More than a mood swing

* Names have been changed to protect the students’ privacy.

“I wasn’t sleeping, I wasn’t eating real well. The three days before I finally went into the hospital, my heart rate was like 150 beats per minute. Finally, when I went, I was just getting so lightheaded; I felt like I was going to pass out and that my heart was going to jump out of my body. All the chemicals were firing all these responses into my body and it was just going, ‘boom boom boom!’ I thought I was going to have a heart-attack and so I went in.”

This first episode that Dan,* a senior, experienced would soon alter his life forever. He is one of 2.3 million American men and women suffering from bipolar disorder, according to an August Time magazine article.

“Bipolar disorder is a medical/psychiatric condition that is generally thought to be an imbalance in brain chemicals, and it causes significant mood swings and problems with impulse control,” said Dr. Robert Chase, who has a Ph.D. in clinical psychology and neuropsychology. “In more moderate severe cases (bipolar disorder) can be socially or functionally disabling, but it can also be controlled in many cases.”

The mood swings can cycle back and forth between the extreme poles of mania and depression. According to bipolarawareness.com, many people with bipolar disorder, unlike people with unipolar depression, experience what they call “ups” and “downs” of the illness.

Changes in mood, or “mood swings,” vary from person to person.

“Waiting for the shoe to drop can last days, months or years in a non-medicated state,” Chase said.

The “ups” are periods of mania, energy or euphoria. Symptoms of mania can include increased physical and mental activity, heightened mood, exaggerated optimism, excessive irritability, poor judgment, decreased need for sleep without experiencing fatigue, reckless behavior such as spending sprees and, in most severe cases, hallucinations.

Dr. Becky Bailey said that the higher the manic stage becomes, the more likely it is people with bipolar disorder can set themselves up for depression.

Dan’s episode was triggered after spending much of his adolescence and high school years always on the go. Almost nothing was too much for him to handle. When he was growing up, his doctors diagnosed him with
“everything from hyperactivity to (attention deficit disorder),” but no one could pinpoint exactly what was going on in Dan’s brain.

Dan admits that he started recognizing signs of bipolar disorder in mid- to late junior high but chose only to tell his family doctor.

“We had an agreement that if things improved and if I stayed in control of it, it would stay between him and me,” Dan said. “He had me come in and give him updates on how things were going, and things just got better and nothing was bothering me.”

All the way though high school, Dan earned good grades. Outside of school, he always worked, except during football season, when he trained about three times a day.

“I was always doing everything, but as long as I was busy and had an outlet, let it be the gym or whatever, it didn’t build up,” he said. “There was a way to release everything. It seemed like (everything) ticked, living like that all the time. You’re always on the go, you’re always happy and everything is always clicking.”

Freshman year at GW, Dan joined several organizations and by junior year worked 80 hours a week with a full course load. He said he slept three to four hours a night. Until his junior year of college, overfilling his plate with hardly any sleep was his specialty, but that did not last.

“Anytime excess was coming on before, I was able always to step back from it,” he said. “I’d go on vacation or take a week off or whatever, but then I got too involved and I couldn’t really slow down. I got really sick and had too much stress and that was my first major episode.”

Dan spent about a month in the hospital.

“When you’re bipolar, it either sends you to one side or the other, and my mania side just grew and grew and grew,” he said. “A couple of weeks before I (went to the hospital, I) could feel my blood pressure getting really intense.”

Rachel,* a junior, said she started experiencing depression around age 10.

“I got labeled as being depressed and at the time I had an eating disorder, so (doctors) thought it went well together,” she said.

Rachel said she often partook in risky behaviors, such as drinking and smoking cigarettes with her friends starting at age 13.

“It wasn’t depression like people think, where you’re crying and that sort of the thing,” she said. “Depression can also have an irritable side, and that was really what was showing up then. I wasn’t able to concentrate.”

In junior high, doctors prescribed Zoloft, a medicine for depression. However, Rachel said the doctors misdiagnosed her and the medicine put her into a hypomanic state. Within a year, her father was able to recognize signs of bipolar disorder. Rachel’s dad could identify signs of the disorder because his sister had been diagnosed with bipolar disorder years earlier.

“Most people talk about (how) when they’re in (a manic) stage, they can do everything,” she said. “I could do one thing at a time and do it well. For me, it was like there were too many things at once and it became all jumbled. I was constantly happy, but sort of like the drama queen happy. I was melodramatic.”

After her diagnosis in tenth grade, the private school she attended discouraged her from staying, implying they could not accommodate her needs. Rachel then went to a doctor in Boston who specializes in children with bipolar disorder.

“Within 20 minutes of meeting with me, (the doctor) said, ‘I really think that you are bipolar and I think we can do something; I think we can help you,'” Rachel said.

Unlike Rachel, whose doctors had trouble with diagnosis, Dan’s diagnosis was immediate because of his previous knowledge of his situation. Up until that point, he had only experienced recurrent hypomanic episodes without any depressive symptoms.

Dan came back to GW a few months after his first episode but soon realized he still needed more time to adjust.

“I was on medications and out of it,” he said.

Since his first episode, one of the biggest adjustments has been monitoring his health and taking care of himself.

“You have to realize that each morning you wake up lends itself to a
new experience,” Dan said.

“It is a daily struggle that you need to be both mentally and physically prepared to deal with. You have to have regular sleeping patterns, you have to force yourself to get seven, eight hours of sleep every night, your diet has to be good, and you have to exercise. You really have to treat your body well.”

Another hurdle for Dan was finding the right medications that caused the fewest side effects.

