The Ultimate Guide to Bipolar Disorder Treatment
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For the 5.7 million Americans suffering from Bipolar Disorder, obtaining treatment can be a frightening and extensive process. While some of the signs and symptoms of Bipolar Disorder can be treated effectively with medication, a variety of other treatment options exist. These treatment options include education about Bipolar Disorder, lifestyle management, reliance on and accountability to strong support systems, and psychotherapies. While each of these broad categories of treatment brings a unique set of characteristics and benefits to a person suffering from Bipolar Disorder, a psychologist or psychiatrist can determine the best treatment option to use for each person. It's important to remember that not all therapies will work for an individual. Therefore, you need to have a general understanding of Bipolar Disorder, how it affects the body, and how a complete mental and psychological evaluation determines the appropriate treatment options.
Bipolar Disorder Spectrum
Before beginning to think about treatment options, consider the basic principles of Bipolar Disorder. There are actually five different types of Bipolar Disorder.
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Bipolar I consists of manic, mixed episodes that last for a minimum of 7-days and episodes of extended depression within the previous 12-months.
Bipolar II is characterized by depressive and hypomanic episodes, but the person with the disorder does not have any full-blown manic episodes.
Bipolar Disorder Not Otherwise Specified does not fit the criteria in the DSM V, but behavior falls outside of what is normal for a person.
Cyclothymic Disorder is similar to Bipolar II. It involves mild manic and depressive episodes
Rapid Cycle Disorder is a severe form of extreme, intense swings between depressive and manic states at least four times within the past 12-months
Signs and Symptoms of Bipolar Disorder
When someone suffers from Bipolar Disorder, the chemical imbalances and irrational thought processes affect a person's ability to function in an appropriate manner. Some of the most common things to watch for when someone is going through a manic episode of Bipolar Disorder include major changes in mood, which includes increased irritability or a sensation of extreme euphoria. Furthermore, the following behavioral changes can identify a person who is currently in a manic state:
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- Fast-paced speech or switching from one topic to another without rationale.
- Becoming easily distracted without reason.
- Increases in activity levels.
- Extreme feelings of restlessness.
- Lack of sleep without feeling tired.
- Unrealistic beliefs in one's own abilities, such as powers or self-identification as a deity.
- Engaging in impulsive behaviors, such as illicit drug use of unsafe sexual practices.
In contrast, a depressive episode of Bipolar Disorder can include one or more of the following symptoms. These symptoms can be related to seasonal changes, especially around the transition from fall to winter, and have been identified exclusively by the Mayo Clinic.
- Suicidal thoughts or behavior
- Sleep problems
- Low appetite or increased appetite
- Loss of interest in activities once considered enjoyable
- Problems concentrating
- Chronic pain without a known cause
- Frequent absences from work or school
- Poor performance at work or school
One of the most effective means of controlling the signs and symptoms of Bipolar Disorder involves careful monitoring and regulation of the lifestyle of someone with this disease. This includes the basic concepts found in social rhythmic therapy (see below) without the need for a therapist's intervention. Create a specific schedule to keep track of when to sleep, eat, and bathe. Furthermore, a person suffering from Bipolar Disorder should avoid self-medication through illicit or legal drug and alcohol use. Exercising, reducing levels of stress, and continuing to spend time in the sun can help improve lifestyle.
According to the National Center for Biotechnology Information, "vitamin D [which aids in organ function, digestion, and feelings of happiness] can be synthesized in the skin through a photosynthetic reaction triggered by exposure to UVB radiation [the sun].
By carefully regulating your lifestyle, you can keep symptoms and mood episodes to a minimum. This involves maintaining a regular sleep schedule, avoiding alcohol and drugs, following a consistent exercise program, minimizing stress, and keeping your sunlight exposure stable year round.
Support systems play a vital role in the successful treatment of Bipolar Disorder. Support systems include family and friends, treatment programs like group therapy, and in-patient hospitalization to provide support during times of crises.
Family and Friends
Family and friends can literally be the strand between life and death for someone suffering from Bipolar Disorder. Often, family or friends will be the first people to notice a significant change in a person's behavior, which may signal a reversal of manic or depressive states as well as self-destructive behaviors.
Treatment programs for Bipolar Disorder include in-patient as well as out-patient treatment centers. During in-patient hospitalization, a person with a mental health disorder is closely monitored and evaluated by a team of mental health professionals. In most cases, the criteria for admission to an in-patient unit requires a patient to be of great risk to harming himself or others. These treatment programs often extend beyond the time of discharge to ensure that follow up care is received.
