What Are The Long
Bipolar disorder is a life-long and often recurring illness. You may need long term support to help manage your condition.
What medication options are there?
Your doctor will look at what medication worked for you during episodes of mania or depression. They should ask you whether you want to continue this treatment or if you want to change to lithium.
Lithium usually works better than other types of medication for long-term treatment. Your doctor should give you information about how to take lithium safely. If lithium doesn’t work well enough or causes you problems, you may be offered:
- Valproate,
- Olanzapine, or
- Quetiapine.
Your doctor should monitor your health. Physical health checks should be done at least once a year. These checks will include:
- measuring your weight,
- checking your liver and heart, and
- checking your pulse and blood pressure.
What psychological treatments are recommended?
You should be offered a psychological therapy that is specially designed for bipolar disorder. You could have individual or group therapy.
The aim of your therapy is to stop you from becoming unwell again. This is known as relapse. Your therapy should help you to:
If you live with your family or are in close contact with them, you should also be offered family intervention.
Family intervention is where you and your family work with mental health professionals to help to manage relationships. This should be offered to people who you live with or who you are in close contact with.
I Know Someone Who Is In Crisis What Do I Do
If you know someone who might be thinking about hurting themselves or someone else, get help quickly.
- Do not leave the person alone.
- Call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK or the toll-free TTY number at 1-800-799-4TTY . You also can text the Crisis Text Line or go to the National Suicide Prevention Lifeline website.
Types Of Bipolar Disorder
There are three basic types of bipolar disorder all of them involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely up, elated, and energized behavior or increased activity levels to very sad, down, hopeless, or low activity-level periods . People with bipolar disorder also may have a normal mood alternating with depression. Four or more episodes of mania or depression in a year are termed rapid cycling.
- Bipolar I Disorder is defined by manic episodes that last at least seven days or when manic symptoms are so severe that hospital care is needed. Usually, separate depressive episodes occur as well, typically lasting at least two weeks. Episodes of mood disturbance with mixed features are also possible.
- Bipolar II Disorder is defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes described above.
- Cyclothymic Disorder is defined by persistent hypomanic and depressive symptoms that are not intense enough or do not last long enough to qualify as hypomanic or depressive episodes. The symptoms usually occur for at least two years in adults and for one year in children and teenagers.
- Other Specified and Unspecified Bipolar and Related Disorders is a category that refers to bipolar disorder symptoms that do not match any of the recognized categories.
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Bipolar Treatment Risks Around Pregnancy
Bipolar disorder itself does not appear to affect the safety of a pregnancy. However, some treatments can pose a risk to the unborn or breastfeeding baby. On the other hand, stopping treatment may increase the risk to the pregnant person.
In some cases, medications can worsen or trigger symptoms of bipolar disorder. For example, treating postpartum depression with antidepressants may increase the risk of psychosis, mania, and rapid cycling. In people with a family history of bipolar disorder, it may trigger the first symptoms.
It is crucial for a person and their doctor to weigh the risk of symptoms with the risk of adverse effects when developing a treatment plan. This may change before, during, and after pregnancy. For a person with severe symptoms, a doctor may recommend ECT, but experts recommend this only as a last resort.
Anyone with bipolar disorder who is considering pregnancy or pregnant should speak with their healthcare team, especially if bipolar symptoms are present.
Manic & Hypomanic Episode Symptoms
Both manic and hypomanic episodes include three or more of the below symptoms:
- Talking much more than usual
- Racing thoughts
- Feeling the need for less sleep
- Feeling abnormally upbeat, jumpy or wired
- Increased activity levels, energy or agitation
- Inflated sense of well-being and self-confidence
- Poor decision-making and increased impulsive behavior
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Manic And Hypomanic Episodes
Manic and hypomanic episodes share largely the same symptoms, even though they differ in severity. The symptoms include:
- Exaggerated self-esteem or grandiosity
- Difficulty concentrating, remembering, or making decisions
- Frequent thoughts of death or suicide
The severity, duration, and disabling nature of depressive episodes vary from episode to episode and from person to person. Researchers say some people have only one or two episodes during their lifetimes, many have frequent recurrences, and still others will experience less severe but chronic depressive symptoms.
