Health Conditions / Mental Health / Bipolar Disorder

Selena Gomez spoke about being diagnosed with bipolar disorder and having a psychosis episode in a new interview with Rolling Stone. The 30-year-old actor and singer shared candid details about her mental health ahead of the release of a new documentary about her journey. Called My Mind and Me, it’s available on Apple TV+ on November 4.In the new interview, Gomez said her mental health took a turn for the worst during her early twenties: “It started to get really dark…I started to feel like I was not in control of what I was feeling, whether that was really great or really bad.” She said periods of highs and lows would last for months on end, and that, at times, she couldn’t sleep for days. The lows were particularly difficult to navigate, Gomez said: “It would start with depression, then it would go into isolation. Then it just was me not being able to move from my bed. I didn’t want anyone to talk to me.” This took a huge toll on her health: “Sometimes it was weeks I’d be in bed, to where even walking downstairs would get me out of breath.” During this time, Gomez said, she considered killing herself.Then, in 2018, Gomez had a psychosis episode, which led to a diagnosis of bipolar disorder. The episode started when she began to hear voices that eventually grew louder and louder. She said she only remembers certain parts of this time, but that she was in a treatment facility for “several months.” Gomez explained she felt constant paranoia and didn’t trust anyone. She also said doctors tried putting her on several different medications, which left her feeling unlike herself. “It was just that I was gone,” Gomez explained. “There was no part of me that was there anymore.”After she left the treatment facility, a psychiatrist took her off all but two of the medications she was taking. “He really guided me,” Gomez said. “But I had to detox, essentially, from the medications I was on.”Aside from getting used to a new medication routine, Gomez had to essentially reprogram her mind, she said. “I had to learn how to remember certain words,” she explained. “I would forget where I was when we were talking. It took a lot of hard work for me to (a) accept that I was bipolar, but (b) learn how to deal with it because it wasn’t going away.”My Mind and Me isn’t the first time Gomez has been open with fans about her health: She’s also talked about living with lupus, an autoimmune disorder that left her with organ damage and led to her getting a kidney transplant in 2017, at age 24.Gomez admitted that it’s nerve-wracking to be so open about herself—particularly when she’s releasing footage of times in her life when her mental health wasn’t great. “I’m just so nervous,” she said of the new documentary. “[But] because I have the platform I have, it’s kind of like I’m sacrificing myself a little bit for a greater purpose.” She added that she was so apprehensive about My Mind and Me, she didn’t know whether she’d sign off on the release until fairly recently: “I don’t want that to sound dramatic, but I almost wasn’t going to put this out. God’s honest truth, a few weeks ago, I wasn’t sure I could do it.”

With 310 million followers and counting, Selena Gomez has the fifth-most-followed account on Instagram. Clearly, her social media platforms are active, but the 29-year-old singer and Rare Beauty founder told Vogue last year that her assistant is responsible for sharing her content. For more than four years, Gomez admits she has cut herself off from social media in the name of preserving her mental health. In a new interview with Good Morning America, during which she drew attention to her new mental health destination, Wondermind, Gomez said: “I haven’t been on the internet in four-and-a-half years… It has changed my life completely.” And it doesn’t seem like she will be changing her mind any time soon. “I am happier, I am more present, I connect more with people,” she said in the interview.In a 2020 Instagram Live chat with Miley Cyrus, Gomez discussed her bipolar disorder diagnosis “after years of going through a lot of different things.” Bipolar disorder, formerly known as manic depression, is a mental health condition that causes severe shifts in mood, which can range from extreme highs (leading to feelings like elation or boosted energy) to extreme lows (leading to feelings like indifference, sadness, or hopelessness). Prior to this, Gomez was candid about living with depression and anxiety. In a 2018 Instagram Live, which occurred before her social media hiatus, she spoke openly with her followers about how mental illness took over her world. “Depression was my life for five years straight. Depression and anxiety were at the forefront of everything that I did in my life. Every single thing. I would make myself have the courage to just keep going,” Gomez said.Related: Instagram Made Me Forget Who I Was. This Is Why I Left—And Came BackIn her Good Morning America interview, she said that quitting social media is part of her larger plan to prioritize her mental and emotional well-being. “I can’t believe that I’m where I am mentally, just because of how I took the necessary steps in order to kind of remove myself from that,” she said.Of course, Gomez is no stranger to the undeniable magnetism of the internet. “I understand how powerful the internet is, and in so many ways it’s done the best things for the world,” Gomez said. But she says that removing herself from social media means she no longer feels plagued by the intense scrutiny Instagram, in particular, was placing her under. “I woke up one morning and looked at Instagram, like every other person, and I was done,” Gomez recalled. “I was tired of reading horrible things. I was tired of seeing other people’s lives. After that decision, it was instant freedom.” 