If you think of community-based centers with the purposes of assisting persons with mental health disorders or who are developmentally delayed, you have seen a treatment center before. Treatment centers can often assist in providing treatment for substance abuse issues while addressing mental health disorders. Since substance abuse and mental health disorders go hand-in-hand, it is beneficial to have all of these services available in one place.
Medications for the treatment of Bipolar Disorder have been tested by the FDA in order to ensure they do not cause additional problems. According to the National Alliance of Mental Illnesses, the most common medication treatment options for Bipolar Disorder include mood stabilizers, anticonvulsant, second generation anti-psychotics, and standard antidepressants. However, some of these classes of medications can possess side effects that intensify the symptoms of Bipolar Disorder, such as suicidal thoughts or actions.
For the greater part of history, mood stabilizing medications have been used to successfully treat the variances in mood for those suffering with Bipolar Disorder. With the exception of Lithium, most mood stabilizing medications are actually anticonvulsant medications. However, the FDA issued a warning detailing how extreme caution must be taken when starting or stopping anticonvulsants for the purposes of mood stabilization, as they have been shown to "increase the risk of suicidal thoughts or behaviors." In addition, special considerations must be taken when treating Bipolar Disorder in children or pregnant women, as certain drugs can affect the growth and development of the brain or other organs during gestation.
Second Generation Anti-Psychotic Medications
These medications can assist in delusions or hallucinations in severe cases of bipolar disorder and are often given in conjunction with a mood stabilizer, according to the National Alliance of Mental Illnesses.
Therapy for Bipolar Disorder
Cognitive-behavioral therapy seeks to help a person identify his or her own thoughts that result in self-destructive behaviors. This therapy rose out of a need to make changes in a person's actions rather than simply identifying the root causes of thoughts and feelings found in psychoanalysis. A licensed therapist, which can mean a psychologist, psychiatrist, social worker, or family counselor, will help someone with Bipolar Disorder identify negative, false thought processes. This goal of cognitive-behavioral therapy rests with giving a patient the ability to change his thoughts before the thoughts lead to certain actions, such as self-harm or inflicting harm upon other people. In most cases, cognitive-behavioral therapy teaches persons living with Bipolar Disorder healthy coping skills to deal with everyday life stressors, emotional events, and situations causing a trail of negative thoughts.
Interpersonal and Social Rhythm Therapy
Interpersonal and social rhythm therapy helps a person with Bipolar Disorder learn to improve existing relationships with other important people in their lives by addressing mental health problems directly. Furthermore, evidence suggests that interpersonal and social rhythm therapy reduces the amount of stress someone experiences in social situations. Social situations can involve visits from family members, friends, or even engaging in business transactions.
When someone with Bipolar Disorder loses control over his or her own life, the biological factors influencing sleeping, eating, and drinking habits fail to function properly. Social rhythm therapy re-instills the need to perform activities at a certain time each day. For example, someone in a manic state may benefit from a set time to go to bed, eat, or even bathe. However, this example can also apply to people currently going through a depressive episode, especially with respect to eating and bathing.
Family-focused therapy takes interpersonal therapy one step further to help persons living with Bipolar Disorder maintain working and healthy bonds with their family members or spouses. This type of therapy identifies key aspects in family life that may be responsible for triggering either a manic or depressive episode of Bipolar Disorder. Furthermore, this therapy involves the family members of someone living with the disease, and the therapist provides information and advice to family members in this situation. Each step taken towards addressing problems in home life can greatly reduce the burden of treatment through other treatment options.
Successful treatment for Bipolar disorder includes a wide variety of treatment options. Whether you know someone with Bipolar disorder or you are seeking advice for your own use, you will be surprised to learn that treatment doesn't end a few days after diagnosis. Bipolar disorder requires lifelong treatment and should always be a priority.
Bipolar disorder is a brain disorder causing abnormally severe, debilitating cycling of moods, thought patterns, and activity levels. Bipolar disorder typically emerges in the late teens or early 20s, although it has been known to affect children as young as 10.
What makes bipolar disorder a mental illness more difficult to treat than other psychological issues is its ability to induce alternating episodes of psychotic depression and mania. Consequently, bipolar treatment programs must not only address depression symptoms, but also delusional thinking, agitated (manic) states, suicidal ideation, and extremely impulsive behavior that often leads to a bipolar patient being arrested, contracting a sexually transmitted disease, or becoming involved in dangerous situations.
