What is it like to live with bipolar disorder?

11:50Dr Nick Prior:So there's a real risk if you have bipolar. It's much harder to manage than a normal person. And that's compounded by some of the drugs as well that you take.

12:02Kimberley Wilson:Are there any other conditions that are often frequently seen alongside this condition?

12:07Dr Nick Prior:So there seems to be a link between bipolar neurodiversity, especially ADHD and ASD, so autism. I think there's a three or fourfold increase chance of having autism if you've got bipolar. So there does seem to be patterns there. I think the substance misuse one is obviously a big one. But also generalised anxiety disorder is more common in people with bipolar. And it makes the depressions often worse as well. When you've got a combination of anxiety and depression, the psychological burden and distress is that much greater.

12:41Kimberley Wilson:What do we know about the causes of bipolar disorder?

12:45Dr Nick Prior:Well, we know that it's very complex. So you've got biological factors, so things like your genetics. so my mother also has bipolar disorder so I was born probably with a propensity towards having it and very sadly my grandmother took her own life and trying to find out what was really going on for my grandmother speaking to a few of my older relatives it was very difficult to really get to the bottom of it psychological factors like how were you brought up where you bullied at school how have you learned to cope with things and social factors looking after yourself going to the gym, stopping drinking so much.

13:22Dr Nick Prior:It will be a combination almost always of four or six different things that if they find those four or six things, they will be able to hold their mood and they'll be able to move forward with their life and build a sustainable, thriving life. But it's just, can they go through that process and can they find those four or six things? And do they have the discipline and motivation to do them? It's not about saying you need to do this because you need to manage your mood it's you need to do this because this will mean that your relationship with your wife is better and you feel better about yourself and you're actually meeting your long-term kind of needs and purpose and values and i think not to put you under the

14:01Kimberley Wilson:spotlight but you are someone who is thriving you are you know you're you're a doctor you're working at a high level with people with serious conditions. And I guess I say that because there will be people listening who either have just had an early diagnosis or they are very anxious that there might be something going on for them. Maybe they have a loved one who's had a diagnosis. And there can be a very kind of negative, pessimistic story about these serious mental health conditions. And it can feel like, well, that's it. My life is over. I can't do anything. I won't get a job, I won't have a relationship.

14:40Kimberley Wilson:And so it's good for people to see these examples of people who are succeeding and thriving.

14:46Dr Nick Prior:Yeah, thanks for that. Yeah. And I think when you're in the illness, the illness is skews your perceptions of things. So certainly when I was depressed, I was terrified of the diagnosis and I would hold it, you know, even if it was like my third or fourth time. And I was at the middle of medical school and I kind of, I understood quite a lot about mental health. But when I was severely depressed, all of that kind of rational, clear thinking goes away. When you come out the other side, that's the important point in terms of how do we get that people that inflection point, that moment when they're motivated.

15:20Dr Nick Prior:And I would argue often, in my case, I've seen what's really interesting is actually the people who've experienced severe depression are often more motivated because they never want to go back there again. Whereas some of the rarer cases where they've never had depressive episodes, they've just gone up it's much harder for them to actually accept the need to change their life because actually there's a part of them that actually wants to keep it how it is yes people

15:43Kimberley Wilson:kind of like their mania or they might associate it with creativity or focus or drive or energy

15:48Dr Nick Prior:yeah it happens all the time it can even be more intoxicating for people who've had really traumatic pasts as well and they've got really negative inner critics and stuff like that because actually the hypermania or the mania turns that off as well for them it's like this is the best i've ever felt. I don't have all of that pain with me. And I'm doing interesting things. And in their minds, they don't have the insight or the self awareness to see they're starting to head towards a bit of a car crash. But I think it's very hard to motivate that group. And basically, what you're saying to them is, you know, I've sat here now, I've talked to you, probably six times over the last year.

