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Addiction, anxiety, mental health.

How do we address our traumas and how do we begin to move forward?

The path to healing and understanding is through candid conversation.

I'm Aisha Sultan, and this is Things We Don't Talk About.

For millions of people, something goes wrong with their mood, their energy, and their relationships, and no one can tell them why.

It might take years before anyone gives it the right name, bipolar disorder.

Maybe it's because the symptoms look like something else, but the years spent searching for an answer takes a toll.

Bipolar disorder doesn't just affect the person living with it.

It reshapes relationships.

It tests families.

It changes everything around it.

And this can happen long before there's a diagnosis.

Today, a man will share his journey to understanding what was happening inside his own mind and what it meant for the people he loves.

Then, a clinician will help us understand what bipolar disorder actually is and what the road to recovery can look like.

I'm joined by Adam Flesner, who's written a book, "Still Here, A Bipolar Survival Manual."

Thank you so much for sharing your story with us today.

- Thank you for having me, grateful to be here.

- So take us back to your junior year of college when you started noticing something was going wrong with you.

- Yeah, so I just started experiencing this fatigue that I'd never experienced before.

And I've always been an avid exerciser, and so it wasn't like I just exercised hard and I felt fatigued.

It was like, I just can't do what I used to be able to do.

And I eventually just couldn't exercise anymore either.

Like I couldn't do the output that I used to do.

I would get tired just walking to class.

And eventually I started seeing doctors after doctor, after doctor, to try to figure out what was going on, doing blood tests.

I did a 24 hour urine sample.

I did all sorts of just like physical testing.

- What did they think might be going on?

What were some of the ideas that they had?

- Well I had had strep throat and get sicking around of antibiotics for it.

And so we were thinking maybe it was mono or something, like it just kind of just kept going and maybe I had mono.

I mean, there were, you know, testing all different sorts of things.

- And then when did you finally get some kind of diagnosis?

- So eventually we couldn't find anything, so I got referred to a counselor, and she, you know, ran me through some testing and diagnosed me with major depressive disorder.

- Okay.

- And referred me to a PCP who then prescribed Prozac.

So.

- And it sounds like there was some negative consequences initially to that.

What happened?

Yeah, so Prozac triggered my first ever manic episode.

And so it's kind of well researched that the antidepressants without a mood stabilizer or even with one is risky, can trigger mania and bipolar disorder.

So because nobody knew that you had bipolar disorder at this point.

Yeah, just presented as depressed.

So.

And so then what specifically happened to you?

Yeah, so I remember sitting in chemistry class in college and this was like a couple of days after I started Prozac.

And I felt this extreme irritability just in my body and just so much tension and like I had never experienced that before.

And then like another couple of days went by and I for some reason decided that I needed to drive to California.

So I packed up my car full of water and crackers and I just took off towards California.

Made it a couple hours west from Springfield, Missouri, which is where I was in college.

And eventually, you know, I had family calling me and freaking out and my brother got to me and I pulled over and I kind of came down from it and just didn't really know what happened.

- That's really interesting.

So when you made this plan in your head, I mean, you're a smart person, you're in college.

Did it seem logical to you that I'm just gonna pick up my life and drive to California?

What was going on in your head?

It did feel logical, but at the same time, like looking back, you know, you're just in this like zone, or like this is what you're supposed to do.

And I don't know why I felt that way, but it's just like you're just tunnel vision.

Like this is what you're just called to do type thing almost.

Right, right.

And you're almost, you're not really in control of that.

And so then what happened when you were a couple hours away?

Yeah, just my brother got to me and he's, you know, I pulled over and then, you know, my girlfriend at the time came and got me and they drove me back.

And what did your family decide was going to happen with college at that point?

Yeah, so I just wasn't really able to function at the time.

And it's the, you know, withdrew me from school.

I came back to St.

Louis and again, I didn't have a bipolar diagnosis yet.

It was still depression.

And so I was put on, you know, antidepressant after antidepressant and I had serious side effects from each one.

