When a loved one is cycling into mania, she may become more energized than usual–more driven to get everything done all at once. If you’re a people pleaser by nature, it’s easy to get swept up into the vortex and even contribute to it by being too helpful (in the wrong ways). If possible, it’s better to slow down and take a more rational approach. Otherwise, you and your loved one are likely to run around “like chickens with your heads cut off,” increasing everyone’s stress level.

As we write in Bipolar Disorder for Dummies, bipolar mania tends to feed itself. Mania increases stress, which fuels the mania, which further increases stress and deepens the mania. It can be a vicious cycle.

There has been a lot of discussion about the over-diagnosis of bipolar disorder in kids, but what about in adults? In the wake of increased bipolar awareness and vigilance, are doctors mistaking other disorders or even excessive irritability and anger as bipolar disorder? If the doctor has a hammer, does everything start to look like a nail?

Researchers in Rhode Island have looked at this specific question and found evidence of a pattern of over-diagnosis of bipolar disorder in adults. In a study published in 2008, Zimmerman and others reported that out of a group of 700 patients who had previously received a diagnosis of bipolar disorder, fewer than half met the criteria when given a more comprehensive psychiatric evaluation.

During an acute and severe manic episode, a doctor is likely to treat mania more aggressively, perhaps by taking the following steps:

• Prescribing substantial doses of medications such as Abilify or Seroquel.
• Using loading doses of Depakote to reduce acute mania more rapidly. A loading dose is a higher initial dose than normally prescribed. Loading doses are used to ramp up a medication to a therapeutic level more rapidly.

These more aggressive interventions for mania are often performed in hospital. When providing outpatient treatment, doctors usually ramp up these medications more slowly to reduce side effects. Lamictal, which is used to prevent mood cycles, requires many weeks to reach a therapeutic level because of the risk of a skin condition that is much lower if the doses are increased very slowly.

Antidepressants are another story. Routinely, patients are told that they won’t be likely to experience any benefits from their antidepressants for at least a few weeks. Sometimes it can take much longer, and doctors rarely, if ever, suggest what to do in the meantime. Patients are often expected to tough it out. And if the person complains, the doctor often advises them to “BE PATIENT.” Easier said than done in the midst of debilitating depression.