Bipolar affective disorder (BAD). Bipolar disorder

The ICD-10 does not divide bipolar personality disorder into types, since many psychiatrists believe that there are no clear boundaries between the types of this disease. Pathology belongs to the category of mental. The second type of bipolar disorder occurs 4 times more often than the first.

Features of the course of a mental disorder

The difference between type 2 bipolar disorder and the classical form is the absence of a severe form of mania. A person with such a disease stops at the stage of hypomania

This is a mild form of mania. The danger of such a bipolar affective disorder (BAD) - in the absence of a manic stage, the disease can lead to very severe depression.

How Bipolar II Disorder Manifests

The depressive phase is considered more dangerous in BAD type 2. It should be noted that this form of BAD is characterized by a rapid change of depression and hypomania. If the patient is taking antidepressants, then he may mistake the symptoms of the hypomanic stage for the effectiveness of these drugs, that is, improvement in the condition. Regarding mood swings, everything is very individual. On average, several phases of BAD are observed per year. Some patients have only a couple of episodes in their lifetime.

Hypomania

Mania is very different from hypomania. During the hypomanic phase, a person may feel very happy and productive. This can complicate the diagnosis of type 2 bipolar disorder. Characteristic signs of hypomania:

• increased excitability;
• the patient is talkative;
• a feeling of an extraordinary surge of strength and energy;
• a good mood;
• the presence of many new ideas;
• reduction of sleep to 2-3 hours, insomnia.

Depression

The line between hypomania and severe mania is very thin. After an emotional upsurge on the verge of euphoria, a sharp decline occurs when a person begins to sink into depression.

This happens gradually, as there may be a long period of normal mood between hypomania and the depressive stage. Without treatment, a person will still go into a phase of depression, which is much more severe than with type 1 bipolar disorder. The main signs of type 2 bipolar disorder:

• lethargy;
• complete indifference to everything;
• feeling of helplessness;
• anxiety;
• distraction;
• thoughts of suicide;
• sleep throughout the day.

Diagnostics

The danger of bipolar disorder lies in the fact that, if misdiagnosed, the disease can lead to serious consequences. The reason is that the treatment of ordinary depression and a depressive episode of bipolar disorder are significantly different. Antidepressants for bipolar disorder should be used with caution as they may exacerbate suicidal thoughts. The complexity of the diagnosis is as follows:

• Most patients with this pathology consider themselves healthy.
• The period of hypomania for them is a feeling of happiness.
• From the outside, a person's expressiveness can be perceived simply as a feature of character.

The diagnosis of "bipolar personality disorder type 2" is confirmed in the presence of at least one episode of affect. One of them must be manic or hypomanic. It is necessary to differentiate BAD type 2 from the following diseases:

• epilepsy;
• schizophrenia;
• arousal when taking psychoactive drugs;
• neurosis;
• traumatic brain injury;
• psychosis;
• chronic lack of sleep.

Treatment

Bipolar affective disorder cannot be completely cured, but with the right therapy, patients with this disease can live a normal life. The goal of lifelong treatment is to stabilize the patient's mood. Several drugs are used for this, since depression and mania are opposite conditions.

The complexity of therapy lies in the fact that each drug has a different effect on the nervous system of a particular patient. The selection of the right funds sometimes takes several months. General list of drugs used:

Bipolar disorder of the second type, unlike the first, usually implies a depressive phase. At the same time, periods of slightly elevated mood (hypomanic) are extremely difficult to diagnose. In fact, even for psychiatrists, this disease is both an ethical and a diagnostic problem.

Firstly, because patients in this condition do not go to the doctor. After all, everything is fine, the mood has improved, I want to live and work, new ideas and plans appear ... Secondly, because it is extremely difficult to distinguish such an episode from a normal recovery or improvement in depression.

Bipolar disorder of the second type, as well as the first one, however, such aspects as hospitalization, recognition of incapacity for work, assessment of the adequacy and the ability to make decisions by patients cause great ethical problems. For example, can a person diagnosed with bipolar II disorder control their property and life? Is it possible to recognize that he has free will, or should his desire to sell an apartment or get married be perceived as a deviation?

The classic variant, which proceeds with pronounced phases of excessively high and low mood, is diagnosed quite quickly.

