Bipolar Disorder For Dummies
Overview
Wrap your mind around bipolar disorder and understand your treatment options
Bipolar Disorder For Dummies, 4th Edition explains everything about this common mental health diagnosis in easy-to-understand terms. If you or a loved one has recently been diagnosed with bipolar disorder, you aren’t alone. This book helps make sense of options when it comes to medications, therapies, and treatments that could improve your quality of life. You can live a full life with bipolar disorder by managing your symptoms and following a solid treatment plan. With compassionate advice and friendly insights, this book empowers you with the information you need to find support for yourself or assist a loved one who has been diagnosed with bipolar disorder. This updated edition covers emerging and alternative therapies, including ketamine, transcranial magnetic stimulation (TMS), marijuana, and psychedelics.
- Get the latest on medical, therapeutic, and self-help strategies for bipolar management
- Navigate your way through the challenges of a bipolar diagnosis
- Learn the chemistry behind bipolar disorder—in terms anyone can understand
- Control symptoms, function in times of crisis, and plan ahead for manic or depressive episodes
If you suspect you may have bipolar disorder, if you have recently been diagnosed, or if you have a loved one with bipolar disorder, this Dummies guide offers you an accessible resource for learning all the basics.
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About The Author
Candida Fink, MD, is a psychiatrist with board certifications in adult and pediatric psychiatry. She specializes in a neurodevelopmental approach to psychiatric illnesses, including mood disorders, in children, adolescents, and adults. She has navigated family challenges with bipolar disorder as well.
Joe Kraynak is a writer and editor who has co-authored numerous Dummies guides. He has been married to an incredible woman with bipolar disorder since 1984.
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bipolar disorder for dummies
CHEAT SHEET
To manage bipolar disorder effectively, you first need to know what it is. Then you can develop and follow a treatment plan, which usually includes a combination of medication, therapy, self-help, and support from a network of understanding and committed friends and family members.This Cheat Sheet can help you get up to speed on the basics of bipolar disorder in a hurry.
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Bipolar Disorder
To be a savvy consumer in the world of doctors and therapists, you have to assess your caregiver's credentials and qualifications, make informed treatment choices for your bipolar disorder, determine how you can tell if treatment is working, and know what to do if you begin feeling worse.This article provides a list of questions to ask a psychiatrist or therapist to obtain the information you need.
Bipolar Disorder
If a loved one has bipolar disorder, you're probably wondering what you can do to help. Although your loved one ultimately decides what your level of involvement will be, the two of you may want to consider the following ways you can help:
Get educated. Knowing what your loved one is dealing with leads to understanding and empathy, which are essential to becoming an effective support person.
Every illness has a better prognosis when the people who have it are informed, invested, and involved in their treatment plans. This is especially true for serious mood disorders, including bipolar. In general, the more involved you are in your recovery and mood maintenance, the better the outcome. Here are ten strategies and skills for managing bipolar.
Bipolar Disorder
When a loved one experiences a major mood episode, you may be at a loss for what to do. Here are ten practical ways to help your loved one. Ultimately, the task of managing bipolar disorder is the responsibility of the person who has it, except for periods during which the person is incapacitated by a severe mood episode.
Bipolar Disorder
Overall health and stress levels impact the brain. Those with bipolar disorder tend to be more sensitive. Recent research even suggests that these factors can flip certain genes on or off to protect against or trigger illness. To give your body, including your brain, what it needs to function well, focus on five major areas: sleep, nutrition, exercise, stress management, and relationships.
Bipolar Disorder
When your moods are out of sync with reality, your brain's physiology is disrupted. A psychiatrist, fondly referred to by many with bipolar disorder as a p-doc, prescribes medications to help adjust the neurobiological systems in your brain to enable it to respond appropriately. Medication doesn't cure your bipolar disorder, but it helps regulate your moods so you can function and begin to deal with real-life issues that may trigger mania or depression.
Bipolar Disorder
Your brain and central nervous system form an intricate power grid that carries very low-level electricity. With serious central nervous system malfunctions, as in epilepsy, neurons misfire to such an extent that they can cause seizures. Anticonvulsants — including valproate, commonly known as valproic acid (Depakote) — appear to reduce seizures, at least in part by regulating neuron firing.
Bipolar Disorder
Atypical antipsychotics (atypical neuroleptics or second-generation antipsychotics) were originally formulated to treat psychosis in schizophrenia, but this class of medications has also proven effective in reducing mania and augmenting antidepressant treatment.
