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Challenges That No One Talks About

Beyond the common hurdles of bipolar—mood swings, medication side effects, irregular sleep—I’ve discovered some difficult, often-overlooked dilemmas. Here are my solutions to the top six. By Stephen Propst I’ve faced the more familiar facets of bipolar—unpredictable mood swings, medication side effects, irregular sleep patterns—for decades. However, I’ve discovered some difficult dilemmas that often go undiscussed. It’s important to acknowledge and address these issues, too. Here are six challenges worth confronting, perhaps with your doctor, in therapy, or at a support group; and some ways to proactively deal with these stumbling blocks. #1 Fleeing friends: Maintaining friendships can be difficult. Some friends back away out of fear or over frustration with past episodes. Others simply fall out of touch when we have extended periods of depression and isolation.  

I try to focus on forging friendships with people who naturally understand or are willing to learn. When I put myself in their shoes, exercise patience, and openly discuss the details of bipolar, they’re more apt to take my situation into account and less prone to abandon me.

#2 Suffering self-esteem

There’s an easy way to check your self-esteem. Have a trusted friend write half page about how he or she sees you; then, compare it to your own self-evaluation. I tried this years ago, and I was shocked at the differences.

Despite learning to see myself in a more realistic light over the course of 10 years of therapy, maintaining solid self-esteem remains challenging. Now, I try to give myself credit for even small accomplishments, and I’m more forgiving of myself when I make mistakes.

#3 Rough relationships

Sustaining an intimate relationship is another matter. It can be overwhelming for someone to routinely go along on our roller-coaster ride. It’s no wonder the divorce rate is so high!

It’s best to be honest and transparent with your significant other. And don’t forget that your partner has needs, too. If you’re still searching for your soul mate, stay optimistic. You never know when you’ll meet the right person.

#4 Lingering lethargy

My worst depression lasted nine months. I slept around 18 hours a day, yet I still lacked energy. These days I continue to occasionally face sometimes crippling depression and the accompanying fatigue.

You have to work hard to counteract the mental and physical drain that are symptomatic of bipolar. Having a reason to get out of bed in the morning, sticking to a routine, and watching what you eat are habits worth developing.

#5 Pessimistic perspective

I may write about the power of pursuing life from a positive perspective, but I never said doing so was easy. Because bipolar impacts us physically, psychologically, emotionally, and otherwise, it’s really hard to put on a happy face when times are tough.

That said, it’s worth trying my best to adopt a healthy attitude. For example, if I find myself wallowing and worrying in bed, I try to at least get up and go for a walk. Taking that simple step, and avoiding negative self-talk along the way, helps clear my head and change my mind-set for the better.

#6 Erratic employment

When you’re contending with unpredictable mood swings, work can be challenging. I have a friend with bipolar who lands jobs with ease. His record is 22 in one year! (Holding on to them is a different matter.)

For many of us, merely finding work that’s manageable, let alone meaningful, is difficult. I look for jobs that are less likely to jeopardize my well-being, versus those based purely on my education and experience. Being transparent with potential employers helps ensure that more reasonable, mutually accepted expectations are established.

Aside from known symptoms, living with bipolar comes with some problematic predicaments. It pays to practice simple strategies to help overcome these obstacles. Concentrating on concepts like being patient with friends, giving yourself a break, or just taking a walk can help improve everything from your relationships to your self-esteem to your overall well-being.

Printed as “Mind Over Mood: Difficult dilemmas,” Winter 2019


Stephen PropstStephen Propst, a former chair of DBSA, is a public speaker and a coach/consultant focusing on living successfully with conditions like bipolar. He can be reached at

How to Get Help

How to get help.

One issue I have had over the years is to find the right Psychiatrist.  There were many times I couldn’t afford the cost but needed the help.  Over the years I have found alternatives for inexpensive or free treatment and medical support when I was in a difficult financial situation.  What is most important is to gain the medical support to help stabilize your life. 

I have found in the Boston and Eastern Pennsylvania areas some resources which may be helpful to investigate if you are in a situation that you want help but cannot afford it.  These resources exist in nearly every state and can be found through searching the web. 