16:24Dr Nick Prior:And can we just objectively see what's happened? Is this where you want to be going? and here's some more objective proof you know this is your your family saying this yes and just slowly but surely building the case getting it out of their heads into writing making it feel more concrete and you can just hope that at some point it will dawn on them

16:48Kimberley Wilson:are there any gender differences between how this condition is experienced yes so it's actually

16:54Dr Nick Prior:great to see this topic being brought up more and more now and recognizing that actually there are some fundamental reasons for why women as a general rule find it harder to manage bipolar one thing which is obviously the menstrual cycle and the hormonal changes that come with that

17:11Kimberley Wilson:which have an influence on mood which we think is also one of the reasons that women in general

17:15Dr Nick Prior:experience more depression compared to men and then there's also uh the fact that going through pregnancy can be difficult because often medications might need to be changed. The whole hormonal changes that come with birth, the lack of sleep, all mean that actually women, I think, have a harder job of managing bipolar.

17:35Kimberley Wilson:And so I'm thinking about the listener who maybe has had these recurrent depressive episodes, ones kind of that you described in your 20s. how would they be able to distinguish between these depressive episodes and bipolar disorder?

17:53Dr Nick Prior:Yes, I think the two main things to do are to really reflect on your previous depressive episodes and to think actually in my early 20s or when I was younger, did I ever have a hypermanic episode? Was there a summer where I was behaving pretty loose and getting on planes and spending too much money and everyone was a bit like, what's going on with Nick? He's just a bit. But because I was 22 and I recovered after a few months, it just kind of rolled on. But if you can identify an episode like that, then I would start thinking much more bipolar. And the other one would be if you're having these recurrent depressive episodes and they're really not responding to classic standard treatment.

18:31Dr Nick Prior:So CBT, antidepressants, and you're still stuck, you know, three, six months later, no movement, nothing going on. then it'd be worth exploring more openly like trying other medications and as it happens and it's been designed like this the treatment resistant depression pathway in terms of medications pushes you towards ending up on the same drugs you'd be on anyway with bipolar

18:56Kimberley Wilson:just for the listeners a treatment resistant depression is the type of depression where we don't see any responses to our frontline medication so maybe you've tried two or three different antidepressant medications and you're not seeing any improvement and we see that in about 30 % we think of people diagnosed with major depression and also if you're listening and you're recognising yourself in this and you don't already have a diagnosis then I do really urge you to seek specialist support you don't have to struggle on your own there are services available there are mental health organisations that can give you advice and you can also find sources of support in the show notes on BBC Sounds.

19:41Kimberley Wilson:And so our treatment pathways include I guess first of all talking to your GP if you're in a position to do that the GP will hopefully be able to get you onto a pathway in terms of increasing the kind of level of service support. Alongside that what can people do to help manage their condition assuming that they've had a diagnosis okay yeah

20:03Dr Nick Prior:so if they've got a diagnosis uh sadly the state of affairs of the nhs means that if you're reasonably stable and you're managing your condition pretty well you're not going to get much from the nhs so then it becomes quite self-directed and i think there's not necessarily um wrong that approach but I think it's important for me to be realistic.

20:24Kimberley Wilson:Honest, yeah. And so what I would recommend,

20:28Dr Nick Prior:I think bipolar does mean that you have a different experience to other people and it might mean that it is hard to connect with the people you most love but you should start there with the people you most love and try and open up a dialogue. Don't make it overbearing so it all becomes about me and my bipolar and it becomes an unbalanced relationship but I think if you've got a diagnosis like bipolar, it's you know a realistic thing is to say actually let's just sit down for an hour once a month and

20:54Kimberley Wilson:just review how the last month has been but also that it adds some context to you know when that summer where i was on the planes and i was spending all that money and you could you know i wasn't

21:03Dr Nick Prior:sleeping this is what was going on for me yes yeah yeah and that can be really helpful in terms of

21:08Kimberley Wilson:everybody being on the same page and understanding what's happening yeah i think being aligned with

21:12Dr Nick Prior:the people you most love makes a huge difference the outcomes for people who have someone like that you can always see that there's much more hope there's much more positivity about where they're going to end up yeah i think some people find mental health very hard to understand and that's fine you know we're all different i'm not expecting everyone to have the same understanding of bipolar i do and i think it's really important not to expect your loved one or friend or whatever to really completely get it sure and i think then there are support groups in the community where you can go and share some of your problems and learn from each other and feel more supported

21:47Kimberley Wilson:realizing you're not alone and is there anything else you can do yes so mood tracking can be really

