look at my past in detail, so that I could see what might have been depressive or manic episodes. I want conclusive proof that those events weren't caused by stress or other events taking place in my life at the time. If I am manic depressive, I want proof that the bipolar medication works, and that I will be better in a few months time. And if I am manic depressive, I want it fixed so that I can forget about it and get on with my life.

I don't think anyone embraces the manic depressive diagnosis with open arms.

There is no medical test yet for determining if you are manic depressive. (The exception is a malfunctioning thyroid - hypothyroidism - which can mimic the symptoms of being bipolar and can be tested for. Ask your psych about it.)

As I found out, at the end of everything, the decision on whether you are bipolar rests with you alone. The psychiatrist's bipolar diagnosis is only the start of the process. You have to now finish the diagnosis and determine if it makes sense to you. But you have to be honest. Really honest.

If you have been diagnosed, you can double check the doctor's diagnosis by checking to see if you have ever had the symptoms of being manic or of depression?

You need to examine the last five or so years to see if there have been periods in which you have been depressed or manic. You can check further back in time if you wish. My experience is that it is a lot easier to remember the depressed periods because they stand out as problem times. You may not be able to remember periods of mania or hypomania as anything other than really efficient or good times in your life, unless the mania caused a disruption in your life or finances. You should pay close attention to things that happened in the last few months as you will be able to remember with more clarity and in better detail what happened and how you were feeling during this time.

When examining your history, look to see if you exhibited symptoms of depression or mania during your down or up periods. The symptoms I have experienced are listed in my When I Am Manic and When I Am Depressed pages. Other web sites have additional descriptions as well as the medically defined symptoms for depression and mania. Your symptoms might be milder or slightly different than what is described here. It doesn't mean you aren't bipolar.

Low/Depressed Periods
In looking back at periods, check to see if anything caused them. You might need to check your memory a bit carefully. Back then you would have attributed the low period to something happening in your life at the same time. In the past, I have wrongly thought that my low periods were caused by the following:

Overwork. The onset of my depression frequently happened at the end of a period of high productivity and hard work for me. I therefore used to assume that I was tired because of all the time and effort I had been putting out. But it wasn't so. All it meant was that the depression either kicked in and brought my productive period to an abrupt halt, or I just switched from being manic to depressive.

Arguments. With friends, or family, or co-workers. And then I would get tension headaches, and my mind would start rambling down all sorts of paths and I would be extremely annoyed with the person, or consider breaking off the relationship, or plot revenge. And if I was feeling down, I would attribute feeling down to the argument that happened. And it would make sense because I would be constantly thinking about it. But it turns out that the reverse was true. I was thinking about the argument because I was depressed and not I got depressed because of the argument.

The reversal of apparent cause and effect is very common with manic depressive persons. You think that an incident caused a high or low mood when in fact the high or low mood caused you to focus on an incident. I can't prove this to you. But if you are manic depressive and you monitor your moods, you will see this happening in real life.

The reason we don't usually recognise this is that we are not used to our moods changing for no reason. As a result, when our mood changes we look for a reason for the mood change. Since there is none, we pick the most convenient excuse at the time - I was vexed with Janet, I have too much work at office, the constant dropping of children to piano / football practice is wearing me down,...well, you get the idea.

In fact what happens is that you are going along pretty okay and then you become depressed or manic. No reason at all, it's just how it happens. And if you become depressed, the same things that were pretty okay suddenly look problematic. And of course we can always find a problem if we look for one. So you are feeling low and there are now problems in your life and you assume that the problems caused you to feel low. People never assume that feeling low can cause the problems.

Which is probably why depression goes undiagnosed so often.

Other things that I thought caused my low periods are:

Grappling with a Dilemma. I can remember times in my life when I thought my low periods were caused by problems that seemed difficult or unsolvable at the time. One of them was just after I got my Bachelor's degree and I couldn't get a job in my field. There I was, young and eager, and having to deal with the fact that I would have to set aside all my hard earned knowledge and do something else. For nearly two months, I wandered about the place, going bowling and wandering the beach all day and night trying to decide what to do (okay, so it doesn't sound as if I was in agony, but I was, all right.). When I finally got excited on what I would do next, I thought it was the decision itself that pulled me out of my low mood.

Now I'm not so sure. The aimless wandering and the other things I did during that time are remarkably similar to the symptoms of depression. It's not clear to me if my mulling over the topic for two months helped my decision either, and the transition from not being able to do anything constructive to a sudden flurry of activity is just like my current transitions from depression to hypomania.

Stress. I always thought that stress caused my low moods. And perhaps it did to some extent. But I also wonder how much my low moods caused me to do things which increased my stress. It was a kind of a vicious circle.

I do know that a lot of the stress was caused by poor time management. Now a lot of people have problems with time management, but it annoyed me how often I would start being organised and keep to it for a while and then everything would fall apart in a matter of two to three days. And fall apart completely to nothingness, not just be bending under the strain.

One of the things that convinced me that I was manic depressive was the start / stop madness of my time management. I'm a little too smart to be so stupid about keeping things in order but yet I was never able to keep things in order. And later on when I started keeping a mood chart, it turned out that the start / stop pattern of my time management exactly matched my mood chart.

Productive/Manic Periods
In addition to examining your life to see if your down or problematic periods may be caused by depression, you also need to check to see if your periods of high activity may have been caused by hypomania or mania.

Check your very productive times in the past and see if you also had any of the indicators I listed in the When I Am Manic section (also check against the official symptoms for hypomania - I don't get all the standard symptoms). In particular, check the ones I listed regarding work at the bottom of the list - these are most likely to be the things you remember.