Bipolar 2 disorder manifests differently. First of all, the doctor draws attention to a long period of depression, however, a necessary symptom that will allow differentiating the disease from major depression is the presence of at least one hypomanic episode. According to many studies, bipolar 2 disorder is much less commonly diagnosed. Nevertheless, according to scientists, it is this disease that leads to suicide more often than classical depression.

Patients are much less likely to come to the attention of a psychiatrist, they do not often seek help, perceiving their condition as temporary and transient.

Bipolar II disorder is often accompanied by comorbidities such as social phobia and obsessive compulsive disorder. Very often, obsessive-compulsive disorder is perceived as an independent nosological unit, but patients, ashamed of their quirks, do not try to use the help of a specialist. Sociophobia manifests itself in a progressive withdrawal from public life, fear of communication, of contacts with other people. This factor further exacerbates the suffering and problems experienced by people with bipolar disorder. For mental illnesses affecting the sphere, antidepressants and lithium are most often prescribed.

It can be argued that bipolar disorder of the second type has relatively recently begun to be considered as an independent nosological unit. It still causes scientific discussions and poses the problems of diagnosis and timely assistance to doctors.

Bipolar disorder, or manic depression, causes extreme mood swings that include an overabundance of energy (mania or hypomania) and a drooping state (depression). When a person becomes depressed, sad, or feels hopeless, they lose interest in life. When the mood changes, you may feel full of euphoria and energy. Mood changes may occur only a few times a year, or more often, such as several times a week.

Although bipolar disorder is a devastating, long-term condition, you can control your mood swings with the following treatment plan. In most cases, bipolar disorder can be managed with medication and psychotherapy.

Bipolar Personality Disorder Symptoms and Signs

There are several types of bipolar and related disorders. For each type, the exact symptoms of bipolar disorder can vary. Bipolar 1 and 2 also have additional specific features that are considered in the diagnosis based on specific signs and symptoms.

Criteria for Bipolar Disorder

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, includes criteria for diagnosing bipolar and related disorders. This guide is used by psychiatrists to diagnose mental conditions and by insurance companies to reimburse treatment.

Diagnostic criteria for bipolar and related disorders are based on a particular type of disorder:

Bipolar disorder type 1

You have had at least one manic episode. It may be preceded by hypomanic or depressive episodes. The symptoms of mania cause a significant deterioration and then hospitalization is necessary or they can cause a break with reality (psychosis).

Bipolar disorder type 2

You have had at least one major depressive episode lasting two weeks and one hypomanic episode lasting four days, but never a manic episode. Major depressive episodes or unpredictable changes in mood and behavior can cause extreme fatigue or difficulty in areas of daily life.

Cyclothymic disorder

Over the course of two years - or one year, children and adolescents have had multiple periods of hypomanic symptoms (less severe than a hypomanic episode) and periods of depressive symptoms (less severe than a major depressive episode). During this time, symptoms occur in at least half of the cases and never disappear for two months. The symptoms cause significant stress.

Other types

These include, for example, bipolar and related disorders due to another disease such as Cushing's disease, multiple sclerosis or stroke. The other type is treatment-induced bipolar and related disorder.

Bipolar type 2 disorder is not a simplified type 1 disorder, but a separate diagnosis. While bipolar 1 manic episodes can be severe and dangerous, people with bipolar 2 are depressed for longer periods of debilitating personality.

Criteria for a manic or hypomanic episode

The DSM-5 has specific criteria for diagnosing manic and hypomanic episodes:

A manic episode is a distinct period of pathologically and persistently increased, expansive, or irritable mood that lasts at least one week (or less than a week if hospitalization is necessary). An episode involves ever-increasing activity or energy.

A hypomanic episode is a distinct period of pathologically and persistently increased, expansive, or irritable mood that lasts at least four consecutive days.

For manic and hypomanic episodes, during a period of disturbed mood and increased energy, three or more of the following symptoms must be present and represent a significant change in normal behaviour:

• Inflated self-esteem or megalomania
• Reduced need for sleep (for example, you feel refreshed after just three hours of sleep)
• unusual talkativeness
• Leap of ideas
• pathologically increased distractibility
• Increased goal-directed activity (socially, at work or school, in sexual life) or arousal

Actions that are unusual and that have a high potential for painful consequences - such as an unrestrained buying urge, sexual indiscretion, or foolish business investments

What is considered a manic episode:

The mood disturbance must be severe enough to cause significant difficulty at work, school, or social activities or relationships; when a person needs to be hospitalized to prevent harm to themselves or others; or cause a break with reality (psychosis).

