Bipolar Support Groups.com blog

The Goal of Therapy

Posted on April 24, 2016 by JmaC

Question:

After much self work and therapy it is apparent that I suffered some type of traumatic abuse while a young child. My therapist and I have tried regression hypnosis and I just won’t reveal those memories. All I do is cry. That part of me is just a black hole. I function reasonably well as a wife, mother, and employee but it takes a tremendous amount of energy to manage my deep seated rage. My therapist seems to think my inability to remember is related to my firm belief that safety is an illusion and I can never truly be safe. My questions is, should I just trust my defense mechanisms and stop trying to dig out these memories? I’ve been functioning with my anger and depression for almost 40 years. Should I just settle for this level of normalcy and be grateful that I’ve made it this far?

THIS DISCLAIMER APPLIES TO THE ANSWER BELOW

Answer:

There are many different ideas about how therapy is supposed to work. One of them that is quite widespread goes something like this: Long ago you were damaged by the world. A dragon came to live within your heart and head and its poison infected the rest of your life. In order to help you recapture your vitality and innocence again it will be necessary to dive down into the muck of your heart and head, do battle with the dragon, and conquer it. Only then will you be healed. This is a vision of therapy as enacted myth – you get to be the hero or heroine who does the battles and is rewarded at the end. This is a beautiful vision I think. Only problem with it is that it is not the only good vision of therapy out there. Sometimes it is the wrong vision for the problem at hand. I think that might be the case here.

p>It is just not always helpful to go exploring in the depths of the psyche. A good and proper alternative goal is to help you adapt and cope with your moods, thoughts and relationships with others. There is a need to help you to deal with your rage. An outward focus (rather than an inward one) might be more helpful. Work with your therapist to manage your depression and anger in the present (or find another therapist who will work with you on these issues) and don’t feel you need to remember everything. Consider going forward into your present life rather than backwards into your past.

– Mark Dombeck, Ph.D.

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Psychology of Anger

Posted on April 24, 2016 by JmaC

Introduction

Anger is a natural and mostly automatic response to pain of one form or another (physical or emotional). Anger can occur when people don’t feel well, feel rejected, feel threatened, or experience some loss.The type of pain does not matter; the important thing is that the pain experienced is unpleasant. Because anger never occurs in isolation but rather is necessarily preceded by pain feelings, it is often characterized as a ”secondhand”emotion.

Pain alone is not enough to cause anger. Anger occurs when pain is combined with some anger-triggering thought.
Thoughts that can trigger anger include personal assessments, assumptions, evaluations, orinterpretations of situations that makes people think that someone else is attempting (consciously or not) to hurt them.

In this sense, anger is a social emotion; You always have a target that your anger is directed against (even if that target is yourself). Feelings of pain, combined with anger-triggering thoughts motivate you to take action, face threats and defend yourself by striking out against the target you think is causing you pain.

Anger: A Substitute Emotion

Anger can also be a substitute emotion. By this we mean that sometimes people make themselves angry so that they don’t have to feel pain. People change their feelings of pain into anger because it feels better to be angry than it does to be in pain. This changing of pain into anger may be done consciously or unconsciously.
Being angry rather than simply in pain has a number of advantages, primarily among them distraction. People in pain generally think about their pain. However, angry people think about harming those who have caused pain. Part of the transmutation of pain into anger involves an attention shift – from self-focus to other-focus.
Anger thus temporarily protects people from having to recognize and deal with their painful real feelings; you get to worry about getting back at the people you’re angry with instead. Making yourself angry can help you to hide the reality that you find a situation frightening or that you feel vulnerable.
In addition to providing a good smoke screen for feelings of vulnerability, becoming angry also creates a feeling of righteousness, power and moral superiority that is not present when someone is merely in pain. When you are angry, you are angry with cause. “The people who have hurt me are wrong – they should be punished” is the common refrain. It is very rare that someone will get angry with someone they do not think has harmed them in some significant fashion.

Defining Anger

The definition of whether someone’s anger is a problem often turns on whether or not other people agree with them that their anger, and the actions they take in the name of their anger, is justified.

What is anger

Posted on April 24, 2016 by JmaC

Anger is a basic human emotion that is experienced by all people. Typically triggered by an emotional hurt, anger is usually experienced as an unpleasant feeling that occurs when we think we have been injured, mistreated, opposed in our long-held views, or when we are faced with obstacles that keep us from attaining personal goals.

The experience of anger varies widely; how often anger occurs, how intensely it is felt, and how long it lasts are different for each person. People also vary in how easily they get angry (their anger threshold), as well as how comfortable they are with feeling angry. Some people are always getting angry while others seldom feel angry. Some people are very aware of their anger, while others fail to recognize anger when it occurs. Some experts suggest that the average adult gets angry about once a day and annoyed or peeved about three times a day. Other anger management experts suggest that getting angry fifteen times a day is more likely a realistic average. Regardless of how often we actually experience anger, it is a common and unavoidable emotion.

Anger can be constructive or destructive. When well managed, anger or annoyance has very few detrimental health or interpersonal consequences. At its roots, anger is a signal to you that something in your environment isn’t right. It captures your attention and motivates you to take action to correct that wrong thing. How you end up handling the anger signal has very important consequences for your overall health and welfare, however. When you express anger, your actions trigger others to become defensive and angry too. Blood pressures raises and stress hormones flow. Violence can ensue. You may develop a reputation as a dangerous ‘loose cannon’ whom no one wants to be around.

Out of control anger alienates friends, co-workers and family members. It also has a clear relationship with health problems and early mortality. Hostile, aggressive anger not only increases your risk for an early death, but also your risk for social isolation, which itself is a major risk factor for serious illness and death. These are but two of many reasons why learning to properly manage anger is a good idea.

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Intro To anger Management

Posted on April 24, 2016 by JmaC

The Experience of Anger

Anger is a fundamental emotion that everyoneexperiences from time to time.From a very early age, people learn to express anger by copying the angry behavior they seemodeled around them, and by expressing angry behavior and seeing what they can get away with.

As our culture has an uneasy relationship with anger expression, many people are brought up to think that it is inappropriate to express anger directly; that it must not be tolerated; that it is always dangerous. Such people learn to distrust anger, to bottle it up and ignore it, to express it only in indirect ways or to use it as a weapon.

Healthy Expression of Anger

The idea that anger is dangerous is not without merit. Angry people are capable of great violence.However, while anger can certainly be abused, it is more than a simple destructive force.

Anger is also a critically important part of what might be called the self-preservation and self-defense instincts. People who are incapable of getting angry are also incapable of standing up for themselves. It is important then that people learn how to express anger appropriately. People need to learn healthy and socially respectful ways to express angry feelings, and to not to let anger get out of control to the point where it negatively affects relationships, employability and health.

If you are reading this document, there is a good chance that you (or someone you care about) have an anger problem. An anger problemexists when people become dependent on anger as a primary means of expressing themselves; when they inappropriately use anger or the threat of violence as a weapon to get their way.

Effects of Anger

Inappropriate and uncontrolled anger is harmful for both targets of anger and the angry person as well. Inappropriate anger destroys relationships, makes it difficult to hold down a job, and takes a heavy toll on angry people’s physical and emotional health.

Help for anger problems exists in the form of anger management programs which are coordinated interventions designed to help angry people learn and practice methods of bringing their anger under control.

What You’ll Find in This Section

This section reviews what is known about anger and anger management.

It starts with a discussion of the nature of angerand anger’s effects on people’s social, emotional and physical welfare.
Reasons and motivations for pursuing anger management are discussed, and then specifictechniques used in anger management courses are described.
The document concludes by describing ways motivated people can use anger management techniques to learn to control their anger so as to protect their health, promote the quality of their relationships and become more socially effective.