Can Children And Teens With Bipolar Disorder Have Other Problems
Young people with bipolar disorder can have several problems at the same time. These include:
- Misuse of alcohol and drugs. Young people with bipolar disorder are at risk of misusing alcohol or drugs.
- Attention-deficit/hyperactivity disorder . Children and teens who have both bipolar disorder and ADHD may have trouble staying focused.
- Anxiety disorders. Children and teens with bipolar disorder also may have an anxiety disorder.
Sometimes extreme behaviors go along with mood episodes. During manic episodes, young people with bipolar disorder may take extreme risks that they wouldnt usually take or that could cause them harm or injury. During depressive episodes, some young people with bipolar disorder may think about running away from home or have thoughts of suicide.
If your child shows signs of suicidal thinking, take these signs seriously and call your childs health care provider.
If you think your child is in crisis and needs immediate help, call 911. You also can call the National Suicide Prevention Lifeline at 1800273TALK , or text the Crisis Text Line . These services are confidential, free, and available 24/7.
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What Are The Treatments For Cyclothymia
Cyclothymia frequently goes undiagnosed and untreated. Most people’s symptoms are mild enough that they do not seek mental health treatment. In fact, some people resist the idea of treatment, which reduces their “up” episodes as well as “down.”
The depressive symptoms of cyclothymic disorder are typically more frequent, unpleasant, and disabling than the hypomanic symptoms. Feelings of depression or instability are usually what cause people with cyclothymia to seek help.
No medicines are specifically approved for the treatment of cyclothymia, although mood stabilizers such as lithium or lamotrigine are sometimes recommended as a possible strategy to reduce mood fluctuations. Antidepressants such Prozac, Paxil, or Zoloft are generally not recommended unless someone develops a full major depression, which, by definition, does not occur in cyclothymic disorder. There is also a small risk that antidepressants could trigger or worsen mania symptoms in a subgroup of vulnerable people. Antidepressants alone also are not known to improve fluctuations in mood, which are hallmark characteristics of cyclothymic disorder.
Technically speaking, when elevated or depressed moods become severe, a person no longer has cyclothymia, but rather has bipolar disorder. This progression to more severe symptoms can happen, and this is when many people first receive treatment.
Bipolar Disorder And Suicide
The depressive phase of bipolar disorder is often very severe, and suicide is a major risk factor. In fact, people suffering from bipolar disorder are more likely to attempt suicide than those suffering from regular depression. Furthermore, their suicide attempts tend to be more lethal.
The risk of suicide is even higher in people with bipolar disorder who have frequent depressive episodes, mixed episodes, a history of alcohol or drug abuse, a family history of suicide, or an early onset of the disease.
Suicide warning signs include:
- Talking about death, self-harm, or suicide.
- Feeling hopeless or helpless.
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Can People Tell They Are Bipolar
People can often tell that something is wrong , but may not always be able to accurately label it as bipolar. For example, it is frequently easy for people to know when they are depressed, but sometimes symptoms of mania go unnoticed, or feel good, so they are not as easily seen as an issue, says Simon A. Rego, PsyD, Chief Psychologist at Montefiore Medical Center and Associate Professor of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine in New York City.
What Are The Signs And Symptoms
A person with bipolar disorder will go through episodes of mania and at other times experience episodes of depression . These aren’t the normal periods of happiness and sadness that everyone experiences from time to time. Instead, the episodes are intense or severe mood swings, like a pendulum that keeps arcing higher and higher.
Symptoms of mania include:
- anger, worry, and anxiety
- thoughts of death or suicide
In adults, episodes of mania or depression usually last for weeks or months, although they can be shorter in length. In children and adolescents, though, these episodes can be much shorter, and a kid or teen can even go back and forth between mania and depression throughout the day.
Episodes of mania or depression may happen irregularly and follow an unpredictable pattern or they may be linked, with a manic episode always following a period of depression, or vice versa. Sometimes episodes have a seasonal pattern. Mania in the spring, for example, may be followed by depression in the winter.
