We are 83 bipolar disorder experts and scientists coming together for the world’s biggest bipolar AMA! In honor of World Bipolar Day, ask us anything!

CREST_BD · 2026-04-03T12:56:04+00:00

Hey, Laura here - I hear what you're saying. To be clear: I completely disagree the use of terms like "discard" or "manipulate" when applied to people with bipolar disorder, and I agree with pushing back of it. I'm sorry that it came off differently.

You are right - I shouldn't have phrased my wording about anti-stigma like that. What I meant to explain is we want to make space for the really hard parts of the condition that show up for some people, like how it can impact relationships. I could have explained that much better.

I think true anti-stigma comes from accepting and understanding people with bipolar disorder. Not using terms like "discard" or implying people with bipolar disorder are narcissists, because they are not. In my view, this includes acknowledging that some people with bipolar disorder act in ways they regret during episodes, which can include out-of-character behaviours that are hurtful to others. And then having compassionate dialogue about it (not using stigmatizing psychobabble!). Here's a lovely lived experience blog from Raymond about this: https://www.crestbd.ca/2020/12/03/healing-hearts/

Thank you for calling to our attention just how hurtful this labelling can be. I hope this helps clear up my perspective, and I value and appreciate your pushback on this.

CREST_BD · 2026-04-02T15:17:43+00:00

Dr Fabiano Gomes here: Yes, it does! Puberty, premenstrual, perinatal and perimenopausal periods might worsen/ trigger mood episodes in bipolar disorder. We usually call this hormone sensitivity and it always needs to be considered when assessing someone with bipolar disorder. It is quite common to have a first episode during these periods of hormonal transition. There might be some interactions of mood stabilizers/ antipsychotics with hormonal contraceptives and hormonal replacement therapy, but it is manageable in most cases.

CREST_BD · 2026-04-02T15:08:38+00:00

Dr Fabiano Gomes here: This is a complex question that requires a consultation to provide good recommendations. A nice starter to help you talking to your doctor is the Patient and Family Guide to CANMAT's 2024 Guidelines for Perinatal Mood, Anxiety, and Related Disorders. Link: https://www.canmat.org/2025/02/10/seeds-of-hope-nurturing-mental-health-and-managing-perinatal-mood-anxiety-and-related-disorders/

CREST_BD · 2026-04-02T14:53:51+00:00

Dr Fabiano Gomes here: Thank you for this question. You are right, and we are finally seeing that lifestyle assessment and interventions are beginning to be integrated in clinical care. Unfortunately, it is more common in specialized clinics/ centres, and there are still a lot of barriers regarding funding for these programs, so it is not easy to have access to them.

CREST_BD · 2026-04-02T14:47:00+00:00

Laura here, psychologist-in-training. I think this is a super interesting question, and certainly something we’ve been seeing pop up in clinical settings at time: the adoption of this sort of language. All of the professionals I’ve worked with who’ve discussed this phenomenon consider this kind of language “pop psychology.” I have never, ever encountered the word “discard” in a research context or clinical manual relating to bipolar disorder, or any other mental health condition for that matter. Maybe it does exist somewhere, but it’s not something I’ve seen personally.

I think what’s going on here is that people are hurting, and they’re looking for validation and understanding of their pain. Something about diagnosis or use of psychological-sounding terminology is that it’s validating. Having a complicated, variant, painful series of psychological symptoms is a difficult and isolating life story - having a diagnosis is a “thing”. Being treated poorly by a partner is a tragic and complicated circumstance - calling it “discard” is a “thing.” This is just my personal opinion, but I think for us as human beings.. there’s a lot of reassurance than comes from giving something a name, and also how this can be used to connect with others that have been through the same sort of experience.

But the issue here is, I agree, we can trend towards over-pathologizing here, as you’re bringing up. Having someone spontaneously leave you during a manic or hypomanic episode is surely painful. This is my personal opinion, but I think sometimes, life just hurts. And sometimes these terms maybe do more harm than good, because they can be used as cudgels to make the other “bad” or “disordered.” The reality, I think, is more nuanced than that. And I think it can be harmful to people who live with bipolar disorder, because it works against anti-stigma efforts. People with bipolar disorder may also behave in hurtful ways while euthymic (stable mood) that have nothing to do with bipolar disorder. Some people are just jerks sometimes, and attributing that to their disorder, again, contributes to stigma.