The symptoms are not due to the direct influence of something else, such as alcohol or drug use; treatment; or disease.

What is considered a hypomanic episode:

An episode is a different change in mood and body functioning that is not characteristic when symptoms are not present.

The episode is not severe enough to cause significant difficulty at work, school, or social activities or relationships, and you do not need hospitalization.

The symptoms are not due to the direct influence of something else, such as alcohol or drug use; treatment; or other disease.

Criteria for major depressive episode

The DSM-5 also lists the criteria for a diagnosis of a major depressive episode:

The five or more symptoms below occur in the syndrome over a two-week period, and represent a change from previous mood and functioning. At least one of the symptoms is always present - it is a depressed mood or loss of interest or pleasure.

The symptoms may be based on your own feelings or on observations of someone else.

Signs and symptoms include:

Almost every day, a person has a depressed mood during the day, for example: feeling sad, empty, hopeless, or tearful (in children and adolescents, a depressed mood can manifest as irritability).

Markedly diminished interest or dissatisfaction with everything - or almost everything.

Significant weight loss if diet is not followed, weight gain, decreased or increased appetite almost every day (children cannot gain weight, this may be a symptom of depression).

• Also insomnia or too much sleep every day
• Restlessness or slow action
• Fatigue or loss of energy almost every day
• Feelings of worthlessness or excessive guilt, such as believing something that isn't true
• Decreased ability to think or concentrate, indecisiveness, almost every day
• Recurrent thoughts of death or suicide, planning or attempting suicide

What is considered a major episode of depression:

Symptoms must be severe enough to cause significant difficulty with daily activities such as work, school, social activities, or relationships

Symptoms are not due to the direct influence of alcohol or drug use, medication, or another medical condition

Symptoms are not caused by sadness, such as after the loss of a loved one

Other signs and symptoms of bipolar disorder

Signs and symptoms of bipolar type 1 and type II disorder may include additional signs.

Anxiety disorder - Feeling agitated, tense, or restless, having trouble concentrating, fearing something terrible is about to happen, or feeling out of control.

Mixed features - meeting the criteria for a manic or hypomanic episode, but also having some or all of the symptoms of a major depressive episode

Features of melancholia - loss of pleasure in most activities and lack of improvement even when something good happens

Atypical features - overcoming symptoms that are not typical of a major depressive episode, such as a significant improvement in mood when something good happens

Catatonia - lack of reaction to others, holding the body in an unusual position, not speaking or imitating the speech or movement of another person

Postpartum symptoms - symptoms of bipolar disorder that occur during pregnancy

Seasonal pattern - the pattern of manic, hypomanic or depressive episodes that change with the seasons

Rapid circulation - having four or more episodes of mood swings within a year, with complete or partial remission of symptoms in manic, hypomanic, or depressive episodes

Psychosis is a severe case of depression (but not hypomania) that leads to a break with reality and includes symptoms of false beliefs (delusions) and hallucinations

Symptoms of Bipolar Disorder in Children and Adolescents

The same diagnosis of bipolar disorder is used for adults, children and adolescents. Children and adolescents may have various depressive, manic, or hypomanic episodes between which they return to normal activities, but not always. Their whims can change rapidly during acute episodes.

The symptoms of bipolar disorder are difficult to identify in children and adolescents. It's often hard to tell if these are just normal mood swings, the results of stress or trauma, or signs of mental health issues other than bipolar disorder. And children who have bipolar disorder are often also diagnosed with other mental health conditions.

The most common symptoms of bipolar disorder in children and adolescents may include mood swings that differ from their usual behavior.

When to See a Doctor

If you have any symptoms of depression or mania, see your doctor or psychiatrist. Bipolar disorder does not go away on its own. Seeing a psychiatrist with experience in bipolar disorder can help control your symptoms.

Many people with bipolar disorder do not get the treatment they need. Despite their mood swings, people with bipolar disorder often don't recognize how much their emotional instability is ruining their lives and those of their loved ones.

And if you're like some people with bipolar disorder, you get feelings of euphoria and periods. However, this euphoria is always accompanied by emotional catastrophe, which can leave you depressed, exhausted - and possibly financial, legal and personal problems.

If you refuse treatment, confide in a friend or loved one, a healthcare professional, a rehabilitation specialist, or someone else you trust. He or she may be able to help take the first steps towards successful treatment.