The atypical or second-generation moniker stems from the fact that this newer breed of antipsychotics works differently than the older standard or first-generation neuroleptics, such as chlorpromazine (Thorazine) and haloperidol (Haldol).
Anxiety can mimic symptoms of bipolar disorder. Anxiety disorders are common in children, and they trigger changes in mood and behavior that can look like manic or depressive symptoms. Anxiety disorders cause fear and distress that are out of proportion to any actual threat.
The fear and distress then trigger behavioral responses to try to reduce the threat, typically in one of two forms — fight or flight.
Bipolar Disorder
The diagnostic criteria for mania clearly overlap with those for ADHD. Distinguishing between the two conditions is critical because treatment for ADHD is different from treatment for bipolar.
For instance, the stimulants used to treat ADHD, such as Adderall (a combination of dextroamphetamine and amphetamine) and Ritalin (methylphenidate), can wreak havoc in a manic child, and antimanics, which can help with mania, don't help kids with ADHD.
Bipolar Disorder
Autism spectrum disorders (ASD) are developmental disorders that present with impaired social interactions/communications and repetitive patterns of language and behavior. The severity can range from very impaired (with severe intellectual disability and little or no language) to average or superior intellectual function and typical verbal language skills.
Bipolar Disorder
The most commonly used purely antianxiety meds used int he treatment of bipolar disorder are benzodiazepines (also known as anxiolytics or tranquilizers, or benzos for short). These medications slow down the whole nervous system, thus reducing agitation and anxiety levels, both of which can be problems in bipolar disorder.
To manage bipolar disorder effectively, you first need to know what it is. Then you can develop and follow a treatment plan, which usually includes a combination of medication, therapy, self-help, and support from a network of understanding and committed friends and family members.This Cheat Sheet can help you get up to speed on the basics of bipolar disorder in a hurry.
Oppositional defiant disorder (ODD) is not just typical childhood rebellion. All children are oppositional at times; it's part of growing up and developing independence and personality. For most kids, rebellious behaviors respond fairly well to the usual carrot-and-stick parenting techniques, but oppositional kids exhibit a much more tenacious defiance.
Psychopharmacology is the use of psychotropic medications (any prescription meds that affect mood, emotion, behavior, or perception) to treat mental illness. In the case of bipolar, psychopharmacology has four primary goals:
Alleviate acute manic symptoms
Ease depressive symptoms
Eliminate or lessen any psychosis
Maintain mood stability and reduce the likelihood or frequency of future mood episodes
The treatment goals are clear, but psychiatrists sometimes have trouble meeting these goals for the following reasons:
Symptoms vary dramatically.
Bipolar Disorder
Pinpointing the location of bipolar disorder in your brain is almost as difficult as finding affordable health insurance. Brain imaging studies have found few consistent changes when looking at large brain structures. They've had much more success looking at changes at the cellular level and, in particular, at functional changes in cells and groups of cells in different brain areas.
Bipolar Disorder
When choosing whether to take the name-brand or generic version of a medication for bipolar disorder, you and your doctor may want to consider the possible differences.Many people wonder whether name-brand medications are any better or even any different from their generic equivalents. Although the Food and Drug Administration (FDA) regulates both name-brand and generic medications, how those regulations apply to generic medications can lead to differences in how effective the medication is and in the side effects it causes, even when the generic has the same amount of the same active ingredient(s) as the name-brand version.
Bipolar Disorder
Marketed as the antidepressant Wellbutrin and the smoking cessation product Zyban, bupropion increases the levels of dopamine and norepinephrine in the brain synapses. It has an unknown mechanism of action but is clearly different from antidepressants in other classes, such as SSRIs, SNRIs, and tricyclics; therefore, bupropion belongs in its own category.
Bipolar Disorder
Bipolar disorder carries the distinction of having some of the highest rates of comorbidity with other psychiatric illnesses, which means that someone diagnosed with bipolar disorder is likely to have at least one other psychiatric diagnosis. Some researchers suspect that because bipolar disorder may actually be closely related to some of these illnesses, in terms of underlying brain changes — they may not really be separate disorders at all.
Continuity of care is an extremely important factor in the success of long-term management of bipolar disorder. If you shuffle from one doctor or therapist to the next and the changes result in medication and therapy adjustments, your moods are likely to fluctuate.
