Big Think and the Mental Health Channel are proud to present Big Thinkers on Mental Health, a new series dedicated to open discussion of anxiety, depression, and the many other psychological disorders that affect millions worldwide.

This week, psychiatrist Nicole Foubister delves into the world of bipolar disorder. Most people are casually familiar with bipolar disorder, although few understand the colossal strain it can have on the lives of sufferers and their loved ones. It’s vital for people diagnosed as bipolar to open themselves up to treatment and for people close to them to be aware of the illness’ ramifications. What’s most important is to understand that no one chooses to be bipolar; you must learn to be calm and patient with people who suffer from it. It’s not their fault that they lack mental wellness and their behavior during manic episodes is not reflective of who they really are.

Nicole Foubister: Bipolar disorder can have lots of effects on a person's day-to day functioning. So, for instance, again, in the middle of an episode of either mania or depression, people who are manic will often do things that are really impulsive and really out of character. And so issues of infidelity can come up, for instance, in a patient with mania who's having a sexual partner or sexual partners outside of the relationship in the midst of a manic episode. People will often spend money that they really can't afford to spend in the midst of a manic episode, which you can imagine will cause a lot of strain for them personally, but also in the context of their families. People in the midst of mania often don't appear to be logical and so they will go to work and will have lots of irritability. And you can imagine, again, that coworkers are confused; bosses are confused; and especially if they don't understand a lot about the illness it can affect their work relationships and their ability to maintain their employment.

You can imagine that if it's hard to get up out of bed and even go to the supermarket and get your groceries for the day that it can be very difficult to go to work and get all the things that you need to get done either in your work life or in your personal life. People will report guilt or sometimes feeling like they're worthless. People will also report that they feel like they're either kind of moving in slow motion, which is known as psychomotor retardation. And occasionally will people report that they actually feel jittery, which is known as psychomotor agitation. In addition, people will report disturbances in their sleep, which are most commonly insomnia. So either difficulty falling asleep, waking up in the middle of the night, or waking up earlier in the morning than one intends to. Occasionally this can be hypersomnia though where people are sleeping, for instance, 10, 12, 13, 14, or more hours per day.

Patients with bipolar disorder often are resistant to receiving treatment, especially during a manic episode. And this is really part of the illness in terms of not understanding that one is sick. Bipolar disorder cannot be cured, however people often find that they will go, you know, periods of time without having any illness or periods of euthymia. It really depends on the individual and how their clinical course goes as well as finding treatments that work. The mainstay of treatments are mood stabilizers. So these are medications that are used to keep somebody from having most notably a manic episode or a depressive episode. Finding the right treatment can sometimes be a little frustrating and patients really need to hang in there as their doctors try different medications to figure out what works best with their neurobiology.

In order to support a loved one who has bipolar disorder, it's really important to realize that this is an illness, like any other illness. A lot of times people think of mental illness as it's being something that's within the control of the individual and the individual will often think that as well feeling tremendous guilt when they do have episodes of either mania or depression. And so the first thing is realizing that people don't choose to have bipolar disorder and they would definitely choose to live with more mental wellness than having this illness. It's really important to be calm, present, and consistent with people with bipolar disorder, as well as supporting them and maintaining their treatment. In the next 10, 20, 30, 50 years I really see a lot more research being done to try to find treatments that are effective and have less side effects than some of the medications that we have currently available today. I really only see better things for the future.