When a person is diagnosed with a potentially severe and/or terminal illness, both they and their family may wonder if they can still live a normal life. The same is true with bipolar disorder, which millions of people live with. (At least seven million people in the U.S. have been diagnosed with the condition, according to NAMI, the National Alliance for the Mentally Ill, and many others do not know they have it.) Whether in online forums and chat rooms or in doctors’ offices, people often ask some variation of the question, “Can you live a normal life with bipolar disorder?”
When we put this question to FHE Health Chief Clinical Officer, Dr. Beau A. Nelson, DBH, LCSW, in a recent interview, he gave “a resounding ‘yes.’” What follow are his insights into why that is the case and other related areas of concern, as well as helpful information about treatment for the condition.
Living with Bipolar Disorder – “Can a Bipolar Person Live a Normal Life?”
If a bipolar person can indeed live “a normal life,” what might that look like? Dr. Nelson gave an encouraging picture of what living with bipolar disorder can be like:
Of course, there is no “normal,” per se, but you can live with the diagnosis of bipolar disorder, if you manage your health, follow a healthy regimen that controls symptoms and take care of yourself. For many, the diagnosis of a mental disorder leads to feelings that they will not be functional, a lot of fear and a lot of unknowns.
In fact, the reality of life with bipolar disorder may turn out to be a good deal better than what a person might fear, according to Dr. Nelson. He said that “many people with bipolar disorder, knowing that they need to take care of themselves, might actually do better than ‘normal,’ because they are conscientious about their health.”
Dr. Nelson used the analogy of living with diabetes. He noted that “many diabetic patients are so committed to their healthy diet that they are the healthiest eater in the family—because they know that eating poorly will affect their health more intensely.”
How to Live with Bipolar Disorder
If it is possible to live well with bipolar disorder, how do you do that? If someone with diabetes needs to maintain a healthy diet, what might the equivalent be for someone with bipolar disorder?
Here Dr. Nelson prefaced his remarks by saying that “living with bipolar disorder means educating yourself on the illness, the treatments and the warning signs to heed if you are not doing well.” He was also quick to recommend consulting a healthcare provider or licensed clinician.
What Is Bipolar Disorder?
Learning how to live well with bipolar disorder starts with a basic definition of what it is. Dr. Nelson described it as “an imbalance of chemicals in the brain called ‘neurotransmitters.’” He explained that it is “a part-genetic, part-environmental, part-behavior disorder.”
While bipolar disorder tends to run in families, “a parent has a one in 10 chance of giving it to a child,” so the odds of passing it down to a child are “not overwhelming.”
Stress, though, can be a major issue for someone with bipolar disorder: “Environmentally speaking, stress is a problem for any mental health issue (or those not suffering from any mental health disorder) but can be destabilizing for a person with bipolar,” Dr. Nelson said.
A Healthy Lifestyle and Effective Stress Management
“Healthy living and managing stress” are therefore “very important.” On this point, Dr. Nelson said that “one thing that helps bipolar patients be at their best is a regular sleep schedule.” Why? Because “ensuring you get a good night’s sleep, going to bed and waking at the same time, helps the body’s clock and allows the brain to work at its best.”
Exercise is another critical component of effective stress management and a healthy lifestyle. Dr. Nelson named “stress reduction, social support and a balanced life” as some of the many self-care advantages that a fitness regimen can offer someone living with bipolar disorder.
Staying Mindful of Potential Warning Signs
Living well with bipolar disorder requires a certain level of self-awareness and mindfulness:
As a general rule, if you notice a change in your routine, your moods or your symptoms, you should assess what is going on. Let’s say you all of a sudden start sleeping for three hours and wake up so full of energy that you stay up and get less sleep over several days.
Another thing could be spending more or feeling sexually promiscuous. Maybe people start mentioning that you seem to be so full of energy, are talking very fast and you are never sitting down—all these things could be signs that a manic episode is coming. On the other side, if you are sleeping too much, your appetite has changed, or you have little interest in things that you used to enjoy, this may indicate a depressive episode.
What Is Treatment Like?