There are many affordable alternatives in your area.

There is a national   organization NAMI.  NAMI is the National Alliance of Mental Illness. 

There are many locations of this free support group for friends, families and patients.  Locally in Trenton, NJ here is the contact information

Address: NAMI Mercer NJ
1235 Whitehorse-Mercerville Rd.
Building C, Ste 303
Hamilton, NJ 08619
Phone: (609) 799-8994
Email Address:
Serving: New Jersey Capital Area

For more information where there is help in your area for support and those who need support and greater understanding of your illness please see this site: 

  Another good resource is a local university which has a psychiatry program and department.  In these departments there is an area for Mental Health specialization.  Locally in Pennsylvania here

I.  University of Pennsylvania

            1.Department of Psychiatry – Penn Behavioral Health – Mood Disorder Treatment Center

            2. Penn Nursing – Nurse Practitioner – Psychiatric-Mental Health –

II.  Lenape Valley Foundation –

In Boston MA here are some resources

  1. McLean Hospital :
  2. University of Massachusetts – Boston
  3. Mass General Hospital – Mood Network Resources

These websites can give great help, direction and understanding.  The biggest factor is to be willing to get help. 

Sometimes it is very hard, sometimes we think we can ‘fix it’ on our own and weather the storm of depression or mania.  The goal is to be stable and move forward in a balanced life.  In order to do that – you have to be willing to get guidance and help from professionals. 

I encourage you to investigate these and please offer comments of your experience when researching and gaining help.

About Bipolar Disorder


According to the Sutherland Bipolar Center in Boulder Colorado. ‘Bipolar disorder, also known as manic-depressive illness, is a disorder characterized by extreme shifts in mood, energy, behavior and functioning. According to 2012 statistics from the Depression and Bipolar Support Alliance Organization, Bipolar I and Bipolar II disorder (described below) affect approximately 5.7 million adult Americans, or 1.8 percent of the population. The number is much higher when taking into account “Bipolar Spectrum” and “Soft Bipolar Disorder” (described below). Bipolar disorder typically emerges in adolescence or early adulthood, although it may appear in childhood or later adulthood. Men and women are equally likely to develop bipolar disorder.

The specific causes of bipolar disorder are not yet known. Research suggests a strong genetic contribution, but the specific genes involved and exactly how these genes influence the development and expression of bipolar disorder are unclear. Environmental factors, such as traumatic experiences, daily life stressors, family conflict, and even positive life events, also play a significant role in the development of the disorder and the triggering of mood episodes.

Categories of Bipolar Disorder: The Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) identifies four types of bipolar disorder:

  • Bipolar I
  • Bipolar II
  • Cyclothymic Disorder
  • Bipolar Disorder Not Otherwise Specified (NOS)

Each of these four disorders is comprised of a different combination of mood episodes (manic, hypomanic, major depressive episodes and mixed). Following is a brief description of the four types of bipolar disorder. The mood episodes are described below.

Bipolar I: The individual has had one or more manic or mixed episodes. Often the individual has also had major depressive episodes, although this state is not required for this diagnosis.

Bipolar II: The individual has had one or more major depressive episodes and at least one hypomanic episode, but has not had a manic or mixed episode.

Cyclothymic Disorder: For at least two years the individual has cycled between low-grade depression and hypomania, with little time symptom-free. The person has never had a manic or mixed episode, and the depression has not been severe enough to meet the criteria for major depressive episode (if it has, then the diagnosis is Bipolar II).

Bipolar Not Otherwise Specified (NOS): An individual does not meet the full criteria for one of the other bipolar disorders, but clearly suffers from a mood disorder that appears bipolar in nature. An example is a person who experiences major depressive episodes and also experiences hypomanic symptoms, but the hypomanic symptoms do not last as long as is required for a hypomanic episode.

Major Depressive Disorder: Major depressive disorder, also known as unipolar depression, is when an individual has one or more major depressive episodes but has never experienced a manic, hypomanic, or mixed episode.

So, what are manic episodes, hypomanic episodes, major depressive episodes and mixed episodes?

