Bipolar Disorder
Bipolar disorder is a mental illness that causes dramatic shifts in a person’s mood, energy and ability to think clearly. People with bipolar experience high and low moods—known as mania and depression—which differ from the typical ups-and-downs most people experience. There are two classifications of bipolar disorder: Bipolar 1 and Bipolar 2. Bipolar 1 is associated with more extreme and long lasting swings in mood.
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Unlike common depression or anxiety, bipolar is often a genetic condition and is typically passed down from a parent or grand parent. The average age-of-onset of bipolar conditions in a person is 18 to 25 years old, but can begin to appear earlier in the teens, or more uncommonly, in childhood. The condition affects men and women equally, with about 2.8% of the U.S. population diagnosed with bipolar disorder.
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If you or a loved one begins to experience significant and sustained changes in mood and behavior, you are advised to consult a doctor to see if you may be experiencing bipolar disorder. If left untreated, bipolar disorder usually worsens, and people often turn to alcohol or other substances for relief from their conditions ("self medicating"), which is dangerous and compounds their symptoms. However, bipolar can be successfully managed with a good treatment plan, typically including medication, therapy and a healthy lifestyle.
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Symptoms
Symptoms and their severity can vary. A person with bipolar disorder may have distinct manic or depressed states but may also have extended periods—sometimes years—without symptoms. A person can also experience both extremes simultaneously or in rapid sequence.
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Severe bipolar episodes of mania or depression may include psychotic symptoms such as hallucinations or delusions. Usually, these psychotic symptoms mirror a person’s extreme mood. People with bipolar disorder who have psychotic symptoms can be wrongly diagnosed as having schizophrenia.
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Mania. To be diagnosed with bipolar disorder, a person must have experienced at least one episode of mania or hypomania. Hypomania is a milder form of mania that doesn’t include psychotic episodes. People with hypomania can often function well in social situations or at work. Some people with bipolar disorder will have episodes of mania or hypomania many times throughout their life; others may experience them only rarely.
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Although someone with bipolar may find an elevated mood of mania appealing—especially if it occurs after depression—the “high” does not stop at a comfortable or controllable level. Moods can rapidly become more irritable, behavior more unpredictable and judgment more impaired. During periods of mania, people frequently behave impulsively, make reckless decisions and take unusual risks.
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Most of the time, people in manic states are unaware of the negative consequences of their actions. With bipolar disorder, suicide is an ever-present danger because some people become suicidal even in manic states. Learning from prior episodes what kinds of behavior signals “red flags” of manic behavior can help manage the symptoms of the illness.
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Depression. The lows of bipolar depression are often so debilitating that people may be unable to get out of bed. Typically, people experiencing a depressive episode have difficulty falling and staying asleep, while others sleep far more than usual. When people are depressed, even minor decisions such as what to eat for dinner can be overwhelming. They may become obsessed with feelings of loss, personal failure, guilt or helplessness; this negative thinking can lead to thoughts of suicide.
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The depressive symptoms that obstruct a person’s ability to function must be present nearly every day for a period of at least two weeks for a diagnosis. Depression associated with bipolar disorder may be more difficult to treat and require a customized treatment plan.
Treatment
Bipolar disorder is treated and managed in several ways:
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Psychotherapy, such as cognitive behavioral therapy and family-focused therapy.
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Medications, such as mood stabilizers, antipsychotic medications and, to a lesser extent, antidepressants.
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Self-management strategies, like education and recognition of an episode’s early symptoms.
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Complementary health approaches, such as aerobic exercise meditation, faith and prayer can support, but not replace, treatment.
The largest research project to assess what treatment methods work for people with bipolar disorder is the Systematic Treatment Enhancement for Bipolar Disorder, otherwise known as Step-BD. Step-BD followed over 4,000 people diagnosed with bipolar disorder over time with different treatments.
Types of
Bipolar Disorder
Bipolar I Disorder is an illness in which people have experienced one or more episodes of mania. Most people diagnosed with bipolar I will have episodes of both mania and depression, though an episode of depression is not necessary for a diagnosis. To be diagnosed with bipolar I, a person’s manic episodes must last at least seven days or be so severe that hospitalization is required.
Bipolar II Disorder is a subset of bipolar disorder in which people experience depressive episodes shifting back and forth with hypomanic episodes, but never a “full” manic episode.
Cyclothymic Disorder or Cyclothymia is a chronically unstable mood state in which people experience hypomania and mild depression for at least two years. People with cyclothymia may have brief periods of normal mood, but these periods last less than eight weeks.
Bipolar Disorder, “other specified” and “unspecified” is when a person does not meet the criteria for bipolar I, II or cyclothymia but has still experienced periods of clinically significant abnormal mood elevation.