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Yoga for Mental Health

Posted on April 24, 2016 by JmaC

Frequent visitors to this website know that I write an advice column, “Ask Dr. Dombeck”. A typical question I tend to see again and again is, “How can I best manage my (condition)?”. Because I strive to be an ethical advice-giver, and because there are severe limitations of information in the online question and answer format, I usually recommend that the writer visit his or her doctor to get an accurate diagnosis of the problem, and then follow the doctor’s treatment recommendations. There is simply no substitute for a face-to-face personal relationship with one’s own physician, psychologist or psychotherapist.

Beyond this necessary ‘stock’ answer, I often try to provide a further pearl or two of wisdom that the writer might consider. Specifically, I tend to recommend activities known to be generally helpful in promoting mental health and peace of mind including socialization, exercise and relaxation. It occurred to me that it is fully possible to get the benefits of all three of these recommendations by performing only a single activity which is called Yoga.

Yoga?

Despite the fact that over the last maybe twenty years, Yoga has gone from a marginal activity to an almost mainstream one here in the West, my impression is that Yoga is still not altogether well understood. Most everyone has heard of Yoga, but not everyone really knows what it involves.

Yoga originated in India several thousand years ago as a system of physical and spiritual practices. It was formalized in the second century BC in the form of the Yoga Sutras, attributed to the scholar Pantanjali. The word ‘Yoga’ means ‘union’ or ‘yoke’ or ‘joining’. Originally, Yoga was (and is in places where it is practiced as such) a method for joining a regular imperfect human being with the divine principle, or God. You could liken it to a form of prayer which serves a similar purpose, only prayer tends to be verbal, while Yoga tends to involve action.

Importantly, the bulk of the religious aspect of Yoga has not traveled to America, probably because it is more esoteric and mystical than the materialist and practical Western mind can easily appreciate. What has successfully traveled to America is a highly developed disciplined system of physical exercise that offers many benefits (physical, social, psychological and ‘spiritual’) to those who practice it. Personally, I see this ‘stripping’ off of the parts of Yoga that Americans can’t easily appreciate as a good thing. While probably regarded as a bit of an abomination by yogis back in India, the secularization of Yoga has made accessible a set of powerful techniques for tangible self-improvement that would otherwise not be available.

American Yoga then is really about one subset of Yoga proper; Hatha Yoga (or the Yoga of physical postures). Hatha Yoga is specifically concerned with the learning of special physical postures which are typically named in imitation of the way animals and structures move. Some examples include ‘cat pose’, ‘downward-facing dog pose’, ‘mountain pose’, ‘boat pose’ and ‘corpse pose’. There are a lot of these postures, and they are harder to get into than they look. Where very basic practice might focus on learning individual poses, more advanced students learn to link different poses together so that they flow into one another gracefully and, in so doing, complement one another. A good example is the ‘Sun Salutation’ posture flow which combines standing, lunging, and arching poses into a graceful flow.

Yoga lends itself to being non-competitive. There are no Yoga teams, and no Yoga trophies to win. There are no Yoga belts to earn. You simply practice Yoga because it is good for you and helps you to feel good while you are practicing it, and you get better at it (more able to do advanced poses) at your own pace. Each posture or pose is designed to one degree or another to help the person performing them to improve their physical strength, their bodily flexibility and range of motion, and their balance. My understanding is that these desirable attributes originally helped spiritually-minded yogis to be healthy enough to not have to worry about bodily pain so as to better concentrate on God. Here in America the same attributes help us to be more physically healthy, to concentrate better, to relax more fully, and to gain greater control over our emotions.

Yoga Benefits For Mental Health

I’m a clinical psychologist by education. When I recommend Yoga as a great practice to take up in order to promote one’s health, I’m thinking more about the mental benefits than the physical ones although both are present. To my mind, Yoga offers the following benefits:

Yoga Provides The Health Benefits Of Physical ExercisePsychologists have long known that moderate exercise is good for depression and anxiety. Such exercise can easily be found in Yoga practice. Yoga postures are designed to promote physical strength, flexibility and balance. Anyone who has ever taken a Yoga class will attest that there are cardio/heart benefits to be had; your heart rate is frequently up while performing postures much as it would be if you were performing more conventional exercise. Though Yoga gets your heart rate up and your endorphines pumping, it also provides for many rest periods. These rest periods lend a gentle quality to the conditioning that makes it easier to endure than ‘marathon’ style exercise. You seldom feel as though you can’t go on.
By emphasizing gentle stretching of the joints and spine, Yoga promotes increased range of motion, and joint health. It helps work out muscular kinks and minor problems that might otherwise lead to back pain or stiffness. In promoting joint and spinal flexibility, Yoga also seems to promote a certain kind of mental freedom; there is a definitive feeling of mental ease and comfort that you experience at the end of a Yoga class that is linked to being free to move muscles that were tight before the class started. It doesn’t always last long, but it is very real and very soothing while it lasts.

As with any physical workout, Yoga practice concentrates your mind on the physical sensations and on the perfection of the postures. The immersive concentration factor Yoga provides works as a helpful tonic for anxious and obsessional people. The practice of Yoga (or most any other demanding physical exercise) can be a great distraction from worry as it forces the mind to attend to the body and the breathing; the moment.
Yoga Promotes Relaxation And Emotional ControlAs much as us mental health types like to emphasize language and verbal expression (or the blunt hammer of Valium) as the best ways of dealing with emotional problems, body-based therapeutic interventions have a role to play too. After all, the ‘stress response that so many anxious and depressed people have problems with begins with the fight or flight reflex – the physical preparation of the body to defend, or flee. Chronic stress has an impact on the body in the form of chronic muscle tension and stiffness, and this very stiffness and tension seems to produce some of the worry and agony that anxious and stressed out persons report.
Yoga is a very effective stress reduction and relaxation tool. Performance of various postures requires the tensing and stretching and then relaxing of muscle groups and joints, which effectively produces relaxation in much the same way that a massage or Progressive Muscle Relaxation (a technique used by behavioral psychologists) does. Yoga practice also draws attention towards breathing, which produces a meditative and soothing state of mind. Yoga methods for stress reduction and self-soothing are generally cheaper than other professional interventions (Yoga can be done for free if you know what you’re doing, and classes are no more expensive than group psychotherapy prices), pretty much safe, free of side effects, and empowering in comparison to medication alternatives.

On a more theoretical note: In the last decade, leading therapists have discovered that coupling a self-soothing, relaxation-inducing group of techniques with action oriented (cognitive behavioral) therapy often produces better results for difficult-to-treat patient populations than action-oriented therapies alone. I’m thinking of Linehan’s Dialectical Behavioral Therapy (aimed primarily at Borderline Personality Disorder patients), and Hayes’ Acceptance and Committment Therapy as examples. Yoga techniques promoting relaxation, self-soothing and body awareness skills are a good fit with these newer therapeutic approaches, and might prove helpful in getting impulsive and chaotically driven patients to engage the structured tools and techniques of cognitive therapy that could help them progress.
Yoga Provides Structured Social OpportunitiesWith due respect to stereotypes of yogic mystics sitting cross legged in splendid isolation on a mountain top, most Yoga in the west (and I suspect in the east) is done in classrooms. As such, the practice of Yoga on any regular basis becomes a significant social opportunity as much as anything else. You don’t necessarily get to know everyone, or quickly, but if you commit yourself to the practice of Yoga, you’ll soon enough find that you recognize faces in the class, and sooner or later, you end up making friends unless you do something to discourage that from happening. The friendships of our childhood were formed in just such a group crucible, only this one is available to adults. I know I don’t have to mention that participation in social events is a way to combat depressive withdrawal, but I will anyway (grin!).

Not For Everyone

As practiced in the West, Yoga is basically a form of exercise. Many of the things about Yoga that promote mental health can also be gained from other forms of exercise, as Psychologist Kate Hays will tell you. This is important to keep in mind, becuause not every personality will click with Yoga. To my mind, Yoga works best for people who are anxious or depressed or frantic or impulsive or obsessional and who are looking for stress relief, self-soothing and a calm way to get in some gentle exercise. More competitive persons may find Yoga boring, but might derive similar benefits from some other form of exercise more to their liking.

