Bipolar Disorder Treatment

What is Bipolar Disorder?

Bipolar disorder (formerly called manic-depressive illness or manic depression) is a mental illness that causes extreme shifts in a person’s mood, thoughts, and behavior. People with bipolar disorder experience extreme shifts between euphoric happiness (mania or hyper-mania) and depressive lows in which the sufferer feels sad and hopeless and loses interest in most activities.

The mood changes that people with bipolar disorder experience are different from the normal ups and downs that we all experience. The mood swings in bipolar disorder tend to be severe and unpredictable compared to normal mood shifts. These shifts in overall mental well-being can lead to a variety of other issues including insomnia. Bipolar disorder can also cause social issues and affect a person’s ability to maintain relationships and steady employment. 

Risk Factors

Bipolar disorder often develops in the late teens or early 20s. Extreme changes in lifestyle, energy levels, sleep and behavior are often the early warning signs of a person affected by bipolar disorder. 

Scientists aren’t exactly sure what causes bipolar disorder. However, they have identified some things that increase the risk for bipolar, including: 

• Family History: Having a parent, sibling, or another close relative with the disorder 
• Psychological Comorbidity: The presence of an existing psychiatric disorders such as alcohol use disorder, anxiety disorder, attention-deficit hyperactivity disorder (ADHD), or personality disorders.
• Medical Comorbidity: The presence of inflamatory related medical issues such as IBS, asthma, cardiovascular disease, type 2 diabetes mellitus, and other endocrine disorders.

Signs and Symptoms of Bipolar

Those with bipolar disorder typically experience intense shifts in mood from their “normal” mood. These shifts range from overly excited and euphoric (manic) to sad, depressed, or hopeless (depressive). On occasion, a person may exhibit moods characterized by both mania and depression, which is commonly referred to as a “mixed state.” Bipolar disorder is characterized by the presence of extreme mood swings that include depressive episodes and manic episodes. 

• Depressive episodes – Episodes in which a person feels very sad, anxious, or down. During these periods, the person may find it difficult to get out of bed, work, or do activities that they normally enjoy. They may feel hopeless and have thoughts of suicide. 

• Manic or hypomanic episodes – Periods of extreme elation, happiness, or joy. A person experiencing a manic episode may have a decreased need for sleep, racing thoughts, and pressured speech. During manic episodes, a person may engage in risky behaviors that put them and others at risk for harm, such as driving recklessly.
  • (Mania = the more severe form lasting a week or longer.)
  • (Hypomania = a milder version lasting a few days.)

• Rapid cycling – At least four mood episodes within the past 12 months that meet the criteria for a manic, hypomanic, or major depressive episode. Approximately 10-20% of individuals diagnosed with bipolar disorder will experience a period of rapid cycling at some point. In many cases, rapid cycling eventually subsides on its own, and individuals return to a pattern of longer and less frequent mood episodes.

Bipolar symptoms may affect a person’s ability to work or go to school. Bipolar disorder can also cause impairments in judgment and thinking, which can lead to legal issues. 

Types of Bipolar Disorder

There are several different types of bipolar disorder. Here are the most common forms: 

1. Bipolar I Disorder: To be diagnosed with this type of bipolar, a person must have experienced at least one manic episode. 
2. Bipolar II Disorder: This type of bipolar is marked by the presence of at least one depressive episode and one hypomanic episode. This type of bipolar is more common in women. 
3. Cyclothymia: People with cyclothymic disorder have episodes of mild depression or hypomania that are present for at least two years, but aren’t severe enough to meet the requirements of bipolar I or bipolar II. 

Treatments for Bipolar Disorder

Bipolar disorder can’t be cured, but it can be treated effectively with the help of your doctors and mental health professionals. Since bipolar disorder is a chronic disease, treatments are usually ongoing and may include a combination of medications, counseling, and lifestyle changes. 

A treatment plan is generally geared around controlling depressive symptoms and manic symptoms, as well as addressing any coexisting mental health conditions. 

Medications

Different medications used to treat the symptoms of biploar include:

• Mood Stabilizers – Lithium, Depakote, Lamictal, Neurotin, Topamax, and Trileptal are popular choices for treating bipolar disorder.
• Antipsychotics – These are often used to treat symptoms, though generally in correlation with other medications, such as antidepressants. Zyprexa, Abilify, Seroquel, Risperdal and Geodon are often prescribed.
• Antidepressants – Medications like Prozac, Paxil, Zoloft and Wellbutrin are examples of antidepressants that may be prescribed to treat depressive symptoms of bipolar disorder. 