As with any medication, it’s a good idea to ask your doctor about side effects and what to look out for so you can flag a negative response if you experience one. For example, drinking alcohol while taking lithium can decrease its effectiveness or increase potential negative effects like sedation, according to the National Alliance on Mental Illness (NAMI).AntipsychoticsSevere manic or depressive episodes can cause symptoms of psychosis, in which you may lose touch with reality and have delusions or hallucinations, according to the NIMH. Antipsychotic medications, which are often used to treat people with psychotic disorders1, such as schizophrenia, can help in that situation. Dr. Mondimore says these drugs have mood-stabilizing qualities, so they’re frequently prescribed to people with bipolar disorder as well.There are two types of antipsychotics: first-generation (typical) and second-generation (atypical), the NIMH explains. Some common first-generation antipsychotics include chlorpromazine, haloperidol, perphenazine, and fluphenazine; second-generation drugs include olanzapine, risperidone, quetiapine, aripiprazole, ziprasidone, lurasidone, cariprazine, and paliperidone.Antipsychotics generally work by changing the levels of brain neurotransmitters, chemical messengers such as serotonin, which impact mood, according to Jamie Alan, Pharm.D., Ph.D., assistant professor of pharmacology and toxicology at Michigan State University. Both types of antipsychotics treat manic symptoms, but only second-generation antipsychotics are thought to work more broadly to target depression as well, the NIMH explains.Generally, some symptoms like hallucinations subside within a few days of taking antipsychotics, but it can take up to six weeks to fully benefit from these drugs, according to the NIMH. Sometimes, antipsychotics are prescribed alongside other medications, such as those mood stabilizers we just discussed, to help you feel better faster. “The thought is that the antipsychotic can manage the episodes while the mood stabilizer has time to work,” Dr. Alan tells SELF. “The general consensus is that an antipsychotic and a mood stabilizer provide a greater benefit.”AntidepressantsSometimes, people with bipolar disorder may take antidepressants if other medications don’t help completely resolve their low mood episodes. There are plenty of antidepressants out there, but the most common are selective serotonin reuptake inhibitors (SSRIs), which can affect mood by increasing the amount of serotonin in the brain2. (Other antidepressants also work by changing the levels of neurotransmitters, the Mayo Clinic explains.)But antidepressants can sometimes trigger a manic episode in people with bipolar disorder, according to Dr. Alan. So it’s important that you pay attention to how you feel and talk to your doctor if you notice signs of mania (talking really quickly or having feelings of euphoria, for example), your other symptoms worsen, or you experience severe side effects like not being able to sleep. Some commonly prescribed antidepressants include fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro).Anti-anxiety medicationsOftentimes, people with bipolar disorder may also develop symptoms of an anxiety disorder, such as generalized anxiety. With a generalized anxiety disorder, you may have trouble controlling your nervous thoughts, worry excessively about common events such as driving to work, and have trouble relaxing or sleeping, according to the NIMH.

