How Is Bipolar Disorder Treated
Treatment can help many people, including those with the most severe forms of bipolar disorder. An effective treatment plan usually includes a combination of the following therapies:
- Psychotherapy .
- Self-management strategies, like education and identifying the early symptoms of an episode or possible triggers of episodes.
- Helpful lifestyle habits, such as exercise, yoga and meditation. These can support, but not replace, treatment.
- Other therapies, such as electroconvulsive therapy in cases that are poorly responsive to medication or where rapid control of symptoms is necessary to prevent harm.
Bipolar disorder is a lifelong condition, so treatment is a lifelong commitment. It can sometimes take several months to years before you and your healthcare provider find a comprehensive treatment plan that works best for you. Although this can be discouraging, its important to continue treatment.
Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder dont have mood changes, but some people may have lingering symptoms. Long-term, continuous treatment can help manage these symptoms.
Again, even though it may be difficult to treat these conditions, its not impossible. Be sure to stay committed to finding a treatment plan that works for you.
Talking To A Health Care Provider About Your Mental Health
If you or someone you know is in immediate distress or is thinking about hurting themselves, call or text the 988 Suicide & Crisis Lifeline at 988 or chat at 988lifeline.org. You can also contact the Crisis Text Line . For medical emergencies, call 911.
Communicating well with a health care provider can improve your care and help you both make good choices about your health. Find tips to help prepare for and get the most out of your visit. For additional resources, including questions to ask a provider, visit the Agency for Healthcare Research and Quality website.
Historical Developments Regarding The Concept Of Mixed Phenomena
FIG. 1Diagnostic criteria for manic, depressive and mixed states according to DSM-5. As opposed to previous editions, in DSM-5 the specifier with mixed features is used for manic, hypomanic or depressive episodes in bipolar spectrum and major depressive disorders. The term mixed episode used in the context of bipolar disorder type I has been discontinued in DSM-5. BD: bipolar disorder, MDD: major depressive disorder, MDE: major depressive episode.
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What Bipolar Disorder Depression Feels Like
Hopelessness. Loss of interest and energy. Difficulty sleeping. Trouble concentrating. Weight changes. Suicidal thoughts. All phrases used in therapy while seeking help.
We strive to share insights based on diverse experiences without stigma or shame. This is a powerful voice.
Those are just some of the symptoms listed for a bipolar disorder depressive episode in the recent edition of the Diagnostic and Statistical Manual of Mental Disorders .
But this doesnt fully capture peoples experiences with bipolar disorder and depressive episodes. What do they actually feel like? How do people cope?
How Is A Bipolar Episode With Mixed Features Diagnosed
Diagnosing bipolar disorder can be difficult. There is no one test. Instead, a variety of tools are used. Once bipolar disorder is confirmed, the type of bipolar disorder will be determined, as well.
Bipolar disorder is diagnosed by a psychiatrist or another mental health professional. They will take a medical history and discuss symptoms. They may work with a primary care doctor to rule out any other conditions that could explain the behavior.
A bipolar episode with mixed features can be diagnosed, per the DSM-5, if:
- there are three or more manic or hypomanic symptoms during a major depressive episode
- there are three or more depressive symptoms during a manic or hypomanic episode
While there are noted risk factors for bipolar disorder and bipolar episodes, risk factors for episodes with mixed features are less clear.
and/or substance use disorders.
Psychotic features may also be more common in episodes with mixed features, so its important to treat symptoms of these episodes and work with your doctor to manage bipolar disorder.
Following a treatment plan and support when needed can help with managing bipolar disorder, reducing the frequency and severity of episodes, and improve daily life.
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Broadening Of The Concept Of Mixed States
Within the framework of DSM-5 the extension of the perception of mixed states implies that in an affective episode, clinicians are able to diagnose patients with only few concomitant symptoms of opposite mood polarity. Essentially, this shows that bipolar and MDD patients are more likely to be considered as having mixed episodes, and while this is the modern rendition of a century old idea espoused by Kraepelin, it has significant ramifications for the pathogenesis and treatment of these ailments. Approximately 40% of patients have mixed episodes, but this figure may be much higher within the context of DSM-5.5 For the improved management of these conditions, it is therefore necessary to cultivate a better understanding of the neurobiology and longitudinal course of mixed states.
Here Is How This Young Man Describes The Middle
This is what I imagine its like for everyone else you know, normal people. I wake up in the morning and I feel fine. I dont dread going about my day. I go to work, get things done, and have plenty of energy throughout the day.
I can roll with the punches the average day gives me. Im not freaking out over small problems, I enjoy the little things, and Im not loathing the future.
I feel normal and its how I see myself. Im not some lunatic running around or some mopey, lazy slug.
I honestly wish I could stay in this mindset all the time, but I know that wont happen. Ive accepted that my moods will change on their own, so I enjoy the calm more when its there.