Bipolar Episodes: As noted above, each of the four bipolar disorders is comprised of a different combination of mood episodes (manic, hypomanic, major depressive episodes and mixed).

Manic Episodes: Mania is the high state, the time when people might feel invincible or euphoric, and have a grandiose sense of self. Typically, people in manic states experience what they believe is a heightened sense of clarity, often as their thoughts race. Mania is commonly described as pleasurable, even addictive or seductive. However, some people experience an extremely irritable mood during mania, which may be quite painful. Also, manic episodes are sufficiently severe to cause significant problems with social or work functioning. Therefore, even when mania feels good, it tends to have painful consequences. A manic episode is defined as a period of at least seven days (or less if the person has to be hospitalized) with:

  • Abnormally elevated, expansive or irritable mood and at least three other symptoms (four if the mood is irritable rather than elevated)
  • Inflated self-esteem or grandiosity
  • Decreased need for sleep ( example feeling rested after 2-3 hours of sleep)
  • Increased activity socially, at work, school or physically
  • Being more talkative than usual
  • Racing thoughts
  • Easily distracted
  • Engaging in risky behavior

  • Hypomanic Episodes:Hypomania is a mild version of mania where the symptoms are the same but are less intense – they only need to last four days and do not significantly impair a person’s functioning. Many people find they are more productive and have positive social interactions when hypomanic. Others find that although a single hypomanic episode does not cause much impairment, repeated episodes negatively affect finances, social relationships, and/or work performance.
  • Major Depressive Episodes (MDEs): Depression is the down state when people feel sad or blue, or simply cannot enjoy anything. This state tends to be characterized by changes in sleep, appetite and weight, energy, and cognitive (thinking) abilities. People may feel worthless and guilty, and may consider suicide.

Major depressive episode is defined as a period of at least two weeks with five or more of the following symptoms:

  •  Depressed mood and/or anhedonia (an inability to take pleasure in things, or greatly diminished interest in activities usually enjoyed) and
  •  A decrease or increase in appetite; weight loss or gain
  •  Sleep disturbance (insomnia or hypersomnia)
  •  Feeling physically slowed down or physically restless
  •  Fatigue or loss of energy
  •  Feelings of worthlessness or excessive guilt
  •  Difficulty concentrating or making decisions
  • oRecurrent thoughts of death or suicide

Mixed Episodes: Approximately 40% of people with bipolar disorder have mixed episodes, when both mania and depression are experienced at the same time, nearly every day, for at least one week. People describing mixed states often comment that they feel “tired but wired,” or that they go from laughing to crying in a matter of seconds. Similarly, people tend to be over-energized, agitated and irritable. Their thoughts race, but unlike pure mania, the thoughts are nearly all negative. Mixed states are perhaps the most dangerous mood episodes of all, with risk of suicide higher than pure depressive episodes.

Psychotic symptoms: In addition to the symptoms described above, severe depression or mania may be accompanied by psychotic symptoms. These symptoms include hallucinations (hearing, seeing, or otherwise sensing the presence of stimuli that are not there) and delusions (false personal beliefs that are not subject to reason or contradictory evidence, and are not explained by a person’s cultural concepts). Psychotic symptoms associated with bipolar disorder typically reflect the extreme mood state at the time.

Bipolar Spectrum and Soft Bipolar Disorder: Many believe bipolar disorder is not easily grouped into one of the four categories described above but is actually a spectrum disorder (called Bipolar Spectrum). For example, according to DSM-IV, a mixed episode is part of a Bipolar I disorder. However, some experience hypomania and depression at the same time. In this case, clinicians and researchers use the term “Bipolar II, mixed” even though this terminology is not consistent with DSM-IV. Also, some clinicians and researchers believe certain forms of major depressive disorder are better classified as a “Soft Bipolar Disorder” (e.g., when a person has many depressive episodes, starting at a young age, with a poor response to antidepressant medications).

  • Such distinctions are helpful in treating mood disorders, so psychologists and psychiatrists continue to develop diagnostic systems that will best guide patients and doctors.
  • Course: The course of bipolar disorders can be quite variable. Bipolar disorders tend to be recurrent, where people experience multiple mood episodes over time. Left untreated, bipolar episodes typically become more frequent and more severe over time.

