Bipolar Disorder

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks.

• As many as 20% of people complaining of depression to their doctor actually have bipolar disorder.
• About half of people with bipolar disorder have seen three professionals before being diagnosed correctly.
• It takes an average of 10 years for people to enter treatment for bipolar disorder after symptoms begin. This is caused in part by delays in diagnosis.
• Most people with bipolar disorder have additional psychiatric conditions (such as substance abuse or anxiety) that can make overall diagnoses more challenging.

There are four basic types of bipolar disorder; all of them involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, and energized behavior (known as manic episodes) to very sad, “down,” or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.

• Bipolar I Disorder— defined by manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depression and manic symptoms at the same time) are also possible.
• Bipolar II Disorder— defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes described above.
• Cyclothymic Disorder (also called cyclothymia)— defined by numerous periods of hypomanic symptoms as well numerous periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.
• Other Specified and Unspecified Bipolar and Related Disorders— defined by bipolar disorder symptoms that do not match the three categories listed above.

Signs and Symptoms

People with bipolar disorder experience periods of unusually intense emotion, changes in sleep patterns and activity levels, and unusual behaviors. These distinct periods are called “mood episodes.” Mood episodes are drastically different from the moods and behaviors that are typical for the person. Extreme changes in energy, activity, and sleep go along with mood episodes.

People may experience:

• Mood: mood swings, sadness, elevated mood, anger, anxiety, apathy, apprehension, euphoria, general discontent, guilt, hopelessness, loss of interest, or loss of interest or pleasure in activities
• Behavioral: irritability, disorganized behavior, aggression, agitation, crying, excess desire for sex, hyperactivity, impulsivity, restlessness, or self-harm
• Cognitive: unwanted thoughts, delusion, lack of concentration, racing thoughts, or slowness in activity
• Psychological: depression, manic episode, agitated depression, or paranoia
• Sleep: difficulty falling asleep or excess sleepiness
• Weight: weight gain or weight loss
• Other common symptoms: risky behavior, false belief of superiority, fatigue, or rapid and frenzied speaking

Bipolar Disorder Treatment

The best treatment for bipolar disorder is a combination of medication and counseling. Doctors often treat the mania symptoms with one set of drugs and use other drugs to treat depression. Certain drugs are also used for “maintenance”—to maintain a steady mood over time.

Medication

Bipolar disorder is treated with three main classes of medication: mood stabilizers, antipsychotics, and, while their safety and effectiveness for the condition are sometimes controversial, antidepressants.

Typically, treatment entails a combination of at least one mood-stabilizing drug and/or atypical antipsychotic, plus psychotherapy. The most widely used drugs for the treatment of bipolar disorder include lithium carbonate and valproic acid (also known as Depakote or generically as divalproex). Lithium carbonate can be remarkably effective in reducing mania, although doctors still do not know precisely how it works. Lithium may also prevent recurrence of depression, but its value seems greater against mania than depression; therefore, it is often given in conjunction with other medicines known to have greater value for depression symptoms, sometimes including antidepressants.

Valproic acid is a mood stabilizer that is helpful in treating the manic or mixed phases of bipolar disorder, along with carbamazepine (Equetro), another antiepileptic drug. These drugs may be used alone or in combination with lithium to control symptoms. In addition, newer drugs are coming into the picture when traditional medications are insufficient. Lamotrigine, another antiepileptic drug, has been shown to have value for preventing depression and, to a lesser degree, manias or hypomanias.

Other antiepileptic drugs, such as gabapentin, oxcarbazepine, or topiramate, are regarded as experimental treatments that sometimes have value for symptoms of bipolar disorder or other conditions that often occur with it.

Haloperidol or other newer antipsychotic medications, such as olanzapine or risperidone, are often given to patients who fail to respond to lithium or divalproex. They also may be given to treat acute symptoms of mania — particularly psychosis — before lithium or divalproex can take full effect, which may be from one to several weeks. Another antipsychotic, Latuda, is approved for use in bipolar I depression as is the combination of olanzapine plus fluoxetine (called Symbyax). The antipsychotic quetiapine is approved to treat bipolar I or II depression. Preliminary studies also suggest that the atypical antipsychotic cariprazine (Vraylar) also may have value for treating bipolar depression.

