As a woman with bipolar disorder, I’m no stranger to depression. I’ve sunk to some pretty low points just because I have abnormal brain chemistry. Fortunately, due to a combination of medication, talk therapy, and coping strategies, I’ve been stable—and happy!—for the past seven years. So I am willing and able to give you some tips and tricks that may help you recover from the dark pit of depression.
Self-care, defined as actions you take to improve your physical and/or mental outlook, is crucial for recovery from depression. Medication can only help if you take it (which is part of self-care!), and talk therapy is useful, too, but without your meeting your physical and emotional needs on a basic level, there’s only so much the treatments can do.
Self-care is more than just bubble baths and painting your nails. Let me outline some self-care practices below that you can do today to help you recover from depression.
First, there’s the physical side of self-care. Taking care of your body can help you feel loads better and enable you to take on the day—or at least knock some small tasks off your to-do list, like getting the mail.
Physical self-care is an easy and basic way to meet the lowest tier of Maslov’s hierarchy of needs: the physiological section. Without meeting those needs (food, water, warmth, rest), you cannot move on to meeting the next levels of needs on the pyramid.
There are any number of things you can do to take care of your physical body. Hygiene is a big one. I love applying deodorant and brushing my (short) hair when I’m feeling rotten, which takes about 45 seconds.
I’ll outline some hygiene steps below, but please remember that you don’t have to do all or any of these things at first. One step at a time.
The best thing you can do for yourself if you’re at home and safe is take a shower. I know you don’t want to take a shower. I know you don’t want to get out of bed. But if you just can’t bring yourself to endure a full-on shower, at least wash your face.
Maybe from there, you’ll feel good enough that you’ll want to brush your hair. Stop there; if you’re truly in the pits of depression, then you don’t want to overload yourself.
I try to take a shower every night so I feel good when I go to sleep and am ready to wake up refreshed the next morning. It’s easy when I’m stable but a mountain to climb when I’m depressed.
But that mountain is worth climbing. I always feel a little better after a shower, and I’d be surprised if you didn’t, too.
On occasion my legs are itchy because of dry skin, so one of my self-care rituals is to quickly apply lotion to my legs and arms from a pump bottle. My four-year-old daughter enjoys having me apply lotion to her little arms and legs as well! There’s a lot of laughter involved because the lotion tickles her.
You can try to apply lotion, too. A bottle with a pump spigot makes squirting the right amount in your hands easy, so I’d recommend buying one of those. If you take a shower at night, set the lotion on a flat surface near your bed so finding it when you need to apply it before bed is easy.
Brushing Your Teeth
Brushing your teeth takes two minutes. And you can do anything for two minutes. I have full faith in your ability to handle this task. If you want, brush your teeth and go back to bed until you feel you can manage another aspect of self-care.
Physical self-care doesn’t have to take a lot of time, and it doesn’t have to cost too much, either. It means taking care of your body, which is linked to your mind and helps you re-center yourself.
Physical self-care is not an indulgence. It’s a necessity; without taking steps to take care of yourself, you’ll get to the point where someone else has to take care of you.
I’ve been there. My mom drove two hours to my university apartment and washed my hair once because I could no longer function. But after that, I soon started performing self-care and taking my own showers.
I recovered from that depression through a combination of talk therapy, medication, and self-care. Without the building blocks of self-care, I never would have found myself a therapist, which was the beginning of my recovery journey.
You are worth self-care. You are a valuable person who has worth beyond what you produce. And you deserve someone who loves you, even and especially if that person is yourself.
I wish you well.
Stay tuned for part 2 of this post: Emotional Self-care.
Note from the Editor: Please welcome the Bipolar Parent back from my hiatus! I will be posting weekly personal, informative pieces on how to manage your bipolar disorder on Friday mornings. I hope that these posts will help you deal with depressive or manic episodes, and that you’ll be able to stabilize soon.
I wish you well!
Trigger Warning: This post contains a discussions of suicide. If you or someone you know is at risk of suicide, please:
Call the U.S. National Suicide Prevention Lifeline at 800-273-8255
Text TALK to 741741
Or go to SpeakingOfSuicide.com/resources for additional resources.
For a post with a list of domestic crisis lines, click here. For a post with a list of international crisis lines, click here.
What My Experience Being Suicidal Taught Me — and What It Can Teach You, Too
During my pregnancy with my son, I was so miserable, I not only almost ended my life, but his, too.
I was lonely and isolated, having moved 1500 miles away from my family and friends. I endured morning sickness for nine months straight and vomited so much, I lost 30 pounds rather than gaining any weight, putting me on a forced bed rest for six months.
And I was suffering from an undiagnosed bipolar depressive episode. At that time, I couldn’t handle just drifting from day to day in an interminable fog. I wasn’t able to make basic decisions, like what to eat or whether to shower. And it wasn’t like I wanted to die, I just couldn’t live anymore.
