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Bipolar disorder, also known as manic-depressive illness, is when there are unusual shifts in a person’s mood, energy, and ability to function. It is different from the normal ups and downs that everyone goes through, as the symptoms of bipolar disorder are severe. Some may experience psychotic symptoms during times of severe mania or severe depression. Bipolar disorder can result in destroyed relationships, job loss, problems in school performance, and even suicide. The good news is that bipolar disorder is treatable and that people with this illness can lead full and productive lives. Like diabetes, it is a condition that is chronic and requires ongoing treatment. The average person with bipolar disorder typically experiences major depressive episodes more than three times as frequently as symptoms of severe mood elevation or mania.
Many with mood swings question whether they or their children are “Bipolar.” Most of the people who ask this question of me have quickly been determined to either have normal mood shifts or to be depressed where their “highs” are reaching a normal positive mood. That said, bipolar disorder is often diagnosed as ADHD in children or depression in adults. This is largely due to being unable to identify in a person's history an episode where the person was “manic,” i.e., a time where they got very little to no sleep, their minds constantly raced, and often acted impulsively in ways that are out of their norm and/or could be dangerous. Examples are over spending, consuming large amounts of alcohol and/or other drugs, promiscuous behavior, or otherwise acting without thinking about consequences. A recent study revealed that 43% of those diagnosed with bipolar disorder, also had PTSD.
Medication is considered the cornerstone of treatment. The medication that has been used for the longest period of time is Lithium. Over the last 20 or so years, anti-convulsants like Depakote are more often tried first, as they are less likely to have serious side effects. In the last 10 years or so, atypical (newer) anti-psychotic medications such as Risperdal or Zyprexa have proven to be effective for many. Many psychiatrists are still of the mind “take your medication and you'll be fine,” discounting the benefit of talking therapy. While family physicians often can begin and manage medications for anxiety, depression, and ADHD, psychiatrists should be used with bipolar disorder. Once a person has been stable and functioning well, a family physician may be suitable for maintenance, although a psychiatrist would still be preferable for most, especially if they are receiving no other mental health treatment.
There is a growing body of research that shows the addition of talking therapy to medication improves the stability and functioning of those with bipolar disorder. The focus of treatment varies depending on the individual. Many, but certainly not all, have histories of significant abuse. Others certainly benefit from a problem-solving approach to various areas of their lives. A recent review of studies reported that “Treatments that emphasize medication adherence and early recognition of mood symptoms have stronger effects on mania, whereas treatments that emphasize cognitive and interpersonal coping strategies have stronger effects on depression. “ Generally, many to all of these issues will be addressed in talking therapy.
Both children and adolescents can develop bipolar disorder. It is more likely to affect the children of parents who have the illness. Unlike many adults with bipolar disorder, whose episodes tend to be more clearly defined, children and young adolescents with the illness often experience very fast mood swings between depression and mania many times within a day. Children with mania are more likely to be irritable and prone to destructive tantrums than to be overly happy and elated. Mixed symptoms also are common in youths with bipolar disorder. Older adolescents who develop the illness may have more classic, adult-type episodes and symptoms.
Again, while bipolar disorder is often missed or misdiagnosed, it IS treatable. Sometimes, other problems, like depression, are unsuccessfully treated before arriving at the correct diagnosis. Diagnosis is best left to psychologists or other mental health professionals.
If you are on medications and still find your life on STUCK, contact me.
NIMH Bipolar Information
NIMH Children Information
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