Therapy for Bipolar Disorder
Bipolar Disorder at a Glance
There have been distinct periods in your life when you have felt unusually elevated, energized, and possibly irritable. These periods of elevation last at least four consecutive days, sometimes weeks, and you feel elevated for the majority of these days. During these stretches of time you tend to experience a decreased need for sleep. For example, despite getting two or three hours of sleep for several nights in a row, you feel energized and on top of the world. You may be easily distracted and notice that your thoughts dart quickly from topic to topic. You may have been told that your speech seems louder, boisterous, and more rapid than usual.
During a manic or hypomanic episode, you may feel overly confident and take on large projects, possibly with limited knowledge of the topic at hand. You may notice increased participation in multiple activities - sexual, occupational, political, religious. Perhaps you’ve made impulsive decisions that ended up having significant health, financial, relational, or occupational consequences. When you’re in the midst of these episodes, you either don’t seem to notice them or you don’t view them as problematic. It’s often only in retrospect that your mood, energy, and behaviors seemed uncharacteristic of you.
If you’ve experienced a manic or hypomanic episode, you've likely experienced one or more major depressive episodes as well. During periods of depression you feel despondent, flat, and hopeless. You lose interest in things you once found enjoyable. You notice changes in your sleep and appetite, and it’s difficult to concentrate. While you might occasionally enjoy feeling manic or hypomanic, you experience periods of depression as painful and concerning. It’s often these symptoms that prompt you to reach out for support.
Coping with Bipolar Disorder
When a person seeks treatment for and begins managing the symptoms of bipolar disorder, they no longer feel hijacked by unpredictable and extreme shifts in mood and behavior. They learn to recognize warning signs for manic episodes and their lives feel more manageable. They still experience moments of joy, pleasure, and happiness, but these emotional states no longer contribute to erratic behaviors that end up having significant consequences down the road. When a person seeks treatment for bipolar disorder, they also experience fewer depressive episodes.
Reasons to be Hopeful
Therapy is effective for the treatment of bipolar disorder. Cognitive-behavioral therapy (CBT), family focused therapy (FFT), and interpersonal and social rhythm therapy (IPSRT) are a few examples of empirically supported treatments. In a large randomized study, these therapies were shown to be superior to “supportive talking,” and they were found to be equally effective to one another. 85% of individuals with bipolar II disorder return to fully functional levels between hypomania and major depressive episodes.
Medication is effective as well. Mood stabilizers and atypical antipsychotic medications are the two classes of medication most often prescribed. Mood stabilizers include: Lithium, Depakote, Lamictal, and Tegretol. Atypical antipsychotics include: Abilify, Zyprexa, Seroquel, Risperdal, and Geodon. Combining medication and therapy is especially beneficial.
Drs. Casey and Christopher have years of experience helping patients recognize and cope with symptoms of bipolar disorder. Most often, clients with bipolar disorder reach out for help with depression, anxiety, or a substance use disorder. If a patient is in the midst of a manic or hypomanic episode when they initially reach out for support, Drs. Casey and Christopher work with the patient’s family and other healthcare providers to stabilize the patient and possibly help the patient begin an intensive outpatient program. Once manic symptoms have been stabilized, Drs. Casey and Christopher can work with patients to treat the symptoms of major depressive disorder that typically follow manic episodes. They also help patients learn strategies and skills to decrease the frequency and intensity of future manic and major depressive episodes.
Frequently Asked Questions
What’s the difference between manic and hypomanic episodes?
While there are some exceptions, the difference is mostly about the duration of symptoms. Hypomanic episodes last a few days whereas manic episodes last at least one week.
What are the different types of bipolar disorders?
Bipolar I disorder is characterized by at least one manic episode, with or without the presence of intermittent major depressive episodes. Lifetime prevalence of bipolar I disorder is 0.6% of the U.S. population.
Bipolar II disorder is characterized by at least one hypomanic episode, with or without the presence of intermittent major depressive episodes. 5-15% of patients with a diagnosis of bipolar II disorder eventually meet criterion for bipolar I disorder. Lifetime prevalence of Bipolar II is 0.8% of the U.S. population.
Cyclothymic disorder is characterized by a two year period (or more) in which a person experiences hypomanic symptoms that do not meet criteria for a hypomanic episode along with depressive symptoms that do not meet criteria for a major depressive episode. Lifetime prevalence of cyclothymic disorder is 0.4% of the U.S. population.
None of these diagnoses are given if a person’s symptoms are better accounted for by a substance use disorder, a medication, or another health condition. In these cases, a diagnosis of substance-induced bipolar disorder; medication-induced bipolar disorder, or bipolar disorder due to another medical condition may be given. A thorough assessment lends to a more precise diagnosis. Given that mood stabilizers and atypical antipsychotic medications are often used in the treatment of bipolar disorders, a precise diagnosis is important.
Is Bipolar I disorder more severe than Bipolar II disorder?
Not necessarily. In fact, clients with Bipolar II disorder tend to cycle more rapidly and experience more hypomanic and depressive episodes over the course of their lives. Both disorders cause significant impairment in a person’s life. For example, it’s estimated that bipolar disorder accounts for one fourth of completed suicides. The life-time prevalence rates for suicide attempts are similar for Bipolar 1 disorder (32%) and Bipolar II disorder (36%). If any of the symptoms described on this page are negatively impacting your life, we encourage you to reach out for support.