Unfortunately, changes in health insurance and other factors outside of your control often lead to changes in doctors and treatments.
Bipolar Disorder
People often have a different idea of what the term recovery means to them in relation to bipolar disorder. Some think of it as no longer needing to take medication or see a doctor or therapist. Others may think of it as regaining control of their lives with medication, therapy, lifestyle changes, and/or other approaches.
Arriving at a diagnosis of bipolar disorder in children and adolescents is problematic because manic episodes typically first appear in late adolescence or early adulthood. A diagnosis of bipolar I disorder requires the presence of at least one manic episode. Mania (and therefore bipolar I) is much less common in younger adolescents and children, but it does occur.
Bipolar Disorder
DSM-5 introduced a new diagnosis that grew out of research on children with chronic mood dysregulation — irritability and emotional/behavioral outbursts. The concept of chronic mood dysregulation has overlapped with the diagnosis of bipolar disorder, but they're not the same. This diagnosis helps to capture children with baseline irritability and outbursts who don't exhibit the cycles or episodes needed to diagnose mania and therefore bipolar disorder.
Epigenetics is the study of changes that affect how genes are expressed without affecting the genes themselves. These changes occur through a variety of chemical interactions with the DNA. Sometimes these changes in expression occur as part of typical development and function, but some changes can disrupt normal processes and healthy cell function.
Bipolar Disorder
Friends and family have much more invested in your well-being than any third party, including your psychiatrist or therapist, but other people who have bipolar may be able to offer much more in terms of empathy, insight, and connections. Bipolar support groups can offer the following perks:
Camaraderie with people who share your experiences and emotions
Understanding that a mood disorder doesn't define who you are
Motivation to follow your treatment plan
Opportunity to rediscover strengths and humor you thought you lost when you became ill
Insider information on medications, treatments, and therapies
First-hand perspectives of local doctors and therapists
Information about your legal rights
Tips about education and IEPs (Individualized Education Plans) for children with bipolar disorder
Access to credible books and videos about bipolar
You can tap in to the resources a support group offers by joining one.
acute: Relatively short but severe, as in an acute mood episode.adjunctive: Complementary to the main treatment.affective disorder: A category of psychiatric disorders that includes depression, bipolar disorder, and seasonal affective disorder (SAD). Affect is a medical term for mood.akathisia: Severe restlessness, a possible side effect of certain medications, especially some antipsychotics.
Bipolar Disorder
Nature provides a host of effective cures and treatments for common ailments, but does it serve up anything for bipolar disorder? Medical research suggests that some of the supplements listed here may provide benefits to people with bipolar disorder:
Coenzyme Q10: This substance plays a key role in energy metabolism within cells, which may be disrupted in bipolar disorder.
Bipolar Disorder
After a psychiatrist effectively tweaks brain function with the right brew of medications, your problems may be mostly solved. For many people with bipolar disorder, however, medications provide only partial relief; some symptoms persist and you need additional interventions to reach a more complete recovery.
Even if you experience full symptom relief, your system may react in ways that override the medication's mood-moderating effects if you live under constant stress, don't get enough sleep, or use ineffective strategies to resolve problems and deal with conflict in your life.
Bipolar Disorder
Bipolar disorder and borderline personality disorder often share many of the same symptoms — mood shifts, emotion dysregulation, impulsivity. Prior to settling on a diagnosis of bipolar disorder, your doctor should consider borderline personality disorder, among other conditions with symptoms that overlap with those of bipolar disorder.
Medications that work for bipolar disorder continue to puzzle researchers, who don't yet fully understand how they do their thing — their mechanism of action. For example, although antidepressants and antianxiety medications are known to target certain neurotransmitters, this may not be their major effect in treating bipolar.
Bipolar Disorder
When you love a person with bipolar disorder and want to support him or her, you will get a lot of suggestions from a lot of sources, some of which are more reliable than others. This article presents advice you can count on: seven ways to help a loved one with bipolar while retaining your own composure.These ideas have evolved from medical research and practice, along with personal stories and experience, and they can be powerful tools.
Bipolar Disorder
Before arriving at any medical diagnosis, doctors review a differential diagnosis to consider all the possible causes of the presenting symptoms. In bipolar disorder, the differential diagnosis often includes the following conditions that may involve symptoms similar to those of bipolar disorder:
Unipolar depression: A major depressive episode without a history of mania or hypomania doesn't qualify as bipolar disorder.
