Bipolar Treatment

Understanding Your Bipolar Treatment Options

By The Fix staff 12/13/14
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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.

Cyclothymic Disorder

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.

Comorbidity

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

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

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

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

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.

Family-focused Therapy

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

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.

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