If You’re Thinking About Attending A Yoga Class…

Check With Your Doctor Before AttendingBecause Yoga is a form of exercise, each person contemplating actually signing up for a Yoga course is advised to check with their physician beforehand to make sure they are fit enough to safely participate in such a class. This warning applies double to any person who has a pre-existing medical condition.
Pick The Right Kind Of Yoga ClassThere are as many different sorts of Yoga out there today as there are people teaching it. Some of the Yoga forms are safer and more gentle than others. I’ve personally had very good experiences with Iyengar style, and with Kripalu style Yoga teachers. Be careful around Astanga “Power” Yoga, any Yoga that occurs in a “hot” room, and especially Bikram Yoga as these Yoga forms tend to be very physically demanding. Databases listing classes are available on the Internet in various places, such as this one offered by Yoga Journal
For your best bet, look for a teacher who has been teaching for a while and who is certified by a national or internationally recognized Yoga school (like the Kripalu Center in Lenox, MA or the Iyengar Foundation). Tell the teacher you are interested in ‘gentle beginners hatha Yoga’.
Be Careful!Like any physical exercise, Yoga can be dangerous if not practiced properly! Although not common, physical injuries can occur if you follow incompetent instruction (e.g., your teacher pushes you to do something improper), or (more commonly) if you push yourself too hard. When practicing Yoga properly, you should push yourself somewhat (so that improvement occurs), but never so hard that you hurt yourself or experience serious pain. Stop what you are doing if it hurts.

A Closing Anecdote

One of the things I like best about my own personal Yoga practice is how it has helped teach me patience. When I first started classes in the Spring of 1997, I was unable to touch my toes. This galled me as many people around me were able to do this. I had a wise teacher named Stella at the time, and I recalled her noticing how I was straining to get to the floor. She talked to me about it one night, telling me that Yoga was more about experiencing where you are now than about where you should be. She told me I should relax because the floor would be there when my body was ready to reach it. Sure enough, a few weeks later it was.

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Bipolar Disorder Cause and risk factors

Posted on April 23, 2016 by JmaC

Bipolar Disorder Causes

The exact cause of bipolar disorder is unknown, but several factors may be involved, such as:

Biological differences. People with bipolar disorder appear to have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes.
Neurotransmitters. An imbalance in naturally occurring brain chemicals called neurotransmitters seems to play a significant role in bipolar disorder and other mood disorders.
Inherited traits. Bipolar disorder is more common in people who have a first-degree relative, such as a sibling or parent, with the condition. Researchers are trying to find genes that may be involved in causing bipolar disorder.

RISK FACTORS

Factors that may increase the risk of developing bipolar disorder or act as a trigger for the first episode include:

Having a first-degree relative, such as a parent or sibling, with bipolar disorder
Periods of high stress
Drug or alcohol abuse
Major life changes, such as the death of a loved one or other traumatic experiences

Conditions that commonly occur with bipolar disorder

If you have bipolar disorder, you may also have another health condition that’s diagnosed before or after your diagnosis of bipolar disorder. Such conditions need to be diagnosed and treated because they may worsen existing bipolar disorder or make treatment less successful. They include:

Anxiety disorders. Examples include social anxiety disorder and generalized anxiety disorder.
Post-traumatic stress disorder (PTSD). Some people with PTSD, a trauma- and stressor-related disorder, also have bipolar disorder.
Attention-deficit/hyperactivity disorder (ADHD). ADHD has symptoms that overlap with bipolar disorder. For this reason, bipolar disorder can be difficult to differentiate from ADHD. Sometimes one is mistaken for the other. In some cases, a person may be diagnosed with both conditions.
Addiction or substance abuse. Many people with bipolar disorder also have alcohol, tobacco or drug problems. Drugs or alcohol may seem to ease symptoms, but they can actually trigger, prolong or worsen depression or mania.
Physical health problems. People diagnosed with bipolar disorder are more likely to have certain other health problems, such as heart disease, thyroid problems or obesity.

COMPLICATIONS

Left untreated, bipolar disorder can result in serious problems that affect every area of your life. These may include:

Problems related to drug and alcohol use
Suicide or suicide attempts
Legal problems
Financial problems
Relationship troubles
Isolation and loneliness
Poor work or school performance
Frequent absences from work or school

PREPARING FOR APPOINTMENT

You may start by seeing your primary care doctor or you may choose to see a medical doctor who specializes in diagnosing and treating mental health conditions (psychiatrist).

What you can do

Before your appointment, make a list of:

Any symptoms you’ve had, including any that may seem unrelated to the reason for the appointment
Key personal information, including any major stresses or recent life changes
All medications, vitamins or other supplements that you’re taking, and their dose
Questions to ask your doctor

Take a family member or friend along, if possible. That person may provide more information or remember something that you missed or forgot.
Some basic questions to ask your doctor include:

Do I have bipolar disorder?
Are there any other possible causes for my symptoms?
What kinds of tests will I need?
What treatments are available? Which do you recommend for me?
What side effects are possible with that treatment?
What are the alternatives to the primary approach that you’re suggesting?
I have these other health conditions. How can I best manage these conditions together?
Should I see a psychiatrist or other mental health provider?
Is there a generic alternative to the medicine you’re prescribing?
Are there any brochures or other printed material that I can have? What websites do you recommend?

Don’t hesitate to ask questions at any time during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to spend more time on. Your doctor may ask:

When did you or your loved ones first begin noticing your symptoms of depression, mania or hypomania?
How frequently do your moods change?
Do you ever have suicidal thoughts when you’re feeling down?
Do your symptoms interfere with your daily life or relationships?
Do you have any blood relatives with bipolar disorder or depression?
What other mental or physical health conditions do you have?
Do you drink alcohol, smoke cigarettes or use street drugs?
How much do you sleep at night? Does it change over time?
Do you go through periods when you take risks that you wouldn’t normally take, such as unsafe sex or unwise, spontaneous financial decisions?
What, if anything, seems to improve your symptoms?
What, if anything, appears to worsen your symptoms?

TESTS AND DIAGNOSIS

When doctors suspect someone has bipolar disorder, they typically do a number of tests and exams. These can help rule out other problems, pinpoint a diagnosis and also check for any related complications. These may include:

Physical exam. A physical exam and lab tests may be done to help identify any medical problems that could be causing your symptoms.
Psychological evaluation. Your doctor or mental health provider will talk to you about your thoughts, feelings and behavior patterns. You may also fill out a psychological self-assessment or questionnaire. With your permission, family members or close friends may be asked to provide information about your symptoms and possible episodes of mania or depression.
Mood charting. To identify exactly what’s going on, your doctor may have you keep a daily record of your moods, sleep patterns or other factors that could help with diagnosis and finding the right treatment.
Signs and symptoms. Your doctor or mental health professional typically will compare your symptoms with the criteria for bipolar and related disorders in the Diagnostic and Statistical Manual of Mental Disorders to determine a diagnosis.

Diagnosis in children

Although bipolar disorder can occur in young children, typically it’s diagnosed in the teenage years or early 20s. It’s often hard to tell whether a child’s emotional ups and downs are normal for his or her age, the results of stress or trauma, or signs of a mental health problem other than bipolar disorder.
Bipolar symptoms in children and teens often have different patterns than they do in adults and may not fit neatly into the categories used for diagnosis. And children who have bipolar disorder are frequently also diagnosed with other mental health conditions such as attention-deficit/hyperactivity disorder (ADHD) or behavior problems.
Your child’s doctor can help you learn the symptoms of bipolar disorder and how they differ from behavior related to your child’s developmental age, the situation and appropriate cultural behavior.

