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Why it’s done
By Mayo Clinic Staff

Psychotherapy can be helpful in treating most mental health problems, including:
•Anxiety disorders, such as obsessive-compulsive disorder (OCD), phobias, panic disorder or post-traumatic stress disorder (PTSD)
•Mood disorders, such as depression or bipolar disorder
•Addictions, such as alcoholism, drug dependence or compulsive gambling
•Eating disorders, such as anorexia or bulimia
•Personality disorders, such as borderline personality disorder or dependent personality disorder
•Schizophrenia or other disorders that cause detachment from reality (psychotic disorders)

Not everyone who benefits from psychotherapy is diagnosed with a mental illness. Psychotherapy can help with a number of life’s stresses and conflicts that can affect anyone. For example, it may help you:
•Resolve conflicts with your partner or someone else in your life
•Relieve anxiety or stress due to work or other situations
•Cope with major life changes, such as divorce, the death of a loved one or the loss of a job
•Learn to manage unhealthy reactions, such as road rage or passive-aggressive behavior
•Come to terms with an ongoing or serious physical health problem, such as diabetes, cancer or ongoing (chronic) pain
•Recover from physical or sexual abuse or witnessing violence
•Cope with sexual problems, whether they’re due to a physical or psychological cause
•Sleep better, if you have trouble getting to sleep or staying asleep (insomnia)

In some cases, psychotherapy can be as effective as medications, such as antidepressants. However, depending on your specific situation, psychotherapy alone may not be enough to ease the symptoms of a mental health condition. You may also need medications or other treatments.

Bipolar disorder is divided into several subtypes. Each has a different pattern of symptoms. Types of bipolar disorder include:

•Bipolar I disorder. Mood swings with bipolar I cause significant difficulty in your job, school or relationships. Manic episodes can be severe and dangerous.

•Bipolar II disorder. Bipolar II is less severe than bipolar I. You may have an elevated mood, irritability and some changes in your functioning, but generally you can carry on with your normal daily routine. Instead of full-blown mania, you have hypomania — a less severe form of mania. In bipolar II, periods of depression typically last longer than periods of hypomania.

•Cyclothymic disorder. Cyclothymic disorder, also known as cyclothymia, is a mild form of bipolar disorder. With cyclothymia, hypomania and depression can be disruptive, but the highs and lows are not as severe as they are with other types of bipolar disorder.

The exact symptoms of bipolar disorder vary from person to person. For some people, depression causes the most problems; for other people, manic symptoms are the main concern. Symptoms of depression and symptoms of mania or hypomania may also occur together. This is known as a mixed episode.

Manic phase of bipolar disorder

Signs and symptoms of the manic or hypomanic phase of bipolar disorder can include:
•Euphoria
•Inflated self-esteem
•Poor judgment
•Rapid speech
•Racing thoughts
•Aggressive behavior
•Agitation or irritation
•Increased physical activity
•Risky behavior
•Spending sprees or unwise financial choices
•Increased drive to perform or achieve goals
•Increased sex drive
•Decreased need for sleep
•Easily distracted
•Careless or dangerous use of drugs or alcohol
•Frequent absences from work or school
•Delusions or a break from reality (psychosis)
•Poor performance at work or school

Depressive phase of bipolar disorder

Signs and symptoms of the depressive phase of bipolar disorder can include:
•Sadness
•Hopelessness
•Suicidal thoughts or behavior
•Anxiety
•Guilt
•Sleep problems
•Low appetite or increased appetite
•Fatigue
•Loss of interest in activities once considered enjoyable
•Problems concentrating
•Irritability
•Chronic pain without a known cause
•Frequent absences from work or school
•Poor performance at work or school

Other signs and symptoms of bipolar disorder

Signs and symptoms of bipolar disorder can also include:

•Seasonal changes in mood. As with seasonal affective disorder (SAD), some people with bipolar disorder have moods that change with the seasons. Some people become manic or hypomanic in the spring or summer and then become depressed in the fall or winter. For other people, this cycle is reversed — they become depressed in the spring or summer and manic or hypomanic in the fall or winter.

•Rapid cycling bipolar disorder. Some people with bipolar disorder have rapid mood shifts. This is defined as having four or more mood swings within a single year. However, in some people mood shifts occur much more quickly, sometimes within just hours.