And eventually I, you know, got told that maybe I had ADHD.

So I was prescribed Vyvanse.

That made me crazy too.

And then, not crazy, but just, you know, chaotic as well.

And then finally it was like, okay, you're not ADHD.

You're not depressed.

You definitely have bipolar disorder.

And that's when I started the medications I'm on today, which is lithium and the motra gene.

And I stabilized, I went back to school.

I became the first head trainer at the rec center.

I got into graduate school, you know.

- So it sounds like your life really got back on track once they found the right diagnosis and the right medication.

But then, as you explain in your book, things went off track again.

What happened?

So I started experiencing some side effects toward the end of college from my medications.

I had like a droopy thing going on in my face.

And so the psychiatrist at the time decided to wean me off of my medications.

And there was no real plan after that.

Like I said, I had gotten into graduate school.

I went to graduate school in Tampa on no medications.

- That sounds like that was not a great plan.

- Not a great plan, yeah.

And somehow I got a 3.8 in graduate school.

I have no idea how I did that, but I made terrible decisions while I was in Tampa.

- Like what kinds of decisions?

- Yeah, I mean, I decided to start using performance enhancing substances.

And, you know, looking back, it's like I didn't have the brakes in my brain to be like, hey, let's not do that.

You know, that's I'm not trying to make an excuse.

Like I ultimately made that decision to do that.

But I don't think I had, you know, my brain just wasn't able to make good decisions at the time.

And then when I moved home, I got married after grad school and, you know, still not on medications.

And then I got addicted to cannabis for about a year, which obviously made things tremendously worse.

And then things just started unraveling.

You know, I ended up starting a business, which was a very cool, creative venture, but there was a lot of chaos in that, like the business itself, the idea was cool, and I did some really interesting things with it.

But there were no breaks on any of it.

And so I eventually, you know, got into some financial problems with that, had to file for bankruptcy at some point, got divorced, made a couple suicide attempts.

And yeah, lucky to be here, to be honest with you.

I was in the ICU for about a week.

How does, how do suicide attempts go fit in with bipolar as a condition?

- So it's much more, yeah, so I mean, with bipolar disorder, I think it's 15 times greater than the general population that you are to complete a suicide.

It's higher for attempts themselves, but, you know, they're, it's more dangerous with bipolar disorder because you can get what's called a mixed episode where you're both depressed and manic at the same time.

And so think of like, in depression, you have this, I'm a burden narrative going on in your head.

Right.

But if you're low energy and depressed, you're just low energy.

So then if you have manic, you know, tendencies on top of that, you're more impulsive, you have the energy to be willing to act on those depressive thoughts.

And so it's very dangerous to be not.

That sounds like you came very close to almost not being here with us today during that time.

Yeah.

And what changed?

Because I mean, you've been able to publish a book you you know, you moved on very successful in your life.

What happened?

Yeah, I mean, just we finally started putting all the pieces together again of like, this is what happened when I was younger.

And this is what helped.

Let's do that again.

Like go back on the same medications that they'd weaned you off of.

Yeah.

And I found a really good psychiatrist.

And I've been with her ever since.

But you know, we got I remember sitting on my couch, and it had been a week since I had had had any cannabis or alcohol.

And I just thought it was strange that I didn't even need that anymore.

And, you know, for me, the medications helped me with judgment.

And they got rid of any kind of like feeling like I needed something to fix my anxiety or depression or anything like that.

And so for me, fixing the brain condition is what helped me with my addictive behaviors.

What have you learned about bipolar disorder that you wish you had known earlier?

That it's not like a character flaw.

It's in your brain.

You know, your brain is, you have a neurological condition.

It's not just like a character flaw.

Is it something that anyone could have like reasoned you out of, like talk to you and help you snap out of what you were thinking if it didn't make sense or you know, the way you were feeling?

Yeah, no, I mean, when you're, you know, going back to those manic episodes when I was younger, loved ones are surrounding you, telling you these things, and you are just right, no matter what.