For some, episodes are separated by periods of wellness during which the person suffers few to no symptoms. These periods can last for months or even years. Others have a more chronic course with little respite between episodes. When four or more mood episodes occur within a 12-month period, the person is said to have bipolar disorder with rapid cycling.

Treating Bipolar Disorders: People with bipolar disorder are treated with a combination of medications – mood stabilizers, antidepressants, antipsychotics, and/or anti-anxiety agents. Side effects are common and many say they miss the high or clarity associated with mania. Medication is often combined with psychotherapy, which can be individual, family, couples or group therapy.’

For more reference to the Sutherland Bipolar Clinic refer to this link:

Whats this all about?

This is the first post on my new blog. I hope you find it helpful. We are looking for it to be interactive with questions, comments and contribution from you – bipolar Patients, Families, Friends, Medical Practitioners of Bipolar patients. Subscribe below to get notified when I post new updates.

I have an illness, I am Bipolar. At 37 I was diagnosed but over these past 23 years I have come to understand so much. It didn’t take one time to fix my faults …. I call myself a ‘Knucklehead from Jersey’ perhaps because I try and try again thinking I am smart enough to figure out how to fix myself, by myself.

But ohhhh I was so wrong about that even recently, at 59 years old, I had my worst and longest depression. I lost hope that my life would improve. I lost everything.  My spirit was the first to go,  money and home followed. I tried to mitigate this by isolating from friends & families. I felt like a total failure.

Being a single mom I was grateful my daughters’ life was on a new road. She had graduated from College and was moving forward.   You would never know I was at the top of my class in college and I had a great career. Apparently that talent helped me bounce along through the ups and downs of my emotional cycles which started at 26 years old. Unfortunately I wasn’t diagnosed as bi-polar until 1996 but since then probably had 15 cycles of mania and depression. 

Oh yes, I was diligent with my medication, but medication alone cannot ‘cure’ bi-polar.  Actually Bipolar cannot be ‘cured’, only maintained.     Lessons learned, have to be re-learned again and again. I can say after 23 years, I actually can understand ( SOMETIMES) the signs and ask for medical adjustments needed from a good Psychiatrist.    

Having said that, I have many thoughts to share in the hopes that it will start a conversation with people like me, friends and family of bi-polar victims even medical professionals learning about it in order to help their patients.

It seems to take so long and a lot of work to understand this is a life long illness and the ways you can help yourself manage it. The fundamental facts I have experienced to help me manage the mania and depressions over these past decades are as follows:

  1. Sleep Sleep Sleep – we need to be well rested throughout the year.
  2. Find a Psychiatrist you trust.
  3. Listen to your loved ones who see a rapid change in behavior. Even if they don’t know what is going on, they will know it is something and it is our duty to immediately call our Doctor and speak to what was said. Make sure they understand you cannot ‘fix’ bi-polar but rather control and manage it throughout your life.
  4. Take your medications ritually as prescribed by your Doctor. I have not been good during the depression phase,  that is when I lose hope that things will work out.  Today I stand for asking my doctor for the same help when I tick up as when I tick down.   Isolation comforts depression, I mean who wants a Debbie downer in life.  During this phase my M-O was to hibernate and avoid social settings.  I hoped that in 3 – 6 months ‘this too shall pass’.  
  5. Don’t be hard on yourself. The only difference between genetic physical and mental illnesses is the location of that illness.
  6. This is NOT a disease, this is a condition.
  7. Give yourself a break, it can be crushing to struggle with being bi-polar but I can tell you, at 62 I hope I am on the right track and will try to continue to ‘practice what I preach for the rest of my life.

Bipolar Patients, Families, Friends, Medical Practitioners please write your thoughts, share your stories and lets get this conversation going. My hope for this blog is that it will enable all to ask questions, share experiences so that we can all grow and succeed in our lives. Hope to hear from you. I invite you all to share stories and helpful links to further expand these conversations.

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