Bipolar4LifeSupport

Too often, bipolar disorder goes untreated, but it can be managed with the right medical help.

Many people with bipolar disorder don’t recognize the extreme changes in their moods, and the effect these changes have on their lives and the lives of those around them.

As a result, too many people with the condition fail to get the necessary treatment.

If you think you may have bipolar disorder, talk to your doctor, a friend, or a family member. This person may be able to assist you in taking the first steps toward treating the condition.

If you think you may hurt yourself or attempt suicide — or if you think a loved one may do the same or harm others — seek emergency medical help immediately.

Hospitalization may be required in some cases of bipolar disorder. In most cases, though, the condition can be successfully treated in an outpatient setting — ideally by seeing a psychiatrist.

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Most people with bipolar disorder can lead normal and productive lives if they continue with their treatment and regularly see their doctor.

Bipolar Disorder Medications

If you’ve been diagnosed with bipolar disorder, you’ll most likely need to start taking medication to balance your moods immediately.

Once your mood swings and other symptoms are under control, you’ll work with your doctor to develop maintenance treatment to manage your condition over the long term.

A number of medications are used to treat bipolar disorder, including:

Mood stabilizers
Antipsychotics
Antidepressants
Antianxiety medications
Your doctor will prescribe one or more medications based on the type of bipolar disorder you have, as well as the exact nature of your symptoms.

Most people with bipolar I or bipolar II will need mood stabilizers to control their manic or hypomanic episodes.

If you have one of these forms of the condition, your doctor may prescribe one of the following mood stabilizers:

Tegretol (carbamazepine)
Depakote (divalproex sodium)
Lamictal (lamotrigine)
Lithobid (lithium)
Depakene (valproic acid)
Antipsychotic drugs may also be used to control episodes of depression or mania, especially when delusions or hallucinations are occurring.

Examples of drugs in this class include:

Abilify (aripiprazole)
Saphris (asenapine)
Symbyax (olanzapine and fluoxetine)
Latuda (lurasidone)
Zyprexa (olanzapine)
Seroquel (quetiapine)
Risperdal (risperidone)
Geodon (ziprasidone)
An antidepressant may also be used to manage depressive episodes, in conjunction with a mood stabilizer or an antipsychotic.

Finally, your doctor may recommend a benzodiazepine — or another type of antianxiety medication — to relieve anxiety or improve sleep.

There’s a certain amount of trial and error associated with finding the right treatment for bipolar disorder.

But given that there are so many options, you and your doctor should be able to find a combination that works well for you.

Bipolar Medication Side Effects

One of the challenges associated with medication for bipolar disorder is the potential for a wide variety of side effects — some of which may be serious.

If you experience side effects from your drug therapy, talk to your doctor. Don’t stop taking your medication(s) unless your doctor advises you to do so.

If you suddenly stop taking a drug, your symptoms may return or you may experience withdrawal.

In addition to their potential for side effects, many of the drugs used to treat bipolar disorder can interact with birth control pills or may have health implications for women who are pregnant or might become pregnant.

If you’re using birth control, are pregnant, or are planning to become pregnant, talk to your doctor before starting on any medication for bipolar disorder.

Brain Stimulation Therapies

If your condition doesn’t respond well to treatment with drugs, your doctor may recommend electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS).
In ECT, your brain is treated with small electrical currents designed to affect the levels of certain neurotransmitters (chemicals that affect the brain).

In TMS, small magnetic pulses are applied to your brain to stimulate nerve cells that control mood regulation.

Both of these approaches typically involve multiple treatments.

Psychotherapy for Bipolar Disorder

In addition to prescribing medication, your doctor will also most likely recommend that you undergo routine psychotherapy or some other form of counseling.

This may include treatment for drug or alcohol addiction, if you’re dealing with addiction in addition to your bipolar disorder.

There are many different types of psychotherapy. Cognitive behavioral therapy (CBT) is the most commonly used form.

In CBT, a mental health professional (psychiatrist or psychologist) will work with you to identify triggers for your bipolar episodes, and develop healthy and effective strategies for dealing with stress and managing your condition.

Your doctor may also recommend educational and support programs for you and your family, which may help you better understand the disease and its symptoms — as well as how to cope with it.