TREATMENT AND DRUGS

Treatment is best guided by a psychiatrist skilled in treating bipolar and related disorders. You may have a treatment team that also includes a psychologist, social worker and psychiatric nurse.
Depending on your needs, treatment may include:

Initial treatment. Often, you’ll need to start taking medications to balance your moods right away. Once your symptoms are under control, you’ll work with your doctor to find the best long-term treatment.
Continued treatment. Bipolar disorder requires lifelong treatment, even during periods when you feel better. Maintenance treatment is used to manage bipolar disorder on a long-term basis. People who skip maintenance treatment are at high risk of a relapse of symptoms or having minor mood changes turn into full-blown mania or depression.
Day treatment programs. Your doctor may recommend a day treatment program. These programs provide the support and counseling you need while you get symptoms under control.
Substance abuse treatment. If you have problems with alcohol or drugs, you’ll also need substance abuse treatment. Otherwise, it can be very difficult to manage bipolar disorder.
Hospitalization. Your doctor may recommend hospitalization if you’re behaving dangerously, you feel suicidal or you become detached from reality (psychotic). Getting psychiatric treatment at a hospital can help keep you calm and safe and stabilize your mood, whether you’re having a manic or major depressive episode.

The primary treatments for bipolar disorder include medications and psychological counseling (psychotherapy), and may include education and support groups.

Medications

A number of medications are used to treat bipolar disorder. The types and doses of medications prescribed are based on your particular symptoms.
Medications may include:

Mood stabilizers. Whether you have bipolar I or II disorder, you’ll typically need mood-stabilizing medication to control manic or hypomanic episodes. Examples of mood stabilizers include lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others) and lamotrigine (Lamictal).
Antipsychotics. If symptoms of depression or mania persist in spite of treatment with other medications, adding an antipsychotic medication such as olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris) may help. Your doctor may prescribe some of these medications alone or along with a mood stabilizer.
Antidepressants. Your doctor may add an antidepressant to help manage depression. Because an antidepressant can sometimes trigger a manic episode, it’s usually prescribed along with a mood stabilizer or antipsychotic.
Antidepressant-antipsychotic. The medication Symbyax combines the antidepressant fluoxetine and the antipsychotic olanzapine. It works as a depression treatment and a mood stabilizer. Symbyax is approved by the Food and Drug Administration specifically for the treatment of depressive episodes associated with bipolar I disorder.
Anti-anxiety medications. Benzodiazepines may help with anxiety and improve sleep. Benzodiazepines are generally used for relieving anxiety only on a short-term basis.

Side effects

Talk to your doctor or mental health provider about side effects. If side effects seem intolerable, you may be tempted to stop taking your medication or to reduce your dose on your own. Don’t do it. You may experience withdrawal effects or your symptoms may return.
Side effects often improve as you find the right medications and doses that work for you, and your body adjusts to the medications.

Finding the right medication

Finding the right medication or medications for you will likely take some trial and error. If one doesn’t work well for you, there are several others to try.
This process requires patience, as some medications need weeks to months to take full effect. Generally only one medication is changed at a time so that your doctor can identify which medications work to relieve your symptoms with the least bothersome side effects. Medications also may need to be adjusted as your symptoms change.

Medications and pregnancy

A number of medications for bipolar disorder can be associated with birth defects. Discuss these issues with your doctor:

Birth control options, as birth control medications may lose effectiveness when taken along with certain bipolar disorder medications
Treatment options if you plan to become pregnant
Breast-feeding, as some bipolar medications can pass through breast milk to your infant

Psychotherapy

Psychotherapy is a vital part of bipolar disorder treatment and can be provided in individual, family or group settings. Several types of therapy may be helpful. These include:

Cognitive behavioral therapy. The focus of cognitive behavioral therapy is identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. It can help identify what triggers your bipolar episodes. You also learn effective strategies to manage stress and to cope with upsetting situations.
Psychoeducation. Counseling to help you learn about bipolar disorder (psychoeducation) can help you and your loved ones understand bipolar disorder. Knowing what’s going on can help you get the best support and treatment, and help you and your loved ones recognize warning signs of mood swings.
Interpersonal and social rhythm therapy (IPSRT). IPSRT focuses on the stabilization of daily rhythms, such as sleep, wake and mealtimes. A consistent routine allows for better mood management. People with bipolar disorder may benefit from establishing a daily routine for sleep, diet and exercise.
Other therapies. Other therapies have been studied with some evidence of success. Ask your doctor if any other options may be appropriate for you.

Other treatment options

Depending on your needs, other treatments may be added to your depression therapy, such as:

Electroconvulsive therapy (ECT). In ECT, electrical currents are passed through the brain. This procedure is thought to affect levels of neurotransmitters in your brain and typically offers immediate relief of even severe depression when other treatments don’t work. Physical side effects, such as headache, are tolerable. Some people also have memory loss, which is usually temporary. ECT is usually used for people who don’t get better with medications, can’t take antidepressants for health reasons or are at high risk of suicide. ECT may be an option if you have mania or severe depression when you’re pregnant and cannot take your regular medications.
Transcranial magnetic stimulation (TMS). TMS may be an option for those who haven’t responded to antidepressants. During TMS, you sit in a reclining chair with a treatment coil placed against your scalp. The coil sends brief magnetic pulses to stimulate nerve cells in your brain that are involved in mood regulation and depression. Typically, you’ll have five treatments each week for up to six weeks.

Treatment in children and teenagers

Treatments for children and teenagers are generally decided on a case-by-case basis, depending on symptoms, medication side effects and other factors.

Medications. Children and teens with bipolar disorder are often prescribed the same types of medications as those used in adults. There’s less research on the safety and effectiveness of bipolar medications in children than in adults, so treatment decisions are often based on adult research.
Psychotherapy. Most children diagnosed with bipolar disorder require counseling as part of initial treatment and to keep symptoms from returning. Psychotherapy can help children develop coping skills, address learning difficulties, resolve social problems, and help strengthen family bonds and communication. And, if needed, it can help treat substance abuse problems, common in older children with bipolar disorder.
Support. Working with teachers and school counselors and encouraging support from family and friends can help identify services and encourage success.

LIFESTYLE AND HOME REMEDIES

You’ll probably need to make lifestyle changes to stop cycles of behavior that worsen your bipolar disorder. Here are some steps to take:

Quit drinking or using illegal drugs. One of the biggest concerns with bipolar disorder is the negative consequences of risk-taking behavior and drug or alcohol abuse. Get help if you have trouble quitting on your own.
Steer clear of unhealthy relationships. Surround yourself with people who are a positive influence and won’t encourage unhealthy behavior or attitudes that can worsen your bipolar disorder.
Get regular physical activity and exercise. Moderate, regular physical activity and exercise can help steady your mood. Working out releases brain chemicals that make you feel good (endorphins), can help you sleep and has a number of other benefits. Check with your doctor before starting any exercise program, especially if you’re taking lithium, to make sure exercise won’t interfere with your medication.
Get plenty of sleep. Don’t stay up all night. Instead, get plenty of sleep. Sleeping enough is an important part of managing your mood. If you have trouble sleeping, talk to your doctor or mental health provider about what you can do.

ALTERNATIVE MEDICINES

Alternative medicine is the use of a nonconventional approach instead of conventional medicine. Complementary medicine is a nonconventional approach used along with conventional medicine.
There isn’t much research on alternative medicine and bipolar disorder. Most of the studies on alternative or complementary medicine that do exist are on major depression, so it isn’t clear how well most of these work for bipolar disorder.

Omega-3 fatty acids. These oils may help improve depression associated with bipolar disorder. Bipolar disorder appears to be less common in areas of the world where people regularly eat fish rich in omega-3s. Omega-3s appear to have a number of health benefits, but more studies are needed to determine just how much they help with bipolar disorder.
Magnesium. Several small studies have suggested that magnesium supplements may lessen mania and the rapid cycling of bipolar symptoms. More research is needed to confirm these findings.
St. John’s wort. This herb may be helpful with depression. However, it can also interact with antidepressants and other medications, and it has the potential to trigger mania in some people.
S-adenosyl-L-methionine (SAMe). This amino acid supplement appears to help brain function related to depression. It isn’t clear yet whether it’s helpful in people with bipolar disorder. As with St. John’s wort, SAMe can trigger mania in some people.
Herbal combinations. Herbal remedies that combine a number of different herbs, such as those used in traditional Chinese medicine, haven’t been well-studied and the contents may vary among products. Risks and benefits still aren’t clear.
Acupuncture. This ancient Chinese practice of inserting tiny needles into the skin may relieve depression, but more studies are needed to confirm its benefits. However, acupuncture is considered safe and can be done along with other bipolar disorder treatments.

