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Bipolar Depression

Bipolar Disorder used to be referred to as manic-depressive illness. Marked by highs and lows, the individual who struggles with this illness suffers from uncontrollable mood swings. The deep mood shifts from mania, “the activated phase of bipolar disorder,” depression can severely impact a person’s life, keeping them from functioning at home, in school or at work. Jobs, relationships and even a person’s health can suffer when a person is bipolar.

About 10 million people in the United States alone struggle with bipolar disorder. The illness affects men and women at about the same rate. However, as with most mental conditions, women tend to seek treatment more often than men. A chronic condition, bipolar disorder requires lifelong treatment that includes therapy, medication and, sometimes, hospitalization.

Although the condition tends to develop during early adulthood, bipolar disorder can develop in children. The disease is difficult to diagnose, but it is important to get a proper diagnosis so that care can be coordinated. Suicide is a serious risk amongst bipolar patients and will become more of a risk if the illness goes untreated.

The symptoms of bipolar disorder vary depending upon whether the individual is in a manic or depressive state. The symptoms of mania include, but are not limited to:

  • euphoria
  • extremely optimistic
  • inflated self-esteem
  • belief you can accomplish anything
  • poor judgment, recklessness
  • impulsive behavior such as spending sprees, poor driving and sexual promiscuity
  • substance abuse including alcohol, drugs and prescription medications
  • binge eating (and purging)
  • becomes easily distracted
  • denying that anything is wrong
  • needs little sleep
  • difficulty in concentrating, etc.

On the flip side, the symptoms of depression can be:

  • low energy
  • need to sleep a lot
  • sadness and/or crying jags
  • fatigue
  • suicidal thoughts and/or behavior (maybe even suicide attempts)
  • low or high appetite
  • problems concentrating
  • irritability
  • anxiety
  • guilt
  • loss of interest in daily activities
  • chronic pain with no known cause
  • unintentional weight loss and/or gain, etc.

Of course, the bipolar patient has other moods than just manic or depressive. Within these states, the patient can also have a mild to moderate depression, a normal/balance mood, or as many experts refer to it – a baseline. Then, there is a mild euphoric, or manic state, known as hypomanic in which some of the symptoms of mania may be present, but not to the extent that they would be when the patient is in the throes of a full manic episode.

There are several forms of bipolar disorder. These are categorized by how often or many instances of mania and/or depression a person experiences during his/her lifetime. Bipolar I Disorder means that you’ve had at least one manic episode with or without a corresponding depressive episode. Patients who are diagnosed as Bipolar II have a period of depression that has alternated with an incidence of hypomania. The bipolar II patient has not had a manic episode and may never experience one. When neither of these criteria is met, the patient is considered Bipolar NOS (Not Otherwise Specified). Finally, one can be diagnosed with cyclothymia. A cyclothymic diagnosis is rendered when a person doesn’t have severe depressive or manic episodes.

A person is considered to be rapid cycling when he or she experiences multiple episodes within the same day, week or month. That tends to occur as the illness progresses and is more common in women than in men. Without treatment, rapid cycling, just like suicidal ideation and attempts, can become a bigger problem.

Common treatments for bipolar disorder include medications such as mood stabilizers (Lithium) and anticonvulsant medications (Depakote, Topamax, Neurontin). However, these can pose problems for the bipolar woman who is trying to become pregnant or is currently pregnant. They can cause problems for the unborn fetus and a nursing newborn so it’s best to check with your doctor if you are thinking of having a baby and you diagnosed bipolar. Other types of medications like antipsychotics (Risperdal, Seroquel), and insomnia treatments (Klonopin, Ativan) can also be an important part of the prescription equation.

Many patients with bipolar disorder are encouraged to have their thyroid levels checked since low thyroid function can impact mood. Cognitive behavioral, or ‘talk’ therapy is beneficial for many bipolar patients as is Dialectical Behavioral Therapy in either a hospital or private office setting. DBT, as it is called, focuses on teaching patients skills to help them manage their impulses and behaviors so that they can work on core mindfulness, emotional regulation, interpersonal effectiveness and distress tolerance. Some patients find family therapy, alternative treatments such as acupuncture and herbal remedies and a variety of other things very helpful.

The important thing to remember with bipolar disorder is that it is a lifelong condition. It requires skill to manage and a willingness to work with your doctor, your psychiatrist, your therapist and the people you love to help you get through it. It is possible.