When a child is diagnosed with bipolar disorder, teachers, school administrators, and other support staff are often engaged in treatment to make sure the child is doing well.

Alternative Treatments for Bipolar Disorder

Several so-called alternative treatments, or home remedies, have been recommended for bipolar disorder, although there is limited scientific evidence of their effectiveness in managing symptoms.

Most of these approaches involve taking herbal or dietary supplements, including:

Amino acids
Magnesium
Omega-3 fatty acids (such as fish oil or flaxseed oil)
St. John’s wort (for depression)
Commonly recommended amino acids — such as SAMe (S-adenosyl-L-methionine) — and St. John’s wort may interact with antidepressants or trigger episodes of mania or hypomania in some people.

Some people believe that the ancient Chinese practice of acupuncture may help treat depression. Researchers don’t yet know how effective this approach is for bipolar disorder, but it’s known to be safe overall, and it can be tried along with other prescription treatments.

Talk to your doctor before starting any nontraditional treatment for bipolar disorder, to make sure that it won’t interact with any prescription medications you’re taking.

Most important, don’t stop taking prescribed medications even if you’re feeling better.

Living With Bipolar Disorder

Living with bipolar disorder isn’t without challenges — but with the right treatment, education, and support, it’s possible to lead a quite normal and productive life.

If you’ve been diagnosed with bipolar disorder, make an effort to learn about the disease and its treatment so that you can work with your doctor to find the best course of treatment for you.

Learning about the disorder can also help you educate your family and friends about your struggles, so that they can better support you.

Speaking of support, there are many support groups for people with bipolar disorder and their families. You may find these groups helpful.

As you and your doctor work to refine your treatment to minimize both symptoms and side effects, try to be patient and remain motivated toward achieving your recovery goals. There are many combinations of treatments, and one will most likely work for you.

Finally, find healthy ways to channel your energy and manage or reduce stress.

For example, you should quit drinking alcohol or using drugs, as these substances can worsen the risk-taking behaviors associated with episodes of mania or hypomania — as well as make episodes of depression more severe.

Be sure to surround yourself with supportive, caring friends and family who will help you cope with your condition — and not encourage negative or destructive behaviors.

Exercise regularly, as physical activity can reduce stress, stabilize your mood, and signal your brain to release chemicals — called endorphins — that make you feel good.
Getting enough exercise can also help improve your sleep, which may help stabilize your mood.

Work with your doctor to develop an exercise regimen that’s right for you.

Consider taking on hobbies that help you relax, or explore certain relaxation techniques — such as yoga or meditation — that are designed to reduce stress.

Many people keep bipolar disorder a secret from their friends, love interests, co-workers, even family members. Follow this step-by-step guide to striking up this important conversation.
Filling someone in on your health history may not be your typical ice-breaker — and for people with bipolar disorder, sharing the diagnosis can be emotional and challenging.

But bipolar disorder is nothing to be ashamed of, and if you are proactive about starting the conversation, you will set a positive tone, whether you’re breaking the news to a family member, your boss, or a new love interest.

In fact, there are many reasons you should be open about bipolar disorder. “If patients carry their diagnosis around as a secret, it becomes a burden and they may feel even worried and alarmed that people are going to find out,” says psychiatrist Daniel Wilson, MD, chair of psychiatry at Creighton University in Omaha, Neb. Sharing can lighten your emotional load.

Other reasons to have the “bipolar chat” include:

Getting support. Just as when you have the flu, you will need the love and care of people around you during bipolar treatment and they, in turn, will appreciate knowing what’s going on with you.
Educating your loved ones. Finding a way to talk about bipolar disorder will allow you to inform the people in your life about your symptoms, as well as your bipolar treatment.
Identifying bipolar triggers and symptoms. People around a person with bipolar disorder are often the first to notice bipolar symptoms, particularly with mania. “Patients don’t always have the same degree of awareness of what’s happening,” says Dr. Wilson.
Breaking the News About Bipolar Disorder: An Eight-Step Guide

Once you decide that it’s time to tell others about your bipolar disorder, planning the conversation can be challenging. Use these step-by-step strategies:

Pick a calm moment. Too often, these conversations are forced by a crisis, says Wilson. “It’s better to have the conversation when the person is feeling well,” he says. That’s why you should share your diagnosis before another episode requires an immediate response. If you can choose the location, find a place where you feel comfortable and one that offers privacy for everyone involved.
Practice. It’s always a good idea to make a trial run with important conversations. Your therapist or a friend who already knows about your situation could be a good sounding board.
Fine-tune for your audience. Your exact words will be different if you are talking to a family member, a romantic partner, or a co-worker — so plan accordingly. For example, when you are talking to your boss, it might be helpful to bring along some of the highlights of your work history to show that you’ve been a productive employee over the years despite bipolar symptoms. If you are talking to a new love interest, it’s best to pick a time early in the relationship out of respect for your partner’s right to make choices about continuing to date you with full knowledge of your situation.
Be a teacher. There’s a good chance the person you are talking to doesn’t know much about bipolar disorder. Come prepared with helpful information. Bring pamphlets or contact information for a support group if you think that would help, or invite the person to meet with your counselor or doctor to fully understand your bipolar treatment.
Shut out stigma. You might be able to help your loved one better understand the implications of your diagnosis if you use a disease analogy. “I like to compare it to an overactive thyroid,” says Wilson. “Clearly you want to treat that condition.”
Make amends. If appropriate, you might want to acknowledge damage done by past behavior caused by bipolar symptoms. “Explaining that it wasn’t just a personal preference to behave in a particular way and that there is this medical aspect to it can be helpful,” says Wilson, adding that many patients feel guilt and shame over their actions and sincerely want to make amends. In some cases, both the disclosure of your diagnosis and acknowledging the impact of your choices might both be better handled in a letter.
Give them time. Some people are very open and flexible, but others — possibly family members with rigid ideas about family identity — can have a hard time digesting your news. “It’s often helpful to have a cooling-off period, letting people go their own way for a while,” says Wilson.
Accept their responses. Sharing your bipolar diagnosis may leave you feeling vulnerable and, unfortunately, not everyone will respond the way you wish they would. “I’ve had to advise patients to limit their contact with some family members for a while,” says Wilson. Talk to your therapist if you’re disappointed about the response that your disclosure received.
Keep in mind that what the person you are talking to does with the information you share is out of your control. “I’ve seen many cases of excellent, supportive work situations, and situations in which when people at work found out, they clearly tried to shuffle the person out of the job,” says Wilson.

To better help you manage this unpredictability, Wilson advises involving your counselor or therapist along the way, especially if your disclosure causes a major shake-up in your family dynamic or triggers denial or hostility.

TUESDAY, Aug. 16 (HealthDay News) — The manic episodes experienced by those with bipolar disorder are better controlled by antipsychotics than mood stabilizers, a new, large study suggests.

Researchers from Italy and the United Kingdom also found that three antipsychotic drugs — first-generation haloperidol (Haldol) along with later formulations of risperidone (Risperdal) and olanzapine (Zyprexa) — outperformed 11 other drugs. The scientists analyzed results from 68 randomized, controlled trials with more than 16,000 participants over a 30-year period.

Mania typically alternates with depression in those with bipolar disorder, which tends to run in families and begin between the ages of 15 and 25, according to the U.S. National Institutes of Health. Acute manic episodes — characterized by hyperactivity, racing thoughts and reckless behavior — are not experienced by all bipolar patients, but severe symptoms often require hospitalization, health officials said.

Broadly defined as an “excessively raised mood,” mania affects about 1 percent of the population, according to the study authors.

“The most important point is that this is a study about acute treatment of manic episodes, not long-term management or prevention,” said Dr. Gregory Simon, a psychiatrist and mental health researcher at Group Health Cooperative in Seattle, who was not involved in the study. “The idea that antipsychotic treatments are good for manic episodes is well-known, but the finding that one of the older ones is better is newsworthy here.”

Antipsychotics and other drugs commonly used to treat mania are known to have many significant side effects, which can sometimes disrupt treatment. Study co-author Dr. Andrea Cipriani, a lecturer in psychiatry at the University of Verona in Italy, said haloperidol and risperidone are more likely than olanzapine to cause movement problems such as tremors and rigidity, while olanzapine is linked to higher rates of weight gain, metabolic syndrome and diabetes. Some antipsychotic medications may cause irregular heartbeat as well.

