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BIPOLAR DISORDER

Bipolar disorder, once referred to as manic depression, is a mental illness that affects an estimated 2.6% of the adult population in the United States. However, these metrics can be misleading, as many who suffer from bipolar are never diagnosed.

If you or a loved one is struggling with bipolar disorder and you don’t know where to turn, call Peaks Recovery today. We are dedicated to treating adults in a safe and caring environment at our beautiful Colorado Springs location, and we can help.

WHAT IS BIPOLAR DISORDER?

Bipolar disorder (BPD) is a mental condition that causes extreme shifts in a person’s mood, energy levels, thinking, and behavior. While we all have our ups and downs, the severe mood swings characterized by bipolar disorder are so significant that they impair a person’s ability to function for days, weeks, or even months.

Formerly known as manic depression, bipolar disorder causes a person to experience emotional highs (mania) and lows (depression), or combinations of the two (mixed episodes). The symptomatic features of bipolar disorder fall along a continuum, where each case can vary from person to person.

In some cases, a person struggling with the symptoms of bipolar disorder will experience frequent mood swings, while some may only experience a few in their lifetime. This spectrum is what contributes to the difficulty in the diagnosis and treatment of bipolar disorder; often times people are misdiagnosed with another disorder due to overlapping symptoms. Bipolar disorder is a progressive disorder that gets worse over time if left untreated.

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TYPES OF BIPOLAR DISORDERS

Bipolar I

Bipolar I is seen as the most classic form of the manic-depressive disorder, in that a person will experience at least one mixed or manic episode. The manic episodes typically last at least 7 days, and some symptoms can be so severe that the person may need to be hospitalized. Mixed episodes where both hypomanic and depressive symptoms are present is a common feature of bipolar I. Although not in all cases, bipolar I usually involves at least one depressive episode, lasting about 2 weeks.

Bipolar II

Bipolar II is characterized by a pattern of depressive and hypomanic episodes, but full-blown manic episodes are not experienced.

Cyclothemia

Cyclothymia is defined by cyclical mood swings that occur on a fairly regular basis. The symptoms of hypomania and depression in this type of BPD are typically less severe in form but can still have a serious negative impact on a person’s life. Cyclothymia can also progress into full-fledged manic or depressive episodes.

General Bipolarism

On rare occasions, you will find people who fall into this general category and exhibit some bipolar symptoms but do so irregularly or at varying degrees. As a result, the signs are not strong enough to distinguish them from one type of bipolarism to another.

SYMPTOMS OF BIPOLAR DISORDER

Generally speaking, there are four types of mood-disruption symptoms that characterize bipolar disorder:

Mania

When someone with a mood disorder is experiencing a manic episode, they will have heightened levels of energy, often times boosting the person’s creativity and creating a sense of euphoria. The hyperactivity associated with mania can cause you to feel invincible, giving the illusion that you can accomplish anything, and that you are destined to achieve all things considered.

Mania may seem like an appealing feature at first, but manic episodes tend to spiral out of control. When experiencing mania, a person might engage in very unusual or reckless behavior, like spending large sums of money or making inappropriate sexual comments. If left untreated, manic symptoms can last for up to three months and can be dangerous for the individual and those around them.

Some of the common signs and symptoms of mania include:

  • Feeling unusually optimistic or “high”
  • Feelings of extreme irritability and increased aggression
  • Little to no sleep
  • Sustained high energy levels
  • Racing thoughts; jumping from one topic to another
  • Easily distractible
  • Quick speech or rambling
  • Increased impulsivity
  • Impaired judgment
  • Reckless or aggressive behavior
  • Delusions or hallucinations (in severe cases)

Mixed Episodes

In a mixed episode, symptoms of both depression and mania can be present at the same time. A mixed episode can also progress to either a pure manic or depressed state. The back-and-forth emotional deregulations are why the risk of suicide is greatest during this stage.

Hypomania

Hypomania is a less severe form of mania in that it is characterized by many of the same symptoms but in a less severe form and over a shorter period of time. In a hypomanic episode, you still experience feelings of euphoria and have increased amounts of energy, but the symptoms of psychosis or detached reality are not present. These feelings won’t necessarily affect the person’s ability to carry on day-to-day tasks, and to others, it would simply appear as though you’re in an unusually good mood.

That being said, episodes of hypomania can still cause a person to engage in poor judgment and dangerous decision making, putting relationships, among a number of other things, at risk. Hypomania may also be the first step towards a full-blown manic episode or can be followed by a major depressive episode.