After I made an attempt on my life, trying to drown myself in the bath immediately after my son was born, things got better. I committed myself to a mental hospital where I was stabilized on medication and asked to create a Suicide Prevention Safety Plan.
If you’ve faced suicidal thoughts and have no desire to return to that place or even if you suffer from depression and think you might be suicidal, one powerful preventative action you can take is to create one of these plans.
The plan is a written set of steps to follow if you start to think of harming yourself. The benefit to making a suicide prevention plan is simple: following pre-determined steps is much, much easier than trying to figure out your next moves when you’re actively suicidal.
September 5th-11th is National Suicide Prevention Week, an annual campaign in the United States to raise awareness about suicide prevention techniques and the triggers of suicide. The week also tries to reduce the stigma surrounding suicide and normalize steps to prevent suicide and improve mental health. What better time to make a Suicide Prevention Safety Plan?
Are you ready to develop your plan? Find a template of the Brown Stanley Safety Plan, a plan recommended by the Suicide Prevention Lifeline website, here.
Have you printed your plan? Great. Here’s some information to include.
Familiarize yourself with the warning signs of suicide, both in general and specifically how they manifest to you. The first step in making a plan is to write down your warning signs. During what sorts of moods and situations do you find yourself thinking about self-harm? List three to five experiences that lead you down dark paths.
Being a woman with bipolar disorder, I have a few warning signs for when I’m sliding into a depressive episodes and may end up facing suicidal thoughts that I added to my plan. The first and most obvious one is a total lack of self-care. I usually drink up to 144 ounces of water a day, shower daily, and eat three meals. When I stop doing any of those, it’s time for me to take a look at whether I’m sliding into a depression.
Other warning signs are more subtle. I may feel tired all the time and can’t get out of bed, or I may feel weepy and more emotional than usual. One notable sign that’s very specific to me is that I’m no longer creative. Writing flows through my blood; I adore informing my readers or tugging on their heartstrings or both, and when writing becomes a chore and I start dreading it, that sends off klaxons in my brain that let me know I need to take action to get on a more even keel.
Think hard about specific triggers that you may have for depression or suicidal thoughts. List them here.
Next, write down three to five self-care techniques. What can you do for yourself that will help you re-center? List out physical activities that calm you down, like taking a nap, getting a snack, or even something as simple as brushing your teeth. For a long list of self-care techniques, click here.
My personal plan from the hospital didn’t have this section, but because I love self-care, I think it’s a great one. One of the quickest and easiest ways for me to feel better about myself is to take a brief, hot shower. If I can’t do that because I’m too busy with my four-year-old, then I wash my face and arms, brush my hair, and apply deodorant, all of which takes less than five minutes.
Another self-care tactic I use is to eat a healthy snack, like a yogurt or a piece of cheese or, if I have time, some sautéed zucchini squash. Yet another self-care tactic I like is to go outside and breathe in some fresh air, which helps me re-center and realize that life isn’t all about my problems.
Think about what helps you the most in the moment. List your specific self-care techniques here.
Step three is to write down three to five names and numbers of people who are good distractions for you. Who can you rely on to cheer you up with something other than focusing on yourself? If you have no one, write down social situations or place where you feel calm instead, such as in a library.
I wrote down my sister’s number. When my brain is screaming at me that I’m worthless, she can always acknowledge my pain and cheer me up by reminding me that I am valuable as a person to her specifically.
I also tap my online friends. I can message them with something like, “My brain is being mean to me and here’s why,” and they can respond whenever they’re available with virtual hugs and advice on the challenges I may be facing.
Think hard about trusted people in your life that you can rely on. If you do not have any, think about places with people that you can go to instead, like a park.
People You Can Ask for Help
After you write down distractions, write down three to five names and numbers of people you can ask for help. I know it’s hard to think of people who are genuinely interested in your problems and can help you. You may feel as if you have no friends. But think hard. There are likely people out there who want to help you.
This is where I wrote down my husband’s number, as he’s the person closest to me. It’s saved in my phone and I have it memorized, but he is the one who needs to know that I’m thinking of these things so he can tailor his approach, and possibly call in the big guns for me, such as:
Professionals or Agencies
Step five is to list out the names and numbers of doctors and addresses of crisis centers that you can go to in times of trouble. If you have a therapist, list him or her here. (If you need help finding a therapist, click here.) If you have a psychiatrist, this is where he or she needs to be. (For help getting a psychiatric evaluation, click here.) Write down the crisis center numbers and addresses as well. Then write down a suicide hotline for your country.
At the time of my hospitalization, I did not have a psychiatrist, but I did have a therapist. I wrote her number down, and then I wrote down the information for the psychiatrist that the hospital referred me to.
