Bipolar disorder

 

While there are many forms of depression, bipolar depression is oftentimes misdiagnosed as unipolar depression. It should also be treated differently. To help ensure a proper diagnosis, be sure to tell your doctor what you are feeling and experiencing.

 

You may be experiencing “lows.” But have you also had “high” moments? Are there times when you are energized or really agitated? These “highs” are what may indicate you have bipolar disorder. The fact you have highs eliminates the possibility that you have unipolar depression. These “lows” associated with bipolar disorder are what identifies your condition as bipolar depression.

 

Use this Doctor Discussion Guide to have a conversation with your doctor about your condition, your medications, or other questions you feel are appropriate.

 

Diagnosis

To determine if you have bipolar disorder, your evaluation may include:

 

Physical exam. Your doctor may do a physical exam and lab tests to identify any medical problems that could be causing your symptoms.

Psychiatric assessment. Your doctor may refer you to a psychiatrist, who will talk to you about your thoughts, feelings, and behavior patterns. You may also fill out a psychological self-assessment or questionnaire. With your permission, family members or close friends may be asked to provide information about your symptoms.

Mood charting. You may be asked to keep a daily record of your moods, sleep patterns or other factors that could help with diagnosis and finding the right treatment.

Criteria for bipolar disorder. Your psychiatrist may compare your symptoms with the criteria for bipolar and related disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Diagnosis in children

Although diagnosis of children and teenagers with bipolar disorder includes the same criteria that are used for adults, symptoms in children and teens often have different patterns and may not fit neatly into the diagnostic categories.

 

Also, children who have bipolar disorder are frequently also diagnosed with other mental health conditions such as attention-deficit/hyperactivity disorder (ADHD) or behavior problems, which can make diagnosis more complicated. Referral to a child psychiatrist with experience in bipolar disorder is recommended.

Treatment is best guided by a medical doctor who specializes in diagnosing and treating mental health conditions (psychiatrist) who is skilled in treating bipolar and related disorders. You may have a treatment team that also includes a psychologist, social worker, and psychiatric nurse.

Bipolar disorder is a lifelong condition. Treatment is directed at managing symptoms. Depending on your needs, treatment may include:

                                                                                                      

 

Medications. Often, you will need to start taking medications to balance your moods right away.

Continued treatment. Bipolar disorder requires lifelong treatment with medications, even during periods when you feel better. People who skip maintenance treatment are at elevated risk of a relapse of symptoms or having minor mood changes turn into full-blown mania or depression.

Day treatment programs. Your doctor may recommend a day treatment program. These programs provide the support and counseling you need while you get symptoms under control.

Substance abuse treatment. If you have problems with alcohol or drugs, you will also need substance abuse treatment. Otherwise, it can be exceedingly difficult to manage bipolar disorder.

Hospitalization. Your doctor may recommend hospitalization if you are behaving dangerously, you feel suicidal or you become detached from reality (psychotic). Getting psychiatric treatment at a hospital can help keep you calm and safe and stabilize your mood, whether you are having a manic or major depressive episode.

The primary treatments for bipolar disorder include medications and psychological counseling (psychotherapy) to control symptoms and may include education and support groups.

 

Medications

A number of medications are used to treat bipolar disorder. The types and doses of medications prescribed are based on your symptoms.

 

Medications may include:

 

Mood stabilizers. You will typically need mood-stabilizing medication to control manic or hypomanic episodes. Examples of mood stabilizers include lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others) and lamotrigine (Lamictal).

Antipsychotics. If symptoms of depression or mania persist despite treatment with other medications, adding an antipsychotic drug such as olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris) may help. Your doctor may prescribe some of these medications alone or along with a mood stabilizer.

Antidepressants. Your doctor may add an antidepressant to help manage depression. Because an antidepressant can sometimes trigger a manic episode, it is usually prescribed along with a mood stabilizer or antipsychotic.

Antidepressant-antipsychotic. The medication Symbyax combines the antidepressant fluoxetine and the antipsychotic olanzapine. It works as a depression treatment and a mood stabilizer.

