The Ups and Downs of Bipolar Disorder


Editorial75th anniversary

Jose Santana. Courtesy of Josh Santana.

Somewhere between Boston and the White Mountains of New Hampshire, Josh Santana lost touch with reality.

The change marked a marked divergence for the young college student, as the previous weeks were among the best he could remember. He no longer needed an alarm clock to wake up. He ran the fastest mile of him. He walked for hours at night, contemplating how to improve the world. But the best part, he said, was as if years of mental illness disappeared overnight. His pain, depression, restlessness, everything stopped.

“It was such a wave of euphoria that at first I thought, ‘I’m finally out of it.’ I’m not mentally ill anymore,’” Santana said.

The milestone was short-lived. Two weeks later, still euphoric, Santana’s judgment began to fail.

He talked to strangers about the future. He conjured ways to change the planets. He lost trust in his friends. Her strongest supporter, her mother, was worried. Then, on a whim, she skipped a teaching job. And somewhere on a dark mountain road, she thought about jumping off a bridge.

“At that point, the people around me had seen such a marked difference in my behavior that when I walked into my house, I was surrounded by three police cars,” Santana said. “Someone had reported that they were worried about me.”

What Santana, then 21, had experienced was a major episode of mania, a serious and dangerous symptom of bipolar disorder.

“People with bipolar disorder experience periods of ‘high,’ with mania and euphoria or irritability. These periods alternate with episodes of depression or ‘lows,’ with loss of interest, motivation, concentration and energy,” said Matt Rudorfer, MD, head of the Adult Psychopharmacology, Somatic and Integrated Treatment Research Program at the National Institutes of Health. Mental (NIMH).

But it’s more than just mood swings. The changes can be extreme and episodes can last from days to months. Additionally, bipolar disorder is associated with suicide risk, Dr. Rudorfer said.

“The life disruptions caused by bipolar disorder are not well controlled, making it difficult to concentrate, think clearly and, in extreme cases, tell what is real and what is not,” he said. “This can make it difficult or impossible to function at work, school, or home.”

For Santana, the episode was a low point in his life and the culmination of a long history of mental illness.

When life revolves around mental illness

Santana, now 27 and a successful real estate agent and musician, looks nothing like the once-manic college student. He is articulate, organized and motivated to excel.

Recently, it appeared in the book, You are not alone, by Ken Duckworth, MD, medical director of the National Alliance on Mental Illness. Reflecting on lessons learned from his challenges with mental illness, Santana told Dr. Duckworth that his struggles began at a very young age.

“I was removed from regular preschool because I assaulted a teacher during a behavioral outburst,” she told Dr. Duckworth. “I was 4 years old and I was not allowed to return to regular kindergarten unless my mother agreed to have me psychologically evaluated and have a paraprofessional stay with me for the entire kindergarten year. From the age of 5 onwards I was heavily medicated and many of those early years were a blur.”

A childhood photo of Josh Santana wearing a Boston Celtics jersey.

Jose Santana. Courtesy of Josh Santana.

It was a rocky start for the little boy, and Santana later learned that his difficulties stemmed from attention-deficit/hyperactivity disorder (ADHD). The disorder is characterized by a continuing pattern of inattention and/or hyperactivity and impulsivity that interferes with functioning or development.

Although he was academically talented (he learned the basics of algebra at age 8), Santana said he felt ADHD hindered his cognitive development. Although his work was excellent and he achieved excellent results on all tests, his teachers failed him for behavior.

These failures led to feelings of shame and guilt, he said.

“The hardest part was physical energy management on my part because there were a lot of situations where I had to hold back and I had to internalize some of that distress,” Santana said. “I think behavioral issues and excess energy prevented me from being able to focus and nurture that. [gifted] part of me from an earlier age.”

Although he never met Santana, Dr. Rudorfer said the pattern of behavioral outbursts is common in ADHD.

“Usually, children with this disorder will be physically hyperactive, have trouble sitting still, and in some cases will run around the classroom, leading to frequent trips to the principal’s office,” said Dr. Rudorfer, adding that ADHD can persist into adulthood.

For Santana, ADHD was just the beginning. Around sixth grade, bouts of anxiety and depression followed, creating layers of mental illness within him. This led him to take more medications, until, at one point, he found himself going through an “endless menu” of prescriptions. During this time, Santana experienced periods of calm and “windows of stability,” where one wave of his mental illness subsided to be replaced by another.

By the time she turned 15, Santana had begun to experience symptoms of bipolar disorder. His doctor prescribed more medication, this time antipsychotics.

“My life revolved completely around my mental illness: if I was depressed, I didn’t do my homework. If he was hyperactive, he wouldn’t do his homework,” Santana said. “Throughout high school, I had a lot of ups and downs because of that. “I also had a lot of high moods and spent a lot of time doing dangerous things.”

My life is gone

In college, Santana was able to control his symptoms, but the variety of medications sedated him. He slept 13 hours a day and fell asleep in class and while he was driving.

When the psychiatrist she had seen since she was 5 abruptly retired, Santana stopped taking her medication. A manic episode soon followed. While everyone around him could see the changes in his behavior, Santana couldn’t see the changes himself.

“In my head I was thinking, ‘Finally… I’m ready to make a difference,’” he said. “Overall, I felt good, until the end, right before I went into emergency care.”

The police who came to his house after the mountain trip made Santana sober as he realized he wasn’t okay. He entered an outpatient care modality called partial hospitalization.

As the mania faded, reality set in. In those last two weeks, Santana had destroyed relationships, some with lifelong friends.

“Sometimes the emotional symptoms of bipolar disorder do not reflect the underlying intentions of the real person,” he said. “And it’s one of the reasons why the guilt becomes so strong afterwards, because you think, ‘Who the hell was that?’”

He immediately fell into another depressive episode.

“I was watching my whole life go away,” he said.

The road to recovery

During the partial hospitalization, doctors adjusted Santana’s treatment plan, and he slowly began to stabilize. While continuing therapy, Santana reduced his medications to just two, at low doses. He also found a treatment regimen that worked and stuck with it.

He credits this combined effort — therapy, coping mechanisms, perfecting his eating and sleeping routines, and mindfulness practice — for playing a major role in his recovery.

“It was a mix of everything,” he said. “It seems like people’s situations can be unique and often we want a quick solution… but it was a lot of trial and error.”

Dr. Rudorfer acknowledged that treatment is not always easy.

“Finding the right medication, and even the right dosage of a specific medication, can be difficult. Everyone is different and it takes a while to see how the brain will respond to the treatment while trying to keep side effects to a minimum. Many people have other conditions that coexist with bipolar disorder, which compounds these challenges and often requires a combination of medications for best results,” said Dr. Rudorfer.

The important thing is to maintain good communication with your healthcare provider and give the medication time to work while following all parts of the treatment plan, including therapy and attention to the sleep-wake cycle, Dr. Rudorfer explained. .

“While the process can be difficult, people can improve with the right treatment. “Current therapeutic regimens aim not only to reduce symptoms, but also to achieve true life-changing and life-saving remission and recovery,” she stated.

Eventually, Santana returned to school. She made a concerted effort to amend her past behavior and improve. She adopted a dog, Koda, completed her master’s degree in music, earned her real estate license, and joined a nonprofit orchestra for people with mental illness.

Now recovered, Santana’s life no longer revolves around mental illness. He is healthy, prosperous and happy. It was a long journey, but he said it was worth taking.

“I’m at a point where mental illness hasn’t played as much of a role in my life and I feel good,” he said.

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