“My recovery from manic depression has been an evolution, not a sudden miracle.” – Patty Duke

In Part 1 of this two-part series the reader was presented with an overview of bipolar disorder, its various subtypes and occurrence, and its wide-ranging patterns and symptoms.

To briefly review, bipolar disorder, also known as bipolar affective disorder or manic-depressive disorder, is a condition in which people experience mood swings ranging from the low and sense of hopelessness of depression to the euphoria and energized feeling of mania or hypomania.  These shifts in mood can occur rather infrequently, only a few times a year, or as rapidly as a few times a day.  In some cases individuals can experience both the mania and depression at the same time.  The symptoms of bipolar disorder are often quite severe and are very different from the normal ups and downs that we all experience from time to time.  Although far too many people suffer for years before being accurately diagnosed, bipolar disorder can be very effectively treated, thereby dramatically reducing the frequency and severity of episodes, and allowing those suffering from it to lead wonderfully full and productive lives.

Although the exact cause of bipolar disorder remains a mystery most researchers agree that there is no single cause. Rather, many factors likely act together to produce the illness or increase risk.  There are actual biological differences in the brains of individuals who suffer from bipolar disorder.  An imbalance in neurotransmitters (naturally occurring brain chemicals) seems to play a major role in bipolar disorder.  Although science and medicine are still uncertain as to the significance of these differences it is hoped that continued research will assist in ultimately identifying the cause.  In some, hormone imbalances may be a factor, while in others it may be more environmental.  Traumatic experiences such as abuse, significant loss or major life changes may well play a role in “unmasking” bipolar disorder.  Getting enough sleep is extremely important in bipolar disorder as a lack of sleep can trigger a manic episode. We are aware that bipolar disorder is significantly more common in people who have parents or siblings (or other close blood relatives) with the disorder.  Children with a parent or sibling with bipolar disorder are four-to-six times more likely to develop the illness as compared to children who do not have a family history for it.  As such, research continues to try and identify the gene(s) that may increase an individual’s likelihood of developing bipolar disorder.  However, to be clear, most children with a family history of bipolar disorder will not go on to develop it.

There are other conditions that are commonly found in association with bipolar disorder.  It is vitally important that co-morbid conditions be accurately diagnosed and treated, as they may otherwise worsen the existing bipolar disorder.

• Substance abuse/addiction:  Although drugs and/or alcohol may appear to lessen the symptoms, they can actually trigger, prolong or exacerbate both the mania and depression.
• Anxiety disorders:  These include generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), and social phobia.
• Attention-deficit hyperactivity disorder (ADHD):  ADHD and bipolar disorder share many symptoms in common.  As such, it can be very difficult for a clinician to differentiate between the two.  In some cases, a person may be accurately diagnosed with both.
• Physical health problems:  Individuals with bipolar disorder are much more likely to have certain other physical medical conditions including thyroid problems, heart disease, and obesity.

Left untreated bipolar disorder can lead to serious problems negatively affecting every part of a person’s life.

• Frequent absences and poor performance at work/school
• Relationship difficulties
• Isolation
• Legal and financial problems
• Alcohol and drug abuse/addiction
• Suicide

Although there is no cure for bipolar disorder proper treatment helps most people gain good control of their mood swings and other related symptoms.  In the vast majority of cases it can be very effectively treated with medication and psychotherapy.  This is true for even the most severe cases.  Because bipolar disorder is a long-term recurring disorder it is necessary for afflicted individuals maintain treatment over the long run.  Doing so can prevent relapse and significantly reduce the severity of symptoms.

The class of medications known as “mood stabilizers” is typically utilized as the first line of treatment.  These include such medications as:  carbamazepine, lamotrigine, valproic acid, and lithium.  Other anticonvulsants can also be used.  Other types of medications such as anti-anxiety and antipsychotic drugs can be effective in controlling the associated anxiety, mood instability, and, in severe cases, psychosis.  Antidepressant medications are often added to treat depression, but in general should only be used in patients already taking a mood stabilizer in order to protect against it actually causing a manic or hypomanic episode.

Mood-stabilizing medication can be highly effective in treating the symptoms of bipolar disorder.  However, patients often need help and support to take their medicine properly.  Many stop taking the medication as soon as they feel better, or because the euphoria of mania feels good and they miss it.  However, stopping medication can cause serious problems and make future treatment more challenging.

Non-medication medical interventions such as transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT) may be used in stubbornly refractive cases of bipolar disorder that do not respond to numerous medication trials.  ECT uses an electrical current and TMS uses high-frequency magnetic pulsations to target the affected areas of the brain.  TMS is typically only utilized if ECT is proven to be ineffective.

No matter which specific medical treatment interventions are attempted, oftentimes patients in the midst of a manic or depressive episode may need to be hospitalized for their own safety until their mood and behaviors stabilize.

In addition to medication or other specific medical interventions, psychotherapy has been shown to be highly effective in treating bipolar disorder.  It provides guidance, education and support of those afflicted by the disorder and their families.  Some of the types of psychotherapy that have been shown to be effective in treating bipolar disorder include:

• Cognitive behavior therapy (CBT) which helps patients learn to alter negative harmful thought patterns and behaviors.
• Interpersonal therapy assists patients in improving their relationships with others and more effectively manage their daily routines.  Consistent daily routines and sleep schedules have been shown to help guard against the triggering of manic episodes.
• Psycho-educational therapy teaches patients about their illness and treatment.  By doing so, patients are more able to recognize signs of relapse and in doing so helps facilitate earlier treatment before a full-blown episode occurs.  As this form of therapy is most often done in a group setting, it is also very helpful in providing family members and friends the opportunity to learn more about the disorder.
• Family therapy helps improve family coping strategies by improving awareness, communication and problem-solving.

Psychotherapists (psychologists, MFTs, and social workers) are trained to provide these types of therapies, and should work closely in consultation with the medication prescribing psychiatrist in order to effectively monitor the patient’s progress.  Typically, the type of intervention and frequency of sessions is based upon the specific treatment needs of each individual.

The largest clinical treatment study for bipolar disorder ever undertaken and funded by the National Institute of Mental Health (NIMH), called the Systematic Treatment Enhancement Program for Bipolar Disorder, was recently completed.  Researchers compared two groups of patients suffering from bipolar disorder.  The first was treated with medication and intensive psychotherapy (thirty sessions over a nine month period), and the second with just collaborative care (three psycho-education sessions over a six week period).  They found that the first group had lower hospitalization rates, fewer relapses, and markedly better treatment compliance.  They were also more likely to get through their bipolar episode more quickly and remain well longer.

As with other mental health disorders early diagnosis, appropriate referral and effective treatment intervention are essential in addressing the immediate and long term challenges of bipolar disorder.  As previously noted, if not adequately treated the symptoms of bipolar disorder tend to worsen over time making it vitally important to seek appropriate mental health treatment as soon as possible following the appearance of symptoms.

So, if you believe a friend or loved one may be afflicted with bipolar disorder, encourage them to seek appropriate psychiatric treatment.  There are many highly qualified and capable psychiatrists, psychologists, and therapists throughout the Tri-Counties area that can effectively assist those suffering from this potentially life-threatening and devastating disorder.