Like, you are just convinced that you are right.

And your brain, there's no convincing you otherwise.

And so it's just, like I said, it's like that tunnel vision.

You just can't see outside of yourself.

How did it affect your relationships with your family and with other people who loved you and cared about you?

Yeah, so we're still repairing today.

I'd like to think that it's me being stable and having a good job again, being remarried and everything is great now.

I just published a book.

But these things last for a while.

And when I went through and I had a couple of suicide attempts that really impacts my family members who love me, right.

So they struggle, you know, with PTSD around all that, right now, and they're constantly worried about me, rightfully so.

But that's that adds that, you know, dynamic to our relationship that wouldn't have happened.

Now, it seems like a lot more people talk more openly about bipolar disorder right now.

But did you still feel a sense of stigma?

Where do you think we are socially with that?

And was there some fear about publishing this book and telling people about it?

- Totally, yeah.

I mean, I work in medical sales, and in the back of my mind, I'm like, "If I share this, people are gonna think "I'm incapable of doing certain things."

And, you know, my (laughs) my wife convinced me to post on LinkedIn, and I was really scared to do that because I didn't know what the reaction would be from people.

To be honest, I mean, I've had former bosses telling me to do it, and, you know, the reaction I got was unbelievable.

Like, I didn't expect to get such great things from people.

- What kinds of things have you heard that surprised you?

- Like, you're gonna do big things, like people, you know what I mean?

- Yeah.

- Like, you're brave, like, just telling me I have courage, and I got the opposite of what I thought I might get, which was, you know, you're incapable, or something's wrong with you, or, you know.

- Right, well, I think it does take a tremendous amount of courage to talk about something painful that we've been through.

And how would you describe the pain of bipolar when it was untreated for you to someone who's never felt it?

How would you describe that?

- I think the worst pain I ever experienced was in my last suicide attempt, or prior to being in the ICU.

And that's just, you don't see a way out.

Like, there's no way out of it.

I mean, it's just the only logical thing to do in your brain is to just end it, you know?

And, yeah, there's, it's hard to describe the pain, because when you're in it, it's just, there's no, you feel like you're doing a good thing for other people.

You know?

- Right.

- It's almost like this, you feel like you're self-sacrificing for other people.

- Yeah.

- The reality is, I really like a guy named Tim Ferriss, and he describes suicide as strapping on a bomb vest and walking into a room full of everyone you love and pressing detonate.

And so that has changed.

Like I have a goddaughter that I love tremendously.

I would never want to do that to her, you know?

So part of bipolar disorder is you still, I still at least struggle with suicide ideation, but it's like, I can see it, you know?

And it's just a thing that's there.

It's not like I'm not gonna act on it.

It's just part of it.

But like that metaphor has really helped me to realize that it will impact other people.

- The people that really love you.

What would your advice be to people who have either recently gotten a diagnosis?

Because I know there's also some bit of denial.

Like you told me earlier that you didn't really believe this was happening to you.

- Yeah, yeah.

So I think there's, I thought about this a couple weeks ago actually.

And I feel like there's the pre-diagnosis phase where there's just utter chaos.

Nobody knows what's going on, you know.

Then there's the diagnosis phase where you get this diagnosis.

You feel almost a massive amounts of shame around it and you're not really willing to accept it.

And then there's the post-diagnosis phase where you realize, okay, this stuff is actually helping me and my life is getting better again.

And you kind of accept it and are willing to go forward.

- Well, it seems like you've done more than go forward, to be honest.

It seems like you've made an incredible contribution also to other people who are going through something really difficult.

And I commend you and I thank you for that.

Thank you.

Yeah.

Absolutely.

♪♪ Welcome back.

Now we're joined by Dr.

Kelechi Loynd, a psychiatrist who works with students at Washington University in St.

Louis.

Hi, Dr.

Loynd.

Can you tell me exactly what is bipolar disorder?

Absolutely.

Thank you for having me.