•Psychosis. Severe episodes of either mania or depression may result in psychosis, a detachment from reality. Symptoms of psychosis may include false but strongly held beliefs (delusions) and hearing or seeing things that aren’t there (hallucinations).

Symptoms in children and adolescents

Instead of clear-cut depression and mania or hypomania, the most prominent signs of bipolar disorder in children and adolescents can include explosive temper, rapid mood shifts, reckless behavior and aggression. In some cases, these shifts occur within hours or less — for example, a child may have intense periods of giddiness and silliness, long bouts of crying and outbursts of explosive anger all in one day.

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. They may be able to help you take the first steps to successful treatment.

If you have suicidal thoughts

Suicidal thoughts and behavior are common among people with bipolar disorder. If you or someone you know is having suicidal thoughts, get help right away. Here are some steps you can take:
•Contact a family member or friend.
•Seek help from your doctor, a mental health provider or other health care professional.
•Call a suicide hot line number — in the United States, you can reach the toll-free, 24-hour hot line of the National Suicide Prevention Lifeline at 800-273-8255 to talk to a trained counselor.
•Contact a minister, spiritual leader or someone in your faith community.

When to get emergency help

If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately. If you have a loved one who has harmed himself or herself, or is seriously considering doing so, make sure someone stays with that person. Take him or her to the hospital or call for emergency help.

Bipolar disorder can be treated with a number of medications. Some of these medications can increase your appetite or cause changes in metabolism leading to weight gain.

Whether a certain medication will cause weight gain or other side effects varies from person to person. Likewise, how well the medication works to treat bipolar disorder symptoms differs for each individual. Because of this, finding the medications that best treat your symptoms may require some trial and error. In some cases, medications that increase the risk of weight gain may be needed only temporarily to get your symptoms under control. Then, you and your doctor can find long-term (maintenance) treatment that keeps symptoms at bay and causes the least amount of side effects.

Medications for bipolar disorders include mood stabilizers, antidepressants and antipsychotics.

•Mood stabilizers used to treat bipolar disorder include lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others) and lamotrigine (Lamictal). All of these medications are known to increase the risk of weight gain except lamotrigine.

•Antipsychotics commonly prescribed for bipolar disorder include olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), and asenapine (Saphris). Some of these medications cause weight gain when taken alone, but many people need more than one medication to get better control of their symptoms. Weight gain appears to be more likely when an antipsychotic is combined with a mood stabilizer. Children and adolescents with bipolar disorder who take these medications tend to have a greater chance of gaining weight in a short amount of time.

•Antidepressants can cause weight gain in some people, but reactions to these medications vary from person to person. Paroxetine (Paxil) and mirtazapine (Remeron) may be more likely to cause weight gain than other commonly prescribed antidepressants. In general, newer, commonly prescribed antidepressants such as selective serotonin reuptake inhibitors (SSRIs) don’t cause weight gain. The risk of weight gain is more likely with certain older, less commonly prescribed antidepressants — including the majority of tricyclic antidepressants and some monoamine oxidase inhibitors (MAOIs).

Some weight gain may be inevitable when taking medications needed to control your bipolar symptoms. If weight gain is an issue, ask your doctor for advice on strategies to manage it. Learning tips for healthy eating, keeping physically active and getting psychological counseling (psychotherapy) can all help. Be patient and keep working with your doctor to find the best way to keep your symptoms — and your weight — under control

Bipolar disorder in children is possible. It’s most often diagnosed in older children and teenagers, but bipolar disorder can occur in children of any age. As in adults, bipolar disorder in children can cause mood swings from the highs of hyperactivity or euphoria (mania) to the lows of serious depression.

Emotional upheaval and unruly behaviors are a normal part of childhood and the teen years, and in most cases they aren’t a sign of a mental health problem that requires treatment. All kids have rough periods — it’s normal to feel down, irritable, angry, hyperactive or rebellious at times. However, if your child’s symptoms are severe, ongoing or causing significant problems, it may be more than just a phase.