I filled this plan out at a discharge appointment with a doctor, so they were there to help me figure out what numbers to write down. But the crisis centers in your area are only a simple Google search away.
Making the Environment Safe
If you’ve followed all the steps in your plan up to this point, having called the professionals to help you with your suicidal thoughts, you need to make your environment safe until they can help you. What this means is that when making your plan, you need to joy down the two most effective ways to ensure your safety.
Be it withdrawing from other people or putting yourself among them, make sure these instructions resonate with you. You need to be able to take these steps, and if you’re on step six already and you’ve already called your doctors or an emergency number, then keep yourself from acting rashly. Take away anything that will help you enact your suicide plan to the best of your ability. Call a friend to help (step four) and ask them to remove temptations from your home, like knives or pills.
For my plan, I wrote down that I needed to secure child care for my infant son. I didn’t want to do anything to hurt him or even leave him behind in a place where he could get hurt, so making my environment safe was all about making the environment safe for him, too.
Finally, write down the most important positive aspect of your life. What is the one thing worth living for? What is your reason not to give up? What’s the driving force of your life that you would hate to leave behind? Hopefully the reason comes to you quickly, but if not, take some time to think hard and figure something out.
At the time of my hospitalization, my clear reason for living was to take care of my newborn. I printed a picture of him from the hospital’s computer, writing on the bottom, “The Reason I Am Here!” in bold, black and red markers.
Focusing on the care of my son helped me survive through suicidal thoughts.
Find your reason.
My experience with suicidal thoughts gave me the tools to use if I ever found myself in a situation again, such as if my medication ever stopped working or external or internal factors sent me back into a deep depression. The Suicide Prevention Safety Plan is one of those tools.
Now I am a happy, stable woman who happens to have a mental illness, one which I treat with a combination of medication, talk therapy, and self-care. While I’ve had hypomanic and depressive episodes in the interim years since my son’s birth, they’ve been nothing like my deep, debilitating depression during my pregnancy.
I’ve been fortunate enough to have learned how to manage my mental illness, but I still follow my plan when I need it.
I would highly recommend filling out a Suicide Prevention Safety Plan to use as one of the tools to help yourself. It will not only benefit you, but it’ll also benefit your loved ones as well. No one wants you to hurt yourself. And filling out a plan when you’re not in a time of crisis will help you know what to do when a problem hits.
Fill out the plan and place it in a spot where you and your loved ones can find it in times of trouble. You may not be able to prevent thoughts of self-harm but you can take steps to prevent yourself from leaving your life behind.
A new study by researchers at The Picower Institute for Learning and Memory at MIT finds that the protein CPG2 is significantly less abundant in the brains of people with bipolar disorder (BD) and shows how specific mutations in the SYNE1 gene that encodes the protein undermine its expression and its function in neurons.
Led by Elly Nedivi, professor in MIT’s departments of Biology and Brain and Cognitive Sciences, and former postdoc Mette Rathje, the study goes beyond merely reporting associations between genetic variations and psychiatric disease. Instead, the team’s analysis and experiments show how a set of genetic differences in patients with bipolar disorder can lead to specific physiological dysfunction for neural circuit connections, or synapses, in the brain.
The mechanistic detail and specificity of the findings provide new and potentially important information for developing novel treatment strategies and for improving diagnostics, Nedivi said.
“It’s a rare situation where people have been able to link mutations genetically associated with increased risk of a mental health disorder to the underlying cellular dysfunction,” said Nedivi, senior author of the study online in Molecular Psychiatry. “For bipolar disorder this might be the one and only.”
The researchers are not suggesting that the CPG2-related variations in SYNE1 are “the cause” of bipolar disorder, but rather that they likely contribute significantly to susceptibility to the disease. Notably, they found that sometimes combinations of the variants, rather than single genetic differences, were required for significant dysfunction to become apparent in laboratory models.
“Our data fit a genetic architecture of BD, likely involving clusters of both regulatory and protein-coding variants, whose combined contribution to phenotype is an important piece of a puzzle containing other risk and protective factors influencing BD susceptibility,” the authors wrote.
CPG2 in the Bipolar Brain
During years of fundamental studies of synapses, Nedivi discovered CPG2, a protein expressed in response to neural activity, that helps regulate the number of receptors for the neurotransmitter glutamate at excitatory synapses. Regulation of glutamate receptor numbers is a key mechanism for modulating the strength of connections in brain circuits. When genetic studies identified SYNE1 as a risk gene specific to bipolar disorder, Nedivi’s team recognized the opportunity to shed light into the cellular mechanisms of this devastating neuropsychiatric disorder typified by recurring episodes of mania and depression.
