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Treatment for Bipolar Disorder

Life comes with its share of highs and lows, and no one is exempt from experiencing them. When bipolar disorder is in the picture, however, the changes in mood mean much more than a temporary feeling of sitting on top of the world or being down in the dumps.

The mental health condition causes people to experience extreme changes in mood that can leave them feeling unstable and threaten their safety and well-being.

Bipolar disorder is estimated to affect some 60 million people globally, according to the World Health Organization. Numbers vary on how many people in the U.S. are affected. 

According to a Harvard Health Publishing’s March 2019 report, researchers estimate that bipolar disorder can occur in up to 4 percent of the U.S. adult population. However, that number could be higher if a broad definition is used, the report says.

Nearly anyone is at risk of developing bipolar 1 disorder, writes WebMD, and most people, it says, are in their teens or early 20s when symptoms of the disorder appear; nearly everyone who develops it does so before age 50. 

“About 2.5% of the U.S. population suffers from bipolar disorder — almost 6 million people,” the medical website reports.A recent study published in June 2019 in The Lancet Psychiatry underscores the importance of detecting bipolar disorder early enough to help people who have it. The study emphasizes that treating people after they’ve had their first manic episode so that they can receive better care.

If left untreated, bipolar disorder can make life difficult, causing:

  • Substance use disorders (SUDs)
  • Strained relationships
  • Poor job or school performance
  • Financial worries
  • Legal problems
  • Self-harm or harm to others
  • Suicide or attempts at suicide

Read on to learn more about bipolar disorder, including what it is, what causes it, and how to receive proper treatment.

What Is Bipolar Disorder?

Bipolar disorder is a mental health disorder that affects the brain and brings on various and unusual changes in mood, energy, activity levels, and the ability to carry out daily tasks, according to the National Institute of Mental Health (NIMH). It can be referred to as manic-depressive disorder or manic-depressive illness. 

When people have bipolar disorder, they can be happy and energetic at one time and feeling “blue” or “down in the dumps” in the next. This cycling between dramatic changes in moods can be extreme and lead to impaired thinking and reasoning, risky behavior, and suicidal tendencies. 

Therapy and medication can be used to treat bipolar disorder. When properly diagnosed and treated, people with bipolar disorder can lead healthy lives despite it being a lifelong condition.

What Causes Bipolar Disorder?

Researchers could not pinpoint the cause of bipolar disorder, but they continue to study the factors that can cause the mental health condition to develop. According to the Mayo Clinic, several factors may be involved. One of them is genetics. People who have a first-degree relative in their family, such as a parent or sibling, can develop the condition, it writes.

Biological differences are possible causes. People with the disorder appear to have physical changes to their brain structure, the Mayo Clinic writes. There are other risk factors that could contribute to an increased risk of developing bipolar disorder include stressful or traumatic events as well as abuse of addictive substances, such as alcohol or drugs.

Types of Bipolar Disorder

According to the NIMH, there are four basic types of bipolar disorder.

Bipolar I Disorder – This form of the disorder is characterized by manic episodes that last for at least seven days. Manic episodes are periods of abnormally elevated moods and high energy that disrupt daily life. The moods and behaviors linked to mania are usually present most of the day of every day during an episode.

Manic symptoms can be so severe that the person who experiences them must receive immediate care in a hospital. This setting ensures they won’t harm themselves or someone else. A person with bipolar I disorder may have trouble working and/or socializing with others and experience psychosis, a mental disorder in which one loses touch with reality. 

Depressive episodes can last two weeks, and it is possible for people to have depression and manic symptoms at the same time.

Bipolar II Disorder – This form of bipolar disorder is more common. It is similar to bipolar I disorder in that a person’s moods can cycle up and down, causing them to experience highs and lows. However, a person with bipolar II disorder does not experience true, full-blown manic episodes. Instead, they experience periods of hypomania, a milder form of mania, and at least one period of depressive episodes. 

Still, as WebMD explains, “Hypomanic episodes can sometimes progress onward to full manias that affect a person’s ability to function (bipolar I disorder).”  

According to WebMD, people who have bipolar II disorder struggle with depression more. These depressive episodes can happen between periods of hypomania, or they can occur after hypomania periods end. Some people will go back and forth between hypomania and depression. 

It also has been observed that some people can have normal moods for a long time between episodes. Episodes can run from a few days to several months, particularly when they are left untreated.

It is important to note that because full-blown manic episodes are not the norm for this type of bipolar disorder, it can be difficult to identify it. Unhealthy behaviors can long go unnoticed because the person can seem happy and appear to go on with life as usual. 