It's an honor to be here.

So bipolar disorder is one of the central psychiatric diagnosis that we have.

It's characterized by episodes of mania and depression and anything in between in terms of clinical manifestations that may be hypomania or mania or depression.

What is hypomania?

So hypomania, yes, it is an interesting concept.

So mania has specific criteria that you meet over a period of about a week where you have, you know, increased energy, mood, disruptions in your sleep, energy, distractibility, impulsivity, grandiosity, and cognitive problems also.

For hypomania, you have similar symptoms, except you don't have as much intensity.

It doesn't last as long.

It's about three to four days.

A manic episode usually ends up in the hospital for the most part, has the person hospitalized versus the hypomania, where it's just a touch and it may not meet criteria for you to go in the hospital.

- Okay, so there's different types of bipolar.

- Yes.

- Okay, and can you break those down for us?

- Absolutely, so you think about bipolar as a sort of a subtype syndrome, a spectrum of syndromes.

So for example, there's bipolar I, which is at the top of it, if you think about it that way.

Then there's bipolar II, then there's also something called cyclothymia and other specific bipolar disorders and nonspecific bipolar disorders.

So the DSM-5 sort of clarifies the different diagnosis based on what are the symptoms of mood, what are the symptoms of depression, or maybe-- - And the DSM-5 is what doctors use to define what different mental conditions are.

- Absolutely.

- Or illnesses.

- Yes.

- Okay, and so why does it take so long for someone to actually get a proper diagnosis?

- Now, I wish there wasn't a case, but on average, it can take about 14 years before someone's bipolar is recognized as such.

And as you can imagine, in that time frame, people are struggling and suffering and breaking down relationships and occupational deficits.

Why it takes so long is multivariable, right?

So one of the thoughts is that the person doesn't have mania necessarily sort of inaugurating their bipolar.

It could be depression, like the guest talked about.

You could have depression to begin with, or you could have hypomania, where hypomania tends to be a feel-good time, where people are producing a little bit more, and it doesn't really set off that alarm of, "Oh, my goodness, something is wrong.

You need to seek medical help."

And so people can have depressive symptoms that they haven't talked about or hypomanic symptoms that they haven't talked about that go on for years before they actually hit a manic episode that gets them the bipolar diagnosis.

- And it seems like mania can look really different person to person.

It could be hallucinations or paranoia or psychosis or just this grandiosity, this intensity, irritability.

I mean, it can be so variable.

- Yeah.

They are core symptoms that you wanna have.

Like for a manic episode, you definitely wanna have an increase in your energy.

You also wanna have a euphoria.

So people have euphoria or irritability.

So it doesn't always have to be a feel-good mood.

It could be just energy, like irritated energy that people have.

And then in addition, you have difficulties with sleep and wake cycle.

So people feel the need to sleep only decrease need for sleep.

They sleep two, three hours, they feel great.

Some will have grandiosity, where they feel like they have special powers and self-esteem is higher.

Some people have delusions of grandeur, where they feel like they are the, you know, the second coming of the savior of the world, for example.

And so in all of these, people can have different, you know, presentations depending on that person.

But for the most part, people's mania tend to be predictable in that individual.

Why do people get this?

What makes people susceptible to this?

- I know, that's a really very valid, interesting question.

So the short answer is that we don't know definitively what causes bipolar.

What we do know, though, is that they are genetic factors, and so there's a heritability to bipolar.

We also do know is that medications, we have treatment for it, that target it.

So the science is still ongoing.

There's a lot of research looking at, you know, from neuroimaging to neurotransmitters.

For example, dopamine is elevated when people are manic.

Serotonin tends to be the neurotransmitter that's implicated for depression, you know, depressive episodes.

So this is still something a work in progress.

What we also can say is that sleep-wake cycle, your circadian rhythm has a lot to do with it too.

So when your sleep is off, when people have traveled to a different time zone and they have a history of bipolar, it's really important that we make sure that we regulate their sleep as best as possible 'cause that could trigger them into a manic episode.

