A Handle on your Health: Diagnosis & treatment of bipolar disorder
“The Diagnostic and Statistical Manual of Mental Disorders” (DSM-V) is the psychiatrist’s guide for all things psychiatric. The manuel defines bipolar as a group of disorders that result in a change in a person’s mood, energy level and ability to function. They are broken into bipolar I, bipolar II and cyclothymic disorder. And these mood disorders can be quite debilitating for sufferers on a daily basis.
You may have also heard it called, “manic depressive.” Which can describe it perfectly, as most sufferers cycle between depression and mania. Most people understand what depression is — a state of feeling sadness and/or a loss of interest. You no longer find enjoyment in the activities you previously did. You might feel hopeless and sometimes even suicidal. It is a horrible feeling.
Now imagine you go from feeling depressed to manic. With mania people suddenly feel elevated. They can feel like nothing is impossible. They could conquer the world. Suddenly ideas are flying through their head. They are jumping from one idea to the next. There’s a whirlwind of activity in their heads and often in their actions as well. On the surface the feeling of mania might actually sound like a pretty productive problem to have but in reality mania can often lead to terrible decisions and outcomes.
The symptoms of mania are elevated mood, inflated self-importance, racing thoughts, insomnia, difficulty maintaining attention, increased goal-directed activity and excessive involvement in pleasurable activities. The symptoms are so severe they impact a person’s daily living. Typically the change of mood to mania is quite noticeable by the person’s family or friends. They may go from daily depression to seemingly the life of the party. They will start a bunch of projects that never get finished. Their speech may become so pressured that you just simply cannot follow them as they talk. Their involvement in pleasurable activities may be a spending spree or drug use or maybe even sex. The average manic episode lasts about a week or more before they burn out. Instead of elevated mood sometimes these people experience extreme irritability especially if they don’t get what they want.
Bipolar I is the more severe disorder. For a diagnosis, you must have had at least one episode of major depression in your life but you must also have had a full-blown manic episode too. Bipolar II is similar to bipolar I, with moods cycling between high and low over time except it is milder. The “up” moods never reach full-blown mania and are actually called hypomania. In order to be diagnosed with bipolar II, you need to have at least one episode of hypomania and one major depressive episode in your life. Depression, however, is by far the more predominant feeling these patients suffer with. But both those with bipolar I and II experience and often lead ordinary and productive lives.
How do we treat Bipolar? Well, for starters both bipolar I and II get treated with mood stabilizers. One of the oldest and best-known mood stabilizers is lithium. Lithium is an element found naturally in the environment. Some people even pay big money to relax in lithium baths at resorts. Depakote and Lamictal are two newer and more widely-used mood stabilizers. These drugs don’t absolutely take away the mania but reduce the severity of the elevated moods. Because the elevated mood feels so good it can be difficult to keep patients on their mood stabilizers because they miss the euphoric feeling during a manic episode.
Antidepressants are used to treat depression but you have to be careful not to use them alone without the mood stabilizers or you risk sending the person from a state of depression into a state of mania or hypomania.
For severe bipolar I patients, antipsychotics may need to be used. This is because their manic episode can be so severe they actually become psychotic. They may become paranoid as well as hearing voices that aren’t there. The antipsychotics won’t need to be used forever but certainly, during their acute mania they can be helpful.
While the medicines are necessary and helpful, these patients often need psychotherapy too. They need guidance and help with how to recognize when their moods are becoming severe and how to manage them. Family members may benefit from therapy as well. This will help them in dealing with their affected family members so they don’t feel so helpless when an episode occurs.
If you or a family member is experiencing any of these symptoms, please seek help from you doctor. It is worth noting here, though, that all of us experience some of these symptoms in our life and it doesn’t necessarily mean we are bipolar. Everyone experiences feelings of sadness; it's normal.
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Dr. John Turner is a family medicine and emergency medicine doctor with 25 years of experience. He is also the owner of My Primary Care Clinic and My Emergency Room 24/7 here in Hays County. Dr. Turner may be reached at 512-667-6087.
