Is My Husband Bipolar?

Q: I'm concerned that my 34-year-old husband may have bipolar disorder. We can go weeks at a time where he is a wonderful, patient and understanding man, but this tends to be followed by a slow spiral into moodiness and depression. After many weeks of this behavior a "switch" comes on and he gets anxious, agitated and hyperactive. His doctor thought he had depression but those medications didn’t seem to work. This seems to be a  pattern. I have no idea what to do, and his "manic" episodes wear me out emotionally. Any suggestions?

A: I think you have good instincts and your husband may indeed have a type of bipolar disorder. I say this based upon the clues you provided regarding his lack of response to antidepressant medications, in addition to his mood swings and changing patterns of behavior. As for suggestions, please encourage your husband to visit his physician or mental-health specialist. It would also be helpful (with your husband’s permission) for you to join him for the initial visit. You have insight into his behavioral clues that may help in getting to the proper diagnosis. And, if this turns out to be bipolar disease, it is important to work together to improve your understanding of this illness, and ultimately, to solidify your relationship.

Bipolar disorder, which is sometimes known as manic-depressive illness, is best known for causing unusual shifts in a person’s mood and energy levels (several times per month, a few times per year, it varies depending upon the bipolar type). In fact, we often refer to this disease as bipolar spectrum disorders due to the many variations of symptoms. For example, some people may experience severe depression that alternates with bouts of manic behavior, while others may have cycles of depression alternating with hypomania, a form of mania that is less extreme and more difficult to notice. What we are looking for is the repetitive, cycling patterns of behavior. Here are some of the various symptoms in the spectrum:

Mania
• Racing thoughts
• Very little sleep
• Rapid speech
• Poor judgment
• Easily distracted
• Extremely high self-esteem

Hypomania
• Decreased need for sleep
• Can be highly motivated and productive
• Difficulty focusing
• Upbeat

Depression
• Lack of energy
• Loss of interest in everyday activities
• Re-occurring thoughts of suicide
• Changes in appetite
• Negative, pessimistic thinking
• Feelings of worthlessness

Bipolar Spectrum Disorders

On top of the symptoms and mood fluctuations, this illness can also affect a person's ability to think, pay attention, reason, control aggression or to keep a tight reign on their impulsive behavior. Complicating the condition further is that 40 percent to 50 percent of affected people have other illnesses going on at the same time. These may include one or a combination of the following: substance abuse, thyroid disease (slow or overactive), as well as other mood disorders such as schizophrenia, ADD/ADHD or even borderline personality disorders. Putting this into perspective, a person may experience several of the following problems that seem to occur in "cycles":

• Depression
• Anxiety
• Mood swings
• Irritability
• Inability to focus
• Impulse-control problems
• Insomnia
• Erratic behavior patterns that lead to relationship problems (personal, professional, trouble with the law).

With that being said, your husband's physician may focus on the following factors during the evaluation for bipolar disease:

• Family history of this illness
• Previous patterns of manic behavior
• Early age of behavioral changes (before age 25)
• Poor or lack of response to antidepressant medications
• Quick onset and ending of depressive cycles

Additionally, his doctor would most likely have him fill out a screening tool called the Mood Disorder Questionnaire (MDQ). This "test" contains 13 yes/no questions regarding his symptoms, as well as family history and previous diagnosis of bipolar illness. It takes about 10 minutes to complete and can help to identify about 70 percent of people affected with this disease.

I know the above is confusing and many people reading this may see similar patterns in their own or their loved one’s behavior. So while it certainly sounds like your husband experiences an alteration in behaviors or moods that seem to repeat themselves or cause personal problems with his everyday life, I am hoping he visits his physician for a thorough and more accurate evaluation. Depending upon the doctor’s expertise, a psychiatrist may be called in for a second opinion.

The good news is with the proper behavioral and medication treatment approach, most people affected with bipolar spectrum disorders are able to decrease the patterns and cycles of their illness, stabilize their mood fluctuations and lead a full and more productive life.

Find More on MSN Health & Fitness:

• Managing Personal Relationships When You Have Bipolar Disorder
• Drug treatment of bipolar disorder
• Join The Discussion: Dealing With a Family Member With Bipolar Disorder

Find all articles by Dr. Rob.

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Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)