Support and A Balanced Approach
for bipolar disorder
Bipolar disorder was long thought of as a biological condition that was primarily addressed by psychiatrists and other medical providers via medication. It affects one’s moods, thinking patterns, energy level, interactions with others and behavior.
The shifts in state can be sudden and dramatic which makes the condition quite debilitating. It can last days, weeks or many months. Lithium was considered a magic bullet of sorts and regarded as a kind of cure. Fortunately, this perspective has been expanded considerably.
In more recent years, researchers and psychotherapists are seeing the value of approaching the condition through a biopsychosocial lens. In other words, identifying bipolar disorder as a mix of biological and psychological factors where medication is but one area of relief.
“Psychotherapy has found a place of considerable value for clients wanting more than medication to address interpersonal challenges, mood shifts and loss of social identity.”
Managing Mood Symptoms and Interpersonal Disruptions
Many episodes of bipolar disorder are also impacted by stressful events, interpersonal interactions and underlying circadian rhythms. All of these factors interact in various ways and at different times for individuals. As such, psychotherapy has found a place of considerable value for clients who can benefit from interventions that target interpersonal challenges and other factors that can result in more stable remissions.
These interventions include Interpersonal Therapy which was developed for unipolar depression and Social Rhythm Therapy. These therapies delve deep into:
- Exploring and establishing daily routines.
- Monitoring sleep/wake cycles.
- Understanding and mapping the relationship between routines and mood.
- Using strategies to improve interactions associated with loss, changes in social role and disputes about roles. These strategies help improve states of depression and reduce the frequency of remissions.
Stigma and Desperation
Many individuals are so terrified of a diagnosis of bipolar disorder that they often delay treatment or suffer in silence. When they do seek treatment, some try to downplay symptoms or offer other diagnoses as a substitute.
Accordingly, it can be hard to treat the symptoms associated with this condition since many symptoms can actually occur in other diagnoses which may require an entirely different intervention. Not all interventions work equally well for all conditions.
In addition, bipolar disorder is often misdiagnosed even among professionals since depression, high energy moods, cycling, irritability can be evident within autism, ADHD, borderline personality disorder or panic disorder. Indeed, the misdiagnosis rate is thought to be “staggering” with a high likelihood of incorrect diagnosis the first time clients are seen.
If that weren’t enough, these conditions can co-occur meaning a person can have more than one condition.
Contrary to distorted ideas of bipolar disorder, many people can go years without any of the symptoms commonly associated in the media with the condition. Moreover, under medication and with therapy, many individuals participate in many roles that include professional careers and in their social roles as spouses, parents or friends. Bipolar disorder doesn’t mean that people endure endless bouts of rapidly cycling moods.
However, it is the case that if there is a family history, there is a greater likelihood of developing the condition. Stress from life events and interferences in social routines, can make individuals with such history more vulnerable to marked instances of instability that may be reflected in hospitalizations, long periods of depression, suicidal ideation and medications.
Many individuals experiencing psychosis or a marked change in mood that requires hospitalization, do not recognize or have difficulty coming to terms with what has happened.
It’s not uncommon that the onset of symptoms occurs in one’s twenties. However, one need not feel like they are drowning in an abyss of symptoms and disconnection. There is evidence-based treatment that is practical, groundbreaking and flexible.
“Those diagnosed with bipolar disorder, no longer have to feel that they are limited to medication faced with an abyss of symptoms and disconnection. There is evidence-based treatment that is practical, groundbreaking and flexible.“
Manage Mood Without Losing Yourself
Bipolar I and Bipolar II Diagnosis
Bipolar disorder is typically diagnosed by a psychiatrist who prescribes medication as the front line of treatment. The evaluation is quite comprehensive. The hallmarks of bipolar disorder are depressive and high energy “manic” emotional states. Typical symptoms affect one’s ability to function.
Symptoms associated with depressive episodes:
- Feelings of worthlessness
- Loss of interest in activities
- Weight loss or weight gain
- Difficulty sleeping or excessive sleep.
- Low energy
- Thoughts of suicide
Symptoms associated with high energy, or “manic” episodes:
- Racing thoughts
- Difficulty with focus
- Feelings of grandiosity
- Talking fast
- Poor decision-making
- Excessive planning
- Reduced sleep
- Euphoria that can last a week
- Increased risky or self-destructive behaviors
In Bipolar I, patients experience mania that is at least one week in duration and depression that is at least two weeks. It’s possible to experience depressive and manic symptoms at the same time.
In Bipolar II, the symptoms are less severe and there tend to be milder forms of manic episodes (known as hypomania) as well as depressive episodes. Interestingly, many creative types experience hypomania and consider this part of their creative process.
A New Approach to Treating Bipolar Disorder
Coordinating care among medication prescribers, therapists and any other providers involved in care makes for the best integrated approach that recognizes the interplay between biological and psychological factors. At the end of the day, it’s about living a life of dignity in which one’s limits are acknowledged as well as one’s interests, goals, values and above all, supportive relationships.
Cognitive behavioral therapy and psychoeducation are typically used to treat bipolar disorder.
Interpersonal and social rhythm therapy (IPSRT)
IPSRT combines the aspects of interpersonal therapy used to treat unipolar depression with social rhythm therapy that addresses the disruption in circadian rhythms that affect our body clock. Many of the symptoms of bipolar disorder reflect the body functions that are part of our 24-hour rhythm that help us function and affect when we want to eat, our energy levels and ability to concentrate. There’s a reason we don’t feel like eating at 4:00am compared to noon and that we get our deepest sleep, more or less, around 2:00 am. For most people, changes in our routines that affect these rhythms restabilize shortly after some disruption. Not so if someone has the symptoms of bipolar disorder. What might be psychologically insignificant in most, can cause substantial stress for someone vulnerable to a mood disorder and the result is a depressive or manic episode.
This is why so much emphasis is placed on scheduling routines and monitoring transitions in this therapy. This can have a significant impact on social interactions and social role functions.
Four Phases of IPSRT
There are essentially four phases to this treatment, which include (1) history taking and evaluation in which you explore with your therapist the various disruptions that impact your mood, interactions and routines (3-6 sessions); (2) Establishing daily routines and resolution of any identified interpersonal problem which includes charting routine events like when you go to bed and meal times (weekly therapy-10 to 14 sessions); (3) maintenance which consists of building up capability and maintaining euthymic mood, functioning and social rhythms during regular live events (gradual decrease to bi-weekly and then to monthly); and (4) termination (3-5 monthly sessions).
Sometimes “booster” sessions might be appropriate as might be a longer clinical course depending on the presence of other conditions. What is wonderful about IPSRT is that it can be a relatively short intervention.
One of the prominent aspects of bipolar disorder is that it is recurrent. To effectively implement this intervention in an outpatient setting and create the lifestyle changes that support adherence to a medication regimen and reduce the frequency of episodic recurrences, it is important that clients have an established relationship with a psychiatrist or other prescribing provider and have attained some stability with their medications.
If you do not have a prescriber, we can provide referrals.