Keep in mind that symptoms of bipolar disorder in children differ from symptoms in adults. Symptoms in children may include:
- a change in sleep pattern
These behaviors dont always point to bipolar disorder, but you should see a doctor if your childs moods become episodic and frequently shift between happiness and sadness.
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Why Is Bipolar Disorder No Longer Called Manic
In the last few decades, the medical world, especially the field of psychiatry, has intentionally made a shift from using manic-depressive illness or manic depression to describe bipolar disorder. There are several reasons for this shift, including:
- Healthcare providers used to use manic depression to describe a wide range of mental health conditions. As mental health condition classification systems, including the Diagnostic and Statistical Manual of Mental Disorders , have become more sophisticated, the new term bipolar disorder allows for more clarity in diagnosis.
- Theres a lot of stigma and negativity associated with the terms manic and mania, especially due to the use of maniac. Similarly, people use the term depression casually to describe periods of sadness that dont qualify as clinical depression. Using bipolar disorder takes the focus away from these two words. Bipolar disorder is more of a clinical, medical term and less emotionally loaded than manic depression.
- The term manic depression excludes the cyclothymic or hypomanic versions of the condition.
Who Does Bipolar Disorder Affect
Bipolar disorder can affect anyone. The average age of onset is 25 years, but, more rarely, it can start as early as early childhood or as late as in your 40s or 50s.
Although bipolar disorder affects people assigned female at birth and people assigned male at birth in equal numbers, the condition tends to affect them differently.
People AFAB with bipolar disorder may switch moods more quickly. When people with bipolar disorder experience four or more manic or depressive episodes in a year, this is called rapid cycling. Varying levels of sex hormones and thyroid hormones, together with the tendency for people AFAB to be prescribed antidepressants, may contribute to the more rapid cycling in this population.
People AFAB with bipolar disorder may also experience more periods of depression than people AMAB.
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What Medications Are Used To Treat Bipolar Disorder
Certain medications can help manage symptoms of bipolar disorder. You may need to try several different medications, with guidance from your healthcare provider, before finding what works best.
Medications healthcare providers generally prescribe to treat bipolar disorder include:
- Mood stabilizers.
- Second-generation neuroleptics .
- Antidepressants.
If youre taking medication for bipolar disorder, you should:
- Talk with your healthcare provider to understand the risks, side effects and benefits of the medication.
- Tell your healthcare provider about any prescription drugs, over-the-counter medications or supplements youre already taking.
- Tell your healthcare provider right away if youre experiencing concerning side effects. They may need to change your dose or try a different medication.
- Remember that medication for bipolar disorder must be taken consistently, as prescribed.
Mood stabilizers for bipolar disorder
People with bipolar disorder typically need mood-stabilizing medication to manage manic or hypomanic episodes.
Types of mood stabilizers and their brand names include:
Thyroid gland and kidney problems can sometimes develop when taking lithium, so your healthcare provider will monitor the function of your thyroid and kidneys, as well as monitor the levels of lithium in your blood, as levels can easily become too high.
The following are signs of lithium toxicity . Call your healthcare provider immediately or go to the nearest emergency room if you experience:
Information For Family Carers And Friends
How can I get support?
You can speak to your GP. You should be given your own assessment through NHS mental health services to work out what effect your caring role is having on your health. And what support you need. Such as practical support and emergency support.
These are some other options for you:
- Join a carers service
- Join a carers support group
- Ask your local authority for a carers assessment
- Read about the condition
- Apply for welfare benefits for carers
Rethink Mental Illness run carers support groups in some areas. You can also search for groups on the Carers Trust website:
- Rethink Mental Illness: www.rethink.org/about-us/our-support-groups
- Carers Trust: www.carers.org/search/network-partners
How can I support the person I care for?
You might find it easier to support someone with bipolar disorder if you understand their symptoms, treatment and self-management skills.
You should be aware of what you can do if you are worried about their mental state. It can be helpful to know contact information for their mental health team or GP.
You could find out from your relative if they have a crisis plan. You could help your relative to make a crisis plan if they dont have one.
As a carer you should be involved in decisions about care planning. But you dont have a legal right to this. The medical team should encourage the person that you care for to allow information to be shared with you.
You can find out more information about:
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Impact Of Mixed States On Family Life
During mixed states, the participants felt they could hardly cope with themselves, much less with others. Unsurprisingly, this mainly affected relations with close relatives. For instance, 2 parents, or their partner and children, would leave for a summerhouse during bad days, and 1 participant had a room in the house to put the nutter into’ to spare herself and her children, in particular, from contact during her mixed states . The parents were aware that their children were very attentive to their disease states and might get scared and worried – 1 even described his 3-year-old daughter as a differential diagnostician’ . The impacts of mixed states on children led parents to feel guilty and inadequate. Being a bad mother’ was particularly worrying to the women. During mixed states, parents were reliant on their partners to take charge. Partners of patients with higher educational attainment appeared more supportive than the partner of the retired health care worker. Parents had abstained from acting on their suicidal ideations out of consideration for their families, while 2 participants had several suicide attempts when single.