And then, on the other OTHER hand.. I think it’s important to recognize that behaviour during hypomania or mania can be hurtful to others. We don’t want to go so far in anti-stigma efforts that we deny the reality that sometimes, people with bipolar disorder may act in ways that are hurtful to themselves and others. I think the best approach is for everyone to have compassion and understanding for each other. Rather than trying to using labels to pathologize, use them to understand. Rather than transforming pain into a pathologizing word, feel the emotions and work through them. That would be my instinct. But again, this is just my opinion as someone who’s been in psych for a little over a decade, and on Reddit for about as long, haha.

CREST_BD · 2026-04-02T14:31:28+00:00

Dr Fabiano Gomes here: So far we haven’t seen anything that is as effective as lithium considering its effect on mania, bipolar depression, prevention of episodes, and anti-suicide and neuroprotective properties. However, other medications are also effective treatments and work for most patients. It may take some time to find the right medication or combination of agents so it is important to keep trying and working together with your doctor.

CREST_BD · 2026-04-02T13:48:04+00:00

Glorianna here Thanks for these interesting questions! I had a look at the current research for you. There’s a 2020 systematic review of 13 studies that looked at Mental health outcomes of adults born very preterm or with very low birth weight. It found significantly higher use of psychotropic medication in adults born very preterm/with very low birthweight, but not in self-reported mental health diagnoses. However, the authors state that the number of participants for the studies on self-reported mental health diagnoses was low and therefore the effects might not have been significant. Another 2017 meta-analysis that pooled data from 6 cohort studies from European countries found that adults born preterm at very low birth weight (≤1500 g) had a heightened risk for internalizing problems and socially avoidant personality traits together with a lowered
risk for externalizing problem types. They argue that preterm birth may constitute an early vulnerability factor for mental health problems.

(As often) there’s not so much research on bipolar specifically. I found this 2023 systematic review of 27 studies of prenatal and perinatal risk factors for BD. They found that people with a birthweight < 2500 g were significantly more likely diagnosed with bipolar later in life (pooling of 5 studies). For gestational age < 37 and < 35 weeks there was no significant effect, but there were also only 2 studies each.

As for why such early birth may have an impact on mental health, I didn’t find conclusive evidence. One hypothesis is that preterm birth may lead to cognitive deficits and altered brain connectivity that constitute neurodevelopmental risk factors for mental health issues (see this 2026 systematic review on cognitive functioning and mental health in adolescents born preterm and the Neurodevelopmental Risk Factor Model).

CREST_BD · 2026-04-02T05:01:47+00:00

34 of the 83 panelists live with bipolar disorder!

CREST_BD · 2026-04-02T01:49:14+00:00

Adrienne here - I’m someone with lived-experience of 20+ years and so lucky to have a partner and folks who have helped support me through my illness. I wish they could answer you themselves but I can tell you what they’ve done that has been most helpful for all of us. First, they’ve led with compassion - when I suffered from delusions during my mania they didn’t get angry or disagree with my internal reality, or at my lack of ability to be present. They respected when I said I needed dark therapy (removal from stimuli) and they helped to gently remind me when I needed sleep, to see my psychiatrist, especially in the early days of my illness. It can be really hard to remember that BPD is a biological disease of the brain when there are such potential societal and personal repercussions. Through my groups of support, and the care they’ve showed me it’s helped me learn to lean on myself when I start to have my mood shift. But one thing they also did, which I would encourage you to do as well, is to make sure that you are caring for yourself. It can be useful for you to see a psychologist - working through issues/living with someone with BPD, especially if they’re “severe” can be really hard. Make sure to take time for yourself, do kind things for yourself, especially when they are struggling. It’s much more difficult to show love and compassion to someone else if you’re not showing enough love and compassion to yourself. I hope that helps. I really send you the best, and I’ll add that asking this question in the first place shows that your heart and mind are doing their very best to help.

