There are other ion channels that may be over-stimulated in response to various neurotransmitters. In addition, researchers are also looking at the neurotransmitter dopamine, which is involved in pleasure and reward. There is also some evidence that vitamin or mineral deficiencies may play a role. In all likelihood, several processes are occurring at once, and not necessarily the same ones individual to individual.

I think I may have bipolar. What is my first stop?

If you are in a life-threatening situation, or if you may be a danger to others, your first stop is the emergency room of your local hospital. Otherwise, you should book an appointment with a psychiatrist.

Why a psychiatrist?

First, because medications are the cornerstone of bipolar treatment, and only medical doctors such as psychiatrists can prescribe medications, unlike a psychologist who specializes in talking therapy. Second, because of their training and experience, psychiatrists are far more likely to give a correct diagnosis than going to your family doctor.

What should I expect from a psychiatric examination?

You can expect questions ranging from how you are feeling to how you are faring at work and at home to any family history of mental illness, if any. All the while, the psychiatrist will be probing for unusual behavior, such as spending sprees or talking too fast. Unfortunately, it takes bipolar I patients six years and bipolar II patients more than 11 years between first contact with the medical system and a correct diagnoses. This puts a considerable onus on you to reveal as much as you can to your psychiatrist. Basically, your psychiatrist is only as good as what you tell him or her.

So what should I be telling my psychiatrist?

Focus on all those times you didn’t feel your normal self or too much like your normal self. You might want to go back over those times in your life you would rather forget — such as embarrassing yourself in public or attacking your spouse or walking off your job or getting arrested — or where you were unusually productive — working 20 hour days, cleaning the house in the middle of the night, writing a term paper in three hours - and try to remember what you were feeling during the time and the times that led up to these events. If you felt you were smarter than the rest of the world, describe it. If you were in a raging white heat, fill in the details. If you were in an incapacitating blue funk, describe how hard it was to get out of bed. If possible, try to write down everything you can recall in order to organize your thoughts.

To paraphrase Jack Nicholson, I can’t handle the truth.

Admitting that there may be something wrong with you is one of the most difficult tasks there is. Add to that fear and ignorance and stigma, and you begin to appreciate why so few people seek help or get a correct diagnosis.

I have been diagnosed with bipolar. Who should I let know?

As few people as possible, at first. It is important to know that this illness carries a much greater stigma than depression, and you run a high risk of alienating friends and associates simply by breathing the word. Legally, in the US, you should not have to reveal your illness to your employer or prospective employer, but companies may require employees to have an in-house physical where one must disclose one’s medications. If there is any consolation, some of history’s most talented , as well as most notorious , individuals have had bipolar, including Ludwig von Beethoven, Michelangelo, Isaac Newton, Vincent Van Gogh, Ernest Hemingway, Virginia Woolf, Hitler, Stalin, and Napoleon. 

NOTE End of part 2 of a 3 part series. Next months issue "Bipolar Treatment"