Supporting a Loved One With Bipolar Disorder

A Safe Place To Start A New Journey.

"This illness is as old as humankind,
and has probably been conserved
in the human genome,
because it confers great energy
and originality of thought.
People who have had it have
literally changed the course of human history."

Demitiri Papolos,
The Bipolar Child

Introduction

According to psychiatrist, Dr. Demitiri Papolos, Manic Depression (now known as Bipolar) has “fuelled the brilliance of people like Isaac Newton, Abraham Lincoln, Winston Churchill, Theodore Roosevelt, Johan Goethe, Honoré de Balzac, George Frederic Handel, Ludwig Vov Beethoven, Robert Schumann, Leo Tolstoy, Charles Dickens, Virginia Woolf.”

bipolar disorder

These exceptional, high achieving, heroic, historic figures on one end of the Bipolar Disorder spectrum, however, make up only a small number of those afflicted by this complex disorder. In the general population, nearly 5.7 million Americans over the age of 18 suffer from Bipolar Disorder, split equally between men and women, without favoring age, ethnicity, race, social class, or economic group. For them, managing their affliction by controlling the symptoms in order to have a semblance of a normal life takes effort.

"My illness is a huge part of my daily life...a fulltime job."

Cj Laymon,
Bipolar 11 & ADHD Afflicted

Definition

Previously identified as Manic Depression, Bipolar Disorder is a mental illness that is characterized by abnormal and frequently intense alterations and swings in mood, energy, concentration, and activity levels, rendering the afflicted individual incapable of performing daily tasks and managing the responsibilities of life, or barely able to do so.  The exaggerated peaks and valleys of elation and sadness, hyperactivity and lethargy, and extreme energy and fatigue create chaos, destabilize equilibrium, and cause exhaustion rendering the afflicted person unable to thrive and flourish in a regulated manner.

Types of Bipolar Disorders

Bipolar Disorder manifests in three variations. While all three are characterized by the same changes in mood, energy, and activity levels, the intensity of each symptom is different for each type of disorder.

Can debilitate the sufferer with manic episodes that extend over 1 week, often cycling with depressive episodes that last as long as 2 weeks. Sometimes, the person may have interludes of depression that are also marked by manic symptoms. The occurrences may be severe enough to need inpatient hospital care. Sometimes, the episodes of depression may have both manic and depressive symptoms, further complicating an already complicated disorder.

Is a less severe manifestation of the disorder that is marked by alternating depressive episodes absent of the mania that occurs in Bipolar I Disorder. Instead of mania, this variant features hypomania – a lesser form of mania that increases mood and energy without being deviant or out of control. 

Is a condition that cycles between mild depressive and hypomanic symptoms that lasts for a year or two. Due to the mild degree of symptoms, they do not meet depressive and hypomanic diagnostic criteria.

In some cases, when people experience symptoms that do not match diagnostic criteria of the illness, they are assigned to a general unspecified Bipolar and related disorders rubric.

Symptoms

Bipolar Disorder is essentially an out of control mood disorder that affects emotions and influences sleep, activity, and behavior. The manic episodes of the disorder are marked by extremes of elation, irritability, or energized behavior. The depressive episodes can range from deep sadness and depression to hopelessness and indifference. Less severe depressive states feature hypomanic episodes. These mood swings may be brief, lasting hours or a day, or linger for days and weeks at a time. The range, intensity, and duration of human emotions exhibited in Bipolar Disorders, and the rapid changes from one end of the spectrum of emotions to another are evocative of a steep rollercoaster. 

bipolar disorder

"Bipolar is like being on a rollercoaster ride.
Sometimes you can predict drop-offs
and others you just have to hang on because the next turn sends you into an unexpected spiral.
Sometimes you are laughing and throwing your hands in the air
and then other times you are clinging,
simply holding on for dear life
screaming at the top of your lungs."