Bipolar Treatment Options
Before determining appropriate bipolar treatment options, it is essential to obtain a professional diagnosis from qualified mental health experts. Guidelines used to exact a diagnosis of bipolar disorder are taken from the Diagnostic and Statistical Manual of Mental Disorders.
Bipolar I Disorder
People diagnosed with Bipolar I Disorder have experienced manic or manic/depressive episodes lasting at least seven days each time they appear. Manic symptoms so severe that they precipitate admitting the patient to a hospital also warrants a Bipolar I Disorder diagnosis. Depressive episodes usually continue unabated for at least two weeks as well.
Bipolar II Disorder
Defined by a pattern of hypomanic and depressive episodes, Bipolar II Disorder does not include full-blown mixed or manic episodes because they do not last longer than one or two weeks.
Bipolar Disorder Not Otherwise Specified
When someone presents classic symptoms of bipolar disorder but fail to meet Bipolar I or II diagnostic criteria, they may be given a diagnosis of BD-NOS.
A milder form of bipolar disorder, cyclothymic disorder causes people to experience moderate depression and manic episodes for at least two years. People with cyclothymic disorder do not meet Bipolar I or II diagnostic requirements as described in the DSM.
Rapid-cycling Bipolar Disorder
Considered the most severe form of bipolar disorder, rapid-cycling bipolar disorder seems to affect more people (especially females) who experience bipolar symptoms in early adolescence. Rapid-cycling may be diagnosed if someone has four or more depression/mania episodes within one year.
Before Deciding on Bipolar Treatment Options
Psychiatrists will conduct a complete physical examination, interview the patient, order lab tests to detect any blood chemical abnormalities, and talk to family members to develop a comprehensive picture of the patient's psychological state. Some health issues that cause bipolar-like symptoms, such as dementia, brain tumors, drug addictions, and temporal lobe contusion, need to be ruled out before exploring bipolar treatment options. Substance abuse is especially common among those with bipolar disorder, as they attempt to self-medicate instead of seeking professional assistance.
Bipolar disorder is often comorbid with post-traumatic stress disorder, anxiety disorders, ADHD, or phobias. Additionally, people diagnosed with bipolar disorder seem to have a higher risk for suffering migraines, diabetes, hypo-/hyperthyroidism, and heart disease. All of these factors need to be taken into consideration before a psychiatrist can order specific drug therapies, life skills counseling, and psychotherapy to avoid developing a treatment program that does not address a patient's specific needs.
Bipolar Treatment Options--Medications
Although it is incurable, bipolar disorder can be treated successfully with psychotherapy and medications that are taken as prescribed to regulate abnormal brain chemistry.
Mood stabilizers, such as lithium, Depakote (an anticonvulsant that works as a mood stabilizer), Lamotrigine, and Neurontin, are common medications prescribed to control mood swings. Exactly how mood stabilizers work to control bipolar mania and depression is not yet certain. However, lithium seems to inhibit release of dopamine into the brain by interfering with receptor functioning while simultaneously stimulating the release of another important neurotransmitter called serotonin. Moreover, recent research into mood stabilizers has found that lithium, Depakote, et al may prevent brain cell death caused by chronic stress.
Atypical antipsychotics are simply newer antipsychotics developed to control delusions, auditory hallucinations, and other psychotic symptoms of schizophrenia and bipolar disorder. Commonly prescribed antipsychotics include Abilify, Clozaril, Risperdal, Seroquel, and Zyprexa. In addition to relieving psychotic symptoms, atypical antipsychotical also help minimize irritability, impulsivity, disorganized thoughts, and insomnia.
When someone with bipolar disorder presents clinical depression symptoms with psychotic features, the attending psychiatrist may prescribe atypical antipsychotics such as Risperidone, Aripiprazole, or Olanzapine in combination with an antidepressant. Also referred to as "second generation" psychotic medications, these atypical antipsychotics block dopamine pathway receptors in the brain just as older antipsychotics do. However, AAPs do not cause the tremors or muscle rigidity produced by older psychotic medications, especially in long-term use.
Antidepressants treat the depressive phases of bipolar episodes by maintaining sufficient levels of serotonin in the brain, a neurotransmitter vital to regulating moods, sexual behavior, appetite, and sleep. Antidepressants such as Zoloft, Celexa, Effexor, and Wellbutrin are taken as soon as a person feels themselves slipping into the "down" phase of an episode and continued until that phase is over. In addition to relieving depression, antidepressants seem to reduce the incidences of rapid cycling and mania.