Here are some signs and symptoms of bipolar disorder in children:
•Severe mood swings that are different from their usual mood swings
•Hyperactive, impulsive, aggressive or socially inappropriate behavior
•Risky and reckless behaviors that are out of character, such as having frequent casual sex with many different partners (sexual promiscuity), alcohol or drug abuse, or wild spending sprees
•Insomnia or significantly decreased need for sleep
•Depressed or irritable mood most of the day, nearly every day during a depressive episode
•Grandiose and inflated view of own capabilities
•Suicidal thoughts or behaviors in older children and teens

Children with bipolar disorder experience symptoms in distinct episodes. Between these episodes, children return to their usual behavior and mood.

Keep in mind, a number of other childhood disorders cause bipolar-like symptoms, including attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, conduct disorder, anxiety disorders and major depression. Diagnosis can be challenging because these and other mental health conditions often occur along with bipolar disorder.

If your child has serious mood swings, depression or behavior problems, consult a mental health provider who specializes in working with children and teens. Mood and behavior issues caused by bipolar disorder or other mental health conditions can lead to major difficulties. Early treatment can help prevent serious consequences and decrease the impact of mental health problems on your child as he or she gets older.

Factors that may increase the risk of developing bipolar disorder include:

•Having blood relatives 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
•Being in your early 20s

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. They include:

•Anxiety disorders. Examples include post-traumatic stress disorder (PTSD), social phobia and generalized anxiety 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, including heart disease, thyroid problems and obesity.

The exact cause of bipolar disorder is unknown, but several factors seem to be involved in causing and triggering bipolar episodes:

•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.

•Hormones. Imbalanced hormones may be involved in causing or triggering bipolar disorder.

•Inherited traits. Bipolar disorder is more common in people who have a blood relative (such as a sibling or parent) with the condition. Researchers are trying to find genes that may be involved in causing bipolar disorder.

•Environment. Stress, abuse, significant loss or other traumatic experiences may play a role in bipolar disorder.

Bipolar disorder is divided into several subtypes. Each has a different pattern of symptoms. Types of bipolar disorder include:
•Bipolar I disorder. Mood swings with bipolar I cause significant difficulty in your job, school or relationships. Manic episodes can be severe and dangerous.
•Bipolar II disorder. Bipolar II is less severe than bipolar I. You may have an elevated mood, irritability and some changes in your functioning, but generally you can carry on with your normal daily routine. Instead of full-blown mania, you have hypomania — a less severe form of mania. In bipolar II, periods of depression typically last longer than periods of hypomania.
•Cyclothymic disorder. Cyclothymic disorder, also known as cyclothymia, is a mild form of bipolar disorder. With cyclothymia, hypomania and depression can be disruptive, but the highs and lows are not as severe as they are with other types of bipolar disorder.

The exact symptoms of bipolar disorder vary from person to person. For some people, depression causes the most problems; for other people, manic symptoms are the main concern. Symptoms of depression and symptoms of mania or hypomania may also occur together. This is known as a mixed episode.

Manic phase of bipolar disorder

Signs and symptoms of the manic or hypomanic phase of bipolar disorder can include:
•Euphoria
•Inflated self-esteem
•Poor judgment
•Rapid speech
•Racing thoughts
•Aggressive behavior
•Agitation or irritation
•Increased physical activity
•Risky behavior
•Spending sprees or unwise financial choices
•Increased drive to perform or achieve goals
•Increased sex drive
•Decreased need for sleep
•Easily distracted
•Careless or dangerous use of drugs or alcohol
•Frequent absences from work or school
•Delusions or a break from reality (psychosis)
•Poor performance at work or school

Depressive phase of bipolar disorder

Signs and symptoms of the depressive phase of bipolar disorder can include:
•Sadness
•Hopelessness
•Suicidal thoughts or behavior
•Anxiety
•Guilt
•Sleep problems
•Low appetite or increased appetite
•Fatigue
•Loss of interest in activities once considered enjoyable
•Problems concentrating
•Irritability
•Chronic pain without a known cause
•Frequent absences from work or school
•Poor performance at work or school

Other signs and symptoms of bipolar disorder

Signs and symptoms of bipolar disorder can also include:
•Seasonal changes in mood. As with seasonal affective disorder (SAD), some people with bipolar disorder have moods that change with the seasons. Some people become manic or hypomanic in the spring or summer and then become depressed in the fall or winter. For other people, this cycle is reversed — they become depressed in the spring or summer and manic or hypomanic in the fall or winter.
•Rapid cycling bipolar disorder. Some people with bipolar disorder have rapid mood shifts. This is defined as having four or more mood swings within a single year. However, in some people mood shifts occur much more quickly, sometimes within just hours.
•Psychosis. Severe episodes of either mania or depression may result in psychosis, a detachment from reality. Symptoms of psychosis may include false but strongly held beliefs (delusions) and hearing or seeing things that aren’t there (hallucinations).

