Therapy Talks

5 Signs Your Bipolar Disorder Is Undiagnosed and How To Find Help with Stephanie Georgiou

November 08, 2022 Switch Research Season 1 Episode 48
Therapy Talks
5 Signs Your Bipolar Disorder Is Undiagnosed and How To Find Help with Stephanie Georgiou
Show Notes Transcript

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“The diagnosis of bipolar disorder is one of the most complex topics in contemporary psychiatry. Bipolar disorder is a disabling psychiatric illness that is often misdiagnosed, especially on initial presentation. Misdiagnosis results in ineffective treatment, which further worsens the outcome"
The National Library of Medicine 

This week on Therapy Talks, Stephanie Georgiou joins Barb Egan to talk all about Bipolar mood disorder. Barb and Stephanie discuss signs and symptoms, common mis-diagnosis of it, and how we can use therapy to create awareness of the triggering stressors, while minimizing risk and taking a proactive approach to healing.

Stephanie and Barb dive into an in-depth discussion about what Bipolar Disorder is, and how it can be mistaken for other mental health conditions. They also offer hope and practical advice for those who are struggling, and their loved ones.

In This Episode:

  • Differentiating bipolar depression and unipolar depression.
  • Stephanie’s favorite modes of treatment for bipolar mood disorder. 
  • Problems with diagnosing bipolar and why it can go unnoticed or misdiagnosed.
  • Why Antidepressants don’t work with bipolar and the importance of mood stabilizers. 
  • What information is necessary for physicians and therapists to better understand their patients.

Stephanie is a Registered Psychologist, Board Approved Supervisor, Author and Clinical Psychology Registrar who is passionate about changing the lives of others through therapy, education and training. Her experience is extensive as she has worked in private practice, forensic settings and with adolescents, adults and groups. Her psychological assessment and intervention cover; anxiety disorders, mood disorders, eating disorders, personality disorders and substance use disorders.

Find Out More About Stephanie:
TikTok: @mindfoodsteph

Learn More About Switch Research:
Instagram: @switchresearch

Disclaimer: Therapy Talks does NOT provide medical services or professional counseling, and it is NOT a substitute for professional medical care.

Hi everyone, it's Barb Egan with Therapy Talks, and on today's podcast we have Stephanie Georgiou from Melbourne, Australia on a psychologist there who works in bipolar disorder. So we differentiate between bipolar type one and type two. What some specific markers or signs to look for are where it comes from, medication treatment, types of therapy.

Support for family and some other ins and outs, perhaps even famous people who have had bipolar disorder. And so we talk about all of this to normalize it, equip and empower you, and I hope you join us.

Tell us a little bit about you, your story, again, you're in Melbourne, Australia. But yeah, just a little bit about you. Yeah, absolutely. So my name is Stephanie Georgio and I'm a fully registered psychologist, and I've been practicing for over seven years now. And in that time I've also done another clinical masters during lockdown.

So I'm a clinical psychology registrar, which means I'm in my final hours of becoming a clinical psychologist. And in addition to that, I also am a board approved supervisor. So I supervise psychology students along their journey to becoming fully registered. And I've also published a book, Food Jail, Breaking the Bars of Binge Eating, which kind of is, It actually is inspired by my story.

So I went through an eating disorder as an adolescent. There wasn't much support out there. There wasn't much help, and I just, Don't want people to go through what I went through or I want people to have more resources and knowledge and access to Yeah, alternative information. And that's what led me to start TikTok and social media.

Cause I think it's such a great way to inspire people and that's what led to Mind Food stuff, which is my social media name being born. And I just love to educate and validate people cuz I think mental health is such a big space at the. Oh Amen. That's amazing. Wow. Wow. I love And that's when you meet therapists, more often than not, it's a personal story that they've walked through to get to where they're at, of that.

We've been on the other chair in the room, so to speak, that we know what it's like to walk through something. And I think that's really encouraging, that you get to use your pain for good into helping other people. For sure. I remember when I saw a therapist years and years ago, I said to him, Have you ever seen a psychologist?

