Q. I have always been somewhat depressed, but in the last two years, I’ve had mood swings. I talk too much and too loudly, become argumentative, and need less sleep. Then I become depressed again. People tell me I may be bipolar, but I’ve never had hallucinations and delusions. Could I be bipolar?
A. There are two types of bipolar disorders: bipolar I and bipolar II which differ in several ways. First, bipolar II is not diagnosed by hallucinations or delusions (mania), while bipolar I is. Second, people with bipolar II have more depressive episodes which may be a precursor to the condition. The National Institute of Health conducted a study that followed almost 600 patients diagnosed with depression over several years. The study found that almost 9 percent of them eventually were diagnosed as bipolar II. Third, people with bipolar II become “hypomanic.” You report that you talk too much and too loudly, become argumentative, and sleep less than usual. These behaviors are all indications of hypomania. Other symptoms can include flights of ideas, pressured or rapid speech, and an overall increase in energy level. These symptoms can make one the “life of the party,” but they lead to risky behaviors such as over-spending, increased use of recreational drugs, and seeking out unsuitable sexual partners and experiences. Additionally, watch out with your alcohol consumption. Bipolar II patients are more likely to self-medicate with alcohol than those with bipolar I.
Many people worry that bipolar II will suddenly become bipolar I, and they will develop hallucinations and delusions. This is extremely rare. These are two separate disorders which share some of the same symptoms. It may help to think of bipolar II as a less severe form of bipolar I. Even if the condition is less severe, medication can help ease your symptoms of both depression and hypomania. Psychotherapy, in addition to medication, can probably help you deal with emotional issues that usually are present with the disorder.
Q. My father, who is in his 60’s, has been very strange in the past few months. He’s reading the Bible constantly, quoting scripture, having arguments aloud with God, writing things that make no sense, and not sleeping. My mother says he had symptoms like these years ago. I think he is bipolar, but I’m uncertain. Can bipolar just disappear and suddenly reappear after several years? I’m very worried about both my parents since my mother seems in denial.
A. Bipolar disorder can go into remission for a short period of time or for several years. Symptoms can develop and then without treatment suddenly disappear only to reappear later in times of stress or change. The relapse rate with bipolar, especially bipolar I, is extremely high if people are not taking medication. As people grow older, episodes of untreated bipolar tend to escalate, so it is not surprising that you have noticed changes in your father over the past few months. Family members often miss the diagnosis if episodes are far apart because they may not remember the earlier situations or they may no longer seem important. Talk to your mother about your fears. This type of behavior should not be ignored because it usually escalates and could be dangerous both physically and emotionally for both of your parents.
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Your father should get a referral to a psychiatrist, be diagnosed, and placed on the proper medication. Since his behavior is so erratic and eccentric, you should also schedule an appointment with a neurologist to be certain that there are no physical problems contributing to his behavioral changes.
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Nancy Ryburn holds a doctorate degree in psychology. She teaches psychology at Southeast Arkansas College and maintains a limited private practice in Pine Bluff. If you have questions pertaining to mental health, e-mail them to drnryburn@gmail.com. The questions will not be answered personally, but could appear in a future column. There will be no identifying information and all e-mails remain confidential.