But asking for support is a critical step in feeling better. If you’re just not sure where to start, visit your primary care doctor if you have one, Dr. Gilbert says. They can help refer you to a therapist who can further support you if you’ve had trouble finding one yourself. (We’ll dig into that process in more detail below.)During your first few appointments, your therapist will want to get to know you, how you’ve been feeling, and what your goals are with counseling. Heidi L. Combs, M.D., a clinical psychiatrist and director of inpatient psychiatry at UW Health Harborview Hospital, says she develops a depression treatment plan with input from her patients based on their medical history and whether they have other health conditions or mental health disorders (like anxiety or OCD), individual needs based on symptoms, and personal preferences.For example, some people prefer to try talk therapy before they try medication, while others are open to including both in their treatment plan. Or, if you’ve had depression in the past and benefited from a particular medicine or type of therapy, it might be worth trying the same course of action if it’s already been successful for you.Essentially, your treatment might include therapy for depression, medications for depression, or both. For people with really severe symptoms, a combination of the two can be helpful because the benefits of antidepressants can start to take effect in as little as two months for some people, according to the Cleveland Clinic. Of course, anyone can benefit from therapy, but the skills you learn are an ongoing process that may take some time to stick.What types of therapy help relieve depression symptoms?Psychotherapy, or talk therapy, can be a game-changer for people who struggle with depression. A therapist can work with you to identify things that contribute to your symptoms, from grief to stress to buried traumas, and help you find actionable ways to change or adapt your thoughts and behaviors around those circumstances, among other practices.Showing up for therapy to help treat your depression is a commitment: The conversations you’ll have with your trusted provider can be tough, messy, uncomfortable, and very emotional. But over time, you may find that talking to your therapist becomes easier, enlightening, and extremely rewarding.There are two major ways to approach therapy for depression: individual therapy and group therapy. Individual psychotherapy is just what it sounds like: a one-on-one session with a trained mental health professional, which can take place at a hospital, medical clinic, therapist’s office, or your own home via telehealth. If you’re new to therapy, you might feel most comfortable with individual sessions since they’re private. Plus, your therapist can get to know you on a deeper level this way and tailor their treatment recommendations to fit your particular situation.Group therapy, on the other hand, involves more than two people in a therapy session with at least one mental health professional. (Some group therapists may also ask that you get individual counseling, too.) According to psychiatrist Michelle Durham, M.D., M.P.H.,clinical associate professor of psychiatry at Boston University School of Medicine, group therapy allows you to explore perspectives or advice from other people who understand some of what you’re feeling beyond what a therapist notices or shares during group therapy.

Bipolar I disorder usually involves recurring episodes; 50% of patients with the disorder end up developing a second episode within two years of the first one4.Bipolar IIBipolar II, says Dr. Wang, involves less severe depressive and manic episodes than bipolar I, although some people experience severe depression and hypomania, a milder form of mania.To be diagnosed with bipolar II, Dr. Zimbrean says someone has to have at least one episode of hypomania lasting at least four days and one major depressive episode.Bipolar II is milder than bipolar I, but you shouldn’t confuse it as a form of bipolar I disorder because it’s a separate medical diagnosis2. It’s also just as important to treat. People with bipolar II may not experience extreme mania or do anything super risky, but they can be depressed for longer periods of time, which may interfere with their ability to function in daily life.Cyclothymic disorderCyclothymic disorder is another condition on the bipolar spectrum. However, people with cyclothymic disorder don’t have full-blown mania or depression, so they can’t be diagnosed with bipolar disorder7. “Their mood is basically constantly fluctuating between mild depression and periods of elevated mood, but it’s not severe enough to be incapacitating or recognized as very abnormal,” Francis Mondimore, M.D., director of the Johns Hopkins Mood Disorders Clinic and associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine, tells SELF. “When it is diagnosed, these mood fluctuations are very treatable and often very responsive to treatments with medication.”Unclassified bipolar disorderSometimes, a person can exhibit symptoms of bipolar disorder but don’t meet the criteria for having bipolar disorder. For example, Dr. Wang says illicit drug use can complicate bipolar symptoms, making