And he said, I can't imagine anyone doing this kind of work who hasn't seen a psychologist or a counselor or a clinician of some sort. So I think it does give you a different insight into the experience of mental health. Yeah. Yeah. So true. And so you work in eating disorders. What else do you work.

Yeah, so pre, at the moment, I work online, so my business is all telehealth. It started right before the pandemic, and I guess the pandemic really created a space for people to use telehealth, and the presentations I see have ex. Standard. So I'm reaching a whole new audience of people who have a agoraphobia, have severe obsessive compulsive disorder.

They struggle to leave their home. People who really struggle with their weight physically as well. All types of eating disorders, anxiety, depression, bipolar borderline personality disorder. There's not much that I don't see apart from children and couples. Yeah. Neat. Oh, that's so neat. And bipolar I know is something we're gonna focus a lot on today.

So can you give our listeners just bipolar 1 0 1? What? What does that mean? All of that? Yeah, absolutely. So bipolar disorder, Under a category of its own in the DSM five. So I'm not sure if you're familiar. I know over there you might use the ICD 10 or another category, but this is a book that we use.

I'm not sure if people will be able to see it cause it's a podcast, but it's called the Diagnostic and Statistical Manual of Mental Disorders and Bipolar has a. It has its own category and it comes between depressive disorders and schizophrenia spectrum disorders, and essentially bipolar is a mood disorder, and it includes bipolar one, bipolar two, cyclo, imia, and a couple of other categories, which we can go into later.

But essentially the word bipolar, it reflects fluctuations between extreme highs and extreme. For our listeners, if they're thinking, what are some signs and symptoms here? Could that be me? Could it be someone I live with? Or, we've heard that term maybe a little bit more and more as of late, and so we're intrigued by it.

What would we look for? Yeah, and I think that's such a great question because a lot of people will say, I have mood swings. Is it bipolar? What's the cause of it? And I think the common symptoms with bipolar, separate them. There's bipolar one and there's bipolar two. Now, bipolar one is when you experience manic episodes and bipolar two is when you have what's called hypomanic episodes, which is a kind of less elevated form of mania.

So mania is. Expansive moods. So if you were someone who experiences moods where you feel very elevated, very expansive, very energized, you have a decreased need for sleep, you feel super talkative, you may actually feel irritable, You may be experiencing elevated mood and an extreme can. Cases, it could be mania and in less intense circumstances, it could be hypermania.

Now, the difference between, a regular mood swing and having a condition such as bipolar is the level of impairment that the moods have on your functioning. So we all experience highs, we all experience lows. But if your moods are interfering with your social life, your work life, your day to day functioning, and it's persistent and enduring, that's when it may be bipolar.

In addition to that, Bipolar is heavily genetically influenced and it is a brain imbalance. And for that reason, the moods aren't always triggered by something external. Whereas if you're someone who experiences up and down moods, it may be. Due to a stressful life event, and it could be due to something happening at work today.

Whereas bipolar the moods can be quite random. Not to say they're not triggered by stressful life events or stressful life Events have an influence, but more so than not, it is more pervasive. It's less accounted for external events, and it has a much higher level of impairment on your day to day life than say, regular mood swings that people may experie.

And you hear that term thrown out really loosely oh, almost in a derogatory warrant way of bipolar, like the high highs and the low lows. And that can be really hard for someone to hear who really is struggling with that, or a family member. And there's more out there than you recognize.

And yeah, just. Being aware of our wording can be helpful there. But with those, especially in those high highs, how long do they last for? And how long, do the low lows roughly last for, would you say? Yeah, and just to clarify with bipolar one, you may or may not have major depressive disorders, so essentially bipolar.

In bipolar one is mania and you may have major depressive episodes as well, which I'll go into bipolar two. You have major depressive episodes and you have hypomania as well. So just to clarify, a major depressive episode known as a major depressive disorder is low mood for a minimum of two weeks. And in this low mood we see fatigue.

