Bipolar Disorder Therapy – In-depth Facts, Treatment

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Portraits of Bipolar Disorder

Megan is feeling much better. Things were a little rough there for a while after her fiancé ended the relationship and moved to another city. Her often-reckless behavior led her fiancé to distrust her, and that distrust grew into uncertainty.

She’s been single for almost a year, and is beginning to believe that anything is possible. She’s reading three books, on topics ranging from fashion to philosophy, and notes how she’s similar to both Aristotle and Lauren Conrad. She’s fervently working on her own novel, is hardly sleeping and talks a mile per minute. Her friends are getting concerned, but she feels great. She’s even started playing keyboard in a friend’s band, despite the fact that she’s only just picked up the instrument. She still has her full-time job at the jewelry boutique downtown, but her time there feels muted, by comparison, to her nights playing music and partying with her friends into the early morning.

Without understanding why, David has been having a hard time focusing at work. He started working as the eBay sales manager for the pawnshop across town under the promise of making great money, if he worked hard at it, and he out performed his predecessor by a wide margin. For a time, he seemed unstoppable; he felt like he was on cloud nine.

But that was a while ago. Following the immediate success of his first 6 months of breaking the shop’s previous online sales records, he’s found it nearly impossible to reclaim that same frenetic energy that prompted his boss to give him a sizeable bonus.

To add to his misery, he accrued a few thousand dollars in credit card debt from purchases made during his sales streak, assuming that he would continue the trend and have ample funds to pay off his impulse buys: a 4K television screen, a brand new MacBook Pro and an expensive road bicycle he never rides, to name a few. His boss is unhappy, which only serves to further demotivate him and fuel feelings of worthlessness.

Diagnosing Bipolar I and II — Signs and Symptoms

Something about the way the term “bipolar disorder” rolls off the tongue makes it sound pretty scary.

For those with bipolar disorder, the episodes can in fact be very scary, as the symptoms are known to disrupt normal social and professional functioning, but something far scarier than simply being bipolar is experiencing its effects without experiencing the relief that comes through understanding and treating the disorder.

Bipolar disorder, sometimes referred to as “manic depression,” involves abrupt changes in mood, from “normal” to “intense” states of depression and mania (or hypomania, which is like mania but not quite as intense). While the same diagnostic criteria for a major depressive episode (MDE) must be met in order for someone to be bipolar, the reciprocal presence of manic and/or hypomanic episodes sets bipolar disorder apart from major depressive disorder.

And while a person with bipolar I disorder might experience mania and hypomania (in addition to major depression), someone with bipolar II will only have hypomanic episodes. In other words, if someone with bipolar II experiences a manic episode, they would then be diagnosed as bipolar I and, therefore, can no longer be classified as bipolar II.

This will all be a little more clear once you continue to the next section, where we get more detailed about the specific qualifiers for a major depressive episode (which you can read by clicking here) and manic and hypomanic episodes.

Manic Episode

According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), an individual must have experienced at least one manic episode in his or her lifetime in order to be diagnosed with bipolar I.’’

A manic episode is a distinct period in which the individual feels euphoric — perhaps even high — and “on top of the world.” The world and all of its endless possibilities feel, somehow, possible and enduringly pleasurable.

In the diagnostic criteria listed below, the DSM-5 says this mood must be present for most of the day, almost every day for a period or at least one week, with at least three additional symptoms from Criterion B (at least four if the mood is irritable instead of euphoric).

Someone experiencing a manic episode can seem to have limitless energy and enthusiasm, even to the level of it seeming excessive or out-of-place by observers. He or she might begin many new projects at once or take on a task that is entirely out of their capability or skillset, as a result of the inflated self-esteem that is often characteristic of the mania.

Rapid talking to the point that ideas come out mixed together or somehow unintelligible (like a keyed up Dean Moriarty in Jack Kerouac’s novel, On the Road), and the individual often behaves in an impulsive fashion, eschewing caution and concern for negative consequences.

This can lead someone with bipolar I to engage in:

  • sexual indiscretions,
  • shopping sprees,
  • ill-conceived investments or
  • even life-threatening activities,

and often coincides with substance abuse (as is the case with Megan in the above portrait).

Given the heightened sense of self-worth, someone going through a manic episode may not even realize there is a problem — they might even believe that things are better than ever, and trying to shake them from that notion could turn that characteristic loss of insight, poor judgment and hyperactivity to anger or depression.

The DSM-5 defines a manic episode by the following criteria:

A. A distinct period of abnormally and persistently elevated, expansive or irritable mood

      and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 and present most of the day, nearly every day (or any duration, if hospitalization is necessary).

