“Delusional Bipolar Depression More Common Than We Think?” by Natasha Tracy

16 Jul

From the blog Breaking Bipolar:

Delusions are false beliefs that are held in spite of a lack of evidence or even evidence to the contrary. For example, a delusion might be believing that the FBI is surveilling you every day or that you can predict the future. Delusions are a part of psychosis which can be present in bipolar depression or bipolar mania.

Delusions are easiest to spot when they’re exaggerated, like in the above examples, but I would suggest that delusions are much more common when we give them credit for. I would suggest that delusions are present in most cases of severe bipolar depression.

I’m the Worst Person in the World

People with bipolar depression often believe things that are decidedly untrue. Examples of this are:

I’m the worst person in the world.
The world would be better off without me.
I’m the ugliest person on the planet.
Everyone hates me.

These things are clearly untrue but can be staunchly held beliefs anyway. I don’t think these statements would get you diagnosed with psychotic delusions, but I would argue they certainly are. Even when a person can state they know they aren’t true, they will frequently also admit to believing in them anyway. That’s a delusion plain and simple. It doesn’t involve the FBI, but it’s a false belief nonetheless.

Dealing with Psychotic Delusions

In bipolar disorder we fight our brains on what we know to be real in many ways. We fight the hypomania when we know it’s not a good idea to paint our living room purple at 2 o’clock in the morning and we fight the depression when we don’t kill ourselves. Fighting delusions is, in some respects, the same. We have to fight the poor signals coming from our brain with what we know is real. And once we can grasp that our beliefs truly are delusional, this can be easier to do.

Treating Bipolar Depression Delusions

As the name implies, antipsychotics were developed to treat psychosis, traditionally in schizophrenia, but many antipsychotics are now prescribed for bipolar disorder whether recognized psychosis exists or not and they work quite well. And maybe the reason they work in the cases of severe bipolar depression is because what we’re really experiencing is delusions, is psychosis, but is not recognized as such. Maybe the reason why they work is because that end of bipolar disorder is closer to schizophrenia than we think.

(And, by the way, research on the brain supports the link between bipolar disorder and schizophrenia. It’s pretty common to see similar brain deficits between the two disorders only, in the case of schizophrenia, it tends to be more pronounced.)

I could be wrong about this, but I don’t think I am. I think what we’ll find as brain research matures is that the underlying problems in severe depression where these kinds of false beliefs are held are similar to the problems in the brains of people with schizophrenia.

So maybe it’s time for some of us to recognize that what we’re experiencing is delusions and not just garden variety depression. It might help to put things in a new perspective and make those beliefs easier to handle.


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