When to Get Emergency Help

Suicidal thoughts and behaviors are common among people with bipolar disorder. If you think you might hurt yourself or attempt suicide, call an ambulance.

The reasons

The exact cause of bipolar disorder is unknown, but several factors need to be taken into account, such as:

biological differences. People with bipolar disorder have physical changes in the brain. The significance of these changes is still uncertain, but they may ultimately help pinpoint the causes.

Neurotransmitters. Neurotransmitters play a significant role in bipolar disorder and other mood swings.

Hereditary. Bipolar disorder is more common in people who have a relative, sibling or parent with the same disorder.

Researchers are trying to find genes that may be involved in causing bipolar disorder.

Risk factors

Factors that increase the risk of developing bipolar disorder:

• If you have a relative with bipolar disorder
• High stress periods
• Drug or alcohol abuse
• Major life changes, such as the death of a loved one or other traumatic events
• Symptoms that usually occur with bipolar disorder

Cases to pay attention to

Anxiety disorders. Examples include social anxiety disorder and generalized anxiety disorder.

Post Traumatic Stress Disorder (PTSD). Some people with PTSD, a stress or trauma disorder, also have bipolar disorder.

Vincent van Gogh, Beethoven and Virginia Woolf suffered from bipolar disorder, which in one way or another was reflected in their work. Of our contemporaries, BAD was diagnosed in Jim Carrey, Ben Stiller and Catherine Zeta-Jones. Mental disorders and in general have recently begun to be talked about more often, recognizing their danger and increasing prevalence, but thanks to the “rich and famous”, the topic has become really popular. Psychologists are sure that this is very good.

Bipolar affective disorder, also known as manic-depressive psychosis, manifests itself as sudden mood swings from hypomania (a euphoric state) to depression. In a recent TED talk, psychologist Helen M. Farrell talked about the myths and facts surrounding the disease.

Bipolar Disorder = Depression

It is a myth. Bipolar disorder can develop in different ways, it all depends on the type of personality and other individual characteristics. It is customary to distinguish between bipolar disorder type 1 (BAD I) and bipolar disorder type 2 (BAD II). If a person suffers from BAD I, he experiences frequent mood swings with the highest possible points. At the same time, BAD II is more likely to cause less extreme periods of euphoria, but more prolonged depression, which can last for years.

Unlike bipolar disorder, depression as a separate illness does not have the symptoms of mania. That is, a depressed person even occasionally is not in a state where he is ready to work from morning to evening and move the highest mountains, and does not behave impulsively, as is often the case in the case of BAD.

People with bipolar disorder need to take medication

Also a myth. If a person with bipolar disorder takes antidepressants during a period of emotional upheaval, this will only increase his mania. On the other hand, during periods of prolonged depression, special drugs are not only possible, but necessary. A study in The New England Journal of Medicine found that antidepressants, placebos, and stabilizing drugs are equally effective in some cases, so treatment should always be done by a specialist.

BAD can lead to suicide

But this is the pure truth. Bipolar disorder gradually worsens a person's mental state if not dealt with. Delay in diagnosis and treatment can lead to personal, social and financial problems for the patient, making it difficult to communicate with loved ones. Lack of support and social contacts, in turn, lead to suicidal thoughts. At the moment, doctors estimate the risk of suicide in bipolar disorder at 10-15%, and this is already a lot.

Bipolar disorder can be managed

Fortunately, it is. If a person with bipolar disorder seeks help in time, the frightening consequences of the disease - from changes in the structure of thinking to suicide - can be prevented. It is important to understand that only a specialist can choose the optimal treatment by working with the patient and analyzing his reactions to triggers and therapy. There are cases, for example, when a person with BAD was helped by a healthy sleep and wakefulness regimen, regular physical activity and walks in the fresh air. In other cases, however, it can be difficult to do without placing the patient in a medical facility with constant monitoring.

Bipolar disorder: what is it, symptoms, treatment

Bipolar disorder (formerly known as manic-depressive disorder) is a mental disorder characterized by periods of depression and high mood. The extreme degree of elevated mood is known as "mania" or "hypomania", depending on the severity or presence of symptoms of psychosis. During mania, a person behaves or feels abnormally energetic, happy, or irritable. Individuals often make rash decisions without regard for the consequences. The need for sleep usually decreases during manic phases. During periods of depression, crying, a negative outlook on life, and poor contact with others can occur. The risk of suicide among those suffering from the disease is over 6% within 20 years, and self harm is 30-40%. Below you will learn: bipolar disorder - what it is, symptoms, causes, traditional therapy and alternative treatment.