“I hated medication, which is one of the reasons I never came forth when I was younger- because I knew they would just put me on medications, and I was totally against it,” he said.

Dan changed his mind about medicine after his episode and began seeking therapy. About six months after he started seeking treatment, his doctor encouraged him to start a support group to help younger patients struggling with and adjusting to the daily routines.

“I was fortunate enough to learn a lot from my experiences and to be able to help a lot of people out, in return, too,” Dan said. “I guess maybe that is one of the reasons I was put through this ordeal – to be able to deal with it and help other people deal with it.”

He said finding the right doctor and medication are the two most important steps to dealing with bipolar disorder on a daily basis.

But medications are not guaranteed to solve all problems. The right medication and dosage for a bipolar disorder patient is often difficult to determine because of the multitudes of side effects the drugs cause. The medications that help control the emotional sensors in the brain that cause depression, tension and mania unfortunately also often cause short term memory loss, Chase said.

“The medications are used to decrease the over-activity in the temporal lobe of the brain, which is not only involved in emotions, but that same part of the brain is forming new memories, so its hard to form new memories (while on medication),” Chase said.

He said many times students with bipolar disorder study for an exam and cannot remember a thing they studied the next day.

“By treating yourself, it could affect how you do on your exam,” Chase said.

He said another major side effect for college students is weight gain. Dr. Bernard Vittone said other common side effects from drugs such as Lithium include tremors, sedation, cognitive slowing and dehydration.

The most serious alterations Dan has had to make involve adjusting to a significant loss in short-term memory.

“I never had to study through high school and I never had to study freshman and sophomore year here because everything came really easy to me,” he said. “The way my brain used to process is that everything clicked really fast. It’s almost that I could predict what people were going to say before they said it. Now, everything is a lot slower and everything takes a lot more concentration.”

Dan said he tried Adderall to help his concentration, but he did not like that he had to be dependent on another drug.

“For a while, the whole experience made me real angry and I was really depressed. When you think about it, I had to start my life over again,” he said.

Rachel also found adjusting to the medications while having to study difficult.

“I don’t want to say I study more, but I want to say it takes me more hours then what it would take the normal person,” she said. “I have to read things four or five times. I just don’t retain it well.”

To help her inability to concentrate, Rachel takes Concerta, an Attention Deficit Hyperactivity Disorder medicine that is time-released and lasts all day.

“It’s just the longest process to get to that last step that everyone else can get to (in a shorter amount of time),” she said. “Where as for someone else they might just say, ‘oh I’ll read the book (to study).'”

Rachel also said one of the medications her doctor tried caused her to gain 25 pounds in one summer.

Chase explained that common college student practices, such as poor sleep, partying, stress and eating pizza at 3 a.m. without eating dinner, “exasperate those with bipolar disorder.”

“(Students with bipolar disorder) don’t want to feel different,” Chase said. “They don’t want to be the only one who didn’t hang out all night.”

After Dan’s episode, he said he didn’t drink alcohol for almost a year.

“Not necessarily because they recommend that you don’t drink, but I wanted to see if I could do it and I did and it was hard,” he said. “And now I’m probably partying more than I should, but I don’t let myself get as drunk as I used to. I know my limits.”

The word hangover has a different meaning for those with bipolar disorder.

“It takes a couple of days to recover if I get really drunk,” Dan said. “It’s like a daily schedule, something you have to work through, so if you go out and drink you’re guaranteed to at least have two shitty days, so you have to watch yourself.”

For Rachel recovery sometimes takes longer.

“More than one night (of drinking), your mood becomes wrecked and it’s wrecked for at least four or five days,” she said. “I can drink but I have to be careful. It’s extra dangerous with all the medicines.

“I’ll only drink one night of the weekend,” she continued. “Another night we’ll go to a bar and I’ll get a mixed drink and I’ll just hold it in the glass and let the ice melt and kind of walk around with it.”

Rachel helped start the Intercollegiate Bipolar Support Group at GW last spring. The group, cosponsored by University Counseling Center and Disability Support Services, meets monthly during the school year and addresses important issues for managing bipolar disorder, including medication and side effects, stress reduction, self-monitoring, academic and current research.

“It’s designed more as an education seminar then a counseling session. We don’t want it to be viewed as a therapy group,” said Christy Willis, director of Disability Support Services.

The group brings in speakers to help educate the students about their options. Dr. Becky Bailey and Dr. Bernard Vittone were two of their speakers last spring.

“The only rules set in stone is that you have to be diagnosed already,” Rachel said. “We don’t want people coming in and looking for a diagnosis. None of us are doctors. And the second part is you have to be in therapy. We don’t want to be people’s therapy.”

Willis said the best thing the group has done is introduce students in different stages of the disorder and watch them learn from each other.

“It’s important for the student to not feel alone,” Willis said. “College life is so not conducive for this condition, but with students coming forward and realizing they’re not alone, I think is a very helpful thing.”

Rachel said the group has helped allowed her to meet students who have experienced situations and feelings similar to hers.

“It’s been nice to have the support and they’re all normal,” she said. “They’re not the stereotypes of weird crazy kids.”

Rachel is studying abroad this spring and said she has a list of doctors to contact upon arrival overseas for prescription refills and to continue therapy. She said through the years therapy has taught her to think before doing, instead of relying on impulses.

Dan said he also has made a great deal of progress.

“That is one thing I’m thankful for (is) I’m getting closer to where I was and it’s becoming manageable point,” he said. “I can’t complain. I have a ton of job offers.”

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