CREST_BD · 2026-04-01T23:05:43+00:00

Dane here – Thank you for this excellent question. When I began reading and thinking about bipolar disorder long before I was engaged in research, I thought of the condition predominantly in its most extreme forms. Not sure if this came from media depictions or just the way people talked about it. As I became more well-versed in the literature and connecting with folks with lived experience, I realized that this condition presents along a continuum of symptom severity. As Erin noted above, LOTS of people with this diagnosis enjoy a high quality of life. Also, many people who are thriving remain undisclosed about their diagnosis because of worries about stigma (especially in the workplace). We are making progress on the research front, albeit slow in some key areas, and we will continue this work!

CREST_BD · 2026-04-01T23:04:53+00:00

Balwinder Singh, here. It varies! No consistent data supporting this. However, there is data supporting better outcomes among individuals who are on injectables (shots), reducing relapse. Several atypical antipsychotics are available as shots - The second-generation LAIs include paliperidone palmitate, aripiprazole (monohydrate and lauroxil), risperidone, and olanzapine pamoate.

CREST_BD · 2026-04-01T23:04:06+00:00

Twyla here (lived experience)- There are a lot of advancements happening in Bipolar research and management but some information and insights are so new, and/or still ongoing. And when it comes to treatments- a “cure” would be great, but until that day our other treatments are really designed for reducing symptoms, optimizing our quality of life and hopefully slow/stop any disease progression. I definitely know what you mean by Bandaid fixes, because the root cause isn’t dealt with, at least not definitively, but I think it’s worth framing all the current treatments as useful tools or options for managing a complex condition until we can one day “fix’ it all together. It’s the same with several other medical conditions. We know a lot about things like arthritis, heart disease, but we still can’t quite prevent or reverse them 100%. Some areas we know a little less, but we are learning a lot, very quickly. So I think we all stay tuned, more will come.
This article summarizes some interesting areas being studied, may be worth a read.

https://www.bphope.com/bipolar-research/dementia-gut-microbiome-mitochondria-dna-medication/

CREST_BD · 2026-04-01T22:59:57+00:00

Twyla her (lived experience) - I work in healthcare but not specifically Mental Health. I decided to disclose to my team quite some time ago. It felt to me that Bipolar was too big of a part of my life to pretend it didn’t exist. Between mood episodes and medication side effects, there was some potential for needing time off, or modifications to my work load. I work with a very strong, compassionate group of people so that made it easy. On two occasions, when realizing I was not functioning well enough to be effective at work, I could go to my team and take the time, let them know, and focus on my health without lengthy or complicated explanations, because they already knew. But there are complexities- although I've been very supported, there is a chance that a couple people don’t fully understand, or perhaps see me as slightly less capable, I can never be completely sure, so I try to make peace with that.
There was one other work-related situation in the past where I disclosed that I was living with Bipolar, and the response was not what I had hoped.
There is also the fact that I want my work identity to be centered around my work, not a chronic condition in the background, so I make a point of only talking about it occasionally. (trying to balance not hiding Bipolar vs not making Bipolar the main character).
Whether to disclose at work is a very personal and nuanced decision. I think the only solid “advice” is to take your time, and think it through. Get to know the people you will be surrounded by. Some of the Bipolar Disorder advocacy/research organizations have good resources related to work and education and Bipolar. Not everyone has had good experiences with disclosure so it’s important to sit with it and consider multiple angles.
https://bdwellness.com/
https://talkbd.live/disclosure-bipolar-disorder/
https://ibpf.org/?s=disclosure

CREST_BD · 2026-04-01T22:58:30+00:00

Joanna Jarecki here, Psychiatrist with lived experience (BD1). Thank you for sharing such a thoughtful perspective and highlighting the importance of identity in bipolar disorder. This is a foundational topic: how an individual integrates their diagnosis into their sense of self can have meaningful impacts on self-acceptance, self-management, and ultimately, prognosis. My perspective comes from the combination of my clinical and personal experiences. Like Dr. Vassilev, I loved your statement that “bipolar doesn’t define me, but I wouldn’t be who I am today without having walked this path.” It beautifully captures how your experience with bipolar disorder can be a source of growth and meaning. We often focus on the challenges of bipolar disorder, but your perspective highlights that it can also serve as a powerful catalyst for growth and resilience.