For the new study, Rathje led the charge to investigate how CPG2 may be different in people with the disease. To do that, she collected samples of postmortem brain tissue from six brain banks. The samples included tissue from people who had been diagnosed with bipolar disorder, people who had neuropsychiatric disorders with comorbid symptoms such as depression or schizophrenia, and people who did not have any of those illnesses. Only in samples from people with bipolar disorder was CPG2 significantly lower. Other key synaptic proteins were not uniquely lower in bipolar patients.
“Our findings show a specific correlation between low CPG2 levels and incidence of BD that is not shared with schizophrenia or major depression patients,” the authors wrote.
From there they used deep-sequencing techniques on the same brain samples to look for genetic variations in the SYNE1 regions of BD patients with reduced CPG2 levels. They specifically looked at ones located in regions of the gene that could regulate expression of CPG2 and therefore its abundance.
Meanwhile, they also combed through genomic databases to identify genetic variants in regions of the gene that code CPG2. Those mutations could adversely affect how the protein is built and functions.
The researchers then conducted a series of experiments to test the physiological consequences of both the regulatory and protein coding variants found in BD patients.
To test effects of non-coding variants on CPG2 expression, they cloned the CPG2 promoter regions from the human SYNE1 gene and attached them to a ‘reporter’ that would measure how effective they were in directing protein expression in cultured neurons. They then compared these to the same regions cloned from BD patients that contained specific variants individually or in combination. Some did not affect the neurons’ ability to express CPG2 but some did profoundly. In two cases, pairs of variants (but neither of them individually), also reduced CPG2 expression.
Previously Nedivi’s lab showed that human CPG2 can be used to replace rat CPG2 in culture neurons, and that it works the same way to regulate glutamate receptor levels. Using this assay they tested which of the coding variants might cause problems with CPG2’s cellular function. They found specific culprits that either reduced the ability of CPG2 to locate in the “spines” that house excitatory synapses or that decreased the proper cycling of glutamate receptors within synapses.
The findings show how genetic variations associated with BD disrupt the levels and function of a protein crucial to synaptic activity and therefore the health of neural connections. It remains to be shown how these cellular deficits manifest as biopolar disorder.
Nedivi’s lab plans further studies including assessing behavioral implications of difference-making variants in lab animals. Another is to take a deeper look at how variants affect glutamate receptor cycling and whether there are ways to fix it. Finally, she said, she wants to continue investigating human samples to gain a more comprehensive view of how specific combinations of CPG2-affecting variants relate to disease risk and manifestation.
Bipolar disorder, a mental illness of two extremes, is difficult to spot in teenagers because even healthy teens are volatile. The disease typically develops in the early 20s. But the symptoms are often misdiagnosed, especially in teens. What does bipolar disorder look like in a teenager, and how does a parent spot it?
Let‘s dig in.
Bipolar disorder is characterized by “highs” (called mania), and “lows” (called depression). Bipolar patients also have hypomanic episodes. Hypomania means “below mania,” and is considered a lesser form of mania. There are also mixed episodes, where a bipolar patient suffers a form of mania and depression at once.
Teen-onset bipolar disorder is similar to adult-onset. Adolescents suffer similar symptoms to adults. Here are the symptoms of manic, hypomanic, and depressive episodes in teens:
Racing speech and thoughts
Decreased need for sleep
Elevated mood and excessive cheerfulness
Increased physical and mental activity
Reckless and risk-taking behaviors
Drop in grades
Irritability, aggressive behavior, and impatience
Exuberant and elated mood
Decreased need for sleep
Elevated mood and excessive cheerfulness
Reckless and risk-taking behaviors
Extreme focus on projects at work or at home
Anhedonia – loss of interest or pleasure in normally enjoyable activities
Sadness or irritability
Shame or guilt
Sleeping too much or insomnia
Drop in grades
Loss of appetite or overeating
Anger, worry, and anxiety
Thoughts of death or suicide
But there is one crucial difference between teenagers and adults who suffer bipolar disorder: teenagers tend to be rapid cyclers, which means they suffer mood episodes more frequently than adults. Adults typically vacillate between defined episodes of hypomania, mania, and depression, with periods of wellness in between lasting from weeks to years. But teenagers vacillate between extreme mood states within hours to days, with very few periods of wellness in between. Teens are similar to children with regard to rapid cycling.
Irritability and Rage
Teens who suffer from bipolar disorder can exhibit irritability during both manic and depressive phases, just like children and adults. For teenagers, irritability can be a constant issue during the manic phase. Like children, teens are more likely than adults to become irritable. Unlike most children and adults, however, adolescents who present with irritability are more likely to be hostile, and even violent.