Symptoms in children and adolescents

Instead of clear-cut depression and mania or hypomania, the most prominent signs of bipolar disorder in children and adolescents can include explosive temper, rapid mood shifts, reckless behavior and aggression. In some cases, these shifts occur within hours or less — for example, a child may have intense periods of giddiness and silliness, long bouts of crying and outbursts of explosive anger all in one day.

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. They may be able to help you take the first steps to successful treatment.

If you have suicidal thoughts

Suicidal thoughts and behavior are common among people with bipolar disorder. If you or someone you know is having suicidal thoughts, get help right away. Here are some steps you can take:
•Contact a family member or friend.
•Seek help from your doctor, a mental health provider or other health care professional.
•Call a suicide hot line number — in the United States, you can reach the toll-free, 24-hour hot line of the National Suicide Prevention Lifeline at 800-273-8255 to talk to a trained counselor.
•Contact a minister, spiritual leader or someone in your faith community.

When to get emergency help

If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately. If you have a loved one who has harmed himself or herself, or is seriously considering doing so, make sure someone stays with that person. Take him or her to the hospital or call for emergency help.

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.

What Is It?

Sleep apnea is a chronic condition and sleep disorder that causes breathing pauses throughout the night. These pauses can last for several seconds or minutes and can occur multiple times in an hour.

Most sleep apnea patients also experience shallow breathing while asleep. If you have sleep apnea, after a night’s sleep, this shallow breathing can cause you to wake up feeling tired – as if you have not received a full night’s sleep. In the long term, you may feel chronically fatigued, and your blood oxygen levels may become slightly or drastically lowered.

Because sleep apnea patients are sleeping, they may not realize that they are experiencing breathing problems. Sleep apnea can only be diagnosed by observation. Your partner may notice that you are snoring or experiencing breathing pauses while you sleep. To diagnose sleep apnea, you will need to undergo a sleep study in which the doctor will monitor your sleeping patterns.

Sleep apnea is common and can be very serious in the long term, putting patients at risk for hypoxemia, hypercapnia, and congestive heart failure. Other potential damage involves permanent brain injury. You may have trouble staying awake at school or at work, and you may have no idea that sleep apnea is causing your problems. Most cases of sleep apnea remain undiagnosed, and most people have unaware that they have the condition until they start to exhibit serious symptoms.

Types

There are three different kinds of sleep apnea. Obstructive sleep apnea (OSA) results when the pharynx tissues obstruct breathing. Central sleep apnea is rare and causes the brain to malfunction with breathing.

In rare situations, patients might develop mixed sleep apnea, which is a combination of obstructive sleep apnea and central sleep apnea. This type of sleep apnea can be extremely dangerous.

All types of sleep apnea are serious and require treatment. No matter the type of sleep apnea that you have, you may experience symptoms for years – even decade before realizing that you have a breathing problem.

No matter the type, sleep apnea can cause snoring, pauses in breathing, and sustaining fatigue. If you are tired, you should talk to a doctor about undergoing a sleep study as soon as possible to determine whether you have sleep apnea or another condition.

Symptoms & Warning Signs

Loud snoring is a symptom of obstructive sleep apnea, the most common form of sleep apnea. Some sleep apnea patients experience no snoring at all.

The typical symptoms of sleep apnea include sleepiness, morning headaches, dry throat, memory loss, difficulty concentrating, and unexplained irritability.

Over time when left untreated, side effects of sleep apnea can cause you to develop symptoms that are more serious, including hypoxemia, hypercapnia, and congestive heart failure.

You should consult a doctor if you experience loud snoring, trouble breathing that causes you to wake up, and excessive fatigue throughout the day. You may need to undergo a sleep test for sleep apnea, or you may have another problem that requires treatment.