What is bipolar disorder

What is Bipolar Disorder?

Bipolar disorder is a mental illness characterized by extreme mood swings from euphoria (mania) to periods of depression and vice versa. Mood swings can even become mixed so you can feel upbeat and down at the same time.

Bipolar disorder (bipolar affective disorder or BAD for short) is not an uncommon diagnosis. In a 2005 study, approximately 2.6% of the population in developed countries was found to be living with some form of bipolar disorder (1). Symptoms usually appear in late adolescence or early childhood, but they can also occur in children. The onset of bipolar disorder is more common in women than in men, although the reason for this remains unclear.

Bipolar disorder can be difficult to diagnose, but there are warning signs or symptoms by which you can identify the disease.

Causes of Bipolar Disorder

Researchers don't know the exact cause of bipolar disorder, but they attribute it to genetics, brain structure, and brain function.

Recent studies show that bipolar disorder runs in families with people with certain gene mutations (especially in the ODZ4, NCAN and CACNA1C genes) more likely to develop this condition.

But many other genetic and environmental factors are also likely to be involved. In addition, studies involving identical twins have shown that both twins rarely develop the disease, even if they have the same mutations.

Another study found that if you have a parent or sibling with bipolar disorder, you are at a much higher risk of developing bipolar disorder.

Having a family history of bipolar disorder does not mean you will definitely be diagnosed with it. In fact, most people with a family history of bipolar disorder do not develop the condition.

Research using brain imaging tools such as functional magnetic resonance imaging (MRI) and positron emission tomography (PET) has attempted to show how the brains of people with bipolar disorder differ from those of healthy people or people with other mental disorders.

One MRI study showed that the brain of an adult with bipolar disorder has a smaller prefrontal cortex than that of an adult without the disorder. At the same time, the prefrontal cortex of the brain of a person with bipolar disorder functions worse than in a person without this disease.

The prefrontal cortex controls the executive functions of the brain, such as problem solving and decision making.

Other factors that may increase your risk of developing bipolar disorder include:

People with a history of other psychiatric disorders, including anxiety, attention deficit hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD), are also at an increased risk of developing bipolar disorder, although these links are still being studied.

What are the symptoms and signs of bipolar disorder?

The signs and symptoms of bipolar disorder are varied. Many of these symptoms can also be caused by other medical conditions, making the condition difficult to diagnose.

The warning signs of bipolar disorder can generally be divided into symptoms of mania and depression.

7 signs of mania

Mania can cause other symptoms as well, but here are seven key signs of this phase of bipolar disorder:

7 signs of depression

Like mania, depression can also cause different symptoms, but here are the seven main signs of this phase of bipolar disorder:

Types and symptoms of bipolar disorder

There are four common types of bipolar disorder, but two of these types are the most commonly diagnosed.

Bipolar disorder type 1

This classic form of bipolar disorder used to be called "manic depression". In bipolar type 1, the manic phases are clear. A person's behavior and mood are extreme and quickly escalate until they get out of control. If timely treatment is not started, the person may end up in the emergency room.

In type 1 bipolar disorder, a person must have manic episodes. For an event to be considered a manic episode, it must:

People with bipolar type 1 tend to also have depressive episodes, but a depressive episode is not required for a diagnosis of type 1 bipolar disorder.

Bipolar disorder type 2

BAD type 2 is considered more common than BAD type 1. It also includes depressive symptoms, but its manic symptoms are much less pronounced and are referred to as hypomanic symptoms. Hypomania often worsens without treatment, and the person may become severely manic or depressed.

People with BAD type 2 cannot clearly see changes in themselves, and such people are often persuaded to seek help by friends or close loved ones.

Rarer Types of Bipolar Disorder

There are two other types of BAD that are less common than BAD types 1 and 2. Cyclothymic disorder includes mood swings and shifts similar to BAD types 1 and 2, but the shifts are often less pronounced in nature. A person with cyclothymic disorder can often function normally without medication, although this can be difficult. Over time, a person's mood swings can develop into a diagnosis of bipolar type 1 or type 2 disorder.

