Therapy & Medication for Bipolar Disorder
What is Bipolar Disorder?
Bipolar disorder, formerly called manic depression, is characterized by unusual shifts in mood and energy levels. Bipolar disorder can negatively impact concentration, relationships, and overall functioning. Although there is no cure for bipolar disorder, it can often be managed with a combination of psychotherapy, psychopharmacology, and lifestyle modifications. With long term, continuous treatment and support, individuals with Bipolar disorder can often live meaningful productive lives.
Bipolar disorder affects about 2.8% of the U.S. population. The degree of impairment ranges from moderate to severe. It is estimated that about 83% of people with bipolar disorder have serious impairment.
There are three major subtypes of bipolar disorder classified on severity, frequency and character of episodes. Each subtype is marked by alterations in mood, energy, and activity levels sensitive to internal and external triggers. BD also affects a sufferer’s everyday life including sleep, thinking and behavior. Unpredictable mood swings can happen frequently, several times a year, or rarely. Most people do experience some mood symptoms between episodes.
What are the subtypes of Bipolar Disorder?
Bipolar I is defined by a severe manic episode that lasts at least one week and is present for most of the day, every day. Mania is described as an elevated, expansive or irritable mood that has three or more of the following symptoms (as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5):
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- Increased talkativeness
- Racing thoughts
- Increase in goal directed activity or psychomotor agitation
- Distracted easily
- Engaging in activities with a high potential for painful consequences
Although one does not technically need to have a Major Depressive Episode (MDE) to meet criteria for bipolar disorder, MDEs are frequently observed in these individuals. In some cases, individuals suffer from symptoms of both mania and depression. This is what is known as a mixed episode, characterized by feelings of severe sadness, guilt, loss of interest in activities, feelings of worthlessness and thoughts of suicide.
Bipolar II shares some similarities with Bipolar I disorder. Moods cycle between high and low at times with no identifiable trigger. However, in Bipolar II, individuals do not reach a full-blown mania, but rather suffer from hypomanic states during which elevated, expansive, or irritable mood is present for at least four consecutive days. These periods are accompanied by three symptoms from those listed above under Bipolar I. Individuals with hypomanic episodes are symptomatic but still able to maintain day to day activities and might often by quite high functioning. Unlike Bipolar I, Bipolar II patients have suffered at least one MDE. They tend to have longer periods of depression that cause significant impairment. It is not a milder form of Bipolar I, rather it is its own diagnosis.
Cyclothymic disorder causes mood shifts up and down that are not as intense or severe as either Bipolar I or II. Between the ups and downs affected individuals often appear healthy and feel stable. The mood swings of cyclothymia can interfere with relationships and quality of life but do not usually produce functional disability. People with cyclothymia are at risk of developing bipolar I or II and also tend to have an anxiety disorder. Other people may have alternating mood swings caused by related psychiatric disorders induced by drug and alcohol use, or a medical condition.
What are the symptoms of Bipolar disorder?
Swings of symptoms from high to low and back again follow no particular pattern. The severity of the disease is different for each sufferer.
Mania means exaggerated feelings of happiness, hopefulness and excitement that can turn unpredictably into irritability, anger and hostility. People with BD mania exhibit restlessness, rapid speech, racing thoughts, poor concentration, increased energy, decreased need for sleep and food, a high sex drive, impulsivity and grandiosity. They also exhibit poor judgment, a larger-than-life sense of self-confidence and are easily distracted. Drug and alcohol abuse are common.
Hypomania is an abnormally revved up state of mind that is milder than manic episodes. People with hypomania do not have delusions or hallucinations.
Depression is in the form of a major depressive episode that is so severe as to interfere with daily life and includes: sadness, low energy, feelings of hopelessness and worthlessness, difficulty concentrating and making decisions, memory problems, an inability to feel pleasure or enjoy things they once enjoyed, weight gain or loss, no sex drive, uncontrollable crying, excessive sleep or insomnia, and contemplation of or attempted suicide.
What causes bipolar disorder?
There is general agreement amongst experts that mood disorders are multifactorial systemic diseases that involve genetic and acquired factors.
What are the risk factors?
- The risk of bipolar disorder increases if:
- You have a family member with bipolar disease.
- Bipolar like symptoms appear during times of high stress or trauma.
- The person abuses drugs or alcohol.
Bipolar disorder affects both sexes equally. However, women are more likely to experience rapid cycling, meaning they have four or more distinct episodes within a year. Women also tend to suffer more depressive episodes than men. In women, bipolar disorder often develops later in life. Women are also more likely to have medical conditions that impact their bipolar disorder including thyroid disease.
How is bipolar disorder diagnosed?
Typically, onset of bipolar disorder occurs in late adolescence or early adulthood. Diagnosis is based on symptoms as outlined above. Frequently those with bipolar disorder tend to be unaware of their instability and its impact on their life and those close to them. A complete physical exam and blood work are necessary to rule out any comorbid medical issues that could be causing or impacting symptoms.
What are the treatment options?
Treatment of bipolar disorder involves treatment for mood symptoms in addition to the treatment of co-occurring psychiatric disorders, and suicide prevention. Patients must eliminate all mind altering or addictive substances to achieve a true baseline. Psychotropic drugs including mood stabilizers, antipsychotics, antidepressants, sleep medications, and anti-anxiety medications, are often used in combination to return a patient to baseline mental state. Psychotherapies such as cognitive behavioral, dialectic and interpersonal methods may be employed. Additional treatment options may include acupuncture, dietary supplements, lifestyle modifications and
Electroconvulsive therapy. Importantly, involvement of close friends and family can help to identify when a patient is experiencing an exacerbation of symptoms and alert our team that a client is in crisis.
Every patient is unique. At the Midtown Practice we will tailor a treatment plan based on the patient’s specific symptoms. The treatment program will be adjusted until the program is able to stabilize the patient’s moods and relieve symptoms.
McCormick, U., Murray, B., & McNew, B. (2015). Diagnosis and treatment of patients with bipolar disorder: A review for advanced practice nurses. Journal of the American Association of Nurse Practitioners, 27(9), 530–542. https://doi.org/10.1002/2327-6924.12275
Baldessarini, R. J., Vázquez, G. H., & Tondo, L. (2020). Bipolar depression: a major unsolved challenge. International journal of bipolar disorders, 8(1), 1. https://doi.org/10.1186/s40345-019-0160-1
Baldessarini, R.J., Tondo, L. & Vázquez, G.H. (2019) Pharmacological treatment of adult bipolar disorder. Mol Psychiatry 24, 198–217. https://doi.org/10.1038/s41380-018-0044-2