If you choose to use complementary medicine in addition to your physician-recommended treatment, take some precautions first:

Don’t stop taking your prescribed medications or skip therapy sessions. Alternative medicine is not a substitute for regular medical care when it comes to treating bipolar disorder.
Be honest with your doctors and mental health providers.Tell them exactly which complementary treatments you use or would like to try.
Be aware of potential dangers. Just because it’s natural doesn’t mean it’s safe. Before using alternative or complementary medicine, find out the risks, including possible interactions with medications.

COPING AND SUPPORT

Coping with bipolar disorder can be challenging. Here are some strategies that can help:

Learn about bipolar disorder. Education about your condition can empower you and motivate you to stick to your treatment plan. Help educate your family and friends about what you’re going through.
Stay focused on your goals. Recovery from bipolar disorder can take time. Stay motivated by keeping your recovery goals in mind and reminding yourself that you can work to repair damaged relationships and other problems caused by your mood swings.
Join a support group. Support groups for people with bipolar disorder can help you connect to others facing similar challenges and share experiences.
Find healthy outlets. Explore healthy ways to channel your energy, such as hobbies, exercise and recreational activities.
Learn ways to relax and manage stress. Yoga, tai chi, massage, meditation or other relaxation techniques can be helpful.

PREVENTION

There’s no sure way to prevent bipolar disorder. However, getting treatment at the earliest sign of a mental health disorder can help prevent bipolar disorder or other mental health conditions from worsening.
If you’ve been diagnosed with bipolar disorder, some strategies can help prevent minor symptoms from becoming full-blown episodes of mania or depression:

Pay attention to warning signs. Addressing symptoms early on can prevent episodes from getting worse. You and your caregivers may have identified a pattern to your bipolar episodes and what triggers them. Call your doctor if you feel you’re falling into an episode of depression or mania. Involve family members or friends in watching for warning signs.
Avoid drugs and alcohol. Using alcohol or street drugs can worsen your symptoms and make them more likely to come back.
Take your medications exactly as directed. You may be tempted to stop treatment — but don’t. This can have immediate consequences — you may become very depressed, feel suicidal, or go into a manic or hypomanic episode. If you think you need to make a change, call your doctor.
Check first before taking other medications. Call the doctor who’s treating you for bipolar disorder before you take medications prescribed by another doctor or any over-the-counter supplements or medications. Sometimes other medications trigger episodes of bipolar disorder or may interfere with medications you’re already taking to treat bipolar disorder.

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Is there a connection Between Bipolar Disorder and Alcoholism

Posted on April 23, 2016 by JmaC

Bipolar disorder and alcoholism often occur together. Up to half the people who have bipolar disorder also struggle with alcoholism.
Although the association between bipolar disorder and alcoholism isn’t clearly understood, these factors likely play a role:

Inherited traits. Genetic differences appear to affect brain chemistry linked to bipolar disorder. These same traits may also affect the way the brain responds to alcohol and other drugs, increasing the risk of alcoholism and addiction to other drugs.
Depression and anxiety. Some people drink to ease depression, anxiety and other symptoms of bipolar disorder. Drinking may seem to help, but in the long run it makes symptoms worse. This can lead to more drinking — a vicious cycle that’s difficult to overcome.
Mania. This upswing from depression is usually characterized by an intensely elated (euphoric) mood and hyperactivity. It commonly causes bad judgment and lowered inhibitions, which can lead to increased alcohol use or drug abuse.

Bipolar disorder and alcoholism or other types of substance abuse can be a dangerous combination. Each can worsen the symptoms and severity of the other. Having both conditions increases the risk of mood swings, depression, violence and suicide.
Someone who has both bipolar disorder and alcoholism or another addiction is said to have a dual diagnosis. Treatment may require the expertise of mental health care providers who specialize in the treatment of dual disorders.
If you’ve lost control over your drinking or you abuse drugs, get help before your problems become worse and harder to treat. Seeing a mental health expert right away is especially important if you also have signs and symptoms of bipolar disorder or another mental health condition.

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5 POSITIVE THINGS ABOUT BIPOLAR DISORDER

Posted on April 23, 2016 by JmaC

1. It Gives You Strength, Tenacity, or “Chutzpah”

“Having bipolar disorder means I am a fighter and a survivor. I have been through things other people couldn’t imagine, but I am a stronger person because of it.” – Olivia Fuller

“Bipolar has given me Chutzpah. That is a Yiddish word that means a great many things…tenacity, moxie, audacity” – Susan Schlesinger

2. It Makes You More Proactive About Your Overall Health

“A huge part of managing bipolar is being proactive about my physical health: what I eat, how I exercise, and how I sleep. It’s important that I stay away from processed foods (helps to manage moods), practice yoga and meditation every day (to keep my anxiety/depression at bay), and sleep a solid 9 hours (inadequate sleep often results in worsening symptoms).” – Lyndsay Marvin

“In order to take care of yourself mentally, you have to take care of your overall physical health. Exercising and eating better helps you stay more positive in the long run.” – Sarah DeArmond

“I have incorporated various practices into the start of my day to begin in a more grounded yet energized way. My morning activation (routine) consists of meditation, intention statements, and yoga. If I wasn’t diagnosed with bipolar disorder I don’t know if I would have these practices incorporated into my mornings.” – Scott Walker

3. It Gives You Empathy For Other People

“I feel like I’m more sensitive to others and less likely to judge after what I’ve personally been through.” – Sarah DeArmond

“I believe I’m more empathetic towards everyone as a whole. For instance, if someone lashes out at me, instead of getting defensive or wondering what their problem is and being angry for the rest of the day, I’ll think more so about how they could have some issue I know nothing about. They may not be coping well. I should probably make efforts to ease their stress a bit more in the future and maybe ask how they’re doing more often.” – Briana Hedgepeth

4. It Helps You Know Who Your Real Friends Are

“It gives insight ln who is really there for you in your weakest and will abide your side. It proves how much some people love us unconditionally to stand by our side through thick and thin.” – Zeina Adel

“I’m able to tell who my friends are a whole lot quicker than most people.” – Briana Hedgepeth

5. It Gives You The Ability To Help Others Who Have Bipolar Disorder

“The best part is being able to help others” – Jessi Lepine

“I am a Case Manager for Individuals with Intellectual and Developmental Disabilities and suffering with bipolar myself can be difficult, but I think it help me be able to relate with individuals on my caseload at times better. I have “been in their shoes” so to speak. It definitely doesn’t work with all consumers since everyone is so different, but it helps with rapport and trust.” – Lori Krausen

“I was able to help my own child when he was diagnosed with bipolar disorder, he felt comfortable coming to me, because I never hid it from anyone, including my children.” – Terri Smeigh

“I would like others to benefit from my struggles with bipolar disorder” – Shannon Yazurlo

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STIGMA SAY IT FORWARD

Posted on April 23, 2016 by JmaC

DUCATE & INSPIRE

When it comes to mental health conditions, silence is not golden. Silence breeds stigma, and stigma hurts. It prevents people from seeking life-saving treatment and support. International Bipolar Foundation (IBPF) hopes that you will join forces with us to educate and inspire people to learn the facts, and talk about mental illness to eliminate the barrier of stigma.

TAKE ACTION October 12th-18th

Help us Say It Forward to eliminate the barrier by choosing messages from from our
sayitforwardcampaign.org website to share this week via your choice of social media, email, or all three! Reach out to as many individuals as possible and encourage everyone to learn the truth about mental illness this week of October 12th through 18th! #SayItForward #EliminateTheBarrier.

