An estimated 51 percent of people with bipolar disorder are not receiving treatment, according to the National Institute of Mental Health.1 If you have been diagnosed with bipolar disorder or suspect that you may have it, treatment is essential to maximizing your potential. One 2016 study indicated that the longer bipolar disorder remains untreated, the more prone you are to rapid cycling (four or more mood episodes in one year), anxiety disorders and an inability to reclaim your life.2 Untreated bipolar disorder can also lead to substance abuse, difficulty in performing at work or at school, problems with or loss of relationships and even suicide.3
“If not treated, bipolar disorder is progressive and causes permanent brain damage and cognitive decline,” says Kitt O’Malley, a mental health advocate in Mission Viejo, California, who lives with bipolar II disorder. “Each episode negatively impacts the brain, and the changes to the brain are visible in brain scans. The changes to one’s behavior, the destruction of one’s life, of one’s relationships, can be both measured and immeasurable—lost jobs, failed marriages, abused children and financial ruin.”
Why Are So Many Untreated?
Because bipolar disorder can be difficult to diagnose, many people are not receiving treatment. It often coexists with other issues such as attention-deficit hyperactivity disorder (ADHD), eating disorders, substance use disorders and anxiety disorders. Bipolar disorder also shares symptoms with ADHD, personality disorders and major depression. This causes a number of patients to be misdiagnosed before finally receiving a correct diagnosis of bipolar disorder.
Another reason for a lack of treatment is that patients may feel exhaustion caused by the side effects of medication or may believe they can manage everything on their own. This is a potentially destructive attitude that leads to long-term complications. “Those of us living with bipolar disorder have a responsibility to ourselves, to our loved ones, even to the public, to care for our health,” says O’Malley. “As a society, we have a responsibility to compassionately help those not receiving treatment. We must reach out with empathy to support those not receiving help.”
The Dangers of Leaving Bipolar Disorder Untreated
The longer bipolar disorder goes untreated, the more dangerous and lasting the potential complications become. Some potential problems include:
● Difficulty at school or work. According to the World Health Organization, bipolar disorder is the sixth highest cause of disability in the world.4 Coping with the highs and lows of bipolar disorder can be stressful and exhausting even when you’re in treatment. It is taxing to deal with the demands of school or a job on top of the complexities that come with bipolar disorder. When you’re not getting help, it can cause enough missed days or interpersonal issues that it may cost you your job or degree.
● Financial problems. “If somebody with bipolar disorder doesn’t get treatment, they can go on spending sprees and destroy their credit,” says William Drinkwater, a therapist, speaker and adjunct professor of addiction counselor education at the University of Massachusetts at Boston. “I have a patient now who went to Logan Airport one day in Boston and just flew to Paris, France. When I asked him why, he said he wanted a real cup of French roast coffee. Financially, untreated bipolar disorder can lead people to ruin.”
● Relationship stress. When bipolar disorder remains untreated, mood episodes tend to fluctuate more often, resulting in interpersonal stress and other concerns that can lead to the destruction of relationships. “It can create a situation where you have family and friends who are walking on eggshells because they don’t know which person they’re going to get; the happy person or the one who has agitated depression,” Drinkwater says.
“Untreated bipolar disorder can destroy relationships,” says O’Malley. “Even treated with medication and psychotherapy, I am not symptom free. I work very hard learning to not overreact, not to blow up, to give myself time and space when I need it, and to call my psychiatrist when I seem to be moving too far in one direction or another.”
● Substance abuse. According to the National Alliance on Mental Illness, roughly a third of people with mental illnesses and about half of those with severe mental illness also have a substance use disorder.<sup5 Alcohol and drug abuse are exacerbated when bipolar disorder goes undiagnosed. People often attempt to dull the emotional pain and imbalance by self-medicating with binge episodes. “Part of the problem with binge drinkers and drug users is that they tend to use until they pass out, which means that all their organs are getting majorly taxed,” Drinkwater says. “They can end up with the more severe medical issues.”
● Suicide. Living with an untreated mental illness significantly increases the risk of suicide. Not only can untreated bipolar disorder increase feelings of hopelessness, it can impair your judgment and make you feel like there’s no other alternative. According to the National Institute of Mental Health, around one in five people with bipolar disorder commit suicide.6 “Bipolar disorder is the number one psychiatric diagnosis for suicide,” says Drinkwater.
Considering treatment? “There is no one-size-fits-all formula,” says O’Malley. “Proper medication requires trial and error. Most of us require some combination of medication, psychotherapy, regular sleep, peer support, exercise and proper nutrition,” she says. “For a few of my friends who suffered from treatment-resistant bipolar depression, electroconvulsive therapy (ECT) saved their lives. Treatment, both medication and psychotherapy, heals the brain. Brain scans support that fact.”
Common treatment options for bipolar disorder include:
● Medication. The types of medication you may be prescribed depend on which form of bipolar disorder you have, as well as how you respond. It will require experimentation to determine the best combination for you. Generally, bipolar patients are prescribed a combination of antidepressants, antipsychotics, mood stabilizers and anti-anxiety medication.
● Psychotherapy. A key component to successful treatment is learning how to cope with your mood episodes, as well as life in general, with therapy. There are many different forms of psychotherapy, so if the first therapist you see doesn’t feel like a good fit, try again. Among the most popular types of therapy for bipolar disorder are cognitive-behavioral therapy (CBT), interpersonal therapy and psychoeducation. These can be done in individual, family or group settings, depending on your needs and desires.
● Self-care strategies. Eating properly, sleeping regularly, exercising, employing relaxation techniques and making time for activities that bring you joy are ways you can manage bipolar disorder on your own.
“Get an excellent psychiatrist and psychotherapist. Make a plan with loved ones as to what to do should you become dangerously symptomatic, whether it’s severely depressed or manic. Involve your family in your treatment team and inform them of changes in your medication since your behavior is likely to change as you adjust. Know that there is hope with proper medication. Recovery, though not a cure, is possible. Look into supportive resources such as DBSA (Depression and Bipolar Support Alliance) support groups and NAMI (National Alliance on Mental Illness) Peer-to-Peer,” says O’Malley.