B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior:

  1. Inflated self-esteem or grandiosity.
  2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
  3. More talkative than usual or pressure to keep talking.
  4. Flight of ideas or subjective experience that thoughts are racing.
  5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
  6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-diected activity).
  7. Excessive Involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions or foolish business investments).
  8. C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

    D. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or to another medical condition. Note: A full manic episode that emerges during antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence for a manic episode and, therefore, a bipolar I diagnosis.

Hypomanic Episode

As stated earlier, hypomanic episodes are common but not required for a bipolar I diagnosis. Those with bipolar II, by definition, do not have manic episodes in addition to the major depressive episodes (MDEs) — only hypomanic episodes, which do not significantly impair an individual’s occupational or social function.

Since hypomania is less obviously impairing than mania, people with bipolar II disorder often don’t realize something is wrong (although others might recognize the erratic behavior) or seek help until they’re in the throes of a MDE.

Even through the hypomania may be less harmful than mania, bipolar II is not a milder form of bipolar I, since people with bipolar II tend to experience the depressive episodes for longer periods of time and/or more frequently than those with bipolar I, which can be very debilitating in personal and professional environments.

These extended periods of MDE are troubling, especially when the impulsive nature of the disorder is taken into account, since it can contribute to suicide attempts.

According to the DSM-5, the following criteria constitutes a hypomanic episode:

A. A distinct period of abnormally and persistently elevated, expansive or irritable mood

      and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day.

B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) have persisted, represent a noticeable change from usual behavior and have been present to a significant degree:

  1. Inflated self-esteem or grandiosity.
  2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
  3. More talkative than usual or pressure to keep talking.
  4. Flight of ideas or subjective experience that thoughts are racing.
  5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
  6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation.
  7. Excessive Involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions or foolish business investments).
  8. C. The episode is associated with an unequivocal change in function that is uncharacteristic of the individual when not symptomatic.

    D. The disturbance in mood and the change in functioning are observable by others.

    E. The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.

    F. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment). Note: A full hypomanic episode that emerges during antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence for a hypomanic episode diagnosis. However, caution is indicated so that one or two symptoms (particularly increased irritability, edginess or agitation following antidepressant use) are not taken as sufficient for diagnosis of a hypomanic episode, nor necessarily indicative of a bipolar diathesis (the tendency to suffer from a particular medical ailment).

Cyclothymic Disorder

With cyclothymic disorder, the individual experiences frequent and chronic mood changes similar to both hypomanic and major depressive episodes without fully qualifying for either.

In other words, cyclothymia is less severe than bipolar I and bipolar II disorder, so much so that someone with the disorder may never realize something is wrong despite the fact that their mood instability might be the cause of occupational or relational dysfunction.

If the shifts in mood characteristic of cyclothymic disorder being to meet the criteria for a hypomanic, manic or major depressive disorder, however, a person’s diagnosis will then be changed to either bipolar disorder I or II.

The DSM-5 defines cyclothymic disorder by the following diagnostic criteria:

A.

      For at least 2 years (at least 1 year in children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet the criteria for a major depressive episode.

B.

      During the above 2-year period (1 year in children and adolescents), the hypomanic and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than two months at a time.

C.

      Criteria for a major depressive, manic or hypomanic episode have never been met.

D.

      The symptoms in Criterion A are not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

E.

      The symptoms are not attributable to the psychological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hypethyroidism).

F.

    The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

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Causes of Bipolar Disorder

The average age for onset of bipolar I disorder is 18, and in the mid-20s for bipolar II. Since personal development varies from individual to individual, however, it’s difficult to define what “normal” is for one age over another. Some people don’t have their first manic, hypomanic or depressive episode until well into old age, while others can have their first onset occur during adolescence.

The causes, just like the age of onset, of bipolar disorders I and II can also vary.

Environmental: The DSM-5 states that the percentage of people in developed countries with bipolar disorder is essentially twice that of lower-income countries (1.4 vs. 0.7 percent, respectively). There are also links to marital status, though the nature of that connection remains unclear. A higher percentage of people who are widowed, separated or divorce have bipolar disorder than those who are currently — or have never been — married.

Genetic and physiological: You are about 10 times more likely to have bipolar I or bipolar II if someone in your family has the disorder, and the closer your connection to that relative, the more likely your chances of experiencing manic depression. There is also evidence that links bipolar disorder to schizophrenia.