The Say It Forward Campaign is brought to you by

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Bipolar Disorder Defined n pregnancy and children

Posted on April 23, 2016 by JmaC

Bipolar disorder, formerly called manic depression, causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts in the other direction, you may feel euphoric and full of energy. Mood shifts may occur only a few times a year or as often as several times a week.
Although bipolar disorder is a disruptive, long-term condition, you can keep your moods in check by following a treatment plan. In most cases, bipolar disorder can be controlled with medications and psychological counseling (psychotherapy).
There are several types of bipolar and related disorders. For each type, the exact symptoms of bipolar disorder can vary from person to person. Bipolar I and bipolar II disorders also have additional specific features that can be added to the diagnosis based on your particular signs and symptoms.

Criteria for bipolar disorder

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, lists criteria for diagnosing bipolar and related disorders. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.
Diagnostic criteria for bipolar and related disorders are based on the specific type of disorder:

Bipolar I disorder. You’ve had at least one manic episode. The manic episode may be preceded by or followed by hypomanic or major depressive episodes. Mania symptoms cause significant impairment in your life and may require hospitalization or trigger a break from reality (psychosis).
Bipolar II disorder. You’ve had at least one major depressive episode lasting at least two weeks and at least one hypomanic episode lasting at least four days, but you’ve never had a manic episode. Major depressive episodes or the unpredictable changes in mood and behavior can cause distress or difficulty in areas of your life.
Cyclothymic disorder. You’ve had at least two years — or one year in children and teenagers — of numerous periods of hypomania symptoms (less severe than a hypomanic episode) and periods of depressive symptoms (less severe than a major depressive episode). During that time, symptoms occur at least half the time and never go away for more than two months. Symptoms cause significant distress in important areas of your life.
Other types. These include, for example, bipolar and related disorder due to another medical condition, such as Cushing’s disease, multiple sclerosis or stroke. Another type is called substance and medication-induced bipolar and related disorder.

Bipolar II disorder is not a milder form of bipolar I disorder, but a separate diagnosis. While the manic episodes of bipolar I disorder can be severe and dangerous, individuals with bipolar II disorder can be depressed for longer periods, which can cause significant impairment.

Criteria for a manic or hypomanic episode

The DSM-5 has specific criteria for the diagnosis of manic and hypomanic episodes:

A manic episode is a distinct period of abnormally and persistently elevated, expansive or irritable mood that lasts at least one week (or less than a week if hospitalization is necessary). The episode includes persistently increased goal-directed activity or energy.
A hypomanic episode is a distinct period of abnormally and persistently elevated, expansive or irritable mood that lasts at least four consecutive days.

For both a manic and a hypomanic episode, during the period of disturbed mood and increased energy, three or more of the following symptoms (four if the mood is only irritable) must be present and represent a noticeable change from your usual behavior:

Inflated self-esteem or grandiosity
Decreased need for sleep (for example, you feel rested after only three hours of sleep)
Unusual talkativeness
Racing thoughts
Distractibility
Increased goal-directed activity (either socially, at work or school, or sexually) or agitation
Doing things that are unusual and that have a high potential for painful consequences — for example, unrestrained buying sprees, sexual indiscretions or foolish business investments

To be considered a manic episode:

The mood disturbance must be severe enough to cause noticeable difficulty at work, at school or in social activities or relationships; or to require hospitalization to prevent harm to yourself or others; or to trigger a break from reality (psychosis).
Symptoms are not due to the direct effects of something else, such as alcohol or drug use; a medication; or a medical condition.

To be considered a hypomanic episode:

The episode is a distinct change in mood and functioning that is not characteristic of you when the symptoms are not present, and enough of a change that other people notice.
The episode isn’t severe enough to cause significant difficulty at work, at school or in social activities or relationships, and it doesn’t require hospitalization or trigger a break from reality.
Symptoms are not due to the direct effects of something else, such as alcohol or drug use; a medication; or a medical condition.

Criteria for a major depressive episode

The DSM-5 also lists criteria for diagnosis of a major depressive episode:

Five or more of the symptoms below over a two-week period that represent a change from previous mood and functioning. At least one of the symptoms is either depressed mood or loss of interest or pleasure.
Symptoms can be based on your own feelings or on the observations of someone else.

Signs and symptoms include:

Depressed mood most of the day, nearly every day, such as feeling sad, empty, hopeless or tearful (in children and teens, depressed mood can appear as irritability)
Markedly reduced interest or feeling no pleasure in all — or almost all — activities most of the day, nearly every day
Significant weight loss when not dieting, weight gain, or decrease or increase in appetite nearly every day (in children, failure to gain weight as expected can be a sign of depression)
Either insomnia or sleeping excessively nearly every day
Either restlessness or slowed behavior that can be observed by others
Fatigue or loss of energy nearly every day
Feelings of worthlessness or excessive or inappropriate guilt, such as believing things that are not true, nearly every day
Decreased ability to think or concentrate, or indecisiveness, nearly every day
Recurrent thoughts of death or suicide, or suicide planning or attempt

To be considered a major depressive episode:

Symptoms must be severe enough to cause noticeable difficulty in day-to-day activities, such as work, school, social activities or relationships
Symptoms are not due to the direct effects of something else, such as alcohol or drug use, a medication or a medical condition
Symptoms are not caused by grieving, such as after the loss of a loved one

Other signs and symptoms of bipolar disorder

Signs and symptoms of bipolar I and bipolar II disorders may include additional features.

Anxious distress — having anxiety, such as feeling keyed up, tense or restless, having trouble concentrating because of worry, fearing something awful may happen, or feeling you may not be able to control yourself
Mixed features — meeting the criteria for a manic or hypomanic episode, but also having some or all symptoms of major depressive episode at the same time
Melancholic features — having a loss of pleasure in all or most activities and not feeling significantly better, even when something good happens
Atypical features — experiencing symptoms that are not typical of a major depressive episode, such as having a significantly improved mood when something good happens
Catatonia — not reacting to your environment, holding your body in an unusual position, not speaking, or mimicking another person’s speech or movement
Peripartum onset — bipolar disorder symptoms that occur during pregnancy or in the four weeks after delivery
Seasonal pattern — a lifetime pattern of manic, hypomanic or major depressive episodes that change with the seasons
Rapid cycling — having four or more mood swing episodes within a single year, with full or partial remission of symptoms in between manic, hypomanic or major depressive episodes
Psychosis — severe episode of either mania or depression (but not hypomania) that results in a detachment from reality and includes symptoms of false but strongly held beliefs (delusions) and hearing or seeing things that aren’t there (hallucinations)

Symptoms in children and teens

The same DSM-5 criteria used to diagnose bipolar disorder in adults are used to diagnose children and teenagers. Children and teens may have distinct major depressive, manic or hypomanic episodes, between which they return to their usual behavior, but that’s not always the case. And moods can rapidly shift during acute episodes.
Symptoms of bipolar disorder can be difficult to identify in children and teens. It’s often hard to tell whether these are normal ups and downs, the results of stress or trauma, or signs of a mental health problem other than bipolar disorder. And children who have bipolar disorder are frequently also diagnosed with other mental health conditions.
The most prominent signs of bipolar disorder in children and teenagers may include severe mood swings that are different from their usual mood swings.

When to see a doctor

If you have any symptoms of depression or mania, see your doctor or mental health provider. Bipolar disorder doesn’t get better on its own. Getting treatment from a mental health provider with experience in bipolar disorder can help you get your symptoms under control.
Many people with bipolar disorder don’t get the treatment they need. Despite the mood extremes, people with bipolar disorder often don’t recognize how much their emotional instability disrupts their lives and the lives of their loved ones.
And if you’re like some people with bipolar disorder, you may enjoy the feelings of euphoria and cycles of being more productive. However, this euphoria is always followed by an emotional crash that can leave you depressed, worn out — and perhaps in financial, legal or relationship trouble.
If you’re reluctant to seek treatment, confide in a friend or loved one, a health care professional, a faith leader or someone else you trust. He or she may be able to help you take the first steps to successful treatment.