Author Unknown
Supporting a Loved One with Bipolar Disorder

Mania Signs & Symptoms

Depressive Signs & Symptoms

Associated Disorders & Symptoms

The symptoms of Bipolar Disorder are not unique which make diagnosing it a complicated matter for doctors, who must use the sharpest of investigative tools to confirm it. The disorder also co-occurs with those afflicted by eating disorders such as bulimia and binge eating, Attention-Deficit Hyperactivity Disorder (ADHD), anxiety disorders, and drug and alcohol addiction. Physical maladies such as migraine and headaches, hear disease, diabetes and hormonal disorders such as thyroid problems are frequently seen in those suffering from Bipolar Disorders.

Psychosis

In the most severe cases of Bipolar Disorder, during extreme high and low moods, patients may experience hallucinations and delusions. During manic phases, they may believe in fantasies of being famous, rich, or imbued with superpowers. During depressive episodes, they may be paranoid about others motives and behavior, or in doomsday negative beliefs of their own situation with regard to their health, security, and finances. Psychosis when accompanied by Bipolar Disorders is assigned as a schizoaffective disorder.

bipolar disorder

Occurrence

Through early onset Bipolar is significant in children, and later onset Bipolar has been found in people in their 40s and 50s, the median age for occurrence of the disease is 25. Teenagers, young adults, pregnant women, and new mothers are susceptible to Bipolar Disorder. The disease appears to have a hereditary factor-nearly 2 in 3 people with the malady have at least one blood relative afflicted by Bipolar or related Unipolar major depression.

Bipolar disorder in one parent, increases the risk of a child’s tendency for the malady by 15 to 30%. When both parents are afflicted by Bipolar Disorder, the risk to the child inheriting it increases by 50 to 75%. Some 20% of adolescents with major depression develop Bipolar disorder within five years of the onset of depression.

In addiction to genetics, some studies using Functional Magnetic Resonance Imaging (FMRI) suggest that the brain structure and functioning of people with Bipolar Disorders are different from those of people absent from the affliction. Much remains to be learned form extended FMRI studies to draw more solid conclusions.

Evaluation & Diagnosis

Supporting a Loved One with Bipolar Disorder

To rule out all other medical problems, the individual’s doctor will conduct a physical exam and initiate lab tests. Once other maladies have been ruled out, the primary care physician will initiate a referral to a psychiatrist for an assessment.

The psychiatrist will seek information from the patient to gain insight on their emotional, mental, and behavioral profile and conduct. The patient will also be asked to complete a questionnaire for self-assessment of the disorder. The psychiatrist may ask the patient for deeper profiling such as documenting daily mood alterations, activity levels, sleep routines, and functional capacity.

The collated patient information of revelatory symptoms is then compared with those established in the DSM-5 (Diagnostic and Statistical Manual of Metal Disorders) for Bipolar and variant disorders. 

Diagnosing Bipolar in children and teens is a sensitive matter as they often have other disorders that may have similar symptoms, such as ADHD and disorders turning on behavior.

Treatment

There is no cure for Bipolar Disorder. It is a lifelong chronic illness that must be managed throughout one’s lifetime with a cornucopia of treatments that will ease or control symptoms and increases a person’s potential to thrive and flourish. A gold standard of care would include the wraparound services of a psychiatrist specializing in the spectrum of mental disorders including Bipolar, and a psychologist or therapist. 

The primary treatments for Bipolar Disorder include medications and psychological counseling (psychotherapy) to control symptoms, and also may include education and support groups. The treatment protocol could include medications, psychological counseling, groups, and education. A medication protocol will likely include:

Mood Stabilizing

Medications to flatten the constant alterations in mood during occurrences of mania and hypomania. Commonly prescribed mood stabilizers include lithium, carbamazepine, and lamotrigine.

Antipsychotic

Medicines such as olanzapine, risperidone, and quetiapine may be prescribed if symptoms of cycling depression and mania are not alleviated through other treatment.

Antidepressants and antidepressant-antipsychotics

May be prescribed if merited .

Anti-anxiety Medications

To alleviate anxiety and insomnia, the patient may be prescribed benzodiazepines.

Each patient responds to medication differently. A medication or protocol of medication that works for one patient may not work for another because there are so many variables factored into Bipolar Disorder. One patient may tolerate a drug well, while another may be acutely sensitive to it and suffer from severe side effects. The doctor must work with sensitivity when testing and changing medicines to ensure that the patient does not suffer from the trials. Since patients usually seek treatment during depressive episodes, doctors must seek to learn the full profile of their conditions as a first step.