Depression

For someone with BPD, the severe symptoms of experiencing a major depressive episode cause a noticeable difficulty in the ability to carry out day-to-day tasks. Symptoms of depression can negatively impact school or career performance, social activities, relationships, and even the ability to follow basic hygiene.

The common signs of depression include:

  • Intense feelings of sadness, hopelessness, and irritability
  • Loss of interest or pleasure in almost all activities
  • Excessive sleeping or insomnia
  • Fatigue and loss of energy
  • Increased feelings of guilt and worthlessness
  • Decreased concentration
  • Either slowed behavior or restlessness
  • Suicidal thoughts or plans

Rapid Cycling

Rapid-cycling refers to a pattern of frequent and rapidly-occurring fluctuations of episodes exhibited during the course of bipolar disorder. Someone that qualifies as being in a state of rapid-cycling experiences four or more episodes of mania or depression within a given year. This manifested form of BPD may come and go over time and can occur at any point throughout the disorder.

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CAUSES AND TRIGGERS OF BIPOLAR DISORDER

There is a lot of uncertainty surrounding the cause of bipolar disorder, but scientific research suggests that the onset of these mood disorders likely results from a multitude of factors and the interactions that occur between them.

Bipolar disorder is known to run in families, but genes are not the only thing at play here. While some inherit a genetic vulnerability to the disorder, many with the same genetic predisposition never develop the illness. This alone shows that there are other factors aside from genes that are responsible.

Environmental factors, such as stress or loss can act as triggers creating new episodes or exacerbating existing symptoms. Sleep deprivation and substance abuse are also known to trigger and exacerbate symptoms of BPD. The variations in severity coupled with the interplay of biological, genetic, psychological, and psychosocial elements are what cause these disorders to be so complex, and therefore difficult to treat, especially when substance abuse and bipolar disorder are combined.

There is no known cause for bipolar disorder but there are many factors that play into its development. Some are more susceptible than others, which could be due to either genetic or environmental factors, or both. Bipolar disorder is known to run in families, but there are some people with this predisposition that never end up developing the disorder, adding to the ambiguous etiology of BPD.

Advances in science and medicine continue to shift the ways in which we conceptualize and treat physical and mental illnesses. Modern technology has allowed researchers to develop significant insight into psychopathology and our state of consciousness. If you or a loved one suffer from bouts of depression or manic episodes, contact your doctor and seek help.

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MEDICATION FOR BIPOLAR DISORDER

There are several drug therapies that are very effective in treating bipolar disorder, and can help those living with it to work, go to school, and otherwise lead full, productive, normal lives while managing their disease.

In the initial stages of treatment, medication may need to be adjusted until you and your doctor find the right dosage and the right drugs. It often involves a “cocktail” of different drugs which can be dangerous if taken improperly, but with careful monitoring of side effects and symptoms, you will eventually find a program that works for you.

Current trends in bipolar medication favor mood stabilizers. This class of drugs works for many in reducing or eliminating mood cycling, and for some, this means not having any more depressive episodes.

It is important to note that traditional antidepressants are not effective in treating bipolar disorder. In many cases, they can actually exacerbate symptoms and make depressive episodes far worse than they normally would be. Taking all medications as prescribed is essential for success.

Some of these medications include:

Lithium For Mood Stabilization

Lithium is usually the first course of active treatment, as it controls mania. However, those who are affected by rapid mood cycling or mixed episodes may not find it as effective. Lithium also comes with its fair share of side effects, including:

  • Weight gain
  • Drowsiness Weakness
  • Thyroid issues
  • Inability to focus
  • Nausea
  • Vertigo
  • Diarrhea

Anticonvulsants For Bipolar Disorder

Generally prescribed for seizure disorders, anticonvulsants have been found to be effective in controlling rapid cycling and mixed episodes. These medications include:

  • Depakote (valproic acid)
  • Tegretol (carbamazepine)
  • Lamictal (lamotrigine)
  • Topamax (topiramate)

Mood Stabilizers For Bipolar Disorder

Additional mood stabilizers may optimize the course of medication for bipolar disorder. These can include:

  • Lamictal (lamotrigine)
  • Seroquel (quetiapine)
  • Symbyax (olanzapine and fluoxetine)
  • Zyprexa (olanzapine)

Antipsychotics For Bipolar Disorder

If a patient tends to lose touch with reality during their manic or depressive episodes, an antipsychotic may be explored. They may also be indicated if mood stabilizers have proven ineffective or may be combined with mood stabilizing drugs. Antipsychotic medications commonly used to treat bipolar disorder include:

  • Abilify (aripiprazole)
  • Clozaril (clozapine)
  • Geodon (ziprasidone)
  • Haldol (haloperidol)
  • Risperidone (risperdal)
  • Seroquel (quetiapine)
  • Zyprexa (olanzapine)

Other drugs used to treat bipolar disorder include:

Benzodiazepines: not meant for long-term use, but can be helpful in the initial stages of treatment until the mood stabilizers reach their full saturation.