Medications and psychotherapy provide the best results for bipolar disorder. Here is how Dr. Nelson explained it:
There are several medications that can alleviate symptoms and will be prescribed based on the presentation of symptoms that someone is experiencing. For example, a patient who has been depressed for many years, might have had an episode many years ago that was classified as “mania” but has only had depression since. A psychiatrist would need to evaluate this to see the best medication choice in that situation.
However, with bipolar disorder having the possibility of elevated (or “manic”) moods, there are certain typical antidepressants that are not prescribed for a bipolar patient, because they can actually trigger manic episodes. This is why it is best to have a discussion with your healthcare provider and then see a licensed therapist and/or a psychiatrist, a medical doctor who specializes in mental disorders, to get the best and most effective treatment.
In addition to medication, “working with a counselor, psychologist, or social worker, is also very beneficial,” Dr. Nelson said. “They can work with patients on coping skills, education, and support to help a patient to maximize their health and avoid difficulties that may make symptoms worse.”
One important consideration when fielding a therapist is whether they are experienced in working with bipolar patients: “Not all counselors are experienced in working with bipolar patients, so it is a good idea to get a good referral or recommendation and ask about bipolar care—just to make sure that this will be helpful for you. A therapist does not have to be an ‘expert,’ but it is good if they are familiar with the illness and have treated people with it.”
Understanding Bipolar Disorder
Understanding bipolar disorder, treatment for it, and its potential impact on one’s life is therefore key to successfully managing it. Hopefully, Dr. Nelson’s answers to the following questions can be helpful, too, in fostering greater understanding.
Can All Symptoms Subside?
“People can have symptoms from mild to severe,” Dr. Nelson said, adding that often the disorder is diagnosed in the late teen years.
Since the severity of symptoms can vary between individuals, there’s no universal answer to this question. With the right treatment, many or all symptoms may subside. Dr. Nelson explained that bipolar disorder is characterized by “the occurrence of ‘down’ episodes (called depressive episodes) and ‘up’ moods.”
The “up” episodes can be either “hypomanic” or “manic”: “Hypomania is an elevated mood and change in behavior but is not as full-blown or intense as full mania, which can often be characterized by irrational or grandiose thinking, risky behaviors, lack of sleep, and a boundless energy.”
The fact that bipolar disorder can be episodic means that symptoms can reoccur after a period of dormancy. This means that “as with any dynamic system, such as the body or the mind, you need to be aware when you see things that are concerns.”
“Much like the ‘check engine’ light on your car alerts you to go in for a service,” he continued, “there are also some signs that can be helpful to know that a change of medication or self-care adjustment needs to be made.”
“Not everyone has the same warning signs. It is a good idea to talk with your doctor or therapist about the symptoms you experience and things to watch out for.”
Will It Get Worse Untreated?
Yes, untreated bipolar disorder can get worse and become life-threatening. Each successive, untreated episode can become progressively more severe, last longer and prove harder to recover from.
This reality makes early intervention important. “As with all things it is better to catch something early,” Dr. Nelson said. “Usually, a real conversation with a healthcare provider can help someone to see what is going on and get on top of it before the symptoms get worse.”
Once a person is on medication and seeing a therapist, they also need to stick with their treatment program. Stopping medication or falling into unhealthy habits can lead to a return of symptoms and consequences related to bad decision making.
“If you stop your medication or run out, a visit to your healthcare provider is a must,” Dr. Nelson said. “Sometimes a patient may think, ‘I do not need this medication anymore,’ and that is not something you should do without consulting your doctor. It could be a very big mistake and is not something you should decide alone.”
In a similar vein, ongoing maintenance therapy can help to ensure you “catch things early,” since the therapist “will know you, will be able to interpret symptoms and talk with you about what you are experiencing.” From there, it will be easier to see “if a ‘tune up’ is needed or if there are some helpful things you can add to keep yourself healthy.”
In short, bipolar disorder may sound like a serious diagnosis, but with the right tools, supports and a commitment to be healthy, it is manageable for many. You can lead a full and rewarding life.