Slamming doors, yelling, and even telling parents that they hate them is normal for many teenagers, and they recover quickly. But a bipolar teen’s rage is much more extreme. He or she might not be able to calm down for days to weeks. They may hit themselves or others, or break possessions. Adolescents suffering from mania may think their parents are out to get them, to the point where the teens hide in their rooms or throw away their phones. In extreme cases, teens may end up psychotic, where they engage in delusions, hear voices, or see things that aren’t there. If your teen is acting paranoid or psychotic, he or she may need to be hospitalized.
Issues with School
School may be more difficult for teenagers with bipolar disorder than those without. High school forces teens to keep a very rigid schedule, and there is a lot of pressure to perform. If hospitalized, they may miss school and must catch up, resulting in more stress due to missed workload.
Social navigation can also trouble teens. For teenagers, explaining their bipolar disorder to their friends may be next to impossible. Teens with bipolar might suffer guilt or shame after an episode, which makes dealing with their illness even more difficult, and may impact their friendships.
If you can’t tell if your teen suffers from bipolar disorder and you have doubts, it’s okay to consult a doctor. Get a referral from your child’s pediatrician to a behavioral therapist or child psychologist. Refer to the symptom chart, and describe your teen’s manic and depressive symptoms to the doctors. There’s no neon sign over your child’s head that will tell you definitively that your teen has a mood disorder. But if you have suspicions, getting a psychiatric evaluation for your teen is the best step you can take. A diagnosis may help both you and your teen as you parent during his or her adolescence. For more on what to do if your child is bipolar, click here.
Parenting a bipolar teen may be extra difficult. You need to teach him or her how to manage extreme emotional states, and how to deal with his or her rage in a constructive manner. But don’t give up. Dig in now and keep looking for help. There used to be few resources for dealing with mood disorders; now there are plenty.
Even with help, these are going to be difficult years. Finding a balance may be tricky. But there is hope for teenagers with bipolar disorder. Bipolar is one of the most treatable disorders. With talk therapy, and possibly medication, your teen can live a healthy and fulfilling life. You can raise a successful bipolar adults, but first you need to get through the teen years.
Trigger Warning: Brief discussion of suicidal ideation.
Preschool depression is often overlooked, because the symptoms are difficult to spot or may be explained away by hopeful parents and teachers. Depression in adults is widely known, but can preschoolers suffer clinical depression? Science says they can.
Scientists began studying depression in preschoolers 20 years ago, and the research continues today. According to the conclusion of a new study led by Dr. Joan Luby of the Washington University School of Medicine in St. Louis, preschoolers suffer depression. Luby’s team examined 306 children ranging from 3 to 6 years old. This study demonstrated that 23% of the 3-year-olds endured depressive symptoms every day for two consecutive weeks. As the age of the child increased, the rate of major depressive disorder diagnoses also increased. The 4-year-olds suffered depressive symptoms at a rate of 36%, while the 5-year-olds showed a rate of 41%. The children who had suffered extremely stressful or traumatic events in their lives also had a higher incidence of depression than the controls.
Preschoolers generally can’t describe their emotional states. They’re still learning what emotions are and they lack the ability to vocalize them. This is the difficulty in diagnosing depression in preschoolers, and why you may need help spotting it. In order to allow the study participants to express how they perceive themselves and get a sense of what young children were feeling, Dr. Luby’s team asked a series of questions using puppets. How the children responded gave the researchers a clue about how the kids were feeling.
Further complicating the picture is the prevalence of other conditions along with depression, like Attention Deficit Hyperactivity Disorder (ADHD). In Dr. Luby’s study, about 40% of the study participants also dealt with ADHD, which tends to drown out symptoms of depression, because the symptoms are similar. This can even persist later in life. Children who suffer depression are more than four times as likely to suffer an anxiety disorder later in life than kids who don’t suffer depressive symptoms.
But what does depression look like in a 3-to-6-year-old?How can you, as a parent, spot it? Well, depression in children looks a lot like depression in adults. For example, anhedonia, the inability to experience pleasure from normally enjoyable activities, can show up in adults as a lack of enjoyment in things like golfing or writing. Preschoolers with anhedonia find little to no joy in their toys. Both adults and children with depression are restless and irritable. Depressed kids whine a lot, and don’t want to play.
When they do play, children may decide that their stuffed animals decided to “die” today and decide to bury them. Anytime you see a preschooler demonstrate methods of suicide or death with a stuffed animal without mimicking an episode of your life, such as a death in the family, your antennae need to come up. That could indicate suicidal thoughts.
But the most common symptom of depression in children is deep sadness. Not someone who’s sad for a day, but all the time, no matter who he or see is with or what he or she is doing. Sadness in the face of goals that have been thwarted is normal. But depressed children have difficulties resolving the sadness to the point where the misery affects their ability to function regularly. If your child appears to be sad to the point of inability to enjoy anything or regulate their other emotions, then get a recommendation from your pediatrician for a child psychologist or a behavioral therapist.