Diagnostics

People with bipolar disorder experience strong emotional changes that are very different from their normal mood and behavior. These changes affect their lives on a daily basis.

While bipolar disorder causes a variety of symptoms, there is no single test to confirm the condition. Often, a combination of methods is used to make a diagnosis.

What to do before diagnosis

Before the diagnosis, you may experience rapidly changing moods and confused emotions. It's hard to describe exactly how you feel, but you can know that something is wrong.

Bouts of sadness and hopelessness can become intense. Maybe you feel as if you are drowning in despair one moment, and the next, you are optimistic and full of energy.

Periods of emotional decline are not uncommon. Many people deal with these periods due to daily stresses. However, the emotional ups and downs associated with bipolar disorder may be more pronounced. You may notice a change in your behavior, but you are powerless to help yourself. Friends and family may also notice changes. If you are experiencing manic symptoms, you may not see the need to seek medical attention.

Don't ignore how you feel. See your doctor if your extreme moods are interfering with your daily life or if you have suicidal thoughts.

Exclusion of other diseases

If you experience extreme shifts in your mood that disrupt your daily routine, you should see a doctor. There are no specific blood tests or brain scans to diagnose bipolar disorder. However, your doctor may perform a physical exam and refer you for tests, including a thyroid function test and a urine test. These tests can help determine if other symptoms or factors may be causing the symptoms.

Thyroid function test is a blood test that measures how well your thyroid gland is functioning. The thyroid gland produces and releases hormones that help regulate many bodily functions. If your body is not getting enough thyroid hormone (hypothyroidism), your brain may not function properly. As a result, you may have problems with depressive symptoms, or you may experience mood swings.

Sometimes certain thyroid problems cause symptoms similar to those of bipolar disorder. Symptoms can also be a side effect of medications. Once other possible causes have been ruled out, your doctor will likely refer you to a mental health specialist.

Mental Health Assessment

A psychiatrist or psychologist will ask you questions to assess your overall mental health. Testing for bipolar disorder includes questions about symptoms, how long they last, and how they can disrupt your life. The specialist will also ask you about some of the risk factors for developing bipolar disorder. This includes questions about family medical history and a history of drug abuse.

Bipolar disorder is a mental health condition known for its periods of both mania and depression. A diagnosis of bipolar disorder requires at least one depressive and one manic or hypomanic episode. Your mental health professional will ask about your thoughts and feelings during and after these episodes. He will want to know if you can control yourself during mania and how long this episode lasts. He may ask your permission to ask friends and family about your behavior. Any diagnosis will take into account other aspects of your medical history and medications you have taken.

Diagnosis of Bipolar Disorder in Children

BAD is a problem not only for adults, but also for children. Diagnosing bipolar disorder in children can be difficult because its symptoms can sometimes mimic those of attention deficit hyperactivity disorder (ADHD).

If your child is being treated for ADHD and their symptoms have not improved, talk to your doctor about the possibility of bipolar disorder. Symptoms of bipolar disorder in children may include:

Criteria for diagnosing bipolar disorder in children are similar to diagnosing the condition in adults. There is no specific diagnostic test, so your doctor may ask you a series of questions about your child's mood, sleep patterns, and behavior.

For example, how often does your child have emotional outbursts? How many hours does your child sleep during the day? How often does your child have periods of aggression and irritability? If your child's behavior and attitudes are episodic, your doctor may diagnose bipolar disorder.

The doctor may also ask about your family history of depression or bipolar disorder, as well as test your child's thyroid function to rule out an underactive thyroid.

Misdiagnosis

Bipolar disorder is most often misdiagnosed in its early stages, which often occurs during adolescence. When this disorder is confused with another medical condition, its symptoms may worsen. This usually happens due to improper treatment.

Other factors for misdiagnosis are inconsistencies in the timing of episodes and behavior. Most people do not seek treatment until they have experienced a depressive episode.

The condition shares many of the symptoms associated with other psychiatric disorders. Bipolar disorder is often misdiagnosed as unipolar (primary) depression, anxiety, OCD, ADHD, an eating disorder, or a personality disorder. Some things that can help doctors make a proper diagnosis are a good family history, rapid recurring episodes of depression, and mood disorder questionnaires.

Talk to your doctor if you think you may be experiencing any symptoms of bipolar disorder or other mental illness.