Cipriani said the new research was the first of its type to compare anti-manic drugs — including antipsychotics, anticonvulsants and lithium — and rank them according to their effectiveness and ability to be tolerated. She and her colleagues completed a similar study on antidepressants several years ago.

In head-to-head comparisons among drugs, the study authors found that haloperidol was more effective than aripiprazole, asenapine, carbamazepine, valproate, gabapentin, lamotrigine, lithium, quetiapine, topiramate and ziprasidone. Risperidone, olanzapine and quetiapine were most likely to be tolerated by patients and outperformed lithium, lamotrigine, topiramate and gabapentin.

The new research, which was not funded by the pharmaceutical industry, appears in the Aug. 17 online edition of The Lancet.

“Psychiatrists now have an evidence-based hierarchy when they are to prescribe an anti-manic agent for acute mania,” Cipriani said. “These findings are in line with what psychiatrists usually prescribe in their daily practice. There are new treatments that have been recently marketed for acute mania, but this study shows that clinicians should be aware these new compounds are not better — and may be worse — than older ones, and these [new] drugs are much more expensive.”

Long-term management of bipolar disorder usually requires a combination of medications, Cipriani and Simon said, and antipsychotics typically are used for extreme manic episodes for only several weeks at a time.

In a commentary accompanying the study, Australian researchers Dr. Michael Berk, chair of psychiatry at the Deakin University School of Medicine, and Gin S. Malhi, with the department of psychiatry at Royal North Shore Hospital in Sydney, said it’s useful to know that haloperidol seems to be a top-line treatment for the treatment of acute mania.

But, they added, haloperidol “lacks maintenance efficacy for depression — the predominant clinical state [of patients with bipolar disorder] — and indeed carries an inherent risk of incident depression.”

Understanding the signs of bipolar disorder can be challenging, particularly in children and teens.

In general, the symptoms of bipolar disorder depend on which type of the condition a person has.

Bipolar I, for example, is characterized by extreme manic or mixed episodes and at least one major depressive episode.

With bipolar II, you may experience a major depressive episode as well as an episode of hypomania (less severe than full mania), with periods of level mood between episodes.

Finally, in cyclothymia — a milder form of bipolar disorder — people experience less severe manic and depressive episodes that alternate for at least two years.

So what constitutes a manic, hypomanic, or depressive episode?

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Manic and Hypomanic Episodes

The Diagnostic and Statistical Manual of Mental Disorders — which doctors use to guide diagnosis — describes a manic episode as a period of abnormally and persistently elevated mood, characterized by increased goal-directed activity or energy, that lasts for at least a week, with symptoms present most of the day, everyday.

A hypomanic episode has similar daily symptoms but is shorter in duration — at least four days.

During a manic or hypomanic episode, you may experience the following symptoms or changes in behavior:

You’re easily distracted.
You feel as though your thoughts are racing.
You experience high levels of self-esteem.
Your need for sleep is reduced.
You’re unusually, or excessively, talkative.
You engage in reckless behavior (such as shopping sprees or sexual activity).
For your behavior change to be considered a manic episode, it must:

Involve a distinct and noticeable change in mood and functioning
Be severe enough to cause noticeable problems in your day-to-day activities or require hospitalization to prevent harm to yourself or others
Not be the result of alcohol or drug use, a medication you’re taking, or another medical condition
A manic episode may also trigger a break from reality (psychosis).

For your behavior change to be considered a hypomanic episode, it must:

Involve a distinct and noticeable change in mood and functioning
Not be significant enough to disrupt daily activities or require hospitalization
Not be the result of alcohol or drug use, a medication you’re taking, or another medical condition
Depressive Episodes

Signs and symptoms of a major depressive episode include:

Depressed mood
Lack of interest in, or pleasure from, normal daily activities
Significant weight loss or gain and/or changes in appetite
Insomnia or excessive need for sleep
Restlessness or slowed behavior
Fatigue or loss of energy
Feelings of worthlessness or guilt
Inability to think or concentrate
Thoughts of death or suicide
To be considered a major depressive episode, you must experience five or more of these symptoms daily or nearly every day — for most of the day — over a two-week period, with at least one of the symptoms being a depressed mood or loss of interest or pleasure in activities.
Your symptoms must also cause disruption in your day-to-day activities, as well as social activities or relationships.

