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Support for College Students with Bipolar Disorder How to Recognize Symptoms and Get Help on Campus

According to the National Institute of Mental Health (NIMH), 5.7 million Americans age 18 and older experience the extreme highs and lows of bipolar disorder. Symptoms often appear between the ages of 15 and 24—when students are in high school and college. Because of additional stress, many individuals with bipolar disorder struggle with the college experience. This guide focuses on how students with bipolar disorder can find help on campus, the importance of continuing treatment plans and how to make the college experience both a success and a wonderful time that will change an individual’s life for the better.

Experts

Dr. Jennifer “Christy” Thrash Licensed psychologist
Jonathan Stevens, MD, MPH Chief of Child and Adolescent Psychiatry and Outpatient Services at The Menninger Clinic.

Written By:

By the Numbers: Bipolar Disorder in College

To better understand how bipolar disorder affects college students, let’s take a look at some statistics.

About 3.2 percent of college students meet the criteria for bipolar disorder.

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Depression, which makes up one part of bipolar disorder, is one of the most common reasons students seek counseling in college.

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Bipolar disorder can decrease by more than one half an individual’s chances of completing college.

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Up to 50 percent of individuals with bipolar disorder will attempt suicide at least once.

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In most people, the symptoms of bipolar disorder will become evident before the age of 20.

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Understanding Bipolar Disorder & Recognizing the Signs

Bipolar disorder used to be called manic depression. It is a mental health disorder in which an individual will experience extreme mood swings for no apparent or seemingly logical reason. The individual may go from an emotional high (also known as “mania” or “hypomania”) to an emotional low (also known as depression) or vice versa.

While bipolar disorder is defined by extreme mood swings, they can occur in different ways. As a result, there are several types of bipolar classifications.

Bipolar I Disorder. Type one bipolar disorder is when an individual experiences at least one manic episode. Even if an individual experiences major depression, just one instance of mania will classify them as having type one bipolar disorder.

Bipolar II Disorder. An individual has type two bipolar disorder if they have at least one depressive episode and at least one episode of hypomania (a less severe form of mania). If an individual has any manic episodes, they cannot have type two bipolar disorder.

Cyclothymic Disorder or Cyclothymia. This exists when someone experiences the symptoms of bipolar disorder for an extended period of time (one year for children or teenagers and two years for adults), but the symptoms are less severe, such as hypomania (a less severe form of mania) or symptoms of depression (but they do not rise to the level of major depression).

“Other specified” or “unspecified.” This includes bipolar disorder that is the result of a disease, medication, drugs or alcohol. Certain medical conditions, such as stroke or multiple sclerosis, can cause unspecified bipolar disorder.

What causes bipolar disorder?

There is no known cause for bipolar disorder. Scientists and medical researchers are actively looking for the cause. Currently, there are three things scientists and medical professionals recognize as contributing to bipolar disorder: stress, genetics and brain changes. Individuals with bipolar disorder are known to have brains that are physically different from brains without the condition.

Certain factors that may signal the potential for bipolar disorder include experiences of extreme stress (such as the death of a loved one), drug and/or alcohol use and having a close relative (sibling or parent) who also has bipolar disorder.

Most college kids are in the “prime” age for developing bipolar disorder. Some estimates indicate that bipolar disorder is most likely to appear in those between the ages of 19 and 23— the exact age range most people are while in college. Additionally, the use of alcohol and drugs tends to spike for those in college, further increasing the risk of developing bipolar disorder.

Mania: Mania and hypomania (a less severe form of mania) can include the following symptoms:

  • Irritability
  • Thoughts racings through your head
  • Feeling or being very chatty
  • Requiring less sleep
  • Unusually high sex drive
  • Feelings of extreme happiness, euphoria or jubilation
  • Excessive over-confidence
  • Feeling “wired”

Depression: The major depressive episode of bipolar disorder can consist of the following symptoms:

  • Trouble sleeping or sleeping too much
  • Feelings of sadness, melancholy, emptiness or hopelessness
  • Fatigue or tiredness despite getting enough rest
  • Trouble staying focused
  • Thoughts of suicide (doesn’t have to necessarily include a suicide attempt)
  • Drastic change in appetite
  • Drastic change in weight (either significant weight gain or loss)