Note: It’s possible that your medical doctor might not be able to distinguish between some of the issues you’re experiencing, specifically if they are causes of your mood issues or symptoms of either bipolar I or bipolar II disorder. It’s possible, for example, that a substance abuse problem or medical issue could be playing a major role in changes to your mood. In any event, it’s a good idea to report depressed feelings and out-of-the-norm euphoria to your medical doctor, as addressing any physical concerns will greatly support the counseling and therapy side of recovery and symptom management.

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Living with Bipolar Disorder: Treatment

If you are having a difficult time getting things done due to changes in your mood, it’s time to start a relationship with a licensed, professional counselor or therapist who can give you the attention and care you need.

Bipolar disorder is a lifelong issue that can’t ever be fully cured, but there are various forms of treatment that your counselor or therapist can employ, based on the severity of your symptoms.

Possible treatment methods include:

    • Talk Therapy

Speaking with a counselor or psychiatrist is one of the most important elements in your overall treatment of bipolar disorder. The sessions with your clinician will be the foundation from which the other aspects of your treatment will gain support and direction (click here to find a counselor in your area).

    • Education

Understanding what you’re going through by reading the above materials and by learning from your clinician goes a long way toward managing your symptoms. If you can identify what you’re going through, you’ll better be able to determine warning signs for the onset of an episode (while knowing what to do to help prevent them). If you can identify a particular experience as something to do with your disorder, you’ll be better equipped to know how to work through it in real-time.

    • Lifestyle changes

A counselor or therapist will help you determine habits (or the absence of habits) that could be contributing to your episodes. Avoiding substances and practices that take away from your overall health — like alcohol, tobacco, narcotics, stressful activity, lack of sleep, poor diet, little to know exercise — is an excellent step in the right direction.

    • Medication

Antidepressants, mood stabilizers and sleep medications can be used to help regulate the effects of bipolar disorder, minimizing the highs and lows to help you achieve a level of functional balance.

Continued treatment:
After a manic or depressive episode has subsided and the individual has returned to a more “normal” state, approximately 30 percent of individuals with bipolar I and 15 percent with bipolar II experience difficulty returning to their former levels of work performance.

This “functional recovery” in the workplace can take substantially longer than the recovery from other symptoms, which can lead to financial hardships and a lower socioeconomic status compared to others with the same level of education and experience.

Since bipolar disorder is a lifelong issue, it’s important to understand that your relationship with the disorder cannot be a passive one.

Continued treatment is essential to maintaining balance, even if you’ve gone an extended period of time without extreme symptoms.”

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Living with Bipolar Disorder: Action Items

If you (or someone you know) are struggling with bipolar disorder, there are many steps you can take right now to begin seeking relief.

1. Education
Yes, this is listed in the treatments above, and you can do this right now. Read the information on this page and do more self-directed research. While nothing can replace the one-on-one care of counseling therapy, taking the time to learn what bipolar disorder means, what it looks like and how it feels will help you identify symptoms in your own life. For many people, simply having a definition for what they’re experiencing is its own form of therapy.

2. Support:
Humans are social creatures, so providing support for someone with bipolar disorder or finding someone that can be that support for you is important. Simply sharing a painful experience with someone who has your best interest in mind means that they’ll listen to what you’re going through and offer help, not judgment.

3. Be active:
Whether it’s going out to a movie or dinner with someone who cares, taking a walk or starting a daily exercise routine can offer positive distractions from your troubles while also engaging more pleasure-oriented brain activity. Join a rock gym. Go ice skating. Start practicing yoga or take a pottery class. Let you mind relax, and simply exist in the present moment.

4. Dwell on hope, not despair:
You may feel like you’ve tried everything and that all is hopeless, but being intentional (whether self-directed or through the support of a friend) about identifying positive growth and opportunities for relief will greatly impact your overall feelings of self-worth and contentedness. Bipolar disorder is a clinical issue that might require the assistance of medication (treatment is different for everyone), but try to remain focused on the fact that help is out there and relief is possible.

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Care is Available Now

You’ve experienced the often-devastating effects of your mood shifts, and so have your loved ones. You don’t want to live this way. You don’t want to hurt yourself nor those around you, but you feel chained to the tides of bipolar disorder.

Even when things are normalized, you might not be quite up to the challenges each day presents. Your actions in a recent episode might be causing you grief or guilt. Your work performance or relationship success may be suffering.

But it’s OK. The past is the past, and you can’t change that. The future has yet to happen, and worrying about what “could be” is also wasted effort. Instead, create the future you want by deciding to invest in yourself in the present moment – THIS moment. Identify what is, and then take the necessary steps in every present moment toward getting you where you want to be: happy and fulfilled.

You don’t have to wait to get better.”

If you believe you are struggling with uncontrollable mood changes, click here to find a counselor in your area.