it difficult to tell if depression and mania stem from the drug use, from the person’s genetics, or both.What are some signs of bipolar disorder?Because there’s not just one type of bipolar disorder, people’s symptoms and the severity of those symptoms can be different. That said, all types of bipolar include episodes of mania or hypomania and depression, potentially resulting in distress and difficulty functioning in everyday life2. Mood episodes can vary in duration, but symptoms usually last every day for most of the day, for as long as several days or weeks.It’s also important to note that a person’s bipolar disorder signs and symptoms can change over time. For example, bipolar symptoms can occur only in pregnancy or change when the seasons change2. And some people may also experience anxiety in addition to their mood episodes. Here are some of the most common symptoms of depressive, manic, and mixed bipolar episodes that can occur with bipolar disorder.What are some signs of depression?One of the primary features of bipolar disorder is periods of depression. Depressive episodes in bipolar disorder can look a lot like major depressive disorder7, which includes symptoms such as:Persistent sadnessHopelessnessPessimismIrritabilityLoss of interest in activitiesLoss of energyTrouble concentratingMemory issuesChanges in appetiteChanges in sleep habitsSuicidal thoughts

While genetics are an important potential factor in developing bipolar disorder, there are others as well. For example, stressful circumstances, traumatic events, or drug or alcohol abuse could incite a bipolar episode. Studies show difficult events during childhood, such as maltreatment and emotional abuse by parents, may also increase a person’s risk for developing bipolar disorder later on in life5.Bipolar disorder symptoms can appear at any time, but the average age of onset of bipolar disorder is early adulthood, between 18-20 years of age, according to the Cleveland Clinic6. In some cases, bipolar disorder symptoms can appear during pregnancy or following childbirth, and sometimes, children exhibit bipolar symptoms. Bipolar disorder also co-occurs in people who have seasonal depression and anxiety disorders (such as post-traumatic stress disorder, or PTSD).While bipolar disorder can occur in people of any gender, women are more likely to meet the diagnostic criteria for bipolar II disorder, which causes depression and less severe manic episodes (hypomania), according to the Cleveland Clinic6. Women with bipolar disorder may also experience faster shifts in mood, which is called “rapid cycling,” potentially due to shifting hormone levels, however, men can experience this too.Signs and symptoms of bipolar disorderIn general, bipolar disorder is characterized by a pattern of dramatic swings involving periods of low mood and energy (depression) and elevated mood and energy (mania or hypomania). But a person’s experience with bipolar disorder is as unique as they are. Not everyone with bipolar disorder shares the same symptoms or experiences those symptoms with the same severity. Bipolar disorder symptoms typically depend on the type of bipolar disorder someone has, and what type of bipolar episode they’re experiencing.Read on for some of the most common symptoms of the main types of bipolar episodes.Depression signs and symptomsDepressive episodes in bipolar disorder are a lot like any other type of depression. Symptoms of a depressive episode may include persistent sadness, hopelessness, pessimism, difficulty concentrating, irritability, loss of interest in normal activities, and changes in a person’s appetite or sleeping habits6. If the depression is severe, Dr. Mondimore says it may cause suicidal ideation, which is one reason it’s so important to diagnose and treat.Mania symptomsAccording to Dr. Mondimore, mania is the exact opposite of depression. Rather than feeling sluggish and down, people experiencing mania have high energy levels and racing thoughts2. This may result in out-of-character, risky behavior, such as drug use, spending excessive amounts of money, or going on unplanned trips, says Dr. Wang. Generally, mania lasts for at least one week, according to the Cleveland Clinic8.Signs of hypomaniaWhen it comes to hypomania, picture a less severe version of mania. You may experience things like a markedly good mood and increased productivity, but not to the level of a manic episode, according to the NIMH. Typically, hypomania doesn’t affect your ability to work, and episodes last about four days, according to the Cleveland Clinic8. This can sound like a strictly good thing, but untreated hypomania can make you more susceptible to mania and depression down the line.Bipolar mixed episodes Manic and depressive episodes don’t always occur separately. Some people with bipolar disorder have mixed episodes, which include both symptoms of depression and mania. According to Dr. Wang, people may feel depressed and engage in risky activities at the same time, or they may feel hopeless and down but still have a lot of energy. Usually, says Dr. Wang, mixed episodes occur later in the course of a person’s bipolar disorder, between ages 30 and 50. Using illicit substances can also trigger mixed bipolar episodes.