- Is it possible for people to outgrow or just get over a bipolar diagnosis without medicine?

I don't have, we don't have any data to suggest that, you know, not treating bipolar and you're going to outgrow it, kind of like you may with, you know, asthma or something like that.

But treatments are available and they are very effective.

And I think that's the most important message for people to know, that just because you have a diagnosis of bipolar does not mean that you cannot live a fulfilling life, you know, that is productive and, you know, similar to people who don't have bipolar disorder.

And when do most people start showing symptoms?

When does this show up for people?

Yeah.

So it's a younger person diagnosis from 18 to 25 is what the epidemiological studies show.

And man and female is about the same kind of, you know, age range.

So in your early 20s, people are more likely to have the diagnosis come up.

Then a lot of times that's the time where people are going off to, you know, leave their home to go to college.

And so we have a lot of college students who have their first, you know, either manic episode while they're away from home and in college.

There are other subgroups that have a younger onset of bipolar.

So the childhood onset bipolar is present, but those are rare.

But that is something to be also mindful of.

- And so what is something that people who might be in a relationship or in a family with someone who's bipolar may not know or may not understand that you would like to give them some insight on?

- Yeah, no, I think it's important that when we are treating someone who has now gotten a diagnosis of bipolar, that we don't do it in isolation with just that person.

It's important to include the family, because they may be the eyes and the ears for that patient when they have lost insight, right?

So if a person's becoming manic and they think they're feeling good, and just because you're feeling good doesn't mean you're good.

And so it's gonna be left to those family members to be able to recognize the signs, oh, hey, you're not sleeping as well, or remind them to be able to be med-compliant, 'cause when people are manic, the last thing on their mind is to be compliant with their medication.

And so it's important to have good support.

So I would say definitely carry your family along with you, your loved ones along with you, 'cause that goes a long way in terms of helping you have a better prognosis with this diagnosis.

- And what do you wish people who might be having some of these symptoms or have recently gotten a diagnosis, what do you wish they knew that you would like to share?

- It's a treatable disorder.

It's not their fault.

It's not a character flaw.

You know, sometimes there's some sensationalizing of the whole bipolar mania in this media.

So it's important to distinguish what the person is going through and know that this is real suffering.

You know, this is not a personality disorder.

This is not your own doing.

Your insight is really important.

And so if you're starting to notice something about yourself, you may want to reach out sooner rather than later.

Your sleep is important.

I think people don't really connect the fact that if they have a disrupted circadian rhythm, that that could increase their risk of having a manic episode.

- At the college level, do you see students who have some level of denial about this diagnosis?

Can you speak a little bit about that?

- Yeah, I mean, it's a hard diagnosis, right?

'Cause you're telling me that I'm gonna be with this illness for the rest of my life in some shape or form, right?

And good thing I can control it because if you have good treatments, you can help me control it.

But it's not an easy diagnosis for a young person to know who's in college, who has their life ahead of them.

It's a derailment of some sort.

But you have to quickly support them in psychotherapy, in family therapy, and with their physicians to be able to give them the hope that they are really maybe lacking at this point.

- Right, did you find Adam's story as moving as I did?

- Absolutely, absolutely, 'cause he was in college when he had the first break, and he had a depressive episode, and I found it interesting that he talked about sort of atypical features of depression, where he had kind of heavy limbs, like it was hard for him to get to class, and he felt like he wasn't able to exercise and things like that.

So it's important that everybody's depression can be a little different.

Young people's depression could be that they're more irritable versus an older person's where they're sad and withdrawn.

- He described it to me like he felt like he was walking in quicksand, which I thought was such an interesting way to describe that level of fatigue.

But no, thank you so much for sharing this information.

I think it's gonna be helpful to so many people who are struggling or maybe people who love them who don't know the best way to help.

So I really appreciate it.

- Absolutely.

- Thank you.

- Absolutely.

♪♪ - This program is funded in part by the following.