It’s only when the moods become more extreme or the behavior out of control that someone may notice there is a shift that requires closer attention.

Also important to note is that the Mayo Clinic explains that bipolar II disorder is not a milder form of bipolar I disorder; it is a separate diagnosis. 

“While the manic episodes of bipolar I disorder can be severe and dangerous, individuals with bipolar II disorder can be depressed for longer periods, which can cause significant impairment,” it writes.

Medical News Today says that while bipolar II disorder is less severe than bipolar  I disorder, it does not make it less severe.

The last two disorders on NIMH’s list are considered rarer than the first two. They are:

Cyclothymic Disorder Cyclothymic disorder (also called cyclothymia) is a milder form of bipolar disorder that is characterized by experiencing many hypomanic symptoms and depressive symptoms. The symptoms experienced, however, do not meet the diagnostic requirements for a hypomanic episode and a depressive episode, according to the NIMH.

These symptoms must occur for at least two years in adults, and at least a year in children and adolescents. 

Other Specified and Unspecified Bipolar and Related Disorders – This condition is defined by bipolar disorder symptoms that do not fit into the other three categories listed.

Signs, Symptoms of Bipolar Disorder 

Mania, hypomania, and depression are the three main categories of symptoms that can help determine if you should see a doctor about a possible bipolar disorder diagnosis.

Mania

When a manic episode is underway, a person may experience:

  • Increased energy or agitation
  • Strong feelings of enthusiasm, happiness or excitement
  • Anger, restlessness, or irritability
  • Less need for sleep or an inability to sleep
  • Rapid or racing thoughts
  • Fast-talking or talking more than usual; loud speech
  • Rambling speech that doesn’t make sense or is hard to understand
  • Increased risk-taking or reckless behavior
  • Pleasure-seeking behaviors, such as increased interest in sex, alcohol, and drugs
  • Inflated self-esteem
  • Excessive spending

Medical News Today writes that some people who experience mania may find it hard to remain calm or have rational thoughts during a manic episode.

Hypomania

The symptoms of hypomania are similar to those of manic episodes, but they may present as a combination of symptoms. These include:

  • Increased energy or agitation
  • Appetite changes
  • Decreased need for sleep or an inability to sleep
  • Rapid, racing thoughts
  • Talking rapidly or talking more or louder than usual
  • Increased risk-taking or reckless behavior

True hypomanic episodes must last for at least four days, and at least three or more of the symptoms above must occur, according to Medical News Today. A person who experiences these symptoms may think all is well, but their loved ones may notice changes in their behavior.

Depression

A depressive state often follows a manic or hypomanic state. Symptoms of major depressive episodes include:

  • Decreased energy
  • Feeling sad, empty, hopeless, or worthless
  • Showing no interest in usual activities or hobbies
  • Having trouble falling asleep, staying asleep, or sleeping too much
  • Withdrawing from others, becoming isolated
  • Concentration difficulties
  • Weight gain or weight loss without dieting
  • Suicidal thoughts or tendencies

Depressive episodes are often hard to manage when the euphoria and high energy of mania have worn off. 

Signs and symptoms that can occur during periods of hypomania and major depressive episodes are anxiety and melancholy. Rapid cycling between the two states is common in bipolar II disorder, according to Medical News Today.

This on-again-off-again cycle of mood swings and other emotional ups (manic episodes) and downs (depressive episodes) can be confusing for people who are not aware that they have bipolar disorder as well as those who either haven’t been diagnosed or received the treatment they need. 

Diagnosis

If episodes of mania, hypomania, or depression have occurred, and you suspect that you or a loved one may have bipolar disorder, the next step is to speak with a medical doctor about your concerns. This visit may lead to an evaluation that can help you get answers.

According to the Mayo Clinic, an evaluation can include:

A physical exam and lab tests. These can uncover any physical medical problems. This exam also rules out other illnesses that could be causing symptoms that present with bipolar disorder.

A psychiatric assessment. This is given by a psychiatrist, who can talk with you about your patterns of your thoughts, feelings, and behaviors. This step may involve a psychological self-assessment or questionnaire that you fill out.

Mood charting. Mood charting involves tracking your moods, sleep patterns, and other factors daily. This long-term monitoring exercise can help you monitor changes in your moods and symptoms.

Reviewing criteria for bipolar disorder. Your psychiatrist will evaluate your symptoms against the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), which is published by the American Psychiatric Association (APA).

