Living with a bleeding disorder or caring for a child with a bleeding disorder poses a distinct set of challenges. Add a mental health condition such as bipolar disorder and those issues can multiply.
“People with bipolar disorder may have less success managing the bleeding disorder because they may not recognize the significance of it or may be overly optimistic,” says William Lawson, MD, PhD, associate dean for health disparities at The University of Texas at Austin’s Dell Medical School. “Bipolar disorder is characterized by impulsivity, so the person may not be as careful about administering medicines.”
While there are challenges to managing two distinct disorders, there are also management tips to help you. Find out how you can conquer the battle of dealing with bipolar disorder and a bleeding disorder.
Understanding Bipolar Disorder
Also known as manic-depressive illness, bipolar disorder is a brain disorder characterized by extreme changes in mood, energy and activity levels that can disrupt a person’s ability to carry out daily tasks. Although children can be diagnosed with bipolar disorder, it usually develops in the late teens to late 20s. The National Institutes of Health cites the average age of onset as 25.
To be diagnosed with bipolar disorder, a person must have both depressive episodes, periods of severe sadness, lethargy or hopelessness, and manic episodes, periods of unnatural agitation or elation. Hence the term “bipolar,” fluctuating between two opposite poles. Bipolar symptoms can also occur in a mixed state, meaning a person experiences both mania and depression simultaneously. Other symptoms include insomnia or excess sleep, restlessness and prolonged bursts of energy, talkativeness and distractibility.
Different types of the disorder are associated with varying levels of mania and depression. Bipolar I disorder, for example, is diagnosed when people have manic or mixed episodes that last at least a week, or such severe mania that hospitalization is required. In contrast, people with bipolar II disorder have a pattern of depressive episodes and hypomanic episodes (less severe instances of mania), but no full-blown manic or mixed episodes.
With the help of medication and psychotherapy, people diagnosed with bipolar disorder can lead fulfilling, productive lives. A combination of drugs is often used to treat the disorder, including mood stabilizers like lithium, antipsychotics, antianxiety medications and antidepressants. Individuals react differently to medication, so finding the right treatment may take time, Lawson says.
Mental health conditions like bipolar disorder can undermine successful treatment for a bleeding disorder. “If someone is suffering from depression and can’t even get out of bed, the last thing he is thinking of is infusing,” says Laurel Pennick, MSSW, LCSW, a social worker at the Arizona Hemophilia and Thrombosis Center in Tucson. The same holds true for those with manic tendencies, she says. “They may think they’re bulletproof and don’t have to infuse,” says Pennick.
During an educational session Pennick led at the National Hemophilia Foundation’s (NHF’s) Annual Meeting in 2015, caregivers and people with bleeding disorders shared their experiences, including one mother with bipolar disorder who cares for a child with a bleeding disorder. “With bipolar disorder, it’s difficult to raise a child, much less one with a chronic disease,” Pennick says.
Patients with bipolar disorder and other psychological conditions may also self-medicate with excessive use of drugs or alcohol. “This can mask or exacerbate symptoms, and result in poor decision-making and erratic behavior,” says Pennick. “Hemophilia, bipolar disorder, and drug or alcohol abuse do not make a pleasant cocktail.”
Risk-taking is another hallmark of bipolar disorder. For instance, driving too fast or being sexually promiscuous makes people more susceptible to injury and disease, which then complicate their bleeding disorder.
The Culture Divide
The stigma of mental illness can prevent those with bipolar disorder from seeking help. Emotional troubles can be interpreted as weakness by some people. Others perceive them as issues they should simply be able to work through alone. Cultural perceptions also play a role.
Research reveals significant differences in how African American and Latino cultures view mental illness symptoms and treatment. (See sidebar, “Ethnic Differences in Diagnosis and Treatment.”) A 2010 study published in Psychiatric Services by Dartmouth researchers reports that European Americans with severe mental illness were more likely to seek the advice of mental health professionals. In contrast, African Americans and Latinos were more critical of mental health services. They were more likely to attribute symptoms to nonmedical causes. Latino participants in the study were also more likely to view clinical labels as socially damaging. Further, African American participants considered mental health conditions a private matter.
A Network of Treatment and Support
The twin challenges of a mental health issue and a bleeding disorder also affect family members. “It’s very important to involve family members or friends because people with bipolar need strong lines of support,” Lawson says.
In addition to developing a strong support network, people who have or suspect they may have bipolar disorder, depression, anxiety or other mood disorders should pursue help from a licensed professional. Some hemophilia treatment centers (HTCs) have mental health professionals on site, so start there. If not, your HTC can recommend someone.
“Seek treatment early with a mental health provider you trust,” says Pennick. Together you will work out the best treatment for you. That may mean trying different therapies and medications until you find the right combination, she says. “Stick to the plan and let your treatment provider know if symptoms change or if new side effects appear.”
Communication between mental health professionals and bleeding disorders professionals about bipolar disorder and your bleeding disorder is vital. In the best-case scenario, doctors in both disciplines collaborate to ensure that a patient is following an effective, personalized treatment plan.
For families struggling with mental health issues and bleeding disorders, Pennick recommends professional help for all involved. Groups such as the National Alliance on Mental Illness (NAMI) offer education and resources. And most areas have a local NAMI chapter, where people with bipolar or other disorders and their family members can find in-person support groups. NAMI also offers resources to help individuals communicate with family members about their mental health disorder.
If you’re facing two foes—bipolar disorder and a bleeding disorder—there is help. “Involve your family, friends and healthcare team,” Pennick says. Lean on the people you trust to help you follow your treatment plan and manage your symptoms. They can help you triumph on both battlefields.