Mania can probably best be remembered in looking at your happiest or most productive or most satisfying times. You need to check to see if along with your good times you had the symptoms of hypomania or mania. These times don't need to deal with office work only. It could include starting up a good relationship, doing a lot of volunteer work, doing well in studies, or having a particularly memorable vacation. Periods of hypomania or mania tends to have an intensity that makes the period memorable when reminiscing a few years down the line.

During periods of hypomania I have worked with the students of my old secondary school to set up the first web site of any secondary school in my country. I have been president of the youth group of my church and had three extremely successful and well remembered social events in a period of three months. I have hosted one of the largest Divali celebrations ever in my country. I wrote the payroll program that our family business still uses a decade later. I have renovated my townhouse in record time. I have gone out, met, and started great relationships (which I could not sustain, alas). I have written really good poetry. I have done the whirlwind vacation of six cities in seven days to visit friends. I have lost five pounds in two weeks by going to the gym every day and pushing myself as hard as I could.

All of these were memorable tasks. And all were done effortlessly by me. And I don't think I can repeat them now that I am calmer. That is what mania is like - intense, wonderful, and nearly impossible to sustain. In all of the examples above I can remember and identify the symptoms of mania in my daily activities. I don't regret doing them, and they certainly display me at my best, but I also have had to admit that I did them when I was manic.

Saying that you were manic in some of your good times tarnishes the image of them somewhat. Still, the point here is to see if you had symptoms of mania and you have to be honest when you look back at your memories.

About Honesty
A warning. There is a tendency to find symptoms of mania and depression if you go looking, even if they are not present. You have to be honest in admitting the symptoms are present if this is so. But you also have to be able to be honest about saying that the reason you had a bad spell three years ago was because your boss overloaded you with work and you were having a difficult pregnancy and your three year old son broke his leg and that it had nothing to do with depression.

You don't have to have been depressed to have bad spells. Everybody has them. They don't even have to be quite as silly as the example above.

The critical thing to look for is if you have had bad spells more than once or twice and if the same indicators for depression keep reappearing. Or if your symptoms of mania or hypomania are common enough that you are familiar with them.

If you are showing the symptoms for depression or mania or both, then you can seriously consider your psychiatrist's diagnosis as probably being along the right track. But you have to feel comfortable that the evidence supports the diagnosis.

If you are not comfortable with the evidence you are going to downplay the psychiatrist's diagnosis. This is not good because if you are pretty all right you will then always have a nagging doubt about your capability and worth, and if you are indeed manic depressive then you will be delaying treating this medical problem. Either way you lose.

If you are not satisfied with with diagnosis, you should go back to the psychiatrist and argue your points until you are more satisfied or convinced. Or you could get a second opinion from another psychiatrist. Regardless of what you do, do not leave the dissatisfaction with the diagnosis unanswered.

Whichever way to decide, your decision on whether or not you are manic depressive can be changed. It is definitely not a "set in stone" kind of thing. Since there is no definitive test, you will be deciding on the information you have at the moment. As this information changes, you may change your mind as well. There is nothing wrong with that. And it is hard to know sometimes. As late as two years past my bipolar diagnosis, I used to wonder if I was bipolar or faking it.

Whatever your decision, the people around you are going to have to accept that if you make a decision you might change it abruptly and for no reason other than YOU no longer feel it is working in your best interests. This is particularly so in the first few months when you are really coming to terms with the manic depressive diagnosis. My experience has been that I switched back and forth in how I felt about the diagnosis and experimented to see if it was right until I felt comfortable. I think this is a normal part of the acceptance process and is not my being wishy-washy or indecisive.

Whatever you do, don't go into denial about the diagnosis. Keep an open mind until you have gathered enough information. This is particularly so if you have family or friends around you who tell you that there is nothing wrong with you, that you are just lazy, or weak willed, or looking for attention. Such people aren't looking after your best interests, they are looking after theirs and they are in denial.

When I was told I was manic depressive, instead of denying that anything was wrong I took a positive step to monitor myself to see how I was doing. I constantly checked on how I was feeling and what I was doing and kept asking myself - Is this good? Is this healthy? Is this what I should be doing? Am I overdoing it? By monitoring myself for signals for mania and depression I was able to gather information about myself. I kept a mood chart. It was this combination of checking my past and monitoring myself in the present that allowed me to rather reluctantly come to the acceptance that I was manic depressive.

It took a few months to do all the checking before I was satisfied, it was not a simple decision I made after a week. Ignore the persons who want a quick decisive answer from you - it just does not happen that way.

About Your Current Diagnosis
I know this sounds a bit out of character, but I would strongly recommend that you follow the psychiatrists advice, and if you have been prescribed bipolar medications, to take it as directed.

The reason is fairly simple. You've been to the psychiatrist's office because there are problems in you life now. Whether you think the diagnosis is right or wrong, the advice given is still good advice. It is worth following.

If you have been given medications, take them. If you are manic depressive, you will probably feel better than you currently do after a week or so. If you don't, you can always go back to the psychiatrist and complain. In any case, I think that taking the medications even for a short while has its own value (check the I'm Worried About Bipolar Medications page).

Whatever you do, until you are more of less sure of what is happening, keep in touch with your psychiatrist. I think in the first month or two after bipolar diagnosis you should be seeing your psychiatrist about once a week to ask all the questions you have and get advice and reassurance you need.

And Finally
My biggest problem with being manic depressive initially wasn't with being manic depressive. It was trying to deal with the shame and guilt and anxiety of not functioning properly on a day-to-day basis. And of having gotten myself in the mess my life was at the time.

But even while I was deciding if I was manic depressive, I learned to say to myself - "Jinnah, even if I've screwed up, I don't need this extra burden of shame and guilt and anxiety." That's when my then life started to get better. Getting rid of the the shame and the guilt and the anxiety took away more than half of the problems I had when trying to get my life on track again.