Anti-anxiety medications. Benzodiazepines may help with anxiety and improve sleep but are usually used on a short-term basis.

Finding the right medication

Finding the right medication or medications for you will take some trial and error. If one does not work well for you, there are several others to try.

 

This process requires patience, as some medications need weeks to months to take full effect. Only one medication is changed at a time so that your doctor can identify which medications work to relieve your symptoms with the least bothersome side effects. Medications also may need to be adjusted as your symptoms change.

 

Side effects

Mild side effects often improve as you find the right medications and doses that work for you, and your body adjusts to the medications. Talk to your doctor or mental health professional if you have bothersome side effects.

 

Do not make changes or stop taking your medications. If you stop your medication, you may experience withdrawal effects, or your symptoms may worsen or return. 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.

 

Medications and pregnancy

A number of medications for bipolar disorder can be associated with birth defects and can pass through breast milk to your baby. Certain medications, such as valproic acid and divalproex sodium, should not be used during pregnancy. Also, birth control medications may lose effectiveness when taken along with certain bipolar disorder medications.

 

Discuss treatment options with your doctor before you become pregnant, if possible. If you are taking medication to treat your bipolar disorder and think you may be pregnant, talk to your doctor right away.

 

Psychotherapy

Psychotherapy is a vital part of bipolar disorder treatment and can be provided in individual, family, or group settings. Several types of therapy may be helpful. These include:

 

Interpersonal and social rhythm therapy (IPSRT). IPSRT focuses on the stabilization of daily rhythms, such as sleeping, waking and mealtimes. A consistent routine allows for better mood management. People with bipolar disorder may benefit from establishing a daily routine for sleep, diet, and exercise.

Cognitive behavioral therapy (CBT). The focus is identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. CBT can help identify what triggers your bipolar episodes. You also learn effective strategies to manage stress and to cope with upsetting situations.

Psychoeducation. Learning about bipolar disorder (psychoeducation) can help you and your loved ones understand the condition. Knowing what is going on can help you get the best support, identify issues, plan to prevent relapse and stick with treatment.

Family-focused therapy. Family support and communication can help you stick with your treatment plan and help you and your loved ones recognize and manage warning signs of mood swings.

Other treatment options

Depending on your needs, other treatments may be added to your bi-polar therapy.

 

During electroconvulsive therapy (ECT), electrical currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can reverse symptoms of certain mental illnesses. ECT may be an option for bipolar treatment if you do not get better with medications, cannot take antidepressants for health reasons such as pregnancy or are at elevated risk of suicide.

 

Transcranial magnetic stimulation (TMS) is being investigated as an option for those who have not responded to antidepressants.

 

Treatment in children and teenagers

Treatments for children and teenagers are decided on a case-by-case basis, depending on symptoms, medication side effects and other factors. Treatment includes:

 

Medications. Children and teens with bipolar disorder are often prescribed the same types of medications as those used in adults. There is less research on the safety and effectiveness of bipolar medications in children than in adults, so treatment decisions are often based on adult research.

Psychotherapy. Initial and long-term therapy can help keep symptoms from returning. Psychotherapy can help children and teens manage their routines, develop coping skills, address learning difficulties, resolve social problems, and help strengthen family bonds and communication. And, if needed, it can help treat substance abuse problems common in older children and teens with bipolar disorder.

Psychoeducation. Psychoeducation can include learning the symptoms of bipolar disorder and how they differ from behavior related to your child's developmental age, the situation and appropriate cultural behavior. Understanding about bipolar disorder can also help you support your child.

Support. Collaborating with teachers and school counselors and encouraging support from family and friends can help identify services and encourage success.

 

 

 

Jan Ricks Jennings, MHA, LFACHE

Senior Consultant

Senior Management Resources, LLC

Jan.Jennings@EagleTalons.net

JanJenningsBlog.Blogspot.com

724.733.0509 Office

412.913.0636 Cell

December 10, 2021