21:55Dr Nick Prior:helpful and if you can connect that to a buddy even better mood tracking means that regularly maybe two or three times a week you score your mood out of zero to ten there are online tools and apps which can be really helpful and it means that over time you can see trends and you can identify earlier if you're moving in the wrong direction and we often do that in other types of

22:17Kimberley Wilson:therapy as well where we're just thinking about you know what's going on in your life and you can just use smiley faces to depict what mood it is but also to say what was happening before or after that mood so we can start identifying maybe triggers or patterns absolutely yeah and then

22:33Dr Nick Prior:And yeah, the buddy thing is really helpful because some of these tools enable a message to be sent as soon as you go above or below a certain score. So this takes away that need or feeling that you're leaning on people and you're having to proactively outreach. It just does it automatically for you so it doesn't feel like you're putting as much burden on people.

22:53Kimberley Wilson:It's really good to know that there are tools out there that can support you. so that exactly you're not having to try to fully track it all by yourself and identify your own vulnerabilities independently because as we know the more unwell you become the less insight you have into what's happening.

23:11Dr Nick Prior:Yeah, yeah. If you've got a good buddy it makes a big difference.

23:13Kimberley Wilson:I feel like we need that for everything.

23:16Dr Nick Prior:I need one for lots of them. I probably need ten of them.

23:20Kimberley Wilson:Do you ever share with your patients your own diagnosis?

23:24Dr Nick Prior:Yes, I do. and I find it to be an incredibly quick way to build trust and rapport and to actually get them to start to listen to what I'm really saying. I've had quite a lot of pushback. I think it's not done very much. Very few doctors speak openly about serious mental illnesses. But for me, it's been a very natural route to take. And I think the important point to make here, though, is that I wouldn't suddenly start thinking this is something one just divulges and this is something very personal. I think you need to be very careful to protect yourself and to do it in a structured way so that you keep psychological safety at work and in those kinds of environments.

24:12Kimberley Wilson:That is really illuminating and clarifying. Nick, thank you for your openness and bringing your expertise today.

24:21Dr Nick Prior:I loved it. Thank you. and thank you to everyone listening i hope we've brought some clarity to a term that we often hear

24:30Kimberley Wilson:but i think we don't necessarily fully understand and my mission is to do just that to clear up the mental health space and i want complex to be a trusted place for you to come to where you can hear information from qualified experience experts to help you understand and psychology and mental health. And you are very much part of the conversation. Let me know what you want me to talk about. Send us a couple of paragraphs by email to complex at bbc.co.uk. And please note that I can't answer you personally. If you have a concern about a medical or mental health issue, then I do strongly urge you to seek expert help.

25:13Kimberley Wilson:And if you want details or further support with some of the issues raised in the podcast, You can find them at bbc.co.uk forward slash action line. And the link is also in the show notes on BBC Sounds. And that's it. Thank you very much to my guest today, psychiatrist Dr Nicholas Pryor. And a quick thank you to the very lovely production team at Loftus Media. I'm Kimberley Wilson. Thank you very much for listening. Take care and go gently.

25:51Kimberley Wilson:How does someone invent a political theory that reshapes the map of the world? How do you get to a scientific breakthrough that saves thousands of lives or create works of art that stand the test of time? How have brilliant thinkers through history done their best thinking and what can we learn from them? From BBC Radio 4, it's the second series of Human Intelligence with me, Naomi Alderman. From Karl Marx to Marie Curie, from Emily Bronte to Leonardo da Vinci. How did those exceptional minds do their work? And are there ways of thinking we can emulate today? To find out, listen to Human Intelligence on BBC Sounds.

26:34Kimberley Wilson:It's 2009 and we're in the German mountains. A man straps himself into a car on the world's most dangerous racetrack. He whispers to himself, It's time to put my balls on the dashboard. As he starts the engine. In 15 minutes, he's in an ambulance, unconscious. In 15 years, he's a billionaire. This is Toto Wolff, Formula One's most powerful team boss and the breakout star of Drive to Survive. This week on Good, Bad, Billionaire, how Toto Wolff made his billions. Listen wherever you get your BBC podcasts.