As I mentioned in "How to Accurately Diagnose Depression", bipolar disorder is a more difficult mental illness to deal with and can be confused with depression or schizophrenia.

What is bipolar? Let's start with two stories.

Two stories

Once, I hosted the father of a depressed teenager who came to me for help. The boy was originally an honor student in a famous middle school in Wuhan, and his grades ranked in the top five in his grade, and he was a material for going to Peking University. How do you know that in the first year of high school, I suffered from depression and sought treatment for four years, during which I was misdiagnosed with schizophrenia and hospitalized for three months. In the end, the family had to force their son to be hospitalized again and receive electroshock therapy.

On the morning of the scheduled shock, the poor father came to the ward early in the morning and saw that his son had unusually gotten up. Sitting on the edge of the bed, his expression is calm, and his eyes are clear and bright. The father was surprised when the son said, "Daddy, I'm all right." ”

The father was shocked and asked, "How are you doing?" ”

The son pointed to a pot of flowers in the ward and said, "Yesterday I saw that this flower was gray in color, but today it is red. ”

What a joy from the sky! The father hurriedly called the mother, and the family was mixed with joy and sorrow. Then, the son excitedly called his former classmates and told them that they were well. The parents watched with relief as their son made an excited and smooth phone call, sweeping away yesterday's cringe and sluggishness.

After calling his classmates, his son was still unsatisfied, so he took his parents' mobile phones again, opened the address book, regardless of 3721, dialed them one by one, and talked endlessly.

The smile on my parents' faces that had just bloomed froze. They felt something was wrong and rushed to the doctor.

The signs are all too obvious. Four years after the teenager's illness, the doctor made the right judgment: he was moving from a depressive phase to a manic phase. The doctor immediately adjusted the direction of treatment, and the teenager gradually recovered.

Let's talk about my own story. As mentioned in the previous article, on the 19th day of my treatment by Dr. Jiang Tao, I suddenly recovered and all my lost social functions were restored. That night, I was excited and sleepless all night; The next morning, without any tiredness, I went to Hongluo Temple to climb the mountain, walking like flying, and my physical strength was vigorous.

That night, I sent a message to Dr. Jiang Tao to express my gratitude. He quickly replied to the message, just a few words: "You come to me to see." I wrote back, "Okay, I'll come for a follow-up appointment this Saturday." He messaged back: "Can't wait until Saturday, come tomorrow, let me have a look." ”

That's it, I can't help but go. The next day, when Dr. Jiang Tao saw me, he only glanced at me and said, "You have signs of changing your face, hurry up and adjust the medicine." "Then prescribe the drug, add olanzapine, stop reboxetine. That night, sleep returned and gradually stabilized.

Later, I kept wondering, why did Dr. Jiang Tao insist that I let him "take a look"? What did he see?

I guess that this may be like asking the reporter to bring me the manuscript for me to see, and outsiders can't see the fame, but I can see at a glance whether the news facts are enough and whether there is a basis for revision. Perhaps there was some kind of information in my expression, complexion, and demeanor at that time, and Dr. Jiang Tao knew whether he had changed his face at a glance.

The poles of the duplex

From the above two examples, the reader may understand that the patient's excitement, agitation, and energy are one of the characteristics of bipolar disorder.

Bipolar disorder is a condition that combines depressive episodes with manic episodes. The manic phase is characterized by excitement, excitement, optimism, and high emotion; Depression is the other extreme, which is pessimism, sluggishness, depressed mood, slow thinking, and motor inhibition. The two can alternate between the onset of the disease, one stage turns sadness into joy, and the other stage turns into joy and sorrow.

Clinicians summarize the manic manifestations as follows:

1. Mood is high, self-feeling good, elated, triumphant, smiling, infectious, often resonating with the people around him, causing bursts of laughter.

2. Thinking is rushing, quick response, surging thoughts, there are many plans and goals, I feel that my tongue is racing with thoughts, words can't keep up with the speed of thinking, words increase, talk endlessly, mouth like a river, hands and feet, eyebrows flying. Even if your mouth is dry and your voice is hoarse, you still have to talk non-stop, talk about it, the content is unrealistic, and you often change the subject; Empty-eyed, pretentious, domineering, and invincible.

3. Increased activity, energetic, tireless, wide range of interests, quick movements, busy, nosy; He is often extravagant, generous, and a good teacher; Frivolous demeanor, often in and out of entertainment venues, attracting bees and butterflies.

4. The complexion is ruddy, the eyes are bright, the heart rate is increased, and the pupils are dilated. decreased need for sleep, difficulty falling asleep, early awakening, disturbance of sleep rhythms; hyperphagia, overeating; Increased interest in the opposite sex, hypersexuality.

Yan Wenwei, a psychiatrist in Shanghai, has documented a typical case. Here is a brief description as follows:

In 1996, on one occasion, he was visibly depressed. However, suddenly, the mood has improved, and I feel that my thinking has become fast and I am quick to react. Suddenly I like to play with people, and I feel that my future is bright. The "WC" gesture was also invented. He also claimed to have invented methods such as "thieves can wear shoes to commit crimes on snowy days, so that they are not easy to be caught", and he feels that he is very unusual, and he talks more and acts more.

…… In 2001, because of work and love problems, he attempted suicide. In July of the same year, he was diagnosed with major depression by a hospital in Beijing and given venlafaxine. After taking the medicine for two weeks, I felt suddenly better and returned to work. It turned out that he didn't dare to take the main road, and that night, he deliberately walked in the middle of the road, not afraid of meeting people. I was so excited at night that I couldn't sleep, and I felt better now. The next day, I went to the unit, to our colleague's office, and talked endlessly, as if I had found a solution to the problem, and it seemed that everything was so beautiful......