Other notable symptoms of childhood depression are an exaggerated sense of guilt, shame, and insecurity. Depressed preschoolers generally feel that if they do a naughty thing or disobey, that means they are inherently bad people.
Here’s a breakdown of the symptoms of depression in children of any age, including preschoolers:
Deep and persistent sadness
Irritability or anger
Difficulty sleeping or focusing
Refusing to go to school and getting into trouble
Change in eating habits
Withdrawing from friends and toys
Anhedonia – inability to derive pleasure from enjoyable activities, like playing with toys
Low self-esteem and insecurity
Shame and guilt
Preschoolers may be especially vulnerable to depression’s consequences. Young children are sensitive to emotions, but lack the ability to process strong feelings. Early negative experiences–including separation from a caregiver, abuse, and neglect–affect physical health, not just mental. Multiple studies have linked childhood depression to later depression in adulthood.
This is why properly diagnosing and treating these children early is so vital. One established intervention for treating childhood depression is called Parent-Child Interaction Therapy, or PCIT. Originally developed in the 1970s to treat violent or aggressive behaviors in preschoolers, PCIT is a program where, under the supervision of a trained therapist, caregivers are taught to encourage their children to manage their emotions and stress. The program typically lasts from 10 to 16 weeks.
The Bottom Line
Dr. Luby’s research is met with resistance. Laypeople typically think the idea of preschoolers suffering depression ridiculous, and even some doctors and scientists don’t believe children are cognitively advanced enough to suffer from depression. Preschool depression remains a controversial topic, which makes it harder to diagnose in your child.
But depression in children 6 years and older has been well established by decades of data. Is it really so hard to think that preschoolers might suffer depression as well? Dr. Luby and her team have been looking at the data for 20 years, and have concluded that preschoolers can suffer depression, just like older children and adults.
Admitting that your child is depressed may make you feel like you’re a failure. After all, if you can’t protect your children from depression, who can? But clinical depression is chemical. This is not your fault. You may have been told that depression doesn’t exist in preschoolers, or that you’re overreacting. You may be called a helicopter or hovering parent. But trust your instincts. You know your child better than anyone else. Don’t be afraid to go against stigma for your child’s benefit.
Up to 84,000 of America’s 6 million preschoolers may be clinically depressed. If your child is one of them, you are not alone. There is no shame to depression. The condition is not your child’s fault, just as in adults. No parent likes to see her child suffer, and getting help for depressed children is vital to their well-being.
If your child suffers depressive symptoms, especially anhedonia, ask your pediatrician for a recommendation for a behavioral therapist or child psychologist. Typically, the earlier the intervention, the more successful the results.
Bipolar disorder, a disease characterized by “highs” (called mania) and “lows” (called depression), does not discriminate. It affects men and women equally, has been affecting children more and more, and appears to have a roughly similar incidence across all ethnic, racial, and socioeconomic groups. About 2.4% of people around the world are diagnosed with bipolar disorder in their lifetimes.
According to a new 11-nation study conducted by researchers around the world, the United States has the highest incidence of bipolar disorder, at 4.4%. India has the lowest rate at 0.1%, followed by Japan at 0.7%. Lower-income nations typically demonstrated lower rates. Colombia, a lower-income nation, bucked the trend with a incidence of 2.6%.
But why does the U.S. experience the highest bipolar rate among all 11 nations studied? Let’s dig in.
Wealth may play a role. Individuals in higher-income nations were more likely to be diagnosed than those in lower-income nations. The exception is Japan, with an incidence rate of 0.7%.
Unfortunately, the U.S. also has the largest worldwide gap between the rich and the poor. The economic stressors are greater than in other Western societies. This means there are more psychological stressors among the poor of America, which may lead to substance abuse and fragmentation of the family.
Immigrant Melting Pot
Genetics may also contribute in the rate of bipolar disorder in different countries. Studies have confirmed that the condition sometimes runs in families, and that the lifetime chance of an identical twin of a bipolar twin developing the disorder is about 40% to 70%. So the genetic makeup of a country may affect the rate.
But what about immigrants? America is known as the “melting pot” of the world, due to all the immigrants that come here. Among people who have emigrated, the actual expression of bipolar disorder is the same as it is in the population that those people have left. However, what’s interesting to note is that, in those cases, their children tend to have higher rates of mental illnesses, including bipolar disorder, by a factor of as much as tenfold.
Social scientists suspect that the lack of extended family and cultural systems may result in higher incidences of bipolar disorder, as environmental stressors play a factor in the development of the disease. With a lack of familial support, immigrants have less of a buffer in terms of a social network, especially when they first arrive.
