Bipolar Disorder Articles

Article / Updated 07-10-2023

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. Treatment for bipolar disorder and borderline personality disorder differ significantly, so determining which condition a person has plays a major role in selecting the most effective treatments. The following sections present guidelines for distinguishing between bipolar disorder and borderline personality disorder. Considering whether symptoms represent a deviation from a person's baseline A core diagnostic feature that's helpful in distinguishing between bipolar disorder and borderline personality disorder is whether the symptoms represent a deviation from a person's usual moods and behavior: Borderline personality disorder describes patterns of ineffective interpersonal skills and poorly modulated emotional and behavioral responses to the ups and downs of day-to-day life. These patterns have developed since adolescence or even earlier, and the symptoms have always been present — they are part of the person's typical or baseline self. Bipolar disorder is a condition in which emotional and behavioral patterns emerge that differ from the person's typical or baseline self. For example, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) requires that a hypomanic (elevated mood and energy) episode be an "unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic." Distinguishing between situational and episodic symptoms Mood dysregulation in borderline personal disorder and bipolar disorder also differs according to whether the moods changes are situational and short-lived or episodic (lasting for an extended period of time): Borderline personality disorder is characterized by affective dysregulation — big, painful, emotional reactions to stimuli that wouldn't typically cause so much internal and external upheaval. People living with borderline personality disorder struggle chronically with feelings of anger, sadness, and anxiety that often trigger painful and damaging behaviors, such as explosive rages, impulsive actions, or self-harm. These frequent mood changes and behavioral responses are the baseline for a person with this disorder — they occur often and may occur minute-to-minute or hour-to-hour. Something, often frustration, perceived frustration, or fear of abandonment typically triggers the mood disruption in borderline personality disorder. Bipolar disorder is characterized by episodes of mania, hypomania, or depression that last for longer periods of time (days or weeks), are a change from a person's baseline, may occur without any clear trigger, and typically diminish significantly when the mood episode ends. Comparing the types of mood symptoms Although borderline personality disorder and bipolar disorder share some symptoms (for example, irritability that may result from and lead to interpersonal conflict), their symptoms differ: Borderline personality disorder mood symptoms tend toward chronic feelings of irritability/anger, sadness/emptiness, and anxiety. Euphoric feelings aren't part of the diagnostic criteria for borderline personality disorder. Bipolar disorder requires at least one episode of mania or hypomania (elevated mood or euphoria). Mood symptoms in bipolar disorder — specifically mania or hypomania — almost always include some periods of euphoria and grandiose thinking — not just anger. (It can be just irritability/anger, but this isn't typical.) Comparing the nature of the impulsivity Borderline personality disorder and bipolar disorder share the symptom of impulsivity, but the nature of the impulsivity differs: In borderline personality disorder, the impulsivity is a chronic symptom; difficulty controlling or regulating behavior is a challenge that is part of everyday life. In bipolar disorder, impulsivity and disinhibited behaviors occur in the context of a manic or hypomanic period; they aren't chronic or baseline. And if someone is impulsive at baseline, the impulsivity must look significantly worse during a sustained period of time to qualify as a symptom of mania or hypomania. Differentiating bipolar depression from borderline personality disorder The depressive phase of bipolar disorder is also often confused with borderline personality disorder, because both conditions are characterized by periods of sadness that may be accompanied by irritability or anger. However, the two differ in the following ways: Borderline personality disorder is characterized by chronic sadness and anger, which again are part of the person's baseline self. Bipolar depression is episodic, not momentary, and is not limited to mood symptoms such as sadness, anger, or irritability. Bipolar depression is characterized by broader changes in function, which can include low energy and fatigue, diminished interest in activities normally considered pleasurable, changes in appetite or weight, sleeping too much or too little, moving slowly or having physical agitation, feelings of worthlessness or excessive guilt, diminished ability to think clearly or concentrate on a given task or make decisions, and recurrent thoughts of death or suicide. Determining whether they can occur together People with borderline personality disorder are at high risk of developing major depressive episodes and anxiety disorders. They can also develop bipolar disorder, but for both diagnoses to be present the bipolar symptoms have to be different from the person's typical way of behaving (the baseline self). The sadness or impulsivity or anger must differ significantly from the person's usual patterns and must be sustained for longer than just a few moments. Also, sustained euphoric/grandiose periods are almost always going to be present in bipolar disorder, and these must differ from the person's baseline thoughts, feelings, and behaviors. The differentiation between borderline personality disorder and bipolar disorder is often challenging, but important. If you're getting different diagnoses from different doctors, try to have a conversation with your doctor about why the doctor has made a particular diagnosis. Expressing your confusion and asking about your doctor's thought process is okay. If your current doctor is unwilling to have this conversation, consider exploring it with another doctor or therapist. You have a right to understand your diagnosis and have your questions answered.