Treatment for Bipolar Disorder

Bipolar disorder is treated with three main drug classes:

1. mood stabilizers;
2. antipsychotic drugs;
3. antidepressants (although their safety and efficacy are sometimes controversial).

Typically, treatment includes a combination of at least one mood-stabilizing drug and/or an atypical antipsychotic, plus psychotherapy. The most widely used drugs for the treatment of bipolar disorder include lithium carbonate and valproic acid (also known as Depakote or generically as divalproex).

lithium carbonate can be extremely effective in reducing mania, although doctors still don't know exactly how it works. Lithium may also prevent the recurrence of depression, but its value seems to be greater against mania than depression; therefore, it is often prescribed in combination with other medications known to be of great value for symptoms of depression (sometimes including antidepressants).

Valproic acid (Depakote)- a mood stabilizer that is useful in the treatment of manic or mixed phases of bipolar disorder along with carbamazepine (Equetro), another antiepileptic drug. These drugs may be used alone or in combination with lithium to control symptoms. Also, when traditional medicines do not work well enough, doctors may prescribe new drugs. Lamotrigine (Lamiktal) has been found to be another antiepileptic drug of value in preventing depression and, to a lesser extent, mania or hypomania.

Other antiepileptic drugs, such as Gabapentin (Neurontin), Oxcarbazepine (Trileptal), or Topiramate (Topamax), are being considered as experimental treatments, sometimes of value for symptoms of bipolar disorder or other conditions that often occur with it.

Haloperidol (Haldol Decanoate) or other newer antipsychotics such as Aripiprazole (Abilify), Asenapine (Safris), Olanzapine (Zyprexa), or Risperidone (Risperidal) are often given to patients as an alternative to Lithium or Divalproex. They may also be given to treat acute symptoms of mania (especially psychosis) before Lithium or Divalproex (Depakote) can take full effect.

Another antipsychotic, Lurasidone (Latuda), is approved for use in bipolar type 1 depression, as is the combination Olanzapine + Fluoxetine (called Symbiax). The antipsychotic Quetiapine (Seroquel) is approved for the treatment of bipolar depression type 1 or 2. Preliminary research also suggests that the atypical antipsychotic cariprazine (Vraylar) may also be of value in the treatment of bipolar depression.

Some of these drugs can become toxic when taken in too high doses. Therefore, the doctor needs to periodically monitor the patient's blood tests. Because it is often difficult to predict which patient will respond to which drug, or what dosage should ultimately be, the psychiatrist will often have to experiment with several different drugs at the start of treatment.

Although antidepressants remain widely used in bipolar depression, most drugs in this class have not been adequately studied in patients with this disease.

In general, your doctor may try to limit and reduce your use of antidepressants. Long-term antidepressant treatment for bipolar disorder is only recommended when the initial response is clear and there are no ongoing or emerging signs of mania or hypomania. Some antidepressants (alone or in combination with other drugs) can cause a manic episode or cause faster cycles between depression and mania. If an antidepressant does not appear to be beneficial in bipolar depression, there is usually no reason to continue using it.

The patient's family or spouse should be involved in the treatment process. The availability of complete information about the disease and its manifestations is important, both for the patient and for loved ones.

Treatment for depression

Although medication is generally the cornerstone of treatment for bipolar disorder, ongoing psychotherapy is important to help patients understand and accept the personal and social impairments experienced during previous episodes of illness and to better cope with future episodes. Several specific forms of psychotherapy have been found to help speed recovery and improve functioning in bipolar disorder, including cognitive behavioral therapy, interpersonal/social rhythm therapy, family therapy, and group therapy.

Electroconvulsive therapy (ECT) sometimes given to patients with severe manic or depressive states, and to those who do not respond to treatment, or to those women who experience symptoms while pregnant.

Because this procedure is fast-acting, it may be especially helpful for critically ill patients who are at high risk of suicide attempts. In the 1960s, ECT fell out of favor in part because of the distorted negative characterizations of its use in the media. But modern procedures have been found to be safe and highly effective.

The course of treatment, as a rule, consists of 6-12 procedures, usually prescribed three times a week. During ECT treatment (usually two to four weeks), lithium and other mood stabilizers are sometimes discontinued to minimize side effects. Then they are resumed after completion of treatment.

New types of non-pharmacological treatments for depression:

Alternative Treatments for Bipolar Disorder

Some people with bipolar disorder have reported that using alternative treatments improves symptoms. Scientific evidence supports the many benefits of these treatments for depression. But the effectiveness of treating bipolar disorder needs more research.

