Urgent Update — April 2017

The College of Physicians and Surgeons of BC is reviewing and threatening to revoke the licenses of psychiatrists who prescribe clonazepam to people with bipolar disorder. Most people with bipolar disorder have comorbid conditions, and when that comorbid condition is PTSD or CSA-trauma, clonazepam is beneficial, and is best understood by a patient’s personal psychiatrist. Please sign the petition.

Bipolar disorders affect a person’s mood, energy level, and sleep. They can significantly disadvantage a person’s functioning, depending on how well the condition is managed. There are three variants recognized by the APA1:

  1. Bipolar I Disorder: Diagnosis of Bipolar I disorder requires at least one manic or mixed
    Disorder episode, but there may be episodes of hypomania or major depression

    • The mood episodes are not better accounted for by Schizoaffective Disorder and are
      not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or
      Psychotic Disorder Not Otherwise Specified.
    • The mood symptoms cause clinically significant distress or impairment in social,
      occupational or other important areas of functioning.
    • The mood symptoms are not due to the direct physiological effects of a substance (a
      drug of abuse, a medication, or other treatment) or a general medical condition.
  2. Bipolar II Disorder: The diagnosis of this bipolar disorder requires neither a manic or a Disorder mixed episode, but does require at least one episode of hypomania in addition to an episode of major depression
    • Presence or history of one or more major depressive episode.
    • Presence or history of at least one hypomanic episode.
    • There has never been a manic episode or a mixed episode
  3. Cyclothymic Disorder: Diagnosis of this bipolar disorder requires a history of numerous
    Disorder hypomanic episodes intermingled with numerous episodes of depression that do not meet criteria for major depressive episodes

    • A 2 year history of numerous of hypomanic and depressive symptoms that do not meet criteria for a major depressive episode and the patient has not been without symptoms for more than 2 months.
    • No major depressive disorder, manic or mixed episode has
      been present during the first 2 years of the disturbance

Note: this information is not intended for self-diagnosis. If you think you or a loved one might have a bipolar-spectrum disorder, please visit a qualified psychiatrist.

Common Misunderstandings

  • “this moody person is bipolar”: everybody has mood changes. Overuse of this term (like other terms, such as “anorexic”) minimizes the reality of suffering for people with clinical bipolar disorder, who experience disabling mood changes, and are diagnosed by a psychiatrist.
  • “bipolar people alternate between very happy and very sad”: while euphoria may be a symptom of mania, it isn’t always; indeed, many people with bipolar disorder experience high levels of irritability and frustration during a manic episode. Also, “alternate” may be a weak word to use. There are two poles: the mania pole and the depression pole– it’s possible to be manic and depressed at the same time.
  • “bipolar people are violent”: the bipolar people who we hear about in the news are the ones who have behaved violently; violence is perpetuated by people with and without bipolar disorder; people with bipolar may be difficult to interact with during a severe manic episode; however, they are not necessarily violent.

Amy fell down the stairs

1. Information presented on the three variants of bipolar disorder condensed from: http://www.cqaimh.org/pdf/tool_assist_bdcdc.pdf