Article / Updated 07-05-2023

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. (If you have other questions, write them down so you remember to ask them.) Research shows that medical outcomes improve dramatically when patients are empowered to ask questions and actively participate in their care. Don't assume that the doctor has all the answers and will tell you everything you need to know. Be proactive! You have the right to ask for clarification, simplification, or more information at any point in your care. How much experience do you have in treating bipolar disorder? Some psychiatrists and therapists are like general practitioners, whereas others specialize in particular areas, such as bipolar disorder, depression, anxiety disorders, or schizophrenia. Still others specialize in treating children and adolescents. Professionals who have more experience in treating bipolar disorder may be more attuned to the many ways people experience bipolar disorder and better equipped to sort through your history and ask pertinent questions to effectively identify patterns of your condition. They may also have a deeper range of experiences with different treatments and know how to apply their understanding of how people have responded to them over the years. Is it tough to get an appointment? If you can't get in to see your doctor or therapist when your moods begin to cycle, they can't help you much. So before you choose a psychiatrist or therapist, make sure that you won't have to wait three months before your next appointment. (Getting in for an initial appointment with the doctor may take more time because those appointments are longer.) Ask the office how far in advance you usually need to call to make a follow-up appointment so you can get an idea of how hard it is to get in to see this particular doctor or therapist. Can I contact you during a crisis? Nights, weekends, and holidays — the three times you most need your doctor or therapist, they're at home, spending time with their friends and family. The nerve of these medical people! Everybody, even doctors and therapists, needs some time off, but as a person with bipolar disorder, you need some numbers to call in a crisis. Doctors and therapists have a variety of systems for after-hours emergencies. Ask for your doctor's policy and procedures, which should include the following information: Office number: When you call the office after hours, a recorded message should provide instructions for emergency calls. After-hours number: Does the doctor use an answering service that can reach them? Do you call their cellphone or home phone for emergencies? Make sure you're clear about this. Name and number of the person who covers for the doctor or therapist when they're out: Doctors often take turns being on call. Emergency number of the hospital or mental health center where you should go in a crisis: If you're in the middle of a mental health crisis and you can't get in touch with your doctor, where should you go? Ask how long it typically takes your doctor or therapist to return calls if you need to leave a message. What's the diagnosis and how did you arrive at it? Sometimes a doctor prescribes medication without providing a final diagnosis, especially when some uncertainty exists. For example, if a patient is experiencing mania, the doctor may prescribe an antimanic medication without diagnosing bipolar disorder until they have the opportunity to rule out other possibilities. However, your doctor will have some ideas (working diagnoses, as they're often called) that drive their treatment choices. If your doctor doesn't mention a diagnosis, ask them to explain their thinking and the possible diagnoses they're considering. You have a right to understand what they think may be going on and why they're choosing particular treatment plans. How your doctor arrived at your diagnosis may be just as important as the diagnosis itself. Make sure your doctor has considered your family history, any prior mood episodes, the possibility of medication- or substance-induced symptoms, other medical conditions that may be causing symptoms, and aspects of your life that may be causing stress or sleeplessness or is otherwise contributing to symptoms. What's the treatment plan? Your doctor may hand you one or more prescriptions for antidepressants, antimanics, antipsychotics, or sedatives, but your medication doesn't make up your complete treatment plan. In most cases, you should have a doctor and a therapist; ideally, they work together to develop a treatment plan specifically for you. The doctor typically handles the medications, and the therapist deals with everything else, although some doctors are more actively involved in the bigger treatment picture. Your treatment plan should include the following: Medications Individual therapy, self-help, and lifestyle changes Family education and, possibly, family therapy Instructions on what to do if your moods begin to cycle Whenever your doctor recommends a change in medication, be sure to ask what the goal of the change is and how you and your doctor will evaluate whether the change met its objective. In the real world, having ready access to a psychiatrist and therapist isn't always possible. In such cases, you may find yourself relying on your primary-care physician, self-help, lifestyle changes, family and friends, and community resources. When can I expect to feel better? Your doctor and therapist are likely to tell you to remain patient, but you should know upfront what patient means. A week? A month? Two months? In most cases, you can expect to see some improvement in one to two weeks, but some medications may take four to six weeks or even longer to become fully effective. Ask your doctor and therapist to be sure. Typically, your doctor will follow up with you two to four weeks after your initial appointment or after you start a new medication to assess the effectiveness of the treatment and monitor for side effects. If you're feeling very unstable, they may want to see you even sooner. If the doctor tells you to come back in more than one month after you start a new medicine, find out why they don't want to follow your situation more closely. How will I know I'm getting better? With bipolar disorder, feeling better may convince you that you are better even when you're not, particularly if you're cycling into mania. Ask your doctor for more objective signs that your mental health is improving. When an episode of depression is lifting, you may experience these signs: Sleeping more regularly and getting better-quality sleep Doing more with less effort — in other words, better energy Socializing more Crying less Diminished thoughts of death or suicide When recovering from an episode of mania, these signs may appear: More sleep in general and less restless sleep overall Sustained stability in thought patterns — not racing or flying from topic to topic Reduction in pressured speech (rapid, nonstop talking) More typical energy and activity levels Fewer and less intense confrontations with others Improved ability to control impulses Less irritability What should I do if I feel worse? Getting just the right combination of medications requires communication between you and your doctor. Being able to get in touch with your doctor between visits is especially important when you're first starting medicine. Some medications may not work for you or may have an adverse effect on you. If your condition fails to improve or worsens or if you have a bad reaction to the medication (such as a rash or shortness of breath), contact your doctor, who may suggest one or more of the following steps: Stop taking the medication. Keep taking the medication to see whether the side effect settles down or the desired effects kick in and then call or come in to the office in a few days. Take a lower dose of the medication. Take a higher dose of the medication. Add something else to the medication. Be sure to follow up all these actions with additional phone calls or office visits to further optimize your treatment plan. How did you pick this medicine and what can happen when I take it? Most doctors hand you a prescription for the medications they think are going to be most effective and have the least chance of causing serious side effects. The doctor should always review with you how they chose this medicine over other ones (alternatives) and carefully review the potential effects and side effects of the medicine they have chosen to prescribe. Make sure that your doctor has answered the following questions for you before they reach for the prescription pad: How effective is the medication at treating the symptoms I have? Are there more effective medications? What are the potential risks and side effects of this medication, and what are the chances that I'll experience them? Are there any medications that may have fewer, less serious side effects? How will this medicine interact with other prescribed medications and over-the-counter products and with other substances including alcohol and caffeine? Make sure you always know the possible side effects and interactions of a medication before you begin taking it so you know what to watch for. Armed with a list of the most common and most serious potential side effects, ask what you should do if you notice any signs that you may be experiencing one of them. Will you work with my other providers? Coordinated treatment, especially between your doctor and therapist, is an essential component of success. Ask your doctor and therapist if they're willing to exchange notes. Make sure they have each other's contact information and signed consent forms that enable them to share information. If you want family members, friends, and other nonprofessionals to enter the treatment discussion, ask the doctors if they're willing to talk with the people in your support network. Your doctor and therapist can't legally discuss your condition or treatment with anyone unless you've signed consent forms for them.

