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Managing Problems Associated with Bipolar Disorder

Dr. Eric Bellman, bipolar disorder, manic depressionDr. Eric Bellman has over 20 years experience working with bipolars. The discussion focuses on channeling your manic energies in a positive manner, medication non-compliance and dual diagnosis issues.

DavidHealthyPlace.com moderator.

The people in blue are audience members.


online conference transcript

David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Bipolar Disorder: A More Detailed Look". Our guest is Dr. Eric Bellman.

We are going to take a look into some of the details of Bipolar Disorder. We'll be covering medication non-compliance, self-medication, and how to channel your manic energies. If you need general information about Bipolar Disorder, here's the link to the HealthyPlace.com Bipolar Community and to the transcripts from previous Bipolar conferences.

Our guest Dr. Eric Bellman, is a clinical social worker near Los Angeles, California. He has over 20 years of experience working with bipolar individuals in psychiatric hospitals, group homes, and in private practice. Dr. Bellman has performed everything from psychological work-ups of patients to treatment.

Good evening, Dr. Bellman, and welcome to HealthyPlace.com.. From reading the bulletin boards posts in our bipolar community, one gets a sense that, for some at least, remaining faithful to taking the prescribed "Bipolar medications" is a difficult thing to do. Why is that?

Dr. Eric Bellman discusses how to channel your manic energies in a positive manner, bipolar medication non-compliance and dual diagnosis issues. Read transcript.Dr. Bellman: Hello! People often do not take prescribed medication because of the powerful nature of the manic episode. In the flow of experience, the power surge of a true manic episode leads to a sense of grandiosity, mixed with paranoia and disconnection from others. Once we are into huge projects, or the secret life of a manic episode, people absolutely resent the loss of power and the sense of loss of self that medications for bipolar disorder cause.

David: What are the ramifications of coming off the bipolar medications? And I'm referring not only to the medical or physiological issues, but the psychological issues too.

Dr. Bellman: The flip side of not taking medications for a manic episode is a tremendous crash into depression. This leads to a disconnection from one self and all of our important relationships, not to mention our work and our lifestyle. Thus, at the end of the day, we wind up fragmented, with no energy to finish tasks, and a terrible sense of shame that can cycle back into another manic episode, substance abuse or isolation and impulsive actions.

David: A moment ago, you talked about a "sense of loss of self" that having to take bipolar medications may bring about. Can you explain or elaborate on that?

Dr. Bellman: Yes. The person experiencing a manic episode is a universe unto themselves with a flow of seratonin, adrenalin, powerful surges of sensory awareness, grandiosity and paranoia, that minimizes the connection with the world around us and our relationships. In a sense, we are the masters of our own universe. This experience is not recognizable to the very person who is not going through it the next day. Thus, we have such disconnected states of feeling internally, that it is difficult to integrate our sense of our self, especially afterwards when we experience the feedback guilt and shame from others so that we cannot trust ourselves to be consistent or experience ourselves as whole.

David: So, I'm assuming that you believe it's very important to continue taking your medications for bipolar disorder. If that's the case, and it's relatively easy to see, why would anyone want to quit?

Dr. Bellman: People quit because they get caught up in a biologically and externally stressful combination. This combination triggers what causes a manic episode, that again puts us into the world of the manic power surge of the true manic episode. These episodes are marked by feelings of grandiosity, paranoia, huge projects and secret compulsions. These compulsions can include gambling, promiscuity, and buying sprees. Therefore, the manic episode acts as it's own drug and creates it's own internal world that we become addicted to.

David: Here are a few questions, Dr. Bellman, on the topic of taking bipolar medications:

Melody270: Why do doctors take you off of medications, when they think you are doing better, since bipolar disorder is a life-long thing?

Dr. Bellman: There are doses for acute episodes to come down off of. Then, there are what we call "maintenance" doses to help prevent re-occurrences. And then, sometimes we want to take a medication holiday because there may be long-term side effects. Generally, it is foolish to take somebody with fairly frequent episodes or tremendous life stress off of medication. I train people to look for red flags so they can prevent manic episodes by using the following techniques:

For example, I often have my clients keep a note card in their pocket with phrases and thoughts that are red flags as to the beginning of a manic episode. For instance, we might think "I don't feel like sleeping tonight because the great American novel is sitting right inside of me." But even if it is, the flow of creativity is better if we control the manic peaks and valleys.

LeslieJ: Do you ever see anyone being non-compliant when they are in their depressed cycle? You have only mentioned the manic phase. Is that the most dangerous time for us in terms of becoming non-compliant?

Dr. Bellman: Indeed, the depressed cycle involves not only the loss of the up manic phase, but the reality of the wreckage that we just created in our lives and relationships, as well as a biological component. This time is thus ripe for acting our behaviors, suicidal thoughts and substance abuse, and giving up in therapy and on ourselves. Substance abuse also, is antagonistic to most medications for bipolar and we can also fall into that trap too at that time. So, in times of depression, we are indeed at risk, but it also presents the opportunity for reflection and reconnection with our lives, and can be the beginning of an upward movement to change.


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Last Updated: 31 March 2017
Reviewed by Harry Croft, MD

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