Calcium channel blockers: traditionally used to treat hypertension, these drugs can also help to stabilize mood. They are milder than traditional mood stabilizers but also have fewer side effects.

Thyroid medications: rapid cycling can cause wild fluctuations in hormonal levels. Thyroid medications may help to stabilize these numbers.

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BIPOLAR DISORDER TREATMENT

Behavioral Therapy

Similar to addiction therapy, behavioral therapy is the overarching term used to describe the various types of therapy that have arisen to combat mental health disorders. The goal of such treatment is to help the patient see the negative, unhealthy or self-destructive patterns in their life and seek to change them since many of these behaviors are ones that are learned or have developed through repetition.

Cognitive Behavioral Therapy – One of the most popular and effective therapeutic treatments for bipolar disorder, as the name suggests, CBT combines the practices of behavioral therapy with cognitive therapy. Such treatment focuses on how beliefs and thoughts affect one’s moods and actions and seek to solve current and fixable problems. Ideally, such micro-actions will positively change someone’s behavioral and thought patterns in the long term.

Electroconvulsive Therapy

ECT, also known as shock therapy is an effective treatment for several mental disorders, despite what your initial feelings towards it might be. Initially introduced in the 30’s and made infamous through movies such as, “One Flew Over the Cuckoo’s Nest” ECT was much different back then than it is now. At the time, muscle relaxants were not developed or put in use, and the doctor’s ability to modulate the shock voltage to the brain was arcane at best. As a result, patients would regularly suffer broken bones or various injuries due to the violent convulsions and seizures caused by the electric shock to the brain. These days, however, ECT is used for those who do not respond to therapy or medication and, according to the U.S. Food and Drug Administration, it has shown to be useful in aiding nearly 80% of people who suffer from clinical depression.

There are two types of ECT, bilateral and unilateral. With bilateral ECT, electrodes are placed on both sides of the head, and the shock affects the entirety of the brain. With unilateral ECT, a single electrode is situated directly at the top of one’s head, and another is placed on the right side of the temple. This is meant to affect only the right side of one’s brain. Both forms have been shown to be extremely effective at lessening or removing the most severe symptoms of bipolar disorder including catatonia, psychosis, and suicidality.

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SUBSTANCE ABUSE AND BIPOLAR DISORDER

In a national study, about 56 percent of people diagnosed with BPDA experienced drug or alcohol addiction at some point in their lifetime. Although it may not be a cause of BPD, substance abuse frequently co-occurs with BPD and can worsen the symptoms of an episode, along with the overall course of the disorder.

Drugs such as alcohol or tranquilizers can trigger symptoms of depressive episodes, whereas stimulants like cocaine, amphetamines, or ecstasy trigger symptoms of mania. Unfortunately, many turn to drugs or alcohol as a form of self-medicating to weaken the painful feelings of emotional dysregulation but end up intensifying the effects in the process.

Substance abuse is also known to cause alterations in brain chemistry, especially in cases of chronic use. Even a person with a clean bill of health can develop bipolar disorder from frequent drug use. A dual diagnosis of BPD and substance abuse is very difficult to treat, given that many of the symptoms overlap. It’s important to understand the risks associated with drug use, especially those that are diagnosed with or have the potential to develop bipolar disorder.

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Finding Success In Treating Bipolar Disorder

While medication can help to stabilize mood and prevent relapse, it is often an uphill battle to keep patients in compliance with their drug therapy. Once they start to feel better and get back to a normal state of being, there is a danger that they may discontinue their medication. If this happens, symptoms will quickly reappear, putting the patient at a much higher risk for harm to come to them.

Side effects can also be a barrier to compliance and must be monitored closely in order to maintain acceptable levels and to keep the patient feeling good.

Medication alone is not enough, however. A drug program must be combined with therapy, counseling, self-help strategies, healthy lifestyle choices, and peer support in order to realize long-term success in managing bipolar episodes.

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