You should always consult your doctor before starting any alternative treatments. Supplements and therapies may interact with your medication and cause side effects. Alternative therapies should not replace conventional therapies or medications. But some people have reported increased benefit when combining the two therapies.

1. Fish oil

Fish oils and fish are sources of two of the three main types of omega-3 fatty acids:

These fatty acids can affect chemicals in your brain associated with mood disorders.

Bipolar disorder appears to be less common in countries where people consume more fish and fish oil. People with depression also have lower blood levels of omega-3 fatty acids. Omega-3 fatty acids can help:

You can take fish oil supplements to help you meet your daily intake of this important fatty acid. However, fish oil supplements can cause side effects such as:

2. Rhodiola rosea

Rhodiola rosea (golden root or rose root) may help treat mild to moderate depression. Rhodiola rosea is a mild stimulant and can cause insomnia. Other side effects include vivid dreams and nausea.

Talk to your doctor before taking Rhodiola rosea, especially if any of your family members have had breast cancer. This plant binds to estrogen receptors and may increase the risk of breast cancer.

3. S-adenosylmethionine

The results of a review of studies indicate that S-Adenosylmethionine coenzyme supplements may be helpful in depression. This supplement may also be effective for bipolar disorder (4).

Some doses of these supplements can cause serious side effects, such as manic episodes. Talk to your doctor about the correct dosages and ask about how S-Adenosylmethionine may interact with other medications you are taking.

4. N-Acetylcysteine

This antioxidant helps reduce oxidative stress. In addition, a review of the scientific literature reported that in one randomized controlled trial, people with bipolar disorder were given N-Acetylcysteine ​​supplements at 2 g per day in addition to conventional treatment, resulting in significant improvements in symptoms of depression, mania, and quality of life (5 ).

This water-soluble vitamin may be effective in reducing manic symptoms in people with rapid cycling bipolar disorder. One study in six people with rapid cycling bipolar disorder who received 2,000-7,200 milligrams of choline per day in addition to lithium treatment showed an improvement in manic symptoms.

6. Inositol

Inositol is a vitamin-like substance that can help with depression. One study included 66 patients with bipolar disorder. They experienced a major depressive episode that was resistant to a combination of a mood stabilizer and one or more antidepressants. Patients were also given inositol or received additional therapy for 16 weeks. The results of this study showed that 17.4% of people who received inositol as adjunctive therapy recovered from their depressive episode and were free of bipolar symptoms for eight weeks (6).

7. St. John's wort

The results of studies that have evaluated the use of St. John's wort to treat depression are mixed. One problem is that the forms of St. John's wort used in the studies were not the same. The doses also varied.

8. Calming methods

Stress complicates bipolar disorder. Several alternative therapies aim to reduce anxiety and stress levels. These methods include:

• massage therapy
• acupuncture
• meditation

Calming therapies cannot cure bipolar disorder. But they can help you manage your symptoms and be an important part of your treatment plan.

9. Interpersonal and Social Rhythm Therapy (IPSRT)

Destructive patterns and sleep deprivation can worsen the symptoms of bipolar disorder. IPRT is a type of psychotherapy aimed at helping people with bipolar disorder:

• maintain a normal routine;
• inculcate good habits in behavior;
• learn to solve problems that interrupt your routine.

IPRT, in addition to your bipolar disorder medication, can help reduce the number of manic and depressive episodes you have.

10. Lifestyle changes

While lifestyle changes will not cure bipolar disorder, certain changes can improve your treatment and help stabilize your mood. These changes include:

• Regular exercise. Exercise can help stabilize your mood, ease depression, and improve sleep.
• Adequate sleep. May help stabilize your mood and reduce irritability. You can improve sleep by instilling the right habits in your daily routine and creating a calm environment for sleeping.
• healthy eating. Fatty fish and omega-3 fatty acids in your diet are very beneficial. Consider also cutting down on saturated fats and trans fats, which are linked to brain chemistry.

Summarize

Research shows that alternative therapies for bipolar disorder can be helpful when used in conjunction with conventional therapies. However, very little research has been done on the effectiveness of these treatments. Alternative therapies should not replace your current bipolar disorder treatment.

Before using alternative methods, you should consult your doctor. Some supplements may cause side effects with any type of medication you may be taking or may affect your other medical conditions.

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