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Bipolar Disorder

Bipolar Information

Feeling sad or down doesn't always mean you have a depressive disorder. For those who have times where they feel sad or low and then can swing to feeling really high or good, the problem could be bipolar disorder. This is a relatively uncommon disorder affecting about 2.8% of the population but is often mischaracterized as depression or anxiety for many year prior to diagnosis. This is because of many similarities between the disorders such as feeling sad and having racing thoughts. 

For those with bipolar disorder, which is often also called manic-depressive disorder, the difference is in how many symptoms of highs and lows one has, how long it lasts, and what kind of problems it creates. There are several classifications for bipolar disorder and are mainly broken up into categories based on how long symptoms last and how severe the symptoms are. Because there are notable swings to mood and energy, these symptoms are broken up into "highs" and "lows". 

  • Bipolar I Disorder — is defined by the diagnostic and statistical manual of mental health (DSM-V) with "highs" that last at least 7 days and is characterized as needing an elevated or irritable mood with at least 3 symptoms of: grandiosity, decreased sleep, racing thoughts, pressured speech, poor focus/attention, increased goals, seeking pleasurable activity despite risk, and cause significant problems in normal functioning.  Depressive episodes will also typically occur for type I bipolar disorder but not not necessary for the diagnosis. It cannot be caused by another medical illness.

  • Mixed Bipolar Disorder - is defined as depressive and manic symptoms at the same time.

  • Bipolar II Disorder — is defined by the diagnostic and statistical manual of mental health (DSM-V) with "highs" that last at least 4 days (but less than 7 days) and is characterized as needing an elevated or irritable mood with at least 3 symptoms of: grandiosity, decreased sleep, racing thoughts, pressured speech, poor focus/attention, increased goals, seeking pleasurable activity despite risk, and cause significant problems in normal functioning. It cannot be caused by another medical illness or drugs such antidepressants.

  • Cyclothymia — is defined by the diagnostic and statistical manual of mental health (DSM-V) with hypomanic and depressive symptoms lasting at least 2 years for adults and 1 year in children and adolescents. Symptoms do not meet criteria for bipolar II and cannot be caused by another medical illness or drugs such antidepressants.

Bipolar Treatment

Treatment for bipolar symptoms typically involves medications, education, and development of skills to help with symptoms of mania ("highs") and depression ("lows"). Providers often involved in the treatment of bipolar disorder are mental health providers such as physician assistants, nurse practitioners, psychiatrists, and mental health therapists. 

Mood Stabilizers and Antipsychotic Medications

  • Lithium. This drug helps bipolar disorder due to reducing dopamine and glutamate neurotransmission while increasing  inhibitory (GABA) neurotransmission. FDA approved for mania and maintenance therapy.

  • Valproic Acid. This drug helps bipolar disorder due to increasing  inhibitory (GABA) neurotransmission. FDA approved for mania. Typical brand names for valproic acid include Depakote.

  • Carbamazepine. This drug helps bipolar disorder by inhibiting voltage-gated sodium channels and effecting GABA receptors. FDA approved for mania. Typical brand names for carbamazepine include Tegretol.

  • Lamotrigine. FDA approved for prophylaxis against Bipolar I disorder. Typical brand names for lamotrigine include Lamictal.

  • Olanzapine. This class of drugs help bipolar disorder due to their high affinity as antagonists for dopamine D2 receptors. FDA-approved for acute mania maintenance monotherapy in Bipolar I. Typical brand names for olanzapine include Zyprexa.

  • Aripipraizole. This class of drugs help bipolar disorder due to their high affinity as antagonists for dopamine D2 receptors. FDA-approved for acute mania and maintenance monotherapy in Bipolar I. Typical brand names for aripiprazole include Abilify.

  • Chlorpromazine. This class of drugs help bipolar disorder due to their high affinity as antagonists for dopamine D2 receptors. FDA-approved for acute mania.. Typical brand names for chlorpromazine include Clozaril.

  • Risperidone. This class of drugs help bipolar disorder due to their high affinity as antagonists for dopamine D2 receptors. FDA-approved for acute mania. Typical brand names for risperidone include Risperdol.

  • Quetiapine.This class of drugs help bipolar disorder due to their high affinity as antagonists for dopamine D2 receptors.  FDA-approved for acute mania, bipolar depression, and maintenance therapy adjunctive to lithium or divalproex. Typical brand names for quetiapine include Seroquel

  • Ziprasidone. This class of drugs help bipolar disorder due to their high affinity as antagonists for dopamine D2 receptors. FDA-approved for acute mania. Typical brand names for Ziprasidone include Geodon.

Therapy

 

Counseling therapy can help improve bipolar symptoms by helping you develop skills to more effectively deal with the thoughts and feelings you are having. These therapies consist of:

  • Cognitive behavioral therapy. This type of therapy will help you cope better with symptoms by teaching skills specific to management of organization, patterns of thinking, and behavioral patterns. 

  • Family therapy. Because many people with bipolar disorder encounter loved ones, family members, and spouses who are unfamiliar with this disorder, this therapy can help them overcome the stress associated with living with someone who struggles with bipolar symptoms. 

  • Music therapy. This therapy utilizes music to help relax an individual to enhance their mood. Music therapy activates  cognitive, motor, and speech centers in the brain to help improve overall functioning.

  • Talk therapy. This type of therapy employs a variety of techniques to help a person better deal with thoughts and behaviors.

  • Interpersonal therapy. IPT is a type of therapy that focus on personal relationships and how you feel. It is a short-term, intensive therapy.

  • Integrative therapy. This therapy approach takes aspects from different therapy types to create a personal therapy to best treat the presenting problem.

Treatment Resistant Modalities

 

If you go through therapy and several medications without significant improvement of your symptoms related to your bipolar disorder, your provider may suggest treatments reserved for people who don’t respond to traditional approaches. The good news is that most people will respond positively with medication and counseling therapy management. Treatment of depression in people that don’t respond to traditional methods  include:

 

  • Electroconvulsive therapy (ECT)

  • Trans Magnetic Stimulation (TMS)

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