When to get emergency help

Suicidal thoughts and behavior are common among people with bipolar disorder. If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately.
Also consider these options:

Reach out to a close friend or loved one.
Contact a minister, spiritual leader or someone in your faith community.
Call a suicide hotline number — in the United States, call the National Suicide Prevention Lifeline at 800-273-TALK FREE (800-273-8255 FREE) to reach a trained counselor. Use that same number and press 1 to reach the Veterans Crisis Line.
Make an appointment with your doctor, mental health provider or other health care provider.

If you have a loved one who is in danger of committing suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.
The exact cause of bipolar disorder is unknown, but several factors may be involved, such as:

Biological differences. People with bipolar disorder appear to have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes.
Neurotransmitters. An imbalance in naturally occurring brain chemicals called neurotransmitters seems to play a significant role in bipolar disorder and other mood disorders.
Inherited traits. Bipolar disorder is more common in people who have a first-degree relative, such as a sibling or parent, with the condition. Researchers are trying to find genes that may be involved in causing bipolar disorder.

Factors that may increase the risk of developing bipolar disorder or act as a trigger for the first episode include:

Having a first-degree relative, such as a parent or sibling, with bipolar disorder
Periods of high stress
Drug or alcohol abuse
Major life changes, such as the death of a loved one or other traumatic experiences

Conditions that commonly occur with bipolar disorder

Anxiety disorders. Examples include social anxiety disorder and generalized anxiety disorder.
Post-traumatic stress disorder (PTSD). Some people with PTSD, a trauma- and stressor-related disorder, also have bipolar disorder.
Attention-deficit/hyperactivity disorder (ADHD). ADHD has symptoms that overlap with bipolar disorder. For this reason, bipolar disorder can be difficult to differentiate from ADHD. Sometimes one is mistaken for the other. In some cases, a person may be diagnosed with both conditions.
Addiction or substance abuse. Many people with bipolar disorder also have alcohol, tobacco or drug problems. Drugs or alcohol may seem to ease symptoms, but they can actually trigger, prolong or worsen depression or mania.
Physical health problems. People diagnosed with bipolar disorder are more likely to have certain other health problems, such as heart disease, thyroid problems or obesity.

Left untreated, bipolar disorder can result in serious problems that affect every area of your life. These may include:

Problems related to drug and alcohol use
Suicide or suicide attempts
Legal problems
Financial problems
Relationship troubles
Isolation and loneliness
Poor work or school performance
Frequent absences from work or school

You may start by seeing your primary care doctor or you may choose to see a medical doctor who specializes in diagnosing and treating mental health conditions (psychiatrist).

What you can do

Before your appointment, make a list of:

Any symptoms you’ve had, including any that may seem unrelated to the reason for the appointment
Key personal information, including any major stresses or recent life changes
All medications, vitamins or other supplements that you’re taking, and their dose
Questions to ask your doctor

Take a family member or friend along, if possible. That person may provide more information or remember something that you missed or forgot.
Some basic questions to ask your doctor include:

Do I have bipolar disorder?
Are there any other possible causes for my symptoms?
What kinds of tests will I need?
What treatments are available? Which do you recommend for me?
What side effects are possible with that treatment?
What are the alternatives to the primary approach that you’re suggesting?
I have these other health conditions. How can I best manage these conditions together?
Should I see a psychiatrist or other mental health provider?
Is there a generic alternative to the medicine you’re prescribing?
Are there any brochures or other printed material that I can have? What websites do you recommend?

Don’t hesitate to ask questions at any time during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to spend more time on. Your doctor may ask:

When did you or your loved ones first begin noticing your symptoms of depression, mania or hypomania?
How frequently do your moods change?
Do you ever have suicidal thoughts when you’re feeling down?
Do your symptoms interfere with your daily life or relationships?
Do you have any blood relatives with bipolar disorder or depression?
What other mental or physical health conditions do you have?
Do you drink alcohol, smoke cigarettes or use street drugs?
How much do you sleep at night? Does it change over time?
Do you go through periods when you take risks that you wouldn’t normally take, such as unsafe sex or unwise, spontaneous financial decisions?
What, if anything, seems to improve your symptoms?
What, if anything, appears to worsen your symptoms?

Physical exam. A physical exam and lab tests may be done to help identify any medical problems that could be causing your symptoms.
Psychological evaluation. Your doctor or mental health provider will talk to you about your thoughts, feelings and behavior patterns. You may also fill out a psychological self-assessment or questionnaire. With your permission, family members or close friends may be asked to provide information about your symptoms and possible episodes of mania or depression.
Mood charting. To identify exactly what’s going on, your doctor may have you keep a daily record of your moods, sleep patterns or other factors that could help with diagnosis and finding the right treatment.
Signs and symptoms. Your doctor or mental health professional typically will compare your symptoms with the criteria for bipolar and related disorders in the Diagnostic and Statistical Manual of Mental Disorders to determine a diagnosis.

Diagnosis in children

Initial treatment. Often, you’ll need to start taking medications to balance your moods right away. Once your symptoms are under control, you’ll work with your doctor to find the best long-term treatment.
Continued treatment. Bipolar disorder requires lifelong treatment, even during periods when you feel better. Maintenance treatment is used to manage bipolar disorder on a long-term basis. People who skip maintenance treatment are at high risk of a relapse of symptoms or having minor mood changes turn into full-blown mania or depression.
Day treatment programs. Your doctor may recommend a day treatment program. These programs provide the support and counseling you need while you get symptoms under control.
Substance abuse treatment. If you have problems with alcohol or drugs, you’ll also need substance abuse treatment. Otherwise, it can be very difficult to manage bipolar disorder.
Hospitalization. Your doctor may recommend hospitalization if you’re behaving dangerously, you feel suicidal or you become detached from reality (psychotic). Getting psychiatric treatment at a hospital can help keep you calm and safe and stabilize your mood, whether you’re having a manic or major depressive episode.

The primary treatments for bipolar disorder include medications and psychological counseling (psychotherapy), and may include education and support groups.

Medications

A number of medications are used to treat bipolar disorder. The types and doses of medications prescribed are based on your particular symptoms.
Medications may include:

Mood stabilizers. Whether you have bipolar I or II disorder, you’ll typically need mood-stabilizing medication to control manic or hypomanic episodes. Examples of mood stabilizers include lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others) and lamotrigine (Lamictal).
Antipsychotics. If symptoms of depression or mania persist in spite of treatment with other medications, adding an antipsychotic medication such as olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris) may help. Your doctor may prescribe some of these medications alone or along with a mood stabilizer.
Antidepressants. Your doctor may add an antidepressant to help manage depression. Because an antidepressant can sometimes trigger a manic episode, it’s usually prescribed along with a mood stabilizer or antipsychotic.
Antidepressant-antipsychotic. The medication Symbyax combines the antidepressant fluoxetine and the antipsychotic olanzapine. It works as a depression treatment and a mood stabilizer. Symbyax is approved by the Food and Drug Administration specifically for the treatment of depressive episodes associated with bipolar I disorder.
Anti-anxiety medications. Benzodiazepines may help with anxiety and improve sleep. Benzodiazepines are generally used for relieving anxiety only on a short-term basis.