Some of these drugs can potentially become toxic if doses get too high. Therefore, they need to be monitored periodically with blood tests and clinical assessments by the prescriber. Because it is often difficult to predict which patient will react to what drug or what the dosage should ultimately be, the psychiatrist will often need to experiment with several different medications when beginning treatment.

Psychotherapy

Psychotherapy, or “talk” therapy, is an important part of treatment for bipolar disorder. During therapy, you can discuss feelings, thoughts, and behaviors that cause you problems. Talk therapy can help you understand and hopefully master any problems that hurt your ability to function well in your life and career. It also helps you stay on your medication. It can help you maintain a positive self-image.

The types of psychotherapy used to treat bipolar disorder include:

• Behavioral therapy. This focuses on behaviors that decrease stress.
• Cognitive therapy. This type of approach involves learning to identify and modify the patterns of thinking that accompany mood shifts.
• Interpersonal therapy. This involves relationships and aims to reduce strains that the illness may place upon them.
• Social rhythm therapy. This helps you develop and maintain a normal sleep schedule and more predictable daily routines.

Support groups also help people with bipolar disorder. You receive encouragement, learn coping skills, and share concerns. You may feel less isolated as a result. Family members and friends may also benefit from a support group. They can gain a better understanding of the illness, share their concerns, and learn how to best support loved ones with bipolar disorder.

Education is another integral part of treatment for you and your family. People with bipolar disorder (and their families) often benefit from learning about the disorder — its symptoms, early signs of an episode, and types of treatment.

Also, taking these steps may help you cope with bipolar disorder:

• Establish routines. Regular sleep, eating, and activity appear to help people with bipolar disorder manage their moods.
• Identify symptoms. Even though the early warning signs of an approaching episode vary from person to person, together with a psychiatrist you can identify what behavior changes signal the onset of an episode for you. It may be needing less sleep to feel rested, buying things you can’t afford or don’t need, or becoming suddenly involved in religion or new activities and interests.
• Adapt. This can help you avoid embarrassing behavior during manic episodes and set realistic goals for treatment. Your doctor can help you prepare for possible future episodes and manage fear about having more. A key part of adapting is to understand the types of stressors that might increase the risk for manic or depressive episodes and the lifestyle changes that can reduce them.
• Maintain a regular sleep pattern. Go to bed and wake up around the same times each day. Changes in sleep can disrupt the normal functioning of brain circuits involved in the processing of emotions, potentially triggering mood episodes.
• Do not use alcohol or street drugs. These substances can trigger or mimic mood episodes. They can also interfere with the effectiveness of medication.

Complementary treatments for bipolar disorder (including those offered by Prive-Swiss professional team)

Most alternative treatments for bipolar disorder are really complementary treatments, meaning they should be used in conjunction with medication, therapy, and lifestyle modification. Here are a few of the options that are showing promise:

Light and dark therapy – Like social rhythm therapy, light and dark therapy focuses on the sensitive biological clock in people with bipolar disorder. This easily disrupted clock throws off sleep-wake cycles, a disturbance that can trigger symptoms of mania and depression. Light and dark therapy for bipolar disorder regulates these biological rhythms—and thus reduces mood cycling— by carefully managing your exposure to light. The major component of this therapy involves creating an environment of regular darkness by restricting artificial light for ten hours every night.

Mindfulness meditation – Research has shown that mindfulness-based cognitive therapy and meditation help fight and prevent depression, anger, agitation, and anxiety. The mindfulness approach uses meditation, yoga, and breathing exercises to focus awareness on the present moment and break negative thinking patterns.

Acupuncture – Acupuncture is currently being studied as a complementary treatment for bipolar disorder. Some researchers believe that it may help people with bipolar disorder by modulating their stress response. Studies on acupuncture for depression have shown a reduction in symptoms, and there is increasing evidence that acupuncture may relieve symptoms of mania also.