…… In 2005 and 2006, he had several depressive episodes, but he was still diagnosed with social phobia, and was repeatedly hospitalized with paroxetine, sertraline, etc., but the effect was not good. In 2009, he stopped taking the drug on his own and underwent psychotherapy for 10 months, but the effect was not good......

In October 2010, I relapsed into depression again, I remember that in the middle of the treatment, there was a period of feeling good, energetic, addicted to fishing, doing preparations for weekend fishing during the day, watching articles and videos about fishing on the Internet at night, feeling that the need for sleep was reduced, and I was very excited. I even want to go night fishing, participate in fishing competitions, become a master fisherman, and so on. During this period of good mood, I feel that life is very good, I am in a good mood, and I am racing against time to act. After about a month, I felt tired, depressed, fatigued and drowsy, unable to get out of bed in the morning, and slept all day.

In short, in the past ten years, there have been many recurrences of depression. In recent years, seizures have become more frequent. Sometimes it happens once a month, but not more than two months, and there will definitely be a depression, about four or five to ten days. When you are depressed, you have no energy, you don't want to talk, you don't want to do things, you think slowly, you can't get out of bed in the morning, you blame yourself, you worry, you are afraid, etc. After that, the mood will suddenly improve, at this time, I feel that everything is fine, I am not worse than others, but I react faster than them, I am smarter than them, everything is so good, and I have set lofty goals for myself. But it won't be long before you fall back into depression and fear. For more than ten years, it has been going back and forth like this, attempting suicide once, being hospitalized three times, suffering from illness, and having no way to escape from this "magic circle".

Dr. Ngan Man Wai pointed out that this is a very typical bipolar patient. It's a pity that many doctors don't know him, only know that he is depressed, and only know that he is given antidepressants, causing the patient to become a "fast cycle type".

A few instances

In the past two years, I have also communicated with some netizens about the performance of bipolar. Time has passed, and everyone laughed at their various performances at that time.

A netizen, in 2000 in Harbin Ice and Snow World, saw a four-story tower made of ice, and a few hemp ropes were laid down on the city wall, he thought he could climb up, and he had to climb up the tower along the rope. None of the thousands of tourists dared to do so. Later, he was stopped alive by his brother and sister.

A patient in a certain city, who was originally a modest and cautious person, repeatedly went to the mayor during the manic period to discuss with the mayor about the plan to revitalize the city's economy, but was stopped by the secretary and did not succeed once.

A college student, shy by nature. During mania, suddenly become very arrogant. He thought he had realized the true meaning of life, and when he went to the cafeteria to eat, he stood on the steps of the cafeteria and preached. As a result, he was taken to the hospital as schizophrenia. After half a year of treatment, I found out that it was actually biphasic.

A netizen in Inner Mongolia went camping on the grassland for eight days in the summer of 2009 and slept peacefully in the dark night, thinking that he could cope with all the beasts......

It is important to note that bipolar depression has not received sufficient attention from clinicians. It has been reported that 37% of patients with bipolar depression are misdiagnosed with unipolar depression and are treated with antidepressants for a long time, which induces manic, rapid cycle episodes.

Bipolar disorder and depression are two disorders with different mechanisms. If biphasic is diagnosed, it is necessary not to take only antidepressants, but to use mood stabilizers, mainly lithium carbonate, sodium valproate, carbamazepine, and lamotrigine. If you are really overexcited, you can also use olanzapine drugs for schizophrenia to temporarily "suppress" the excitement.

As long as you continue to take an adequate amount of emotional stabilizers, the bipolar will not recur and you can return to your pre-illness state.

How to identify a biphasic

After many patients recover, they will miss the unique life experience of the manic period: happy mood, high mood, increased self-confidence, strong creativity, and improved work performance......

Why is it so amazing? I have a bold guess: what is the potential of human beings? I don't know. On weekdays, only 5% of the human brain is developed, but in bipolar mania, there may be some kind of chemical reaction in the brain, and the brain potential is suddenly developed in a short period of time, and all kinds of abnormalities occur......

Some readers may ask: Isn't that a good thing? I still want to be manic, but I can't!

Yes, a good thing. But can there be a free lunch in the world? Countless blood and tears prove that after mania, there must be depression; As high as the mania, the depression is as deep as the depression. Pressure mania, in fact, is to prevent depression.

I have an explanation for mania: human life is like a bowl of lamp oil, and in general, everyone has about the same amount of lamp oil (except genius). How long your lamp of life burns depends on how strong your flame is. When you are in the bipolar manic phase, the flame of your life suddenly rises and the candle shines brightly; Unfortunately, the good times don't last long, and your life lamp oil is consumed very quickly, and the end result is depletion......

Looking back at my illness before and after my illness, it can be assumed that in the summer of 2011, the first six months of my illness, I may have experienced a period of mania. At that time, I was extremely energetic, and although I only slept four or five hours a day, I did not feel tired; The mood is always high, the mood is always happy, the thoughts are like springs, the confidence is calm, the team is neat, and the work is smooth...... How did you know that the buried bomb was about to detonate......

What has survived is a set of photographs taken during my visit to Poland in October of that year. I used a small card camera, but the framing, composition, and lighting were far beyond my usual level. "The essence of photography is discovery." When I returned, I boasted triumphantly to others.

How did I know that this was a return to depression!

Human life is like a bowl of lamp oil, and generally speaking, the amount of lamp oil that each person has is about the same. When you are in the manic phase of bipolar, the flame of life suddenly rises and the candle shines brightly. Unfortunately, the good times did not last long, and the oil of life lamp was consumed quickly, and the end was depletion.