The Importance of Serotonin in Controlling Bipolar Disorder Symptoms
- Serotonin is a neurotransmitter primarily responsible for controlling symptoms of depression in most psychological disorders, including bipolar disorder. Also called selective serotonin reuptake inhibitors (SSRIs), antidepressants create a condition in the brain that allows defective neuronal receptors to release serotonin back into the brain instead of "reuptaking" it.
- Since the majority of brain cells are influenced by serotonin in one way or another, a deficiency or overflow of serotonin will affect various aspects of mood, sleep, attention, appetite, social behavior, and memory. While no method currently exists to measure exactly how much serotonin is in the brain, researchers know that boosting serotonin levels with SSRIs diminishes clinical depression symptoms.
- An interesting dilemma yet to be resolved by researchers is the question of whether the lack of serotonin causes depression or if depression causes a reduction in serotonin levels.
Tricyclic antidepressants (monoamine oxidase inhibitors) for bipolar depression may work better for those who do not respond very well to traditional antidepressants. They have a unique three-ring chemical structure that inhibits reuptake of norepinephrine, dopamine, and serotonin so that more of these neurotransmitters are available to brain cells. Tricyclics such as Elavil (amitriptyline), Tofranil (imipramine), and Pamelor (nortriptyline) are typically prescribed to bipolar patients who have not found relief with other medications. This kind of antidepressant can also help those suffering from migraines, insomnia, ADHD, and chronic pain syndromes.
Bipolar Treatment Options--Psychotherapy
When combined with medication, psychotherapy can help patients learn what bipolar disorder is, why they experience extreme mood swings, and how they can manage the condition to maintain quality of life and well-being.
Cognitive Behavioral Therapy (CBT)
CBT encourages people with bipolar disorder to examine the strong connections among thoughts, behaviors, and emotions. Therapists specializing in CBT attempt to guide patients through a thought-restructuring program that eliminates negative or otherwise abnormal thinking patterns to improve coping skills. Unlike traditional Freudian psychotherapy, CBT is goal-directed, problem-focused, and actively intervenes in the patient's life.
Interpersonal and Social Rhythm Therapy (IPSRT)
IPSRT is a fairly new type of therapy developed to relieve depression and moodiness by providing in-depth understanding of a person's social and biological rhythms. Considered an effective adjunctive psychotherapy for treating bipolar disorder, seasonal affective disorder, and other mood disorders, IPSRT focuses on learning techniques to improve a person's ability to cope with stress, stay on their medication schedule, and reduce social isolation.
Originally developed by Dr. Michael Goldstein and Dr. David Miklowitz expressely for the purpose of treating bipolar disorder, family-focused therapy emphasizes the relationship that patients have with their families and improves on them if necessary. Symptoms of bipolar disorder (as well as other mental health problems) are often exacerbated by familial conflicts that induce feelings of guilt, resentment, anger, and hopelessness. FFT therapists work to identify and find resolutions to alleviate family conflicts that may be contributing to a patient's bipolar disorder. Additionally, FFT provides insight for family members coping with someone who has bipolar disorder so that caregiver "burnout" is avoided.
Electroconvulsive therapy (ECT) can help bipolar patients who suffer from severe depressive episodes that are long-lasting and debilitating. Research shows that ECT is particularly helpful for people who require immediate stabilization and cannot wait for medications to take effect; elderly patients with severe mania; people who experience suicidal ideation during depressive episodes; and those who cannot tolerate any of the medications typically used to treat bipolar disorder.
Bipolar Treatment Centers
Treatment centers specializing in diagnosing bipolar disorder perform intake assessments that examine and evaluate the severity and frequency of the patient's mood swings, life skill deficits, cognition, and general intelligence. In addition to psychotherapeutic and pharmacological interventions, bipolar treatment centers may provide one or more of the following:
- Supplementary activities to increase self-esteem and develop coping skills
- Meetings with counselors who specialize in spiritual awareness and relaxation/meditation techniques
- Dual diagnosis/bipolar treatment programs for patients suffering from bipolar disorder and other mental health issues
- Drug detoxification, nursing supervision, and addiction help for patients with a substance abuse problem
- Residential or outpatient treatment programs that address the needs of the patient
Bipolar treatment centers also offer post-treatment assistance (typically group and/or individual weekly counseling sessions) for residential patients who have been discharged and are responding well to their medications.