Keep in mind that it might take quite some time to get an accurate diagnosis. “In a majority of patients, the first episode is depressive, resulting in the incorrect diagnosis of unipolar depression (or Major Depressive Disorder) and ill-fated treatment with antidepressants,” according to Dr. Jonathan Stevens, Chief of Child and Adolescent Psychiatry and Outpatient Services at The Menninger Clinic. “In studies, as many as 70 percent of individuals with Bipolar Disorder failed to receive a correct diagnosis in the one-year period following the initial episode, and in approximately 35 percent of them the correct diagnosis has been made only after 10 years had passed. Additionally, up to 70 percent of patients with broader bipolar spectrum symptoms go unrecognized and undiagnosed, and thus remain untreated or inappropriately treated.”

The Effects of Bipolar Disorder in College

In most cases, students with bipolar disorder will have to carefully manage and treat their condition to prevent it from derailing their college career. Below are some of the realities students with bipolar disorder need to be aware of when attending college.

Poor decision-making.

The mania or hypomania side of bipolar disorder can make it difficult to make good decisions in college. It’s hard enough only using a credit card for “emergencies,” going to bed at a reasonable time or not having that one last drink but being in a mania phase just increases the struggle.

Feelings of boundless energy.

If a student is in their mania or hypomania phase, they may feel like they have limitless energy. One of the problems with this feeling is that the students can push themselves too far, such as not getting enough sleep when they party (or even study) for too long. Without enough sleep, any student’s academic potential is diminished.

Trouble focusing.

Whether due to racing thoughts or easy distractions, a manic or depressive episode can make learning extremely difficult. Paying attention in class or while studying for a test can become nearly impossible when an individual is going through a bipolar episode.

Stress triggers.

One of the biggest triggers for a bipolar episode is stress. College is one of the most stressful times in a young adult’s life. Therefore, it’s no surprise that stress triggers are everywhere, and students must learn to reduce them as much as possible.

Medication interference.

Many individuals can manage their bipolar disorder with the help of medications. However, these medications can sometimes have unintended side effects, like trouble with concentration or memorization.

Impulsive behavior.

Making rash decisions can easily hinder a college career. From deciding to skip a class to having unsafe sex to consuming too much alcohol, any of these things can lead to students getting into trouble with the law, harming themselves or interfering with classwork.

Insomnia.

When someone with bipolar disorder is in the depressive state, they may experience insomnia; of course, not getting enough sleep will prevent effective learning. It can also lead to danger if the student has to drive or undertake any other dangerous tasks without enough sleep.

Finding Support for Bipolar Disorder in College

Support for those with bipolar disorder can be found both on campus and off. Here are some of the best options.

  • Counseling centers. “I recommend that new students who were diagnosed with bipolar disorder prior to starting college touch base with the mental health staff at their school’s counseling center at some point during their first semester, whether or not they think they need psychotherapy,” advised Dr. Jennifer “Christy” Thrash. “These professionals can serve as advocates for minor issues such as missing classes or assignments, and they will play an important supportive role if the student has difficulty accessing psychiatric services or needs crisis intervention in the future.”

  • Disability centers. A school’s disability center helps students receive the accommodations they need to succeed in school. Providing these accommodations can be complicated in that it involves the coordination of multiple parties, which is why so many colleges have dedicated staff that handles this for students. Disability centers may also take on the role of promoting an on-campus culture of acceptance for those who may have a disability.

  • Student health center. Student health centers are great for basic medical needs, such as a physical check-up, vaccination, nutritional advice and blood testing. Some schools may include basic mental health services, such as an initial assessment for psychiatric issues. In addition, it’s important to pay close attention to physical health. “Physical health problems, especially in bipolar spectrum patients, are under recognized and under treated,” Dr. Stevens pointed out. “This is probably a consequence of stigma but may also result from unhealthy lifestyle, poor treatment adherence, or irregular contact with health care services.”

  • Meditation centers. College can be an extremely stressful time. As a result, some schools provide meditation rooms or areas where students can find a quiet place to think, pray, meditate or simply seek peace and quiet. Because stress is one of the most common triggers of a bipolar episode in college students, meditation centers can serve as a form of preventative care.