Side effects

Finding the right medication

Medications and pregnancy

A number of medications for bipolar disorder can be associated with birth defects. Discuss these issues with your doctor:

Birth control options, as birth control medications may lose effectiveness when taken along with certain bipolar disorder medications
Treatment options if you plan to become pregnant
Breast-feeding, as some bipolar medications can pass through breast milk to your infant

Psychotherapy

Psychotherapy is a vital part of bipolar disorder treatment and can be provided in individual, family or group settings. Several types of therapy may be helpful. These include:

Cognitive behavioral therapy. The focus of cognitive behavioral therapy is identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. It can help identify what triggers your bipolar episodes. You also learn effective strategies to manage stress and to cope with upsetting situations.
Psychoeducation. Counseling to help you learn about bipolar disorder (psychoeducation) can help you and your loved ones understand bipolar disorder. Knowing what’s going on can help you get the best support and treatment, and help you and your loved ones recognize warning signs of mood swings.
Interpersonal and social rhythm therapy (IPSRT). IPSRT focuses on the stabilization of daily rhythms, such as sleep, wake and mealtimes. A consistent routine allows for better mood management. People with bipolar disorder may benefit from establishing a daily routine for sleep, diet and exercise.
Other therapies. Other therapies have been studied with some evidence of success. Ask your doctor if any other options may be appropriate for you.

Other treatment options

Depending on your needs, other treatments may be added to your depression therapy, such as:

Electroconvulsive therapy (ECT). In ECT, electrical currents are passed through the brain. This procedure is thought to affect levels of neurotransmitters in your brain and typically offers immediate relief of even severe depression when other treatments don’t work. Physical side effects, such as headache, are tolerable. Some people also have memory loss, which is usually temporary. ECT is usually used for people who don’t get better with medications, can’t take antidepressants for health reasons or are at high risk of suicide. ECT may be an option if you have mania or severe depression when you’re pregnant and cannot take your regular medications.
Transcranial magnetic stimulation (TMS). TMS may be an option for those who haven’t responded to antidepressants. During TMS, you sit in a reclining chair with a treatment coil placed against your scalp. The coil sends brief magnetic pulses to stimulate nerve cells in your brain that are involved in mood regulation and depression. Typically, you’ll have five treatments each week for up to six weeks.

Treatment in children and teenagers

Treatments for children and teenagers are generally decided on a case-by-case basis, depending on symptoms, medication side effects and other factors.

Medications. Children and teens with bipolar disorder are often prescribed the same types of medications as those used in adults. There’s less research on the safety and effectiveness of bipolar medications in children than in adults, so treatment decisions are often based on adult research.
Psychotherapy. Most children diagnosed with bipolar disorder require counseling as part of initial treatment and to keep symptoms from returning. Psychotherapy can help children develop coping skills, address learning difficulties, resolve social problems, and help strengthen family bonds and communication. And, if needed, it can help treat substance abuse problems, common in older children with bipolar disorder.
Support. Working with teachers and school counselors and encouraging support from family and friends can help identify services and encourage success.

You’ll probably need to make lifestyle changes to stop cycles of behavior that worsen your bipolar disorder. Here are some steps to take:

Quit drinking or using illegal drugs. One of the biggest concerns with bipolar disorder is the negative consequences of risk-taking behavior and drug or alcohol abuse. Get help if you have trouble quitting on your own.
Steer clear of unhealthy relationships. Surround yourself with people who are a positive influence and won’t encourage unhealthy behavior or attitudes that can worsen your bipolar disorder.
Get regular physical activity and exercise. Moderate, regular physical activity and exercise can help steady your mood. Working out releases brain chemicals that make you feel good (endorphins), can help you sleep and has a number of other benefits. Check with your doctor before starting any exercise program, especially if you’re taking lithium, to make sure exercise won’t interfere with your medication.
Get plenty of sleep. Don’t stay up all night. Instead, get plenty of sleep. Sleeping enough is an important part of managing your mood. If you have trouble sleeping, talk to your doctor or mental health provider about what you can do.

Omega-3 fatty acids. These oils may help improve depression associated with bipolar disorder. Bipolar disorder appears to be less common in areas of the world where people regularly eat fish rich in omega-3s. Omega-3s appear to have a number of health benefits, but more studies are needed to determine just how much they help with bipolar disorder.
Magnesium. Several small studies have suggested that magnesium supplements may lessen mania and the rapid cycling of bipolar symptoms. More research is needed to confirm these findings.
St. John’s wort. This herb may be helpful with depression. However, it can also interact with antidepressants and other medications, and it has the potential to trigger mania in some people.
S-adenosyl-L-methionine (SAMe). This amino acid supplement appears to help brain function related to depression. It isn’t clear yet whether it’s helpful in people with bipolar disorder. As with St. John’s wort, SAMe can trigger mania in some people.
Herbal combinations. Herbal remedies that combine a number of different herbs, such as those used in traditional Chinese medicine, haven’t been well-studied and the contents may vary among products. Risks and benefits still aren’t clear.
Acupuncture. This ancient Chinese practice of inserting tiny needles into the skin may relieve depression, but more studies are needed to confirm its benefits. However, acupuncture is considered safe and can be done along with other bipolar disorder treatments.

If you choose to use complementary medicine in addition to your physician-recommended treatment, take some precautions first:

Don’t stop taking your prescribed medications or skip therapy sessions. Alternative medicine is not a substitute for regular medical care when it comes to treating bipolar disorder.
Be honest with your doctors and mental health providers. Tell them exactly which complementary treatments you use or would like to try.
Be aware of potential dangers. Just because it’s natural doesn’t mean it’s safe. Before using alternative or complementary medicine, find out the risks, including possible interactions with medications.

Coping with bipolar disorder can be challenging. Here are some strategies that can help:

Learn about bipolar disorder. Education about your condition can empower you and motivate you to stick to your treatment plan. Help educate your family and friends about what you’re going through.
Stay focused on your goals. Recovery from bipolar disorder can take time. Stay motivated by keeping your recovery goals in mind and reminding yourself that you can work to repair damaged relationships and other problems caused by your mood swings.
Join a support group. Support groups for people with bipolar disorder can help you connect to others facing similar challenges and share experiences.
Find healthy outlets. Explore healthy ways to channel your energy, such as hobbies, exercise and recreational activities.
Learn ways to relax and manage stress. Yoga, tai chi, massage, meditation or other relaxation techniques can be helpful.

Pay attention to warning signs. Addressing symptoms early on can prevent episodes from getting worse. You and your caregivers may have identified a pattern to your bipolar episodes and what triggers them. Call your doctor if you feel you’re falling into an episode of depression or mania. Involve family members or friends in watching for warning signs.
Avoid drugs and alcohol. Using alcohol or street drugs can worsen your symptoms and make them more likely to come back.
Take your medications exactly as directed. You may be tempted to stop treatment — but don’t. This can have immediate consequences — you may become very depressed, feel suicidal, or go into a manic or hypomanic episode. If you think you need to make a change, call your doctor.
Check first before taking other medications. Call the doctor who’s treating you for bipolar disorder before you take medications prescribed by another doctor or any over-the-counter supplements or medications. Sometimes other medications trigger episodes of bipolar disorder or may interfere with medications you’re already taking to treat bipolar disorder.

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Mental Health Awareness Gallery

The man and the idea – conceptual abstract illustration

Introduction

Anger, Thoughts, & Social Behavior

Anger: A Substitute Emotion

Defining Anger

Benefits and Costs of Anger: Social, Emotional, and Health

The Experience of Anger

Healthy Expression of Anger

Effects of Anger

What You’ll Find in This Section

Conditions that commonly occur with bipolar disorder

What you can do

What to expect from your doctor

Diagnosis in children

Medications

Side effects

Finding the right medication

Medications and pregnancy

Psychotherapy

Other treatment options

Treatment in children and teenagers

1. It Gives You Strength, Tenacity, or “Chutzpah”

2. It Makes You More Proactive About Your Overall Health

3. It Gives You Empathy For Other People

4. It Helps You Know Who Your Real Friends Are

5. It Gives You The Ability To Help Others Who Have Bipolar Disorder

Criteria for bipolar disorder

Criteria for a manic or hypomanic episode

Criteria for a major depressive episode

Other signs and symptoms of bipolar disorder

Symptoms in children and teens

When to see a doctor

When to get emergency help

Conditions that commonly occur with bipolar disorder

What you can do

What to expect from your doctor

Diagnosis in children

Medications

Side effects

Finding the right medication

Medications and pregnancy

Psychotherapy

Other treatment options

Treatment in children and teenagers

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