Confession: I’m a bit fanatical when it comes to mental health apps. I download them indiscriminately and often, secretly hoping with each download that this one will be the one to fix my life and my brain. Of course, that’s a lot of pressure to put on an app and an unrealistic goal in general (I’m not broken and don’t need to be fixed!), but still. I love to problem-solve and explore new methods of self-care, and mental health apps help me do just that.Having a variety of self-care tools at your disposal is helpful even when we aren’t in a global pandemic, but adding to your mental health toolkit might be even more important these days—particularly if you’re currently lacking connection, routine, or in-person mental health support.While these are not a replacement for professional care, there are tons of genuinely helpful mental health apps out there to match a variety of problems, disorders, goals, and more. Below, find a mix of personal recs, reviewer favorites, and expert-approved apps meant to manage and support your mental health. (Heads up: I divided the apps based on what each is best known for, but there’s some overlap, especially among the more multifunctional mental health apps. But you get the idea!)Self-help and therapy skills appsWhether or not you go to therapy, you can never have too many evidence-based tools for managing your mental health. These apps aim to make therapeutic coping skills more accessible by drawing on different types of therapy like cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT, a type of CBT focused on distress tolerance and emotion regulation), acceptance and commitment therapy (ACT, a type of therapy that uses mindfulness and behavior-change strategies to help you better accept and work with your tough emotions), and more. Some support specific disorders, while others aim to help anyone feeling depressed, anxious, or stressed right now.Happify: Meant to address stress and increase happiness, Happify is full of daily quizzes, games, and activities. You can choose one or more “tracks” to tailor your experience, including goals like conquering negative thoughts, building self-confidence, and achieving career success. (iOS and Google Play, free or $15/month for premium)MoodMission: MoodMission is like a Choose Your Own Adventure for feeling better. Specifically built for low moods and anxiety, it asks you a series of questions about how you’re feeling and presents you with a unique list of five “missions” to choose from in the moment. As a bonus, your results are more unique to you the more you use it—after you complete a mission, you rate how you feel so MoodMission can learn what does and doesn’t work for you. (iOS, $8 and Google Play, $6)Woebot: This cute little A.I. chatbot will coach you through a hard time via chat by asking you what’s up and offering CBT-based tips and exercises for you to try. Whether you’re in an anxious thought spiral or just feeling like crap, Woebot will guide you step by step until you feel better. (iOS and Google Play, free)MoodTools: Whether you have a depressive disorder or are dealing with a depressed mood, you can use the CBT-based activities in MoodTools to feel a little better. It also includes space for a safety plan if you deal with suicidal ideation. (iOS and Google Play, free, or $5/month or $30/year for premium)What’s Up: This app has a bunch of tools based on CBT and ACT to help you feel less anxious, stressed, angry, and more. Plus, you can connect with other users via the app’s built-in forum. (iOS and Google Play, free)MoodKit: Not only is MoodKit filled with activity suggestions for improving your mood, but it also allows you to schedule them so you can make a habit out of practicing self-care and feel better in the long run. (iOS, $5)PTSD Coach: Created by the National Center for PTSD, this app is for anyone who has or could have post-traumatic stress disorder, whether they’re currently in treatment or not. Some of its features include educational material, therapeutic tools, and info on professional care and support. (iOS and Google Play, free)DBT Coach: Whether you have an illness like borderline personality disorder, bipolar disorder, an eating disorder, or depression or are just dealing with a lot of emotions right now, this app makes DBT skills accessible through videos and animations. (iOS and Google Play, $12/month)Rootd: If you’ve ever felt the need to hit a big fat panic button during an anxiety or panic attack, Rootd is for you. It provides, quite literally, that virtual panic button. Hit it, answer a few questions, and Rootd will guide you through. (iOS and Google Play, free, or $7/month or $60/year for premium)MindShift: On top of teaching you CBT skills to tackle negative thought patterns (such as guided “experiments” to help you challenge anxious thoughts), MindShift also has tools for setting goals and forming habits. Oh, and my personal favorite: exercises for battling perfectionism. (iOS and Google Play, free)SuperBetter: If traditional mental health apps tend to bore you, SuperBetter might be able to keep your interest. It gamifies mental health skill-building and self-care, teaching you to be more resilient through a series of superhero-themed missions and challenges. (iOS and Google Play, free)Happyfeed: Therapists often recommend gratitude journaling for better mental well-being. If you’ve had a hard time picking up the habit, try Happyfeed. On top of recording daily things you’re grateful for, you can upload pictures and memories to go with it. When you need a pick-me-up, shake your phone to access your “Happiness Jar” and you’ll be able to see a random day from the past. (iOS and Google Play, $4/month or $40/year)Reflectly: On top of encouraging a regular journaling practice, this self-care app uses positive psychology, mindfulness, and CBT to teach you how to reduce stress, develop gratitude, and gain perspective in life. It also doubles as a mood tracker, thanks to the A.I.-generated journaling prompts that collect info on how you’re doing. (iOS and Google Play, $10/month or $60/year)Mindfulness, meditation, and breath work appsTechnically, mindfulness and meditation are therapeutic tools too, but they deserve a section of their own. Experts often recommend apps for beginners who have no idea where to start with meditation because they provide guided instruction to show you exactly what to do and help you stay accountable. The apps below are some of the most popular meditation and mindfulness apps on the market, with a few underrated favorites thrown in there too.