  • Campus advocacy and support groups. These groups meet regularly, usually two to four times a month, and provide a place where students can share their challenges, seek advice, learn more about their condition and find additional help. For those who want to raise awareness about bipolar or other mental health disorders, some schools have special student groups that advocate based on particular characteristics, such as suffering from mental illness, being a member of the LGBT community or promoting a particular humanitarian cause.

  • Mental health centers. “Most colleges and universities offer mental health services on campus. Those that do not, probably refer their students to a nearby mental health center or other treatment providers in the community,” Dr. Thrash pointed out. “Psychiatric providers (e.g., professionals who are able to prescribe bipolar medication) are not always employed by college counseling centers. They can be difficult to find, especially in rural locations. It will be important for students with bipolar disorder to get information about such services as soon as possible or arrange to continue medication management with their prescribing doctor at home.”

  • Online support communities. Online support communities are exactly what the name implies: gatherings of individuals who meet online to provide encouragement, support and advice to one another. However, the format of the online support will vary. Some are less structured and informal, such as a message board or online forums that anyone can join. For more formal support, individuals can look for online support communities administered by formal organizations, such as the Depression and Bipolar Support Alliance.

  • Personal wellness tools. Personal wellness tools are usually online web tools that help individuals manage their health and wellness routines. This can include resources, such as an online journal or tracker that allows participants to keep track of their treatment progress, mood, lifestyle choices and sleep patterns. By writing these things down, individuals can identify potential triggers or stay organized with their treatment routine. Other types of wellness tools include checklists, wellness strategies and databases where individuals can find additional help or advice.

  • Apps. Apps are special programs individuals can download onto their smartphones. Apps that may be helpful to those with bipolar disorder include those that keep track of their medications and help them remember to take them on time, analyze their sleep patterns and record their sleeping habits and mood trackers to help monitor the user’s mindset and mood.

  • Free online screenings. Anyone who thinks they may have bipolar disorder can take a free and anonymous online quiz or test that can indicate whether there’s a chance that they might have bipolar disorder. These screenings usually work by asking about potential symptoms. The results will only indicate if the individual does or does not show signs of potential bipolar disorder; they will not provide an actual diagnosis. Therefore, users must understand that the online screening should never replace the advice of a trained medical professional. Regardless of the online screening’s results, those who are concerned enough about their symptoms to use a screening tool should make an appointment with their counseling center as soon as possible.

  • In-person support groups. Sometimes an in-person interaction is the best way to communicate. That’s why there are bipolar support groups that meet in person. Here, participants can listen, watch and share their own stories, concerns and questions about bipolar disorder. While not as convenient as online support groups, due to the in-person nature of these support groups, the feedback and support will have maximum effect.

  • Treatment locators. Realizing there may be a problem is sometimes half the battle for those with bipolar disorder. The next step is to get treatment, but many won’t know where to begin their search. Luckily, there are many treatment locator tools online. With these tools, users can search for mental health professionals and providers based on search criteria that matters to them, such as their location and type of mental health support sought.

Treatment for Bipolar Disorder

When it comes to treatment for bipolar disorder, the adage “it takes a village” definitely rings true. It’s a joint effort between the patient and their therapist, physician and other members of their medical and psychiatric team to keep them healthy. “The sense of having a personalized treatment “team” can be very important for times when a person has questions, requires advice, or has concerns (e.g., about triggers for mood cycling or medication-related side effects),” Dr. Stevens pointed out.

There are numerous treatment options that might work for those with bipolar disorder. Here are some of the most common.

Medication

Medication is the primary form of treatment of bipolar disorder. Due to the long-term nature of bipolar disorder, individuals can expect to take medications for long periods of time. Medications used to treat bipolar disorder include antidepressants, anti-anxiety, mood stabilizers and antipsychotics. Examples include:

  • Lithium
  • Carbamazepine
  • Quetiapine
  • Lurasidone
  • Risperidone
  • Asenapine
  • Benzodiazepine
  • Lamotrigine
  • Valproic acid
  • Divalproex sodium
  • Olanzapine
  • Cariprazine

Every person’s body and brain are different, and so how their body and brain handle medications can be quite different from what someone else experiences. That’s why it may take time to get the right combination and dosages of these medications figured out, but soon, a person with bipolar disorder will discover which medication regime works best.

