Expert: Joanne Chang - 2/19/2009

Question
Hi Joanne,
I was just wondering if you could tell me wether I should be concerned about
the following, like do they sound like symptoms of bipolar.
I'm 25 and ever since my 20's iv had really up and down emotions. I don't
know if my "up" emotions would be considered manic but I know my "down"
emotions are depressive as was told by a psychiatrist last year.
I regularly feel depressed with EVERYTHING, anti-social, angry, tearful,
hopeless and very suicidal. I often self harm too. When I feel like this I do
very impulsive, regretful things such as throw myself out of the moving car,
or in front of a bus or smash something important to me or just cut myself.
Sometimes I feel okay, but usually when I feel "ok" I feel like if anything upset
me id "fall off the cliff" and get either really upset, suicidal and depressed or
really angry and careless and suicidal.
Sometimes I feel really good and when I reflect on my depressed moods i
think of them as silly and that I was making a deal out of nothing. I can't
connect with that sad part of me when I feel really good. Just as I can't
connect with the happy part of me when im really depressed.
When I feel really good I am VERY CHATTY indeed. I talk very fast and am
very animated with my body language. I laugh a lot and want to be around all
my friends and have no probs talking to strangers or making new friends.
The reason I write to you is that I have noticed i have a few of the symptoms
used to diagnose Bipolar. For instance- shopping yourself into debt!! When I
feel good I like to treat myself. I go shopping and spend spend spend and end
up buying loads of rubbish I don't need. I don't think it's rubbish at the time
tho, I think I NEED it. I do shop to make myself feel better and seem to switch
off my conscience and am just very carefree, I don't care what anyone else
thinks of me. Before I know it I have no money left. I can't actually think what
iv spent it on and when im down I can't remember ever even going shopping!
I seem to shop and switch off my mind as to what im doing/buying when I go
out.
My moods change dramatically everyday, I never know what mood im going
to be in from one day to the next, its very hard to deal with.
I heard bipolar people don't change their moods daily more like weekly or
monthly? is that true? as I change my moods daily. I can feel great in the
morn then spiral into depression and tearfulness during the day and really
want to kill myself then feel "okay" (by okay i mean numb and very apathetic)
and then possibly great again by the evening and loving life. It's weird.
Look forward to hearing from you, than you for taking the time to read this!  

Answer
Hi Sara,

From your e-mail, it certainly seems that you have to deal with a whole lot everyday.  I wonder how you are coping?

Certainly, the past behavior (pressured speech) / action (excessive spending that landed you in debt) / feeling (elevated mood that seemed uncharacteristic / detached) you have mentioned can be taken as symptoms of bipolarity but if you want to be more certain by way of a diagnosis, consider speaking with a psychiatrist so that he or she can ascertain a thorough patient history.  Are you still seeing the psychiatrist you saw last year?  A diagnosis is mainly determined with the purpose of guiding treatment.

You started off your e-mail by asking me whether you should be concerned about the rollercoaster of emotions you are currently experiencing.  I certainly think there is cause for concern if you "regularly feel depressed with EVERYTHING" and often engage in self-harm.  Are you currently receiving treatment for your depression?  If not, I sincerely hope you will promptly do so to improve your quality of life.  It must be stressful feeling as though you are on the edge of a "cliff" on a daily basis.  Please seek help from a mental health professional if you aren't currently seeing one.

At the end of your e-mail, you asked about how rapidly moods can fluctuate for individuals with bipolar disorder.  Some experience rapid cycling with moods alternating between depression and mania / hypomania with four or more episodes a year.  Cases of ultradian cycling with distinct shifts of mood within a 24- to 48-hour period have also been reported.

I do hope things get better for you in that your moods stabilize such that you no longer feel depressed so often and need not engage in self-harm.  Do consider healthier methods of coping with the stresses in life.  I wish you all the best and do write back if you have further queries.

Best wishes,
Joanne :-)