Between episodes, someone with bipolar disorder usually returns to normal functioning. For some people, though, there is little or no “break period” between their cycles. These mood swing cycles can change slowly or rapidly, with rapid cycling between mania and depression being much more common in women, children, and adolescents.
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What Are The Types Of Bipolar Disorder
There are three main types of bipolar disorder:
- Bipolar I disorder involves manic episodes that last at least 7 days or manic symptoms so severe that you need immediate hospital care. Depressive episodes are also common. Those often last at least two weeks. This type of bipolar disorder can also involve mixed episodes.
- Bipolar II disorder involves depressive episodes. But instead of full-blown manic episodes, there are episodes of hypomania. Hypomania is a less severe version of mania.
- Cyclothymic disorder, or cyclothymia, also involves hypomanic and depressive symptoms. But they are not as intense or as long-lasting as hypomanic or depressive episodes. The symptoms usually last for at least two years in adults and for one year in children and teenagers.
With any of these types, having four or more episodes of mania or depression in a year is called “rapid cycling.”
Causes Of Bipolar Disorder
The exact cause of Bipolar Disorders is not precisely understood. It seems to be a combination of 3 things:
1. Genetics.
2. Chemical imbalances in the brain.
3. Stress and triggering events that somehow activate an inherited or genetic predisposition to the disorder.
When you go for an assessment, just like with any other illness, you will be asked about family history. A close relative such as a parent with suspected or diagnosed bipolar disorder greatly increases the likelihood other family members also having the illness.
So far, there does not seem to be any way to prevent the illness, but you can prevent some episodes of mania or depression once a doctor establishes that you do in fact have Bipolar I Disorder.
Bipolar I almost always requires the person to take medication for effective management. Dont worry stability and sanity is SO worth it!3
The key factor is stabilization. Regular therapy, a healthy diet, exercise and MOST OF ALL mood stabilizing medications such as lithium can greatly reduce the frequency and severity of Bipolar I episodes.
References:
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What Are The Treatments For Bipolar Disorder
Treatment can help many people, including those with the most severe forms of bipolar disorder. The main treatments for bipolar disorder include medicines, psychotherapy, or both:
Bipolar disorder is a lifelong illness. But long-term, ongoing treatment can help manage your symptoms and enable you to live a healthy, successful life.
NIH: National Institute of Mental Health
Beyond Treatment: Things You Can Do
Regular Exercise: Regular aerobic exercise, such as jogging, brisk walking, swimming, or bicycling, helps with depression and anxiety, promotes better sleep, and is healthy for your heart and brain. There is also some evidence that anaerobic exercise such as weightlifting, yoga, and Pilates can be helpful. Check with your health care provider before you start a new exercise regimen.
Keeping a Life Chart: Even with proper treatment, mood changes can occur. Treatment is more effective when a patient and health care provider work together and talk openly about concerns and choices. Keeping a life chart that records daily mood symptoms, treatments, sleep patterns, and life events can help patients and health care providers track and treat bipolar disorder over time. Patients can easily share data collected via smartphone apps including self-reports, self- ratings, and activity data with their health care providers and therapists.
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What Are The Complications Of Cyclothymia
Cyclothymia disrupts a persons ability to build and maintain positive relationships. Irritability and emotional reactions have a negative effect in being able to develop successful relationships with family, friends, coworkers, and romantic partners. However, unlike the wide swings seen in bipolar disorder, patients with cyclothymia may have fewer hospitalizations, fewer days away from work, and may be able to function more consistently.
What Is The Treatment For Mania Hypomania And Depression
You can check what treatment and care is recommended for bipolar disorders on the National Institute for Health and Care Excellence website.
NICE produce guidelines for how health professionals should treat certain conditions. You can download these from their website at:
The NHS doesnt have to follow these recommendations. But they should have a good reason for not following them.
What medications are recommended?
Mood stabilisers are usually used to manage mania, hypomania and depressive symptoms.