In addition to medication, psychotherapy (also known as “talk” therapy) will be one of the two primary forms of bipolar treatment. Psychotherapy can take place in individual or group settings and has many variations, such as:

  • Cognitive behavior therapy.

    This looks at modifying an individual’s behaviors and thoughts to bring about improvements in mental health.

  • Interpersonal and social rhythm therapy.

    This type of therapy works on helping patients in their daily routines, such as eating, exercising, sleeping and working. By creating a stable and consistent routine, patients are more able to control their bipolar episode triggers.

  • Family-oriented therapy.

    Patients, as well as their family members, are educated about the nature of the patient’s treatment regimen so they can effectively spot warning signs and provide the necessary emotional support to tackle bipolar disorder.

Because there are several potential causes of bipolar disorder, such as drug and alcohol abuse, treating bipolar disorder will sometimes require treating another mental or physical health issue. For instance, individuals may receive treatment for their drug and/or alcohol use while they receive treatment for bipolar disorder.

Tips for Managing Bipolar Disorder

  • Avoid drugs and alcohol. College will contain plenty of opportunities to indulge in drugs and alcohol, but students with bipolar must avoid the temptation. According to Dr. Thrash, “Abusing illegal drugs and alcohol will interfere with the effectiveness of bipolar medication.”

  • Get enough sleep. Sleep deprivation is one of the biggest triggers for a bipolar episode. College is notorious for irregular sleeping patterns due to late night partying and study sessions. “Lack of sleep can also increase symptom severity,” Dr. Thrash said.

  • Stay organized. Stress is another major trigger for bipolar symptoms, and it’s safe to say college and stress go hand-in-hand. However, you can reduce your stress and anxiety levels by staying organized with your school and work obligations. This includes planning ahead with assignments and projects to avoid any last-minute surprises.

  • Find a good support network. Having understanding friends in college is great, but you will also need someone who can give you “tough love” when necessary, such as when you’re tempted to stop taking your medications.

  • Stick with a routine. “Individuals who live successfully with bipolar disorder know well the importance of maintaining routines as a strategy for keeping well,” Dr. Stevens said. “Having established routines allows my most successful patients with bipolar disorder to get “outside” themselves because they have hardwired routines such as eating and sleeping regularly, exercising, and taking their medicine at set times in the day.”

  • Find fun activities. College should be an overall enjoyable experience, so take time to have fun. Join a sports team, take part in a rally focused on something you believe in, or join an extracurricular activity that will keep you busy. Having fun is also a great way to reduce stress.

  • Keep realistic goals. Be realistic about what you can accomplish while still managing your bipolar disorder. Understand that over time, your needs can change; thus, be open to becoming a part-time student or taking a semester off if that is what it takes to succeed in college.

  • Have the right friends. Find friends who will understand your challenges and the steps you need to take to avoid triggering an episode. Look for roommates who are sensitive to your needs. “Avoid living situations where there is a lot of late night partying, drinking, and substance abuse,” Dr. Thrash said.

  • Eat well. Junk food is a college staple, but processed junk foods can negatively affect your mood. Do your best to eat a well-balanced diet.

Expert Advice: How to Talk About Bipolar Disorder in College

Dr. Jennifer “Christy” Thrash is a licensed psychologist in Colorado Springs, CO. Her passion is helping adolescents and young adults cope with mental illness and life transitions. She has treated teens and adults with anxiety, depression, schizophrenia, and bipolar mood disorders since 2000. To learn more, please visit www.drchristythrash.com

Q. How should students tell their friends about their disorder? How should they tell their professors?

A. Unfortunately our society continues to struggle with stigma and misconceptions when it comes to mental illnesses. Highly educated professors are not exempt from having such biases. Therefore, college students should be cautious when deciding who to confide in. They should wait until they have gotten to know their professors, academic advisors, and new college friends fairly well. Have a few conversations about mental illness in general before revealing too much personal information and see how they react. It’s a good sign if they talk in a positive way about a family member or close friend who struggles with a psychiatric illness. It’s also important to remain in close contact with supportive family and friends from home.

