Bipolar disorder is a lifelong chronic illness affecting approximately six million Americans that requires medication and therapy, and is comprised of episodes of mania and depression, which can vary greatly in degree. Since the painful mood swings of bipolar disorder do not follow a pattern and are not necessarily immediately followed by episodes of depression, it can be a very unpredictable illness. While many people suffering from bipolar disorder can keep their symptoms at bay with appropriate psychiatric medication, the majority of suffers will ultimately require inpatient hospitalization for stabilization. Since Bipolar Disorder tends to run in families, researchers are currently exploring the genetic (as well as environmental) elements of the illness.
Types of Bipolar: What’s The Difference?
• Bipolar 1 involves episodes of extremely acute mood swings, ranging from mania to depression. Depending on the severity of mania, people with Bipolar 1 can develop psychotic features that include hallucination, delusions of grandeur, paranoia, excessive spending, aggressive behavior, and self-damaging thoughts and sometimes critically dangerous plans.
• Bipolar 2 involves episodes of hypomania, which is a less intense form of mania, and depression. Individuals find a decreased need for sleep and an increase in energy. While the elevated mood of hypomania is sometimes seen as a benefit, as individuals are frequently highly productive, there is commonly an elevation in suicidal tendencies, often stemming from extreme burnout and exhaustion.
• Cyclothymic Disorder (also known as Cyclothymia) is a mild form of Bipolar Disorder. People suffering from Cyclothymia have episodes of hypomania that shift back and forth with mild depression, lasting at least two years.
• Bipolar Disorder Not Otherwise Specified (BP-NOS) is diagnosed when an individual have symptoms of Bipolar 1 or 2, but does not meet the criteria for diagnosis of either illness. According to the The Diagnostic and Statistical Manual of Mental Disorders (DSM), an individual may be diagnosed with BP-NOS if they have symptoms of mania and depression, but the episodes are too short to qualify as an actual episode; have episodes of hypomania, but no depressive episode; if the patient has been previously diagnosed with a psychotic disorder or schizophrenia; or if the symptoms are better accounted for by drug or alcohol abuse, or another medical condition.
What Is a “Mixed Episode?”
A mixed episode occurs when symptoms of depression and hypomania or mania are experienced at the same time. These periods often entail tearfulness during manic episodes, or frightening racing thoughts during a depressive episode; and suffers often feel intensely frustrated and are frequently prone to fits of rage, and will sometimes express flight of ideas when speaking. This condition is particularly perilous because it involves a host of symptoms such as agitation, anxiety, fatigue, guilt, impulsiveness, irritability, morbid or suicidal ideation, panic, paranoia, pressured speech, and rage.
What Is a “Rapid Cycling?”
Rapid Cycling is when an individual has four or more episodes of major depression, mania, hypomania, or mixed symptoms within a single year. These episodes can occur several times a week, or even per day; and are often found in people with severe forms of Bipolar Disorder, and has been linked to early-onset of the illness.
There Is Help: Medications & Therapies Used To Treat Bipolar Disorder
• Mood Stabilizers. Many mood stabilizers are also categorized as anticonvulsants, and function to stabilize and/or prevent the deleterious effects of Bipolar Disorder. The most commonly prescribed mood stabilizers include Depakote (Valproic Acid), Lamictal (Lamotrigine), Tegretol (Carbamazepine), Topamax (Topiramate), Neurotonin (Gabapentin), Trileptal (Oxcarbazepine), and the oldest mood stabilizer, Lithium. Potential side effects of mood stabilizers include restlessness, bloating/indigestion, dry mouth, sensitivity to cold weather, and joint or muscle pain. Lithium specifically can cause hand tremors, weight gain, and the thyroid gland to become inactive. Respectively, thyroid levels should be monitored every six months.If this becomes problematic but Lithium is deemed essential to keep the individual’s symptoms at bay, Eltroxin (Levothyroxine), a thyroid-producing medication, may be prescribed by a psychiatrist.
• Atypical Antipsychotics. These medications may be prescribed even when psychotic features are not present, as they have mood stabilizing effects. Examples include Abilify (Aripiprazole), Risperdal (Risperidone), Zyprexa (Olanzapine), Seroquel (Qutiapine), and Geodon (Ziprasidone). Side effects many include fatigue, dizziness, significant weight gain, and sensitivity to the heat.
• Antidepressants. Oftentimes, SSRIs, SNRIs, TCAs, MAOIs, and newer atypical antidepressants such as Wellbutrin, Trazadone, Remeron, and Serzone are also used to treat elements of Bipolar Disorder. Individuals with Bipolar are not prescribed antidepressants on their own, but they can be an exceedingly effective adjunct medication. Side effects are largely contingent on the type of antidepressant administered, and should be discussed with the prescribing doctor.
• Therapeutic models used to treat Bipolar Disorder include Psychotherapy (a.k.a. talk therapy), Family-focused Therapy, Interpersonal and Social Rhythm Therapy (a class of psychotherapy designed specifically to treat Bipolar Disorder, which involves the regulation of daily and nightly routines), Cognitive Behavioral Therapy (CBT), and Dialectical Behavioral Therapy (DBT). CBT functions by helping individuals identify dysfunctional and baneful emotions and behaviors via a goal-oriented, systematic approach. DBT blends CBT with concepts largely derived from Buddhism and Hegelian principle of dialectical progress (thesis + antithesis = synthesis); and includes mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.
And remember, with proper care, this illness does not have to control one’s life in a negative way. As Clinical Scientist Sheri L. Johnson once pointed out, “Literature, arts, and history have been shaped by the remarkable creativity of individuals with bipolar disorder, including Vincent van Gogh, Martin Luther, Robert Schumann, Pytor Illyich Tchaikovsky, and Pulitzer Prize winners John Berryman, Amy Lowell, and Anne Sexton.” There is so much more than just hope.