Causes & Risk Factors

Sleep apnea is most common among men. Men above the age of 65 and women who have completed menopause are the most commonly affected group. Obesity is another strong risk factor. People with large tonsils and irritated nostrils are more likely to develop problems related to sleep apnea. You may develop sleep apnea when your throat muscles and tongues relax more than normal due to alcohol and sedatives. People with a family history of sleep apnea are likely to develop the condition.

Prevention & Treatment

Lifestyle changes can help prevent and treat sleep apnea. It is recommended that sleep apnea patients limit alcohol, lose weight, and stop smoking. Patients might also see improvements after changing sleeping positions. It is recommended that sleep apnea patients avoid sleeping on their backs. Most sleep apnea patients will need to sleep with a mask that provides pressurized air to stop the airway from collapsing. In some cases, patients require surgery.

Tests & Diagnosis

Before consulting a doctor, you should ask your sleep partner to document you’re the severity of your snoring. No lab tests are available to diagnose sleep apnea; rather, the doctor will document your family history, monitor your symptoms, give you a general physical exam, and order a sleep test to check for common symptoms of sleep apnea.

The Symptoms of Traumatic Stress

The phenomenon of anniversary reaction is normal and human, says Matthew J. Friedman, MD, PhD, professor of psychiatry, pharmacology and toxicology at the Geisel School of Medicine at Dartmouth University, and executive director of the U.S. Department of Veterans Affairs National Center for Post-Traumatic Stress Disorder (PTSD).

“Anniversaries are built into the fabric of how we humans behave collectively and individually,” he says. Anniversaries, of course, can be happy events like a wedding anniversary, but they can also remind us of trauma.

When the anniversary marks a sad event, your mind focuses on the damaging memories. Your body is well aware of this, producing a mix of mental and physical symptoms. “A person who has been feeling pretty good all of a sudden feels sad, weepy, perhaps fatigued, and not motivated to do anything,” says Friedman.

Insomnia, headache, hyper-alertness and suppressed appetite can also occur. If you have a chronic health problem, such as high blood pressure or diabetes, it may not be controlled during this time, Friedman says.

Re-experiencing the event is common so if your traumatic event was an assault, for instance, you may spend the anniversary date feeling restless and unsafe.

Anniversary reactions can be especially hard for soldiers and others who have been diagnosed with PTSD, a mental health disorder occurring after war, assault or disaster. They may experience nightmares or flashbacks of the events and avoid anything related to the experience, such as staying home from Veteran’s Day activities.

Coping After the Traumatic Event

When trying to cope with anniversary reaction or PTSD, accepting the emotional and physical responses is a good first step, Friedman says. “You shouldn’t be surprised you are feeling this way on a particular date, considering what happened,” he tells patients and veterans.

You can return to your normal state more efficiently by understanding why you react the way you do, then focusing on happier memories. Of course, you can help manage any harmful physical symptoms by doing a few more things:
1.Go easy on yourself. Recognize that you may be more vulnerable during this time and that you can get through by being good to yourself in a healthy way. Don’t go after short-term, unhealthy fixes, like reaching for alcohol or emotionally binge eating.
2.Talk to others. As you recall traumatic events on the day they occurred one year later, or even 15 years later, open up to others; it helps ease the emotional burden. Don’t allow yourself to experience internalized grief without mentioning it or even discussing it, which many people tend to do.
3.Actively minimize stress. Get a sufficient amount of restful sleep, take your normal medications or pain relievers, chill out with a massage or relaxing movie, or meditate and stretch to relieve stress.
4.Give back. Consider making a specific do-good plan for the actual anniversary day, such as volunteering, babysitting or giving blood.
5.Find comfort. Visit a loved one’s grave, attend a place of worship or take a meditation seminar — anything that helps you find peace.
6.Schedule time with loved ones. Personally speaking, that’s what helps me when I experience my anniversary of grief, and it helps to share and recall how wonderful and loving my mother was as I visit with family and friends.

Unlike hardcore PTSD, anniversary reaction usually passes within a short amount of time. People typically feel better within a few days after the anniversary date. If the symptoms don’t pass, you may need a referral to a mental health professional