Bipolar Disorder
Bipolar disorder is a potentially lethal disease. An agonizing fact is that some people with this disorder do kill themselves. Suicide is a leading cause of death in adolescents, and bipolar disorder increases this risk significantly. To prevent suicide, follow these guidelines:
Never ignore threats of suicide or self-harm.
Bipolar Disorder
Since the 1960s, lithium has been the gold standard, treating the range of bipolar symptoms more fully than any other medication in use today. It treats mania. It may treat bipolar depression. It's also used in maintenance therapy, as long-term medication to prevent or reduce recurrent depressive or manic episodes.
Bipolar Disorder
The overall treatment plan that a person with bipolar disorder should follow to achieve and maintain mood stability is fairly straightforward. Follow this treatment plan:
Take your medications as prescribed, even when you're feeling well, and consult your doctor before making any medication changes.
Establish routines that ensure a regular sleep-wake schedule.
Bipolar Disorder
In the throes of mania or depression, a person may not be thinking clearly enough to seek treatment and may even refuse necessary treatment. Loved ones want to do what's best, but they often hesitate, not knowing when to step in and what to do.
Should they call your doctor or therapist or drive you to the nearest emergency room?
Bipolar Disorder
The first order of business in treating bipolar disorder is to treat the brain. Such treatment usually requires medication and may also include other biological methods that specifically target brain function, such as light therapy. Following are some common biological treatment options for bipolar.
Getting the right meds for your condition
The first, fastest, and generally most effective treatment for mania or depression is medication, which treats acute (severe, short-term) symptoms and is used as a prophylaxis (preventive) to avoid further cycles.
Bipolar Disorder
Studies have shown lower rates of depression in countries where people eat a lot of seafood. Over the last decade, researchers have tried to understand this connection and have focused on omega-3 fatty acids — nutrients that the body can't manufacture itself and must take in through diet.
Omega-3 fatty acids are necessary for healthy brains and cardiovascular systems, and you find them in high concentrations in many types of seafood.
Bipolar Disorder
Certain therapies and types of professional counseling, if available and affordable, are often valuable additions to a bipolar treatment plan. Here are some therapies and other professional offerings to consider:
Cognitive behavioral therapy (CBT): The premise of CBT is that thoughts, feelings, and behaviors are closely interconnected.
Bipolar Disorder
Studies show that bipolar recovery is faster and more durable when it occurs in a community that understands and supports the person who has the disorder. Ideally, when someone experiences a major mood episode, the person's entire family becomes involved and the treatment team keeps them informed about what's going on and how to help.
Bipolar Disorder
Major mood episodes can sneak up on you with the silence of a brooding sadness or the furtive stirrings of enthusiasm. Maybe you feel a little less tired one day, a little more energetic. That's normal. You figure it's nothing to worry about. After all, you have every right to enjoy your life, and you're looking forward to the weekend — TGIF!
Bipolar Disorder
Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) increase the levels of two brain chemicals — serotonin and norepinephrine — in the synapses between brain cells. As with SSRIs, the full mechanism of action of SNRIs is poorly understood. But researchers know that, like serotonin, norepinephrine plays an important role in regulating mood and anxiety.
Bipolar Disorder
Serotonin is a brain chemical that helps regulate mood, anxiety, sleep/wake cycles, sexual behaviors, and many other brain and body functions. Selective Serotonin Reuptake Inhibitors (SSRIs) increase the level of serotonin in the synapses — the spaces between brain cells (neurons) — in the brain.
However, the mechanisms of action of SSRIs are more complex than simply increasing serotonin levels.
Assuming that you're not in the throes of a major mood episode, you can do a great deal on your own to maintain mood stability and avoid future manic and depressive episodes, especially if the people closest to you are on board. Here are some of the most effective ways to help:
Take your meds. The best way to improve the course of the illness is to prevent mood episodes, and the most effective means for doing so is medication.
Bipolar Disorder
The following table lists several antidepressants used in the treatment of bipolar disorder besides Selective Serotonin Reuptake Inhibitors (SSRIs) and Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) that affect serotonin but differ structurally from the SSRIs and SNRIs.
Two of the medications in the table are used commonly as sleep aids because they're so sedating, and some affect other neurotransmitters as well.
Bipolar Disorder
Doctors commonly prescribe sleep aids for the short-term treatment of insomnia, which is often associated with depression and bipolar mania. Benzodiazepines are often used to help with sleep, but a number of sedative hypnotic medications similar to benzos are used exclusively for insomnia and aren't used to treat anxiety.