And immigrants seeking a new life in America might be more risk-taking than people who stay in their home countries. The immigrant belief that they can find success here takes a certain mindset of grandiosity and other symptoms of hypomania, which may be more common among people who suffer from bipolar disorder.
Stigma also plays a part in the incidence rate of bipolar disorder among different countries. Fewer than half of those suffering from the disorder sought help for it. And only a quarter of those in low-income countries were treated by a mental health professional for bipolar disorder.
Some cultures are reluctant to talk about psychiatric things. Lower-income nations experience higher rates of stigma. Fewer people are willing to come forward with their struggle with mental illnesses, which leads to a lower perceived rate of bipolar disorder.
Cultural awareness of mental illnesses also contributes to the problem of stigma. Americans are fairly aware of bipolar disorder as a disease, whereas the symptoms of the condition may be missed or ignored in lower-income nations. This leads to lower rates of diagnosis.
The Bottom Line
No matter where people live, bipolar disorder causes serious impairment among those who suffer from it. People need to be less afraid about seeking help for their mental illnesses. Educating individuals about the disease may help combat stigma. Greater awareness among cultures will only help people get much-needed treatment.
Two patterns of antecedent or “prodromal” psychiatric symptoms may help to identify young persons at increased risk of developing bipolar disorder (BD), according to a new analysis in the Harvard Review of Psychiatry.
Early signs of BD can fall into a relatively characteristic “homotypic” pattern, consisting mainly of symptoms or other features associated with mood disorders; or a “heterotypic” pattern of other symptoms including anxiety and disruptive behavior. Environmental risk factors and exposures can also contribute to BD risk, according to the analysis by Ciro Marangoni, MD, at the Department of Mental Health, Mater Salutis Hospital, Legnato, Italy; Gianni L. Faedda, MD, Director of the Mood Disorder Center of New York, NY, and Co-Chairman of a Task Force of the International Society for Bipolar Disorders on this topic; and Professor Ross J. Baldessarini, MD, Director of the International Consortium for Bipolar & Psychotic Disorders Research of the Mailman Research Center at McLean Hospital in Belmont, Mass.
The authors reviewed and analyzed data from 39 studies of prodromal symptoms and risk factors for later development of BD. Their analysis focused on high-quality evidence from prospective studies in which data on early symptoms and risk factors were gathered before BD was diagnosed.
BD is commonly preceded by early depression or other symptoms of mental illness, sometimes years before BD develops, as indicated by onset of mania or hypomania. Nevertheless, the authors note that “the prodromal phase of BD remains incompletely characterized, limiting early detection of BD and delaying interventions that might limit future morbidity.”
The evidence reviewed suggested two patterns of early symptoms that “precede and predict” later BD. A homotypic pattern consisted of affective or mood-associated symptoms that are related to, but fall short of, standard diagnostic criteria for BD: for example, mood swings, relatively mild symptoms of excitement, or major depression, sometimes severe and with psychotic symptoms.
The authors note that homotypic symptoms have “low sensitivity” — that is, most young people with these mood symptoms do not later develop BD. However, this symptom pattern also had “moderate to high specificity” — homotypic symptoms do occur in many patients who go on to develop BD.
The heterotypic pattern consisted of other types of prodromal symptoms, such as early anxiety and disorders of attention or behavior. This pattern had low sensitivity and specificity: relatively few patients with such symptoms develop BD, while many young people without heterotopic symptoms do develop BD.
The study findings also associate several other factors with an increased risk of developing BD, including preterm birth, head injury, drug exposures (especially cocaine), physical or sexual abuse, and other forms of stress. However, for most of these risk factors, both sensitivity and specificity are low.
Although many elements of the reported patterns of prodromal symptoms and risk factors have been identified previously, the study increases confidence that they are related to the later occurrence of BD. The researchers note that the findings of high-quality data from prospective studies are “encouragingly similar” to those of previous retrospective and family-risk studies.
“There was evidence of a wide range of [psychiatric] symptoms, behavioral changes, and exposures with statistically significant associations with later diagnoses of BD,” the authors conclude. With further study, the patterns of prodromal symptoms and risk factors may lead to new approaches to identifying young persons who are likely to develop BD, and might benefit from early treatment. The investigators add that predictive value might be even higher with combinations of multiple risk factors, rather than single predictors.
Researchers at McLean Hospital, an affiliate of Harvard Medical School, have discovered for the first time that computerized brain training can result in improved cognitive skills in individuals with bipolar disorder.
In a paper published in the October 17, 2017, edition of The Journal of Clinical Psychiatry, the researchers suggest that brain exercises could be an effective non-pharmaceutical treatment for helping those with bipolar disorder function more effectively in everyday life.