The Mayo Clinic advises that a medical doctor who is skilled in treating bipolar disorder and any related disorders is the best person to guide treatment for it. A person’s treatment team may include a psychiatric nurse, a psychologist, and a social worker.

The type of bipolar disorder a person has can be determined after the intensity and duration of the symptoms experienced are reviewed. A medical doctor also will be able to link you with the proper mental health care professionals who can provide further tests and treatment.

Medical News Today reports that no blood test or imaging can diagnose the disorder. However, a doctor may recommend other tests to rule out medical conditions that present with similar symptoms. 

If no medical conditions or medicines are found to cause the symptoms experienced, then the medical professional is likely to consider bipolar disorder. Healthline notes that bipolar is often misdiagnosed in its early stages, which frequently happens when people are in their teenage years. 

It writes, “When it’s diagnosed as something else, symptoms of bipolar disorder can get worse. This usually occurs because the wrong treatment is provided.”

As NIMH explains, the symptoms of bipolar disorder are similar to those of other mental health disorders, such as schizophrenia or (unipolar) depression, so that’s one reason misdiagnosis is common. Another is people with the disorder also have other health conditions that complicate the diagnostic process.

Various sources say it is often a depressive episode that sends people to a doctor’s office to seek a diagnosis and treatment.

Before a person is diagnosed with bipolar disorder, they first must have had an episode of mania or hypomania. This condition is marked by:

  • Mood changes
  • Impaired judgment
  • Disrupted thought patterns
  • Changes in speech

What Does Bipolar Disorder Treatment Look Like?

Treatment is available for all forms of bipolar disorder. These treatments are designed to help a person manage symptoms of the disorder so that they can function in their daily lives. The approach used to treat bipolar disorder will vary depending on the needs of the person requiring treatment. Any combination of medications, day treatment programs, substance abuse treatment and hospitalization can be used to treat bipolar disorder. 

The Mayo Clinic also advises that primary treatments for bipolar disorder can also include psychological counseling (psychotherapy) to control symptoms. It also may consist of education and support groups.

Medications

Various medications are used to treat bipolar disorder. The medication prescribed will depend on the particular symptoms a person has. It is advised that a person starts the medication immediately as these drugs help to balance one’s moods. 

Figuring out which medication works best can take some time. Weeks or months could pass before you find the right combination of medications, so patience is advised. Medications can be adjusted as symptoms change. Tell your physician or mental health care professional if you are experiencing side effects that you find concerning. 

You are advised not to quit or change any medication you have been taking for a period. Suddenly stopping use can result in drug withdrawal effects that can worsen your condition. “You may become very depressed, feel suicidal, or go into a manic or hypomanic episode. If you think you need to make a change, call your doctor,” the Mayo Clinic advises.

Medications can include:

Mood stabilizers. These medications help to control manic and hypomanic episodes, according to the Mayo Clinic. Mood stabilizer drugs include lamotrigine (Lamictal) and lithium (Lithobid), among others.

Antipsychotics. Antipsychotic medicines treat lingering symptoms of mania, psychotic symptoms, and depression. These can be prescribed along with mood stabilizers. Examples of antipsychotics include aripiprazole (Abilify) and quetiapine (Seroquel).

Antidepressants. These medications are prescribed to help one manage symptoms of depression. They may be prescribed along with a mood stabilizer or antipsychotic because they can bring on a manic episode.

Antidepressant-antipsychotic. This combination drug, which is made up of antidepressant fluoxetine and the antipsychotic olanzapine, also stabilizes mood and helps treat depression.

Anti-anxiety medications. Benzodiazepines, such as Xanax (alprazolam) and Ativan (lorazepam) may also be a part of the treatment approach. If they are prescribed, it likely will be for the short-term to help manage anxiety.

Psychotherapy

Psychotherapy is also an essential part of bipolar disorder treatment. It can be provided for an individual or family and group settings.