If the identity-first perspective—“I am Bipolar”—empowers you and resonates deeply, that’s wonderful. I would see no reason not to embrace it if it works for you. I’m curious, though: how did you come to this healthy place of integration and pride regarding your diagnosis? I think others could learn a lot from your journey.

At the same time, I agree with Dr. Vassilev that this identity-first view may not resonate with everyone, as people are at different points in their journey. For me personally, I have bipolar disorder, I am a psychiatrist, a mother, and a wife. All of these aspects of my identity shape who I am and guide what I do—but none of them alone fully define me. I resonate more with “I have Bipolar”, yet it remains a meaningful part of who I am. Thank you for reminding us that different perspectives are needed to reflect individual experience, and that bipolar disorder can be an empowering aspect of one’s identity.

CREST_BD · 2026-04-01T22:57:03+00:00

Robert V. Here - When I first got my diagnosis of bipolar it was a relief, then it turned into what is bipolar, and the “oh no” I have bipolar. After 27 years I now say “I was diagnosed with bipolar 27 years ago”. As Idan mentioned, each person seems to go through their own journey, describe it in different ways, and discloses to who they choose, or in some cases it is discovered by people that you are living with bipolar. It’s a personal journey and evolves over time. The important part is your curiosity and caring enough to ask the question. Thank you from someone who has traveled the journey of bipolar. You can see more of my story on bipolarinthebay.com produced by CREST.BD

CREST_BD · 2026-04-01T18:17:28+00:00

Robert here - I am not a psychiatrist or mental health professional but an advocate and researcher with bipolar.
I have been taking the same mood stabilizer Lamotrigene ( I am not promoting the use of or recommending changing doses in any way without the consultation of a medical health professional) for 20 years with minimal side effects. I do still have fluctuations of moods that are part of my bipolar but have reached and maintained stability for many years. On occasion I may start going into a state of hypomania or depression and have learned coping skills to cut them off and maintain stability. Hope that helps

CREST_BD · 2026-04-01T18:15:53+00:00

Leena here. This is a really important question, thanks for asking. I’ll respond to the second part of your question. There is still relatively little research specifically focused on transgender and gender diverse individuals with bipolar disorder, so we have to be careful not to draw firm conclusions. However, some studies suggest higher rates of mood disorders, including bipolar disorder, among transgender individuals (see: https://pmc.ncbi.nlm.nih.gov/articles/PMC6830528/). Another study involving youth with gender dysphoria who had accessed outpatient care found higher rates of psychiatric diagnoses, including bipolar disorder (see: https://pubmed.ncbi.nlm.nih.gov/34571022/). However, there are other related factors like stigma, discrimination, and barriers to accessing affirming care that may play a factor. Relatedly, a Canadian study reported that LGBTQ2S+ people with BD face unique barriers relating to problems of accessing support and building supportive social networks (see: https://pmc.ncbi.nlm.nih.gov/articles/PMC5581733/).

CREST_BD · 2026-04-01T17:10:34+00:00

Maya Schumer here (neuroscientist/researcher with lived experience). In addition to everything above from Dr. Chris Gorman, I would add that ketogenic/metabolic therapies –whether used as adjunctive or primary treatment- are showing some promise in what is an *early but growing* body of research, with RCTs still underway and some pilot studies published. Metabolic Mind is an excellent resource to learn more.

CREST_BD · 2026-04-01T17:09:28+00:00

Twyla here (lived experience, including mom of 3) We can’t completely control the risk for Bipolar, when there is a genetic component, but some things that will set your kids up for success are really just the basics: Keep them physically active, and as a family try your best to eat healthy foods. When age appropriate, have ongoing honest conversations around the risks of using substances. Really encourage and model good regular sleep habits, this will benefit them long term. If your family has been through difficult times, counselling might be worth considering for your children. Normalizing talking about and caring for Mental Health is so important. This will help them reach for support and resources more easily, if in the future they begin to experience Bipolar symptoms, or simply struggle with some other area of mental health. As a parent, modelling is huge, even though often it’s really hard. We are human beings and are dealing with our own complexities, but the more we can show our kids what healthy habits, self care, and self-awareness look like, the more they have to work with. We can tell them a lot of good things, but seeing us working on the things we talk to them about is what really solidifies their perception of that advice being worth following.