Bipolar Disorder
The idea of childhood bipolar disorder was dismissed as a rare event until about 20 years ago when some researchers began to explore the idea that pediatric bipolar disorder was more common than previously thought. The researchers noted that many adults with bipolar disorder reported that their symptoms started before age 18.
Researchers say that heritability — how much of bipolar disorder is due to genetics — accounts for between 60 and 70 percent of the risk of getting the illness. Genetic studies reveal the following:
The identical twin of a person with bipolar I disorder has about a 50 percent risk of developing the disorder. Because identical twins share all their genes, this finding means genetics accounts for some, but not all, of the chance of developing bipolar disorder.
Bipolar Disorder
Bipolar diagnoses rely heavily on the type of mood episode(s) a person is experiencing or has experienced in the past, so to understand the different diagnoses, you need to know what constitutes a mood episode — specifically a manic, hypomanic, and major depressive episode. Following are the DSM-5 diagnostic criteria for each mood episode type.
Bipolar Disorder
The medications that are available now to treat bipolar disorder work well in many, less well in some, and not well in a few. Scientists are exploring the underlying brain and body changes that are part of bipolar disorder with a long-term goal of identifying new ways to treat it. Several medications that have shown some promise in the treatment of various aspects of bipolar disorder.
Bipolar Disorder
When you have bipolar disorder, you're encouraged to chart your moods, sleep, and energy levels daily to record patterns that may help you spot the early warning signs of a developing mood episode (mania or depression). In addition, this log provides valuable information to guide your doctor and therapist in their treatment decisions.
The primary treatment for bipolar disorder is medication with the goal of restoring normal brain function. The following classes of medications are often used in treating bipolar disorder and related conditions:
Antimanics: Medications that target mania include lithium; certain anticonvulsants, such as valproate (Depakote); and certain newer or atypical antipsychotics, such as olanzapine (Zyprexa).
Bipolar Disorder
Tricyclics and monoamine oxidase inhibitors (MAO inhibitors or MAOIs) are older classes of medications that work differently from the antidepressants used to treat bipolar disorder and even differently from one another. These meds are used much less often than many of the other treatments for bipolar because the side effects of tricyclics and MAOIs can be difficult to manage:
Tricyclics: Tricyclics affect norepinephrine and serotonin levels primarily, but they also touch a number of other brain chemicals, including histamine.
Bipolar disorder wears many masks. It can be happy, sad, fearful, confident, sexy, or furious. It can seduce strangers, intimidate bank tellers, throw extravagant parties, and steal your joy late into the night. However, based on research, psychiatrists have managed to bring order to the disorder by grouping the many manifestations of bipolar into categories that include bipolar I, bipolar II, and cyclothymic disorder.
Bipolar Disorder
Even though a manic episode is needed to make the diagnosis of bipolar disorder, most people with bipolar also experience periods of depression. In fact, bipolar depressive episodes typically occur more frequently and last longer than mania.
Depressive episodes often present long before manic ones do. Before treating depression, the doctor tries to assess the risk that someone will eventually develop mania, which is important because antidepressants alone can sometimes trigger manic symptoms if someone's brain is wired for bipolar disorder.
People with bipolar disorder and their loved ones often have a great sense of humor, perhaps because they tend to be smarter than average or because bipolar disorder creates situations that appear to have been written for the theater of the absurd. Here are a few of the absurdities that can leave you shaking your head or shaking in laughter:
During a hypomanic episode, you have inflated self-esteem, increased energy, decreased need for sleep, increased creativity, and increased goal-directed activity.
Bipolar Disorder
In Western countries, where food is plentiful and enriched, true vitamin and mineral deficiencies are rare, but low levels of these nutrients, even when they don't qualify as a deficiency, may be related to some depressive symptoms. No vitamin or combination of vitamins is effective for treating depression or mania, several vitamins and minerals, including the following, can have a significant effect on brain development and function:
B-complex vitamins: Your body uses the B-complex vitamins in a variety of ways to build and maintain a healthy nervous system.
Bipolar disorder is a physical illness that affects the brain. A bipolar diagnosis requires at least one episode of mania (wired thinking and behaviors that negatively affect one's ability to function) or hypomania (a less severe form of mania), and the disorder typically includes episodes of depression that alternate with the mania or hypomania.
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