The mood stabilisers we talk about in this factsheet are:
- Lithium
- Certain benzodiazepine medication
Mania and hypomaniaYou should be offered a mood stabiliser to help manage your mania or hypomania. Your doctor may refer to your medication as antimanic medication.
If you are taking antidepressants your doctor may advise you to withdraw from taking them.
You will usually be offered an antipsychotic first. The common antipsychotics used for the treatment of bipolar disorder are:
- Haloperidol
- Quetiapine
- Risperidone
If the first antipsychotic you are given doesnt work, then you should be offered a different antipsychotic medication from the list above.
If a different antipsychotic doesnt work, then you may be offered lithium to take alongside it. If the lithium doesnt work you may be offered sodium valproate to take with an antipsychotic. Sodium valproate is an anticonvulsive medication.
Sodium Valproate shouldnt be given to girls or young women who might want to get pregnant.
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Major Depressive Episode Symptoms
The third symptom of bipolar disorder is depression, which can severely impact a persons daily life. A person is experiencing a major depressive episode if they are experiencing five or more of the following symptoms:
- Severe loss of interest or feeling no pleasure in normal activities
- Noticeable weight loss when not trying to lose weight, weight gain, or changes in appetite
- Feeling sad, empty, hopeless, or teary all the time. In children/teens, this depressed mood can present as irritability
- Sleeping too much or not being able to sleep, as with insomnia
- Having less energy or always feeling tired
- Feeling worthless or overly guilty
- Struggling to concentrate or make decisions
- Feeling suicidal or having suicidal thoughts
Are you in a crisis?
While bipolar disorder can cause a person to feel depressed, this condition is not the same as getting diagnosed with depression. Bipolar disorder is marked by periods of two extremes: Mania or hypomania, the up, and major depressive episodes, the down. In contrast, depression causes moods and emotions that are always down without any moments of high energy.
Bipolar Disorder In Teens
Due to hormonal changes that occur during adolescence, mood swings are common among most teenagers. Sometimes, however, these changes in mood may reflect a more serious mental condition. Here are symptoms of a manic episode in teens:
- Acting overly happy
Here are the symptoms of a depressive episode in teens:
- Feeling down and hopeless
- Withdrawing from people and social activities
- Having suicidal thoughts
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What Are The Causes And Risk Factors
Like most mental health disorders, the exact cause of cyclothymia is unknown. However, the genetic component of cyclothymia is strong. For cyclothymia, major depression, and bipolar mood disorders, a family history indicates a greater risk of development. Twin studies suggest that the risk of developing cyclothymia is 2-3 times more likely if an identical twin is diagnosed with the disorder, pointing to the strong genetic component of the mood disorder.
Environmental factors are also a likely contributing factor to being diagnosed with cyclothymia. As with bipolar disorder and major depression, certain life events may increase your chances of developing cyclothymia. These include things like physical or sexual abuse or other traumatic experiences and prolonged periods of stress.
What If Im Not Happy With My Treatment
If you arent happy with your treatment you can:
- talk to your doctor about your treatment options,
- ask for a second opinion,
- get an advocate to help you speak to your doctor,
- contact Patient Advice and Liaison Service , or
- make a complaint.
There is more information about these options below.
How can I speak to my doctor about my treatment options?
You can speak to your doctor about your treatment. Explain why you arent happy with it. You could ask what other treatments you could try.
Tell your doctor if there is a type of treatment that you would like to try. Doctors should listen to your preference. If you arent given this treatment, ask your doctor to explain why it isnt suitable for you.
Whats a second opinion?
A second opinion means that you would like a different doctor to give their opinion about what treatment you should have. You can also ask for a second opinion if you disagree with your diagnosis.
You dont have a right to a second opinion. But your doctor should listen to your reason for wanting a second opinion.
What is advocacy?
An advocate is independent from the mental health service. They are free to use. They can be useful if you find it difficult to get your views heard.
There are different types of advocates available. Community advocates can support you to get a health professional to listen to your concerns. And help you to get the treatment that you would like. NHS complaints advocates can help you if you want to complain about the NHS.
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