Article / Updated 05-03-2023

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. Print this version of the mood chart and make as many copies as you need — or feel free to make your own, if you're spreadsheet-savvy. In the column for each day, record the following: Mood level: Place a check mark in the box that represents your overall mood for that day, which ranges from –5 (Depressed) to +5 (Manic). Hours sleep: Record the total number of hours you slept. Assigning sleep hours for a day can get tricky, because you're likely to fall asleep late one day and wake up early the next day. Consider assigning sleep hours to the night before. For example, if you slept from 10 p.m. Sunday to 6 a.m. Monday, assign those hours to Sunday (add in any nap time from during the day on Sunday). Energy level: Write a number from 0 (no energy) to 5 (supercharged) in the Energy level box. Notes: Jot down notes, such as a change in medication, exercise routine, or diet. Bring your mood charts to your doctor and therapy visits. Having this type of document to point back to and reflect on can be a powerful tool.

Article / Updated 05-03-2023

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. The following sections provide the guidance you need to make well-informed choices between generics and name-brand medications. Consider the cost Most of the time for most people and with most medicines, generics are equivalent products and work just fine. The choice is usually straightforward: With the generic costing less, working just as well, and having the same or similar side effect profile, the more affordable generic is the better choice. However, in a minority of situations, the name-brand product is the better choice. In some cases, cost can be the determining factor in whether the person is able to obtain and take the medication. Being able to afford medications is critical for people to take the right amount of medication and to keep taking it. If the medicine is too expensive, people sometimes try to ration their medicines by lowering or skipping doses or even stopping a medicine entirely. Oddly, in certain situations, insurers cover the cost of a certain name-brand medication but