Co-Occurring
Mental Illness
A co-occurring disorder refers to when one person has two or more mental health disorders or medical illnesses. These co-occurring disorders may overlap and begin at the same time, or one may appear before or after the other.
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Bipolar disorder & co-occurring anxiety
Medication
Guide
(Prescription, Experimental, &
Natural Herbs and Medicines)
With the prescribing doctor, work together to review the options for medication. Different types of bipolar disorder may respond better to a particular type. The side effects can vary between medications and it may take time to discover the best medicine.
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Traditional Prescriptions:
Lithium - Lithium (Lithobid, Eskalith) is effective at stabilizing mood and preventing the extreme highs and lows of bipolar disorder. Periodic blood tests are required because lithium can cause thyroid and kidney problems. Common side effects include restlessness, dry mouth and digestive issues. Lithium levels should be monitored carefully to ensure the best dosage and watch for toxicity.
Lithium is used for continued treatment of bipolar depression and for preventing relapse. There is evidence that lithium can lower the risk of suicide but the FDA has not granted approval specifically for this purpose.
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Anticonvulsants - Many medications used to treat seizures are also used as mood stabilizers. They are often recommended for treating bipolar disorder. Common side effects include weight gain, dizziness and drowsiness. But sometimes, certain anticonvulsants cause more serious problems, such as skin rashes, blood disorders or liver problems.
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Valproic acid and carbamazepine are used to treat mania. These drugs, also used to treat epilepsy, were found to be as effective as lithium for treating acute mania. They may be better than lithium in treating the more complex bipolar subtypes of rapid cycling and dysphoric mania.
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Lamotrigine is used to delay occurrences of bipolar I disorder. Lamotrigine does not have FDA approval for treatment of the acute episodes of depression or mania. Studies of lamotrigine for treatment of acute bipolar depression have produced inconsistent results.
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Second-Generation Antipsychotics (SGAs) - SGAs are commonly used to treat the symptoms of bipolar disorder and are often paired with other medications, including mood stabilizers. They are generally used for treating manic or mixed episodes.
SGAs are often prescribed to help control acute episodes of mania or depression. Finding the right medication is not an exact science; it is specific to each person. Currently, only quetiapine and the combination of olanzepine and fluoxetine (Symbax) are approved for treating bipolar depression. Regularly check with your doctor and the FDA website, as side effects can change over time.
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Standard Antidepressants - Antidepressants present special concerns when used in treating bipolar disorder, as they can trigger mania in some people. A National Institute of Mental Health study showed that taking an antidepressant also to a mood stabilizer is no more effective that using a mood stabilizer alone for bipolar I. This is an essential area to review treatment risks and benefits.
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Experimental:
Although in the early stages of testing, experimental procedures and substances have shown promising results towards helping those with mental health. Please consult with your doctor before moving forward with any new or experimental medicine.
Ketamine - A new study suggests that ketamine may not only be helpful for those with clinical depression, but also bipolar depression. Ketamine differs from traditional antidepressants in its mechanism of action – it affects different brain systems, neurotransmitters, and neural pathways.
Medical
Procedures
Vagus Nerve Stimulation (VNS)- VNS uses a pulse generator, about the size of a stopwatch, placed in the upper left side of the chest to stimulate the vagus nerve, which carries messages to parts of the brain that control mood and sleep, with electrical impulses.
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Electroconvulsive Therapy (ECT)- ECT is a procedure where controlled electric currents are passed through the brain while the person is under general anesthesia. This results in a brief, controlled seizure that affects neurons and chemicals in the brain. It is most often used to treat severe depression and depression with psychosis that has not responded to medications.
Deep Brain Stimulus (DBS) - Deep brain stimulation is currently being studied as treatment for Tourette’s syndrome and major depression. DBS involves two electrodes put surgically directly in the brain and a pulse generator put in a person’s chest.
Alternative
Therapies
Additional
Resources
Support Programs
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The Support Network - Address and promote student mental health and well-being through peer support initiatives in high schools and colleges.