Without complete understanding of the patient’s Bipolar Disorder, a doctor may prescribe antidepressants solely for depression that may trigger manic episodes. A collaborative endeavor between doctor and patient that honors open communication, listening, trial, experiment, adjustments, and patience can lead to a successful medication regimen. This co-created palette of medications that effectively control a patient’s multiple symptoms, depressive episodes and mania will help the patient live with Bipolar without being debilitated by it.

Psychotherapy

Supporting a Loved One with Bipolar Disorder

A range of psychotherapeutic treatments are used to improve and manage the unique mental problems of those suffering from Bipolar Disorder.

Common modalities include:

Cognitive-Behavioral Therapy (CBT)

CBT empowers the patient by giving him/her the tools to identify beliefs and behaviors that are harmful or negative, and the skills to replace them with positive, affirming beliefs and behaviors. It builds their capacity to identify the triggers that lead to their mania and depressive episodes and gives them strategies to manage them without falling apart.

Interpersonal & Social Rhythm Therapy

A close monitoring of daily routines through IPSRT allows patients to be aware of how they manage their lives, identify what is good and harmful, and what they need to even out the highs and lows of their daily lives and stabilize their manic and depressive moods. 

Psychoeducation

A full knowledge of Bipolar Disorder through group counseling work will give those afflicted by the condition, as well as their families, the resources they need to handle, managed, preempt, and perhaps even avoid the disorder of this chronic condition. 

Family Centered Therapy

Bipolar Disorder is a chaotic affliction that takes families of patients on an emotional roller coaster ride with each manic and depressive episode. As such, family therapy is essential for the patient and the family.

Electron-Convulsive Therapy (ECT)

ECT is is employed in severe cases of Bipolar Disorder when other forms of treatment fail, or when the patient is unable to take medications due to side effects, or if the patient is at extreme risk of danger such as suicide. ECT results in the triggering of a seizure through electrical brain stimulation, which can change brain chemistry and stabilize or reverse symptoms of mental illness including Bipolar Disorder.

Transcranial Magnetic Stimulation (TMS)

TMS is a more benign form of brain stimulation that uses magnetic waves instead of electrical current. Still new, this treatment has been shown to be useful for some types of depressive disorders, but its effectiveness in treating Bipolar Disorder has not yet been confirmed.

Addiction Treatment

It is not uncommon for those suffering from Bipolar Disorder to self-medicate with alcohol and other substances which exacerbates mania and depression. Thus, the patient’s primary care physician may recommend residential or outpatient substance abuse treatment.

Treatment for Children and Teen

Research, longitudinal studies, and advances in treatment for adults suffering from Bipolar Disorder have all helped to pave the way for treatment for children and teens with the same medications and treatments. The life-long maintenance program may also include psychotherapy, education, and support. 

Helping a Loved One with Bipolar Disorder

Unlike other illnesses, mental illness such as Bipolar Disorder wreak havoc on those afflicted by the malady, as well as on those who love them. Life becomes both unpredictable and predictable as a loved one cycles through a range of human emotions periodically-sometimes in a single day, other times over weeks, and months. Because of the chronic nature of the disease, a loved one’s illness can take a toll on everyone around them. To help a loved one suffering from Bipolar Disorder, encourage them to manage their condition so that they can thrive and flourish despite their limitations.

To live with Bipolar Disorder is to experience the range of known human emotions with greater intensity, in more extreme depth, for longer or shorter durations, than most humans. It is a roller coaster of emotions—exhilarating, intoxicating, exciting, joyful, yet nerve-racking, stress-inducing, and frightening. Sometimes these moods are distinct and separate, other times they are co-joined in an inexplicable fusion of contrary emotions. With advances in treatment, managing and coping with Bipolar Disorder, and flourishing and thriving despite it is increasingly possible.

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“In my opinion, living with Manic Depression/Bipolar takes a tremendous amount of balls.”

Carrie Fisher,
Actress, Writer, Bipolar I Afflicted

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