The Technical Definition Of A Mixed Mood
The idea of a bipolar mixed mood is simple. It is when the symptoms of mania or hypomania appear concurrently with major depression symptoms. So you can have the vast energy of an elevated mood but the devastating sadness of a low mood at the same time. Its generally, the worst of both worlds and its difficult to treat.
And because people experience hypomania/mania and depression differently, bipolar mixed moods vary in how they manifest dramatically.
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Patient Quote : On Being In A Mixed State
It’s like a tornado or a hurricane, an awful thing that comes and take you and you can’t do anything. You’re inside the tornado, and you scream because it’s got you. It takes over your thoughts. The mixed state is when you get really insane, when you get admitted to hospital, when you’re out of control’ .
Diagnosis With Depression And Mania
One of the issues that complicates diagnosis of bipolar disorder is that it frequently co-occurs with other psychological disorders, Bornstein says. When this happens the patient manifests symptoms of two or more disorders simultaneously, making it difficult for the diagnostician to separate the symptoms of the two co-occurring disorders.
Among the disorders that frequently co-occur with bipolar disorder:
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Mixed Episode Criteria For Bipolar Disorder
Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.
We tend to think of bipolar disorder as a disease characterized by alternating bouts of depression and mania. While it is true that some people with the disorder will experience a distinctive pendulum swing in moods, with clear highs and lows, more often than not the clinical picture will not be so obvious.
What Are The Risks Of Mixed Features During Mood Episodes Of Bipolar Disorder
The most serious risk of mixed features during a manic or depressive episode is suicide. People with bipolar disorder are 10 to 20 times more likely to commit suicide than people without bipolar disorder. Tragically, as many as 10% to 15% of people with bipolar disorder eventually lose their lives to suicide.
Evidence shows that during episodes with mixed features, people may be at even higher risk for suicide than people in episodes of bipolar depression.
Treatment reduces the likelihood of serious depression and suicide. Lithium in particular, taken long term, may help to reduce the risk of suicide.
People with bipolar disorder are also at higher risk for substance abuse. Nearly 60% of people with bipolar disorder abuse drugs or alcohol. Substance abuse is associated with more severe or poorly controlled bipolar disorder.
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My Bipolar Mixed Moods
In the Diagnostic and Statistical Manual of Mental Disorders it used to be stated that mixed moods only occurred in bipolar I. In the latest edition of the DSM, however, it is written that mixed moods happen in bipolar II disorder as well . And I can attest to the accuracy of this. I have bipolar II and I have nasty, wicked mixed moods. In fact, like a lot of people, I experience mixed moods more than I experience pure hypomania.
Mixed moods, for me, tend to happen when my medication gets out of whack. They can also appear thanks to stress. Last year, when I wrote my book, Lost Marbles, I had a bipolar mixed episode that lasted for months.
What Causes Bipolar Disorder
Experts dont know for sure why some people experience bipolar disorder. Your genetics can play a part and your experiences too.
If any of your family members have experienced bipolar disorder, youve more change of developing it too. But scientists say no single gene can be linked to bipolar disorder.
Someone in your immediate family might live with bipolar disorder, like a parent, brother, or sister. If they do, theres a 13 in 100 chance you will develop it too. The risk is higher if both of your parents or your twin live with the condition.
For some people symptoms of bipolar disorder can be triggered by stressful things in their lives. These things can include:
- relationship problems,
- being in debt or money issues.
You can find more information about Does mental illness run in families by clicking here.
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What A Depressive Episode Feels Like
The unpredictable nature of cycling through mood states, being unsure of what symptoms may envelop you next, typically creates underlying anxiety, says Colleen King, LMFT, a psychotherapist who specializes in treating people with bipolar disorder, depression, and anxiety.
People with bipolar disorder can experience mixed states or dysphoric mania, she says. King says her clients experience their dysphoric mania as an excruciatingly difficult mood state that simultaneously combines symptoms of mania and depression, though the typical euphoric feelings are absent.
They also often experience psychomotor agitation, insomnia, anxiety, and restlessness. Sometimes they experience irritability or anger.
You might be especially curt with others and feel like no one understands your experience, says Louisa Sylvia, PhD, associate director of psychology at the Bipolar Clinic and Research Program at Massachusetts General Hospital.
You might lash out and not want to interact with anyone, Sylvia says in her book, The Wellness Workbook for Bipolar Disorder: Your Guide to Getting Healthy and Improving Your Mood.
During a depressive episode, Kings clients tell her that they feel broken or dont care about anything anymore.
They say they dont have the motivation or passion for anything except sleep. Her clients say they cry all the time and feel frustrated and helpless. They fear theyll never feel normal again.