| Treating And Managing Bipolar Disorder |
| Written by Jonathan Green | |||
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Bipolar disorder, also known as manic depression, is a mood disorder -- a medical condition that causes people to cycle constantly back and forth between extreme sadness (depression) and extreme euphoria (mania). Unless they are treated medically, the dramatic changes in mood that characterize bipolar disorder are beyond a person's control to prevent. They shape thought, energy and behavior according to a logic of their own, and respond only weakly, if at all, to events in the outside world. Each phase of the cycle can last anywhere from a few hours to a few weeks.
During the depressive cycle, bipolar patients will experience at least five of the following symptoms -- sadness and crying spells, inability to concentrate, feelings of guilt, changes in appetite and sleep patterns, irritability, anger, anxiety, pessimism, indifference, extremely low energy to the point of exhaustion, a host of unexplainable aches and pains, a lack of interest in pleasurable activities or in socializing with others, alcohol and drug abuse, and thoughts of suicide. During their manic episodes, which follow depression, the same bipolar patients will seem to have utterly changed their personalities. Instead of lethargy, they will show a high, even overbearing level of physical and mental energy. Days of endless sleep and fatigue are replaced by an eerie sleeplessness and wakeful intensity. Rather than feel worthless, patients will seem overly enthusiastic and self-confident; their thoughts will be grandiose, and they will have an exaggerated sense of self-importance. Rather than hide away alone, they will venture with extreme aggression into the outside world. During mania, patients race through life. Their speech and thoughts move at warp speed. They are impulsive and reckless; they make dramatic decisions on the spur of the moment and spend their money too quickly; they drive carelessly and become sexually promiscuous. During the most extreme manic episodes, patients can become delusional and even have hallucinations. Bipolar disorder exists on a spectrum from mild to acute, although it is always somewhat disconnected from the patient's environment; all kinds of manic and depressive thinking are difficult to control simply with willpower. A mild manic episode, known as hypomania, does not include delusions or hallucinations, but it is more extreme than a run-of-the-mill good mood. Mild depressions, called dysthymias, do not usually include thoughts of suicide but their symptoms -- eating too little or too much, insomnia and oversleeping, fatigue, poor concentration and indecisiveness, hopelessness --still get in the way of healthy living. A mixed state has characteristics of both depression and mania, or of hypomania and dysthymia. Patients who cycle between dysthymia and hypomanic episodes have a mild form of bipolar disorder known as cyclothymia. Patients who experience rapid cycling, possibly the most disabling form of bipolar disorder, are subject to four or more manic, hypomanic, mixed or depressive episodes within a 12-month period. Rapid cycling is often a temporary response to stress. Because it is impossible to will oneself out of bipolar disorder, medical treatment is essential. However, treatment plans do not rely solely on medication. Drugs can help even out a patient's moods, so that they are less extreme. However, people with bipolar disorder also benefit from talk therapy and participation in peer groups, where they can find companionship and learn coping skills. Although many people don't realize it, bipolar disorder is a chronic medical condition with many similarities to diabetes, arthritis, or asthma. The symptoms never go away, but they can be managed with a combination of medications and behavior changes. The key to treating bipolar disorder is to set aside feelings of shame or embarrassment and seek treatment. The newest medicines for bipolar disorder are generally safe and have relatively few side effects. However, their effects vary from person to person. Trial and error, under the guidance of a psychiatrist, is the only way to find out which type of treatment is most helpful in controlling moods. Moreover, the proper mix of medication can change over the life cycle; what works one year may not work the next. The Food and Drug Administration (FDA) has approved some medications, such as Prozac or Lexapro, specifically to treat mood disorders. However, doctors sometimes prescribe "off-label" medications, which the FDA has ruled safe and effective for other brain disorders, but not yet for depression or bipolar disorder. Off label prescriptions can help patients whose symptoms don’t respond to standard mood disorder meds. Pregnant and nursing women may need to exercise special caution when taking mood disorder medications, because the meds can work their way into the placenta and breast milk. Patients who are pregnant or want to nurse their babies would be wise to consult with a doctor. Talk therapy, unlike medication, does not have physiological side effects, and it can help patients stay on medication and cope with their disorder's impact on work and family life. Cognitive behavioral therapy helps patients control and change the thoughts and behaviors that accompany mood swings. Interpersonal therapy is useful for patients who need help managing their personal relationships. Social rhythm therapy is useful for the establishment and maintenance of daily routines. For bipolar patients, thoughts, actions and relationships with others are all parts of the same puzzle; each affects the other. For this reason, many different types of treatment may make their lives easier. Patients may benefit from one-on-one therapy, or from regular sessions with their families or romantic partners. In group therapy, several people who are not usually related may work with one therapist and with each other in therapy sessions that explore social dynamics. A good therapist may well combine elements of all three approaches to therapy -- cognitive, behavioral, interpersonal and social-rhythm -- in order to help patients (1) become more aware of their destructive feelings, and (2) change thought and behavior patterns that contribute to those feelings.
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