Some common therapies used, as noted by the Mayo Clinic, include:

  • Psychoeducation. Understanding bipolar disorder will take some time and patience. Psychoeducation can help everyone involved understand the disorder so that they know what to expect, how to give and receive support, and which strategies to use to help the person with the disorder avoid a relapse.
  • Cognitive behavioral therapy (CBT). This therapy helps people focus on identifying behaviors and beliefs that are unhealthy and learning to replace them with healthy ones. This can help align people with their short- and long-term goals. CBT can also give people a clearer picture of triggers that lead to their bipolar episodes and how to use effective strategies to manage stress and stressful situations.
  • Interpersonal and social rhythm therapy (IPSRT). IPSRT helps to stabilize the rhythms of one’s daily routine, which involves when they are asleep, awake, and the times at which they are eating. As the Mayo Clinic explains, “a consistent routine allows for better mood management.”  Establishing a daily routine for sleep, diet and exercise can be beneficial, it writes.
  • Family-centered therapy. This type of therapy helps each family member learn how to best support and communicate with their loved one who has bipolar disorder. It can teach everyone to recognize warning signs of mood swings and figure out the best way to address them. The person who has the disorder can also feel encouraged to remain committed to their treatment plan. 

Electroconvulsive therapy (ECT) is another medical treatment option for people who have severe major depression. In cases involving patients with bipolar disorder, this option is used in cases in which symptoms are severe and other approaches, such as medication and psychotherapy, are not working.

During ECT, a health care provider stimulates certain regions of the brain with a controlled electric shock to cause a seizure, hoping to help regulate the patient’s mood and symptoms.  

As the American Psychiatric Association explains, the patient is under anesthesia when this method is used, and trained medical professionals monitor the patient who receives the treatment. That team typically consists of a psychiatrist, an anesthesiologist, and a nurse or physician assistant, it writes.

As previously mentioned, exercise is recommended to help with anxiety and depression. Consult with your doctor before starting an exercise program.

Bipolar Disorder and Substance Use

The symptoms of bipolar disorder can vary in severity, and managing these symptoms can be debilitating for the individuals who have them. 

Many who have gone undiagnosed or have been misdiagnosed have turned to alcohol and drugs to self-medicate to manage depressive episodes and other complications, a practice that often leads to substance use disorder or addiction. 

This is one of the dangers of leaving bipolar disorder undiagnosed or misdiagnosed. 

The relationship between substance abuse and mental health disorders is complex, and sometimes, it is not easy to determine the order in which they occur or which one happened first. Usually, the more severe a person’s mental illness, the more likely the person will use or abuse an illegal substance to cope with the symptoms. In some cases, sustained substance use and abuse can lead to the development of a mental health disorder.

Alcohol, marijuana, and cocaine are among the most abused substances among people who are battling a drug or alcohol dependence and a mental health disorder. 

When people with bipolar disorder develop a substance use disorder (SUD), they have co-occurring disorders, which means they experience both disorders at the same time. This condition requires specialized treatment, one that addresses both conditions at the same time.

If you or someone you know has a dual diagnosis, find a recovery program at an accredited treatment facility that treats both the substance use disorder and the mental health disorder simultaneously. Dually diagnosed people fare much better and have a better chance of recovering from addiction when services are received for both conditions.

Sources

Mental disorders. (n.d.). Retrieved from https://www.who.int/news-room/fact-sheets/detail/mental-disorders

Harvard Health Publishing. (n.d.). Bipolar Disorder (Manic Depressive Illness or Manic Depression). Retrieved from https://www.health.harvard.edu/a_to_z/bipolar-disorder-manic-depressive-illness-or-manic-depression-a-to-z

Better care needed for people displaying first symptoms of bipolar disorder. (2019, June 24). Retrieved from http://www.sciencedaily.com/releases/2019/06/190624214055.htm

Bipolar Disorder. (n.d.). Retrieved from https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

Bipolar II Disorder: Symptoms, Treatments, Causes, and More. (n.d.). Retrieved from https://www.webmd.com/bipolar-disorder/guide/bipolar-2-disorder#1

Bipolar disorder. (2018, January 31). Retrieved from https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955

Fletcher, J. (n.d.). What is bipolar II disorder? Symptoms and treatment. Retrieved from https://www.medicalnewstoday.com/articles/319280.php

Bipolar disorder. (2018, January 31). Retrieved from https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/diagnosis-treatment/drc-20355961

Diagnosis Guide for Bipolar Disorder. (n.d.). Retrieved from https://www.healthline.com/health/bipolar-disorder/bipolar-diagnosis-guide#misdiagnosis

Bipolar I Disorder Symptoms, Treatments, Causes, and More. (n.d.). Retrieved from https://www.webmd.com/bipolar-disorder/guide/bipolar-1-disorder#1-2

What is Electroconvulsive therapy (ECT)? (n.d.). Retrieved from https://www.psychiatry.org/patients-families/ect

Bipolar Disorder. (n.d.). Retrieved from https://www.nimh.nih.gov/health/publications/bipolar-disorder/index.shtml#pub1

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