As with manic episodes, they must also not be the result of alcohol or drug use, a medication you’re taking, or another medical condition, or be caused by grieving (such as after the loss of a loved one).

Other Symptoms and Patterns

Other potential signs and symptoms of bipolar I and II include:

Anxiety
Mixed episodes (experiencing some of the symptoms of manic or hypomanic and major depressive episodes simultaneously)
Loss of pleasure in all or most activities
Catatonia (state of limited or abnormal movement)
Psychosis (detachment from reality, often with hallucinations or delusions)
People with catatonia don’t react to their environment normally, and they may hold their body in an unusual position. Often they don’t speak.

People with psychosis experience a severe episode of either mania or depression that causes them to become detached from reality. They may develop false — but strongly held — beliefs (delusions) and have hallucinations.

Both bipolar I and bipolar II may occur after a woman becomes pregnant or within a month of giving birth (peripartum onset).

The disorders may also follow a so-called seasonal pattern, in which episodes change with the seasons.

Finally, there is a form of the disorder called rapid cycling in which you may experience four or more mood-swing episodes within a single year, with full or partial disappearance of symptoms between episodes.

Bipolar Tests and Diagnosis

Because of the unresolved questions surrounding the causes of bipolar disorder, the condition remains a challenge to diagnose.

If you or your doctor suspect that you may have a form of bipolar disorder, you will most likely undergo:

A physical exam — including blood tests — to rule out other causes of your symptoms
An MRI, PET, or CT scan to identify potential abnormalities or changes in your brain structure or chemistry that are linked to bipolar disorder or to rule out other disease
A psychological exam, in which your doctor will ask you about your thoughts, feelings, and behaviors (family and friends may also be consulted, with your permission)
Daily tracking of your moods and behaviors to confirm diagnosis
There are also multiple bipolar tests, or formal, clinically tested questionnaires designed to identify and clarify your symptoms and assist in diagnosis. Your doctor may or may not use such a questionnaire.

Bipolar Disorder in Children and Teens

Although bipolar disorder has the same symptoms in children and teenagers as it does in adults, these symptoms may be more challenging to identify in younger people.
This is because they are often difficult to distinguish from normal mood changes that can occur as a result of stress or trauma.

As a result, children with bipolar disorder are frequently misdiagnosed with other mental health conditions.

If your child shows signs of severe mood swings that appear different from previous or normal mood swings, talk to your doctor or pediatrician.

Sources

Bipolar disorder requires managing two distinct categories of symptoms. Manic symptoms may include impulsive behavior, excessive irritability, and anxiety, while depressive symptoms may include a low mood, poor appetite, and emotional indifference, according to the National Institute of Mental Health. Though there aren’t many complementary or alternative medicine (CAM) remedies for manic behavior, a few non-prescription therapies may help alleviate depression. Most people who have bipolar disorder spend the majority of their time depressed rather than manic, notes the National Institutes of Health.

But just because CAM therapies exist doesn’t mean that people with bipolar disorder should throw away their antidepressants. “Bipolar is a very serious, lifelong disorder,” says Philip Muskin, MD, professor of psychiatry at Columbia University Medical Center in New York City. “If you need an antidepressant, you should take it. These other types of therapies are additional or complementary rather than alternative.” 

The complementary and non-pharmacological treatments that have shown some benefit for the depressive side of bipolar disorder are:

1. Rhodiola

Officially known as rhodiola rosea, this herb has been used for years to help manage stress and has also demonstrated positive effects on people struggling with depression. While rhodiola doesn’t ease depression to the extent that an antidepressant will, it has fewer side effects, according to a study published in 2015 in Phytomedicine. “Rhodiola is mildly stimulating,” Dr. Muskin notes. “I wouldn’t use it as a solo therapy, but it is a good adjunct for someone who is on antidepressantsand feels like they [still] don’t have a lot of energy.”

2. SAMe

SAMe, or S-adenosylmethionine, is a coenzyme found naturally in the body that has been extensively researched and shown to reduce symptoms in people with major depressive disorder, according to a review of research published in 2015 in CNS & Neurological Disorders – Drug Targets. But SAMe should be used with caution in people with bipolar disorder who are suffering from depression because it can actually provoke mania, according to the National Center for Complementary and Integrative Health (NCCIH). It should be used only under the direct supervision of a physician.