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The Jed Foundation - Protects emotional health and prevents suicide for our nation’s teens and young adults
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Peer-to-Peer - Depression awareness and suicide prevention education, training, and support for middle and high school students
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The Mighty - A community to share and interact with others going through mental health issues
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ReachOut - An Australian site dedicated to providing self-help information, peer-support program and referral tools for those suffering with a mental illness or having a tough time
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You Are Not Alone from NAMI - A forum for users to read and share their personal stories
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Stigma-Free Society - A resource for parents, guardians, and caregivers to talk to their teens about mental wellbeing
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The 7 Best Online Therapy and Mental Health Support Options for Teens for 2022
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​Blogs​
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The Best Bipolar Disorder Blogs of 2020 from Healthline
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Natural remedies and nutritional tips from Full Circle Function
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Breaking Bipolar from HealthyPlace.com
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Videos
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What is Bipolar Disorder? from Helen Farrell's TED Talk
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Celebrate Recovery and Dual Diagnosis with Pastor John Baker
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How to Repair the Brain Through Healthy Living from Dr. Daniel Amen
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Books
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The Bipolar Disorder Survival Guide, Third Edition: What You and Your Family Need to Know Third Edition by David J. Miklowitz, PhD
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The Bipolar Child: The Definitive and Reassuring Guide to Childhood's Most Misunderstood Disorder
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The Anxiety and Depression Workbook: Simple, Effective CBT Techniques to Manage Moods and Feel Better Now by Michael A. Tompkins PhD ABPP
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The Listening Cure: Healing Secrets of an Unconventional Doctor
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Articles
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Living With Bipolar Disorder from the University of Michigan Bipolar Research Program
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Expert Guidelines for Bipolar Treatment from Psych Education
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What It's Really Like to Struggle with Anxiety and Depression from The Independent ​
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Exercise in Bipolar Disorder: A Testimonial from Psych Education
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3 Things Your College Kid Must Know About Mental Health from Anxiety And Depression Association of America
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Children of Bipolar Parents show Creativity from Science Daily
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The Benefits of Tai Chi - See how tai chi boost your health and wellbeing from VeryWell Health
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Friendship Bench - A Model for Accessible Mental Health Care from BrainBlogger.com
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The Power of Positive Thinking from Harvard Health Publishing
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Mental Illness: Brain Disease or Gut Disease? from Psychology Today
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​17 Great Probiotic Foods for Better Gut Health from Dr. Axe
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Nutritional Psychiatry: The Gut-Brain Connection from Psychiatric Times
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Little Treatments Show Big Promise for Youth Psychiatric Problems from MDEdge
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Quick Facts on Disruptive Mood Dysregulation Disorder (DMDD) from The Child Mind Institute
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What is Dialectical Behavior Therapy (DBT)? from Good Therapy
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What is Narrative Therapy? from Good Therapy
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Relieving Anxiety: Meditation Neutralizes Thought Polarity from EOC Institute
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I Was Paralyzed by Severe Depression. Then Came Ketamine from NYT OpEd
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Could the Embrace of Psychedelics Lead to a Mental-Health Revolution? from Vogue
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Using Hallucinogens as Therapeutic Drugs from VeryWellMind
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Celebrities With Bipolar Disorder
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Peer-to-peer Counselors - Demand for college peer counselors is booming from NPR
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Pandemic leads colleges to revise, and improve mental health efforts from The Washington Post
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5 Reasons Group Therapy Is the Best Choice Struggling Teens from Psychology Today
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10 Alternative Treatments for Bipolar Disorder from Healthline
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Promising evidence on the efficacy of Deep Brain Stimulation (DBS)
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Psychedelic Treatment with Psilocybin Relieves Major Depression from Johns Hopkins
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The Promises and Perils of Psychedelic Health Care from the New York Times
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NYU Langone Health Establishes Center for Psychedelic Medicine
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10 Centers for Psychedelic Healing, Therapy, and Exploration
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Could Psilocybin Be Helpful In Bipolar Depression? Is it Safe?
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Evaluating the risk of psilocybin for the treatment of bipolar depression
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A game-changer for bipolar disorder diagnosis using RNA editing-based biomarkers
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Researchers find the first strong genetic risk factor for bipolar disorder
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NAMI Applauds Key Mental Health Investments Made in FY 2022 Federal Budget
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Websites
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Bipolar “basics”: diagnosis and treatments from the Mayo Clinic
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Helpful Online Bipolar Disorder Support Groups from VeryWell Mind
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DBSA Wellness Toolbox to help you better communicate with your doctor from DBSA
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HelpGuide - Trustworthy resources and content to help improve your mental health and make healthy changes.
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Mental Health Online - Free self-help resources and therapist support
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The Collaborative RESearch Team to study psychosocial issues in Bipolar Disorder (CREST.BD)
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Healing Maps - A source for accurate and honest information about psychedelic-assisted therapy and qualified providers
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Podcasts
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How to Stabilize Circadian Rhythms in Depression and Bipolar by Psych Education
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Handouts
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Information Sheets & Worksheets from The Centre for Clinical Interventions
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Apps
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The Mood Tracker from ReachOut
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MindDoc - Monitoring and self-management app for promoting emotional well-being and coping
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Headspace - Guided meditations, animations, articles, and videos