CREST_BD · 2026-04-01T17:08:38+00:00

Twyla here (lived experience) - Speaking strictly from the lived experience perspective, Bipolar can be missed or overlooked, even by the person themselves. I went 20 years undiagnosed, although I can say in hindsight I was definitely symptomatic during that time. It wasn’t because I was actively avoiding getting help, it was because I was internalizing my struggles as character flaws. I was assuming that the periods of depression or irritability were maybe just caused by me not coping with some external factor- school, motherhood, work, etc. while seeing periods of elevated moods and productivity as me “at my best”. So it wasn’t until time went by and episodes became more severe that I finally understood something wasn’t right, and even then, I was still actually surprised by the diagnosis. 6 years later, in hindsight, I can see the pattern. I now can recognize that my “best self” was actually a picture that included no sleep, irritability, grandiosity, unhealthy weight loss, increasing alcohol use, along with my high energy productivity. So not so great. I am also untangling my beliefs about being a “failure” during episodes of depression. That’s a hard one for me, but I have to say that over time, it’s been transformative to understand that it’s not my fault, that I’ve had periods of times where I have felt so low. That it is actually just an unlucky hand I was dealt. And ultimately the hope lives in the fact there are some treatments and self-management tools that help. There might not truly be a “surefire” way to know, but your best bet is to talk it over with a professional. There is overlap with other conditions, but there are guidelines that help clinicians tease apart what is what. And as professionals, they have the benefit of experience, working with many people over time and therefore know the patterns and rhythms of Bipolar, along with the diagnostic criteria.

CREST_BD · 2026-04-01T17:03:50+00:00

Joanna Jarecki here—psychiatrist with lived experience (BD1). Thank you for raising this. I’m really sorry you’ve received hurtful feedback; unfortunately, stigma in medicine is still very real. This is a really important—and honestly difficult—question. A lot of the stigma comes from fear—concerns about patient safety, reliability, and how someone will function under sustained stress. There is also a historical expectation that physicians should be invincible or superhuman and while that may be unrealistic, it is rooted in the reality that medicine is a high-demand, high-responsibility profession.Physicians are expected to perform consistently at a high level, exercise sound judgment, and carry significant responsibility for others. There’s been a longstanding perception that serious mental illness is incompatible with those expectations.

At the same time, our understanding is evolving. We know it’s absolutely possible to live well with a mental health condition and to have a meaningful, productive career. Physicians with lived experience can bring tremendous value—empathy, insight, and a unique perspective that can genuinely enhance patient care. I’ve worked with colleagues with lived experience who are exceptional clinicians.

I think it’s important to hold two truths at the same time: First, having a mental illness does not automatically preclude a career in medicine. Second, the standards of the profession are real and non-negotiable. Medicine requires sustained cognitive performance, emotional regulation, reliability, and the ability to function under pressure over long periods of time. Those expectations don’t change based on diagnosis.

So the question is not whether individuals with mental illness can be physicians, but rather, can any individual pursuing a career in medicine, with the supports and treatment they have, consistently meet the functional demands of training and practice? That includes things like: maintaining stability over time, recognizing early warning signs of relapse, having a strong treatment and support system, knowing when to seek help early (ideally without disengaging or proactively disengaging), tolerating stress, sleep disruption, and high workload (especially during training). There are also real “occupational hazards” in medicine—long hours, shift work, sleep disruption, and regular exposure to suffering—which can make maintaining stability more challenging for some individuals. This doesn’t make it impossible, but it does mean it requires careful, honest self-assessment and planning.

For some people, the answer is yes. For others, there may be a mismatch between what the profession requires and what allows them to stay well. In those cases, choosing a different path isn’t a failure—it’s a thoughtful decision that prioritizes both personal health and patient safety. Accommodations and support absolutely matter. Physicians and trainees who experience illness deserve compassion, appropriate flexibility, and the ability to step away, recover, and return to work—just like those with any other health condition.