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“Anything that is a real antidepressant can cause mania in bipolar people,” Muskin says, “so there is some risk that a patient taking SAMe might become manic.” Several clinical trials are now underway to determine the best way to use SAMe in people with depression-related disorders as well as bipolar disorder.

3. St. John’s Wort

This herb, which is often used in Europe for mood management, is one of the better-known natural mood enhancers. Even so, evidence is mixed on whether St. John’s wort actually has a positive effect on major depression or bipolar disorder. The NCCIH states that St. John’s wort may help with depression but can also cause psychosis, and the agency warns that it could interact with many other medications people with bipolar disorder may be taking. St John’s wort has been shown to have similar side effects to some antidepressant medications because it appears to affect the body in a similar way, according to 2015 research published in the journal Clinical and Experimental Pharmacology and Physiology.

4. Meditation

People who meditate using a supervised mindfulness-based cognitive therapy approach may see a reduction in depression that directly correlates to how many days they meditate. The more they meditated, the fewer symptoms they had, according to a study published in 2013 in Behaviour Research and Therapy.

5. Omega-3 Fatty Acids

People with bipolar disorder may have extra motivation to start eating more fish that are heavy in omega-3s, such as salmon, mackerel, and sardines, or they may want to consider taking omega-3 supplements. That’s because the anti-inflammatory effects of omega-3 fatty acids could help regulate mood, according to research published in 2015 in the Journal of the American College of Nutrition. Adding about 300 milligrams of omega-3s each day to a depression treatment plan can enhance results, according to research published in 2012 in the journal Polish Psychiatry. “If you look at countries where they eat a lot of fish, they have a relatively low incidence of bipolar disorder,” Muskin says. “In the brain, we think omega-3s might help with moving neurotransmitters in and out, which may help stabilize moods.”

6. Light Therapy

People with bipolar disorder may have interrupted circadian rhythms, which means their daily biological clock isn’t working well. A number of strategies may help to reset this internal clock and improve bipolar management, according to a 2012 research review published in Dialogues in Clinical Neuroscience. These include timed exposure to periods of light and darkness and a forced change in sleep times. Be sure to discuss these or other similar strategies with your doctor before you try them on your own.

7. Traditional Chinese Medicine

This approach relies on certain herbal combinations and comprehensive changes in diet and daily habits. There is not enough evidence yet to support or rule out Chinese herbal preparations, concludes a review published in 2013 in Evidence-Based Complementary and Alternative Medicine. But some combinations may benefit mood disorders. Work with a practitioner trained in the field in collaboration with your doctors.

8. Interpersonal and Social Rhythm Therapy

This technique teaches people with bipolar disorder to maintain a more regular schedule in all aspects of life, including sleeping, waking, eating, and exercise. It has been shown to improve daily functioning, according to a study published in 2015 in Bipolar Disorders.

9. Eye Movement Desensitization and Reprocessing Therapy

EMDR uses a supervised program of eye movements, combined with actively remembering traumatic experiences, to improve symptoms. This approach can be helpful to people who have bipolar disorder and a history of trauma, according to research published in 2014 in the journal Psychiatry Research. 

Complementary Bipolar Treatments: A Few Words of Caution

“The reality is that there is not a lot of data on complementary therapies for bipolar disorder,” Muskin says. “That doesn’t mean these products shouldn’t be used, but when patients try to find out about them, they shouldn’t expect to be able to go to [websites] like The New England Journal of Medicine and download a lot of articles.”

Muskin recommends ConsumerLab as a reputable site where people can go to research complementary therapies. “You can find out whether or not the product you’re buying really contains the product you think it does, as well as what it’s indicated for and whether it has contaminants,” he says. The National Institutes of Health Office of Dietary Supplements also provides an extensive online database of dietary supplements that includes detailed product and manufacturer information.

Most of these therapies are safe, and there is limited evidence of negative interactions with prescription medications. Regardless, patients and their family members should actively research these products and discuss options with a psychiatrist before taking them, especially because complementary therapies do not undergo the same strict review process as pharmaceutical medications.

Additional Reporting by Madeline Vann, MPH.