“Problems with memory, executive function, and processing speed are common symptoms of bipolar disorder, and have a direct and negative impact on an individual’s daily functioning and overall quality of life,” said lead investigator Eve Lewandowski, PhD, director of clinical programming for one of McLean’s schizophrenia and bipolar disorder programs and an assistant professor at Harvard Medical School. “Improving these cognitive dysfunctions is crucial to helping patients with bipolar disorder improve their ability to thrive in the community,” Lewandowski added.
Lewandowski and her colleagues knew from previous studies that this type of intervention had helped patients with schizophrenia improve cognitive functions. “There is considerable overlap in cognitive symptoms between bipolar disorder and schizophrenia,” Lewandowski noted.
The researchers therefore decided to test the impact of brain exercises in the bipolar population. They randomly assigned patients with bipolar disorder, aged 18-50, to either an intervention group or an active comparison group (used as a control). The intervention group was asked to use a special regimen of neuroplasticity-based exercises from Posit Science — maker of the BrainHQ online exercises and apps — for a total of 70 hours over the course of 24 weeks. These exercises use a “bottom-up” approach, targeting more basic cognitive processes early in the treatment to strengthen cognitive foundations, then moving on to training focused on more complex cognitive functions later in the program. The control group was asked to spend an equivalent amount of time on computerized exercises that focused on quiz-style games, like identifying locations on maps, solving basic math problems, or answering questions about popular culture.
At the end of the study, the participants in the intervention group displayed significant improvements in their overall cognitive performance as well as in specific domains, such as cognitive speed, visual learning, and memory. “The intervention group maintained cognitive improvements six months after the end of the treatment, and in some areas even showed continued improvements,” Lewandowski reported.
Lewandowski is encouraged by the findings, as they demonstrate that “this type of non-pharmaceutical intervention can significantly improve cognition in patients with bipolar disorder,” she said. “These findings suggest that once the brain is better able to perform cognitive tasks, it will continue to strengthen those processes even after patients stop using the treatment.” In addition, Lewandowski said, “The study indicates that affordable and easily accessible web-based interventions can be effective for a broad group of patients.”
Lewandowski noted that further research is needed to determine how the improvements in these cognitive skills impact work and leisure activities and daily functioning in patients with bipolar disorder.
Why, hello, there! The Bipolar Parent just celebrated an anniversary of sorts: two years of weekly posts! The blog has technically been running for about six years, but back when it started, posts were infrequent due to my not having my bipolar disorder under control. I was either riding the highs of mania and unable to focus, or suffering from the lows of depression and unable to muster up the energy to do much of anything, much less blog.
But now that I’ve stabilized on Wellbutrin and Risperidone, I’ve been able to update weekly and keep on top of posting. Here is the Master Link list to almost all of my posts. Enjoy the site, and thanks for stopping by!
Fibromyalgia and bipolar disorder appear to be connected. New research shows that a quarter of fibromyalgia patients who were screened tested positive for bipolar symptoms. Because these diseases are found in tandem, it’s known as comorbidity. If you have one disorder going on, despite their differences, you might have both.
The causes of fibromyalgia are yet to be discovered, and up to 5% of the population may be affected. More common in women, fibromyalgia is a disorder that causes muscle and joint aches. Other symptoms are fatigue, and, occasionally, depression.
Dr. William Wilke from the Cleveland Clinic in Ohio and his colleagues gave 128 patients with fibromyalgia four questionnaires. The first was the Mood Disorder Questionnaire (MDQ) for bipolar disorder, to determine the link between bipolar and fibromyalgia. Next was the Beck Depression Inventory (BDI) for depression. The scientists also used the Epworth Sleepiness Scale (ESS) for daytime sleepiness, and the Fibromyalgia Impact Questionnaire Disability Index (FIQ‐DI) to assess for functional capacity.
According to the MDQ screen, just over 25% of the patients were likely to have bipolar disorder, demonstrating a clear link between fibromyalgia and bipolar disorder. People who showed symptoms of bipolar also suffered from more severe depressions than people who didn’t show symptoms of bipolar disorder, which is really no surprise, given bipolar disorder’s depressions.
The BDI’s results were also of interest: 79% of the fibromyalgia patients were clinically depressed. Of those people, up to a third of the people who suffered from depression also reported symptoms of bipolar disorder.
The ESS showed that 52% of the patients with fibromyalgia–just over half–experienced daytime sleepiness, which doesn’t relate to bipolar disorder, but is interesting nonetheless.
Wilke’s team pointed out that some medications that treat fibromyalgia may also trigger mania in bipolar patients, and therefore doctors are urged to be cautious.
So, if you have fibromyalgia, you might want to talk to your doctor about the potential for bipolar disorder before you take medications to treat the disease, because those medications can trigger manic episodes. Similarly, if you have bipolar disorder, those muscle aches and fatigue might be something more; get screened for fibromyalgia.