Psychotherapy

Psychotherapy (talk therapy) is often used in combination with medication and can be a very effective treatment for bipolar disorder. Common psychotherapy treatments include:

• Cognitive Behavioral Therapy (CBT)helps those with bipolar disorder learn to change harmful or negative thought patterns that lead to episodes of mania or depressive behavior.
• Family-focused Therapy (FFT) involves family members and details coping strategies as well as recognizing patterns and onset behavior for episodes.
• Interpersonal and Social Rhythm Therapy (IPSRT)helps people affected by bipolar disorder improve their relationships with loved ones as well as learn to manage their daily routines such as sleep and eating schedules.
• Psychoeducation teaches those affected by bipolar disorder how to recognize problem behavior as well as the patterns that lead to episodes. This type of psychotherapy is typically done in a group setting.

Brain Stimulation Therapies

Brain stimulation therapies have been found to provide relief when other treatment options haven’t worked. This field is rapidly evolving. Some of the most promising brain stimulation therapies include:

• Electroconvulsive Therapy (ECT) is a brain stimulation technique that can alleviate severe symptoms of bipolar disorder. Healthcare providers may recommend ECT when other treatments have been ineffective or when a rapid response is needed, such as in cases of high suicide risk or catatonia (a state of unresponsiveness).
• Repetitive Transcranial Magnetic Stimulation (rTMS) is another form of brain stimulation that uses magnetic waves to reduce depression over multiple sessions. While rTMS is less intense than ECT, it doesn’t require general anesthesia and carries a low risk of side effects on memory and cognition.
• Accelerated Intermittent Theta Burst Stimulation (aiTBS) is an advanced form of rTMS, a non-invasive brain stimulation technique used primarily for treating depression and other mental health conditions, including bipolar disorder.
• Vagus Nerve Stimulation (VNS) involves the use of a device implanted under the skin to stimulate the vagus nerve. While VNS is more commonly used for epilepsy and treatment-resistant depression, it may also be considered for bipolar disorder in certain cases.

Self Help & Lifestyle Strategies 

Managing stress, sleep and a healthy food choices are an important part of any treatment plan. Here are some critical lifestyle recommendations for individuals struggling with bipolar disorder:

• Sleep Management: Maintaining a regular sleep schedule is crucial for individuals with bipolar disorder. Irregular sleep patterns can trigger mood episodes, so sleep hygiene and, in some cases, sleep aids may be recommended as part of a comprehensive treatment plan.
• Mindfulness and Stress Management Techniques: Practices such as mindfulness meditation, yoga, and other relaxation techniques can help manage stress, which is a known trigger for mood episodes in bipolar disorder.
• Omega-3 Fatty Acids: Some research suggests that omega-3 supplements, particularly those containing EPA (eicosapentaenoic acid), may have a mood-stabilizing effect in individuals with bipolar disorder, especially when used alongside other treatments.
• Light Therapy: Light therapy is the most well-supported treatment for seasonal affective disorder (SAD). Since many people with bipolar disorder experience seasonal depression or SAD during the winter, light therapy can also be used to address milder seasonal exacerbations of bipolar depression.

Why Work With a Therapist?

Therapy can help individuals with bipolar disorder better manage the disease and return to doing the things that they enjoy. It can also help them learn how to cope with symptoms, improve relationships, and more. It is important to find a therapist that is trained in a variety of treatment approaches and can address the complexity of this disorder as well as any co-existing mental health conditions.

What to Look for When Finding a Therapist

Search for a therapist with experience in treating bipolar disorder. It is a good idea to talk to several therapists to determine their treatment approach and whether it will be a good match. Some questions to ask include: 

• What kinds of therapy do you use to treat bipolar disorder? 
• What do you think of medication when it comes to bipolar disorder? 
• How many years of experience do you have in treating bipolar? 

You might also ask if they offer virtual visits if that is something that is important to you. 

You could also try joining a support community for people with bipolar disorder, and ask forum members for recommendations. 

Post-Pandemic Update 

The coronavirus pandemic caused increased mental health symptoms for many people, including those with bipolar disorder. One of the most important things post-pandemic is to make sure you are managing stress and getting help for bipolar disorder. There is no cure for bipolar disorder, but treatment can help you manage the symptoms.

References

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10. Sheline YI, Makhoul W, Batzdorf AS, et al. Accelerated Intermittent Theta-Burst Stimulation and Treatment-Refractory Bipolar Depression: A Randomized Clinical Trial. JAMA Psychiatry. Published online July 10, 2024. doi:10.1001/jamapsychiatry.2024.1787
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