Q. What are some of the most important things parents and friends need to know in order to help someone with bipolar disorder?

A. Individuals who have bipolar disorder cycle through episodes of severe depression and manic/hypomanic periods, and these are interspersed with periods of normalcy that can last several months, even without medication or treatment. If family or friends notice their student is experiencing emotional or behavioral problems that represent a noticeable change from their usual behavior, or they see an escalation in such problems to the point that they are interfering with the student’s daily functioning, then they should intervene immediately and get them psychiatric help. It does not matter if the student has a big exam or project that’s due. Take them to the nearest hospital emergency room if it’s a crisis. Call 9-1-1 if they refuse to go.

You must put their mental health needs first, because there could be serious long-term consequences if they do not get their bipolar symptoms under control as soon as possible. To put things in perspective—the lifetime risk of suicide in individuals with bipolar disorder is 15 times higher than the general population.

Q. Let’s assume a student knows something is wrong but isn’t sure what. Are there any signs that might point them in the direction of bipolar disorder?

A. Unfortunately there are no definitive telltale signs that an individual has bipolar disorder because the disorder is cyclical in nature and it often mimics other mental health disorders. A person who has severe depression may have bipolar disorder or they may have a major depressive disorder. Individuals who exhibit mania (e.g., decreased need for sleep, racing thoughts, fast speech) or psychosis (hearing or seeing things that are not there, bizarre ideas) may have bipolar disorder, but they could also have schizophrenia, schizoaffective disorder, or substance induced mania.

If a college student is struggling with severe depression, suicidal thoughts, substance abuse, lack of sleep, racing or bizarre thoughts, or any other emotional or behavioral issue that is causing them major problems, they should seek psychiatric help immediately. If a crisis occurs after business hours or on weekends, they should have a friend, or a family member take them to the nearest hospital emergency room for an evaluation.

Bipolar disorder is difficult disorder to diagnose. The student will need to give a very thorough psychiatric history, including specific dates and durations of their symptoms and a family history of mental illness before an accurate diagnosis can be reached. It may take more than one visit.

Scholarships for Students with Bipolar Disorder

Figuring out how to pay for college is a major source of stress for college students, even those without bipolar disorder. To help make the bottom line easier to handle, students can find any number of scholarships to help pay for school. Luckily, there are a number of scholarships that focus on students with certain traits, including those with bipolar disorder.

Additional Resources

Bipolar is a serious mental health illness and anyone suffering from it will probably appreciate as much help as they can get. Therefore, we’ve provided additional resources that offer information and assistance to anyone who has or thinks they may have bipolar disorder, as well as friends and family of those who have been diagnosed.

  • Active Minds: Through student-run mental health groups on college campuses, Active Minds encourages students to share their mental health issues and challenges so that other students may feel free to seek help.

  • Depression and Bipolar Support Alliance (DBSA): Focuses on helping those living with mood disorders by establishing a wide variety of resources, including hundreds of support groups across the nation.

  • International Bipolar Foundation: This foundation not only explains bipolar disorder and ways to get help but provides opportunities for those not living with bipolar disorder to get involved and help those that do.

  • MedlinePlus–Bipolar Disorder: Part of the United States National Library of Medicine, MedlinePlus offers an in-depth great overview of bipolar disorder, including research data from clinical trials and medical journals.

  • Mental Health America–Bipolar Disorder: A nonprofit organization that uses a community-based approach to help those dealing with mental illnesses, such as bipolar disorder.

  • National Alliance on Mental Illness (NAMI)–Bipolar Disorder: NAMI provides background information about bipolar disorder, but unlike many other sites, NAMI provides message boards for individuals to connect with others struggling with bipolar disorder or other mental health issues.

  • National Institute of Mental Health: Works to improve the treatment of mental illnesses, especially through research. Those with bipolar disorder will not only learn more about their disorder but have an opportunity to join a study.

  • TeensHealth–Bipolar Disorder: An excellent resource for teens that provides background information about bipolar disorder, including how to treat it.

  • WebMD–Bipolar Disorder Health Center: One of the biggest and most comprehensive sources of medical information online, including pages on mental health ailments like bipolar disorder.