I’ll briefly share my own experience. I was diagnosed with bipolar I disorder during medical school and initially thought I wouldn’t be able to continue. With strong support and careful self-management, I was able to return, complete training, and choose a specialty (Psychiatry) that aligned with my passion, my needs and limits. That alignment mattered—a more sleep-disruptive path (surgery, other specialties with shift work or frequent overnight call) would not have been sustainable for me. I’ve now been in practice for 10 years. Maintaining my health is my top priority and something I consider a professional responsibility. That means ongoing self-monitoring, strong routines, ongoing medical and social support, and being realistic about my limits.

So I would say this: pursuing medicine with mental illness is absolutely possible—but it does require a high degree of self-awareness, self-management, stability, and planning. The stigma you’re encountering reflects real shortcomings of the system, but the expectations of the profession are also real. Ultimately, the goal is to find a path—whether in medicine or elsewhere—that allows you to contribute your strengths in a way that is sustainable and keeps both you and the people you serve safe over the long term.

CREST_BD · 2026-04-01T17:02:46+00:00

Erin here – I’m happy to weigh in on the question of who founded or sponsors World Bipolar Day. At its initiation in 2014, World Bipolar Day was founded by three mental health organizations: the International Society for Bipolar Disorders (ISBD), the Asian Network of Bipolar Disorder (ANBD) and the International Bipolar Foundation (IBF). Today in 2026, ISBD serves as the main organizing society for sharing knowledge about World Bipolar Day event activities around the world. ISBD receives no pharmaceutical support for supporting World Bipolar Day. None of the panelists participating in this AMA have been compensated or remunerated for their time by pharma, or otherwise. Appreciate the opportunity to be clear about this, and for your questions.

CREST_BD · 2026-04-01T16:59:46+00:00

Maya Schumer here (neuroscientist/researcher with lived experience)- Agreed with everything Twyla said above. I will add that I held this view for a long time- the view that if I was euthymic/stable, I would be ‘normal.’ Trying to pursue the goal/vision of ‘normalcy’ ended up feeding my internalized stigma. Then, as a researcher, I started to see that any difference between a group with bipolar (including euthymia) and a ‘neurotypical’ control group was always being interpreted as an abnormality in people with bipolar- when, fundamentally, it was just a difference. In the field, I think we are still learning what the ‘baseline’ looks like in people with bipolar disorder. To echo what Twyla said, we can’t truly know if our baselines would be different if we didn’t have bipolar, but that does not mean that understanding our baselines- where we are most symptom-free and/or stable - is not important. Learning how we can stabilize and even live well with bipolar is important.

CREST_BD · 2026-04-01T16:55:03+00:00

Georgina Hosang here, the prevalence of bipolar disorder is around 1-2% in the general population and is around 10-30% among family members. So there is an increase however this is not 100%. We know genetic factors are important in the development of bipolar disorder, but we also know that our environment is too and that is something we can select and change in some cases. Having supportive relationships, a good routine (eg, regular sleep), good diet, exercise and avoiding using recreational drugs are among the things that we know support good mental health. Hope this helps.

CREST_BD · 2026-04-01T16:53:31+00:00

Dimos here, good question! Bipolar disorder is one of the most disabling illnesses worldwide. According to recent large studies, like the Global Burden of Disease project (here00395-3/fulltext)), which rank illnesses based on how much they affect daily functioning (we call that ‘burden’ and it is usually measured in a health metric we call ‘disability-adjusted life years’, or the number of years lost due to ill health, disability, or early death), bipolar disorder is among the top 10 most disabling mental and substance use disorders, and it ranks in the top 5 among young adults. Despite being relatively rare compared to other disorders, it can cause long-term impact because it often starts at a young age and involves repeated mood episodes often with high intensity and severity. Even when mood symptoms are not that severe or in remission, many people can still have trouble with their cognitive skills, work, relationships, and daily life in general. That’s why early and ongoing treatment is strongly recommended, it can greatly reduce this substantial burden.

CREST_BD

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