We see people struggl. To wake up, we see changes in weight. Some people may gain weight, some people may lose weight, just depending on. Your coping mechanism. Some people overeat, some people undereat. We see more suicidal ideation. So thoughts around not wanting to be here, Thoughts around worthlessness, hopelessness yeah, fatigue.

And just that really low mood. And this needs to occur for a minimum of two weeks. And the other key characteristic is a loss of interest in activities you used to previously enjoy. So for example, if you. Reading and you're not finding that enjoyment anymore. That's actually called anhedonia when you lose interest in something you used to enjoy.

So that's a major depressive disorder or a major depressive episode. And that occurs in bipolar, and it may occur in bipolar one, but not necessarily. Now, when we talk about the highs, mania is the most severe elevated mood, and people like to think of hypermania as a more mild version. Now, mania lasts. A minimum, we'd say seven days, and it can go on for longer than that as well.

But mania tends to be longer, whereas hypomania tends to be a minimum of four days and. Is less, enduring in nature and just uncharacteristic of the person. It seems like they've had too much caffeine. They're a bit more energetic than usual, perhaps a little bit more creative or on the go.

Whereas someone with mania, they may actually experience hallucinations a. At the extreme end delusions and more often than not, need to be hospitalized because they can engage in dangerous and reckless behavior, which Yeah, can ultimately put them at risk. Wow. And thank you for clarifying that and giving some examples.

That is so helpful. Does bipolar what type one and two, Where are some theories of where it comes from or some of the risk factors if someone's susceptible to, struggling with this? Yeah, and it's such an interesting topic cuz there's a lot of different theories. Is it caused by stress? Is it caused by genetics?

And essentially they're found. What is called the vulnerability stress model. This is what a lot of, theorists and research look at. And basically the theory is, There are genes which make you more vulnerable to developing bipolar or make you more vulnerable to how you handle stress. We do know that there is a high genetic component, so if you do have relatives who have bipolar, there is definitely a genetic vulnerability that is inherited.

And then we have the kind of more brain biology. You may have a predisposition to have some abnormal functioning of your brain circuits, your dopamine. Serotonin is a little bit I guess different to someone without bipolar. And then the theory is that. There are personality attributes that make you more vulnerable to stress and how you handle stress.

And I guess the theory is the combination of genetic predisposition and environmental stresses such as being sleep deprived having adverse living conditions. Can make you more vulnerable to developing bipolar. And more often than not, people can have this genetic predisposition and it can lay dormant and not be activated until a stressful life event occurs.

And this is why the onset of bipolar is usually 18 to 20 years old. It's something we see later in life. Yes, it can be. In children, however, we see Bipolar one and two confirmed in people's later teenage years. And one important thing I will say is people usually get a diagnosis eight to 10 years after their first episode.

So it, it does get, it gets very misdiagnosed and missed quite frequently. Wow. Why is that, do you think? Eight to 10 years? That's a good chunk of time. Like eight to 10 months is frustrating. If you've had a struggle, I'm just gonna equate this to a physical injury. Let's say you have a really bad knee.

You've, you had a car accident in our sports century and you have to wait eight to 10 months for care or proper care, that would be incredibly frustrating. Same for mental health of. If you have that and it's eight to 10 years till you get the proper support that you need and deserve, what?

What are some factors for that, do you think? Yeah, and it's such a great question. The reason. Bipolar usually gets missed or misdiagnosed is because people typically present to therapy in the depressed phase when people are experiencing hypermania, they're feeling quite good, they're more productive, they don't need to sleep.

They're quite energetic, so they're not likely to present to therapy and say, Hey, I feel really good. What is happening here? That's in Hypermania. So when people come to therapy, They are usually in the depressive episode or they're in major depressive disorder, a major depressive disorder. It is a diagnosis in itself.

You know it's low mood for a minimum of two weeks. So when someone goes to therapy in this depressive mood, they're likely to be given a diagnosis of depression. And whilst that is true, a lot of clinic. Perhaps we'll overlook screening for mania or hypermanic symptoms. And sometimes people can have hypermanic symptoms and not even be aware.

That is, it is hypermania because I think, we all have a lot of caffeine and we all have different situations where we feel more energetic. But I guess what leads people to recognize. Hey, I don't think this is just depression is when they're put on antidepressants, they get worse, and that's a key indicator of bipolar.

If you try to medicate bipolar with antidepressants alone, it leads to cycling, so the person's mood is actually going to get worse. And how far after, cuz some of the clients that I've worked with, we've dealt with the physician or the psychiatrist in this instance where you see that or it's like a spike of certain very typical to bipolar symptoms like you were mentioning earlier.

What do you do then? How long after? Because sometimes with anxiety or depression medication, it's Oh, we'll see you in two weeks and see if you're doing better or than four weeks, or, Oh, it could take some time for your body to acclimate and adjust. And so that could be typical or people think that of, Oh, it.

Might get a little worse, or I might not notice improvement for a bit, but when would you say, Okay, I'm on antidepressants, but something's really not right and I gotta talk to my health provider? That is such a good question, and I think it's very individual as well, because everyone responds to medication differently.

But I think if you've been having a medication for a few weeks, and yes, antidepressants can take quite a while to work, but if you are feeling worse, More suicidal thoughts. Your mood is getting more, severe. You're getting more depressed. That's when I guess you really wanna speak to a psychiatrist or a doctor about the medication and the possibility of considering is this the right diagnosis for me?

Cuz generally with antidepressants, they can take time to adjust, but we don't see people. Severely worse, essentially, but everyone is different. The, you really take a deep dip in your mood. Yes. Yeah. Yes. So we of talked about what are the signs and symptoms of bipolar, some theories of where it comes from.

Are those risk factors, medication or diagnostic? What does that look like? Let's say it's finally properly. Even if there's some blunders along the way of like the, what you just gave as that antidepressant example, and it just tanks your mood so much. And that's a good indicator.

Hey, something else besides depression is just at play here. Then what is the medication or the treatment plan often with bipolar? Yeah, so the medication and treatment plan for bipolar. The most evidence based, treatment plan is a combination of therapy and medication. And as mentioned earlier, they don't.

They won't just prescribe antidepressants. Usually mood stabilizers are the first line of medication, and antipsychotics are also being used as well. There's also anti-anxiety agents, but if you're going to use an antidepressant, it has to be with a mood stabilizer. And I just wanna put out there that I'm not a doctor or psychiatrist, but this is what the research suggests, but people find different.

Medication useful, so it really is a trial and error. Consistently monitoring what is working for you and medication compliance, that is a significant factor. What sometimes happens is there's a lot of, shame or embarrassment or denial. That and stigma that people have with bipolar, and when they are feeling better, they may deny the need for medication or say, You know what?

I think I'm feeling better. I won't take it, but it's a brain based condition. It's not, I. A medication you can choose, like your brain is not making the chemicals in the way that it should. So medication helps to correct that. And then we use therapy to create awareness around triggers. What may trigger a manic or hypermanic episode?

How can we manage those triggers? So therapy is really about prevention. It's about early intervention. And if you are in that phase, how can we keep you safe whether you are in a depressive phase. Or a mania or a Hypermanic episode. How can we keep you sta? How can we keep you safe? How can we minimize the risk, especially with bipolar two?

I'd like to point out that bipolar two was often thought of as a less severe form of bipolar, but the depressive episodes are very debilitating for people and. Significantly impairing. People struggle to go to work. People struggle to do their day to day life, and there is very high suicidal ideation and.

A lifetime risk of suicide. 25 to 50% of people with the major depressive Yeah. Episodes in bipolar too. So I definitely wanna say it's not a less severe form because whilst the hypermania may not as be as severe as mania, They get it on the depressive episodes. Yeah. What do physicians or psychiatrists do to diagnose or differentiate between the two types of bipolar disorders?

That is such a great question, and I think the key difference is, let's just say both disorders have major depressive episodes, which is more common. There's not a lot, or the statistics are smaller for people who just have mania and no depression. So let's say they both have major depressive episodes.

The differentiator, the differentiating factor would be. How debilitating the depressive episode is and how often it happens. What we see in bipolar two is they experience many more depressive episodes in a given year or timeframe than bipolar one. Then we would look at the elevated mood, How severe is it?

With mania, we tend to have three phases, so we've got the prodromal phase, which is feeling a bit giddy, feeling a bit alert, feeling a bit more. Also known as hypermania. And then if that progresses to the active phase mania, it is a loss of time. They may need to be hospitalized, reckless driving, excessive spending sexual activity that may be promiscuous in nature.

And then they have this recovery phase. So after hospitalization, if they are hospitalized, they need time to recover. Whereas if their elevated mood. More adaptive. It's more functional. They're able to go to work. They're able to do their day to day, but they're not experiencing delusions, which are fixed false beliefs about the world.

They're not having hallucinations. They aren't necessarily engaging in reckless and dangerous behavior. Then it would more likely be bipolar two. So I think the intensity of. Elevated mood is a key factor. And then the intensity of the depressive moods as well, right? Yes. Is there more and more research coming in about these two types specifically?

Like previously, was it just all lumped together or not understood? What are you seeing as the research emerges of what it's indicating? Yeah, the research. To be honest, I'm not up to date with the latest research, but the diagnostic criteria has changed. So there used to just be bipolar one, bipolar two, and now you know there's cyclo Imia, and then there's.

Bipolar not otherwise specified, which kind of captures people who may be in the early phases or children, but the research is essentially showing that types of therapy are more useful. So they've found family integration. Therapy, that's not the specific name, but therapy which integrates family members, educates them, gets them on board with people's early symptoms, is getting a lot more recognition and I guess appreciation because it isn't a disorder that someone you know, can effectively always manage on their own.

They need those around them to mirror to them, Hey, are you okay? I'm noticing this. So for example, if you know about bipolar and if your family member knows about. If you come up with a business idea of night and all of a sudden you're gonna start this business, they may be like, Hey, is this mania?

This doesn't sound they can help you notice the early signs, because the key with bipolar treatment, just going back to your treatment question, is medication and therapy is about early recognition of the signs and having those around you support you through that as well. What does it look like?

For the family to walk through this cuz I, I walk with people who are wives or children or friends or parents of someone with a diagnostic quality of bipolar one or two. And that, that can be really hard for them because like you said, it's often not diagnosed until later on in life, although there's probably markers earlier on.

So it can, for some people it can feel very abrupt or out of nowhere or they're like, I know something. Up, but now we know, but I don't know many people going through this. How do you support the family through that? Yeah, that's such a great question, and I think it's difficult on both ends. I think it's challenging for family members because there may be a lot of guilt or I didn't recognize the signs.

How did I not know this? But then at the same time, there's likely to be a conflict between. Is this a manic episode? Is this hypermania or are they just excited? Is this something that they really wanna do? Which is what the person with bipolar will, will say, why can't I just have, regular moods, like regular people.

So it's about discerning. Is this, a regular mood swing that people have or is it, I guess the, a more intense depressive episode or mania or hypermanic episode? And I think there also is challenges in relationships because if someone is elevated or manic, they may engage in reckless behavior.

They may, cheat on their partners, spend a lot of money, reckless driving, and that can put people at risk and it can put relationships at risk and cause a lot of, yeah, a lot of difficulty within the family. To be honest, I haven't worked with families. That much. But I guess I'm curious to know from you, Bob, what do you see from families and the impacts?

Yeah, I think especially in the last few years, more mental health. Issues are coming to light and we're becoming more talked about, especially anxiety and depression. But bipolar still has that early mental health stigma around it. Okay, anxiety and depression, I get that. But bipolar who, Wow, you must be really crazy.

Then, there's a lot of stigma and so I think a lot of education and normalization is that. Step that I work with people with of just talking about it, creating a safe space. I think of just some of the families that I walk with, and especially the wife that really comes to mind of walking with her, or the husband or the partner or whatever that looks like.

Just supporting them cuz it's a lot, It's almost like their world's been flipped upside down in a short period of time and that can be really unsettling. Again, there's probably markers along the way, but it's so easy to think a misdiagnosis or, oh, it might be depressive episodes or it just might be, that's just how they are.

There's just more knowledge or talk about it. So if that's uncovered that process. Of itself, especially if there's suicide, ideation involved or hospitalization can just be really taxing on a family, especially if there are kids involved. And how do you describe that to kids or things like that. And just the stigma around it, I think.

And like you said, the medication compliance of getting people on board with that consistently and not taking it because, Oh, I feel okay today. That's a big one, but often it's just being that support for that. It's like supporting the caregiver really of that person because it's not always gonna be terrible.

That's not what I'm trying to say whatsoever. But it's supporting them so that they can show up if those difficult moments come up or when they do to be strong and sturdy and it doesn't crumble the whole house. Yes, I agree. There is a lot of stigma and I'm glad. Getting less and less stigmatized. But even yesterday I walked into the lift in my building and I was just talking to the people in the lift, the concierge and a guest, and I was saying, Oh I'm going on a podcast tomorrow talking about bipolar and.

The person, the lift said, Oh, my mom has bipolar. And then the other guy on the lift said, My mom has bipolar. And I was just thinking, Wow, over here one in 50 Australians have bipolar. That's a big number. That's 2.5% of the population, essentially. And we usually find 1%. Bipolar one 1% has bipolar two, so there's not much difference in the statistics, but it is more common.

We just don't talk about it. Wow. . And so if somebody's listening and maybe, it's like that person Oh, my mom has it, my dad has it, my partner has it, my friend, my colleague. What do you suggest for them to do? Because often the person who's diagnosed, hopefully medication and consistent therapy, and maybe afterwards we can talk about what does therapy look like with that?

What are the modalities? Yes, but what can that person, that caregiver, that support person, they often don't maybe have the same unless there's groups or you integrate that family. What are some things they can do to just care for themselves to keep showing up? Yeah, fantastic question and I think if anyone is listening to this and thinking, Oh gosh, do I have bipolar?

How do I know? What do I do? The best thing you can , the best thing you can start to do is track your mood. And this is something we do in therapy as well. It's called a mood chart and tracking your moods. Because a lot of people come to me and say, How do I know if it's this, How do I know if it's borderline?

How do I know if it's bipolar? And the first recommendation will be track your mood. So at least when you go to a psychologist or you go to a doctor, that's the first thing they're gonna ask you to do. But at least you go in there with some data. So if you are in your early stages, you are considering whether this might be a diagnosis, start to track your mood.

So how you are feeling when you're feeling expansive. You can rate it on a scale of one to 10, but that's the first I. Recommendation or suggestion if you are listening to this? The general, I guess question. To go into your next part of the question, this might tie in with what therapy would look like.

There's a lot of self management strategies that. People can do to manage the disorder and I always think of mental health management because I think whether it's anxiety, whether it's depression, it's not about waking up and magically not having it anymore. Anxiety is normal. We are meant to experience it.

It's about how do we manage it effectively? And what they've found is those who do best with bipolar are the ones who recognize triggers, mood cycles, and minimize the impact of these triggers. They stay close to their medication regimens. They have good relationships with their clinicians and they have regular therapy, and they learn as much as they can about it.

If anyone's listening to this, do a lot of research. Do your reading, see if you resonate with anything you and you can, and make an appointment to speak to a professional because it is definitely manageable and people can have a rewarding and fulfilling life with bipolar disorder. Yeah. Yeah. What would you say in terms of the readings, or do you have any resources that are really beneficial or books or podcasts or spaces that are great to recommend to people?

The is a great book. It's called. This is an audio book. I'm a massive fan of audio books because I just find, I struggle to listen to, Sorry, I struggle to sit down and concentrate on a book. So there's a great audio book called The Bipolar Disorder Survival Guide, What you and your family Need to Know, and it's by David.

Milo Wits and it has some great resources in there and we can link it to the show notes if you like. But there's a lot of people on social media as well, on TikTok. They're talking about it. And I think TikTok is great for social TikTok is great for mental health awareness, but I wouldn't say, don't self-diagnose from TikTok.

But it can be useful to hear other people's stories about. Yes. Cause it can be, it's almost you read about something on Dr. Google and you're like, Oh, I think I have that . And so far our listeners don't necessarily go right there of, Oh, maybe I could have that or worse, you're projecting that diagnosis.

Diagnosis on someone else, that doesn't feel good either , but just doing that research, getting just more accustomed to it. Because like you said, if one in 50 Australians are not sure the statistics in the states or in Canada, but probably more so chances are you're gonna bump into. Someone who's connected to someone with bipolar disorder or an actual person.

And so just having some tools on board around language, around treatment of that person that we wanna see the person, not the disorder, and treat them with. Love and kindness and respect and all that good stuff, but also just being aware of our language or how to support someone walking through that can, it can't hurt, that's for sure.

Listening to some of these tips, . Absolutely, and I think it normalizes it and it's not something to be ashamed of or to hide and. Talking about it with others allows others to recognize warning signs and intervene and help people with bipolar. So I think it can be really effective letting people around, perhaps a workplace or, and that's a tricky one as well, because, a lot of workplaces are open to mental health and willing, yet other people feel their workplace may not be so supportive.

But yes, if you can speak to others around you. because treatment is psychosocial. It does include the psychology, the medication, the social. It can help people a lot, manage the condition. And I just wanna point out as well that women need to be recognized. Independently of men as well, because there are a lot of implications.

So for example, women need to monitor their moods, especially around their cycle because there is another disorder called premenstrual dysphoric disorder, which can look like bipolar and also. Women need to be mindful around medication during pregnancies because there are adverse side effects of medication and some need to be monitored very carefully around that pregnancy period or postpartum or menopause.

So I do wanna let women know that it is important to be mindful of these other factors, hormonal imbalances as well when it comes to bipolar disorder. Yes. Yes. And it's e it can be tempting to hear some of these and jump right to this or right to the, And it's like that rabbit trail. But what would you just encourage our listeners, they're good mental health habits, of what it means.

Mentally healthy but specific to bipolar, what are some tips to be Yeah. Mentally healthy with bipolar. What would be some of your suggestions? Yeah, great question. So some self-management strategies that you can use if you are. Struggling with bipolar include your sleep and wake cycles are super important.

Trying to have a routine with your sleep because they're found risk factors to a manic episode include sleep deprivation, stress drug and alcohol use, and if you can manage those three things, then you are less likely to have an episode. So having enough. Waking up at the same time, if you can. Trying to incorporate a healthy diet, a balanced diet as well.

We want people to have consistency with medication if they are a medication, regular therapy as well, talking about what's going on and all the other factors. Exercise. Breathing, trying to regulate your nervous system. And I guess just taking an approach that you are learning about yourself and you are unique, and this is your journey.

So treating your condition from a place of curiosity and kindness. Learning about yourself, you are a person who has this condition, you are not the condition Essent. Yes. Yes. Oh, I love that. Yeah, that's so true. And so for someone or someone listening that is supporting a loved one going walking through bipolar disorder, where do they even start to find a good therapist?

What types of therapy? Like on this podcast, we highlight all sorts of talk all sorts of different types of, traditional psychotherapy or talk therapy, cognitive behavioral. EMDR or somatic therapy, what are some modalities that you would suggest they look at or how to even find someone trained to work in bipolar?

That is such a great question. The type of therapy for bipolar may vary because essentially cognitive behavior therapy is great because what it can do is a lot of cognitive restructuring. When we wanna do therapy is in the depressive phase of treatment, because if someone comes to therapy and they're manic or hypermanic, they're probably not gonna take a lot in.

So you wanna intervene in the depressive episodes. And depression, we know, responds really well to cognitive behavioral therapy. In most cases. So for those who don't know, cognitive behavior therapy is the theory that your thoughts control how you feel. So if we can control and manage our thoughts, we can essentially control how we feel and when we control how we feel, we can then control our behavior and actions.

However, people with bipolar may have comorbidities. They may have a comorbid. Traumatic disorders such as ptsd, they may have a comorbid A D H D. They've found that 60 to 70% of people with bipolar also have a D H D, which is a Neurodevelopmental disorder, which requires a whole different type of therapy and medication.

So the point is, depending on your unique circumstances, that will depend on your therapy. If you have gone through trauma, I definitely recommend seeing a therapist who has a trauma informed approach or experience in working with bipolar, or if it is trauma, emdr, which is eye movement desensitization and reprocessing.

So which therapies for you? I guess it depends on whether you have comorbid conditions. Comorbidity means more than one disorder occurring at the same time. And finding someone who, I guess we are not allowed to say the word specializes in psychology unless you've done, specific training but finds find a therapist who has experience in that area, I think is a really fantastic start.

Not, therapy is not a one size fits all. Yeah. Not every therapist will work in bipolar. Not every therapist will work with teens or children. So it does finding that right fit is so important. Absolutely. And I saw on your website you offer a lot of different therapies, which is amazing because I think people need options when it comes to working with bipolar.

So as mentioned, we. To do cognitive interventions in the depressive phase, try to help them manage that. And then in the manic or hypermanic phase, it is about risk management, keeping that person safe, tailoring in how they're feeling, getting them to recognize it, and just increasing that insight and awareness as well.

Yeah. Yes. Oh, that's so good. So Stephanie, do you have any kind of leaving or closing thoughts for us today on bipolar disorder? Anything else? Oh, leaving thoughts? I guess the important thing to know is regardless of what you're going through, whether it's bipolar disorder or a different mental health condition, is that it's okay.

It doesn't mean that you are any less than or you're incompetent. Of course, life is going to be challenging, but I do want people to know that they can live a fulfilling and enjoyable life, but it does take time to find that right strategy or that right therapist. Don't give up. Have faith that you can get through it and you can manage it effectively.

Because there are many people and many artists especially, Ernest Hemingway, Vincent Vangogh, who have had bipolar, and I think, yeah, it does have, it, it's out there. And not to be ashamed of it if you do have it or you're experiencing. Yes, so true. Oh, I love that. And I think it's really powerful when we can see other people who quote have been successful and still diagnosed with that.

We resonate with them, they're, and that could be something I encourage people, find people who that. There's a similarity, whether it's bipolar or if you're walking through an eating disorder or anxiety. People who talk about it, whether it's online or an autobiography, and read about it, their story is not necessarily your story, but there's probably parts that help bring out your story, and that can be really powerful too.

Yeah, absolutely. And it definitely normalizes what's going on and reduces. The stigma too. Yes. Yes. Oh Stephanie, thank you so much for coming on today, all the way from Australia, and where can our listeners find you? How can they connect with you? Yes. Thank you for having me. It was great to be up early today,

I loved it. For anyone listening, you can find me on social media. My name is Mind for the Mind Food, Steph. So Mind Food, Steph. And that is on Instagram, TikTok as well. TikTok is very psychology related. I do a lot of videos there to come on over, ask a question, say hi, and I would love to connect. With you all.

So thank you so much, Barb, for having me. It's been a great interview and thank you for the work that you do as well. I was looking at your website and it's incredible the amount that you've accomplished and the people you work with, so keep doing amazing things. Oh, thank you. Likewise. I love that you're a.

Supervisor too. I supervise graduate students and therapists here and it's just, it's so exciting to see the new wave coming up and that people are in really good hands and mental health is opening up. It is becoming more talked about and that we can. Thank you for your mental health tips too, because I think a lot of the times we get stuck on the issue or the mental health issue.

But really how to be mentally healthy regardless of what our issue, which we all have stuff, . Yes. And to lean more into that in the normalization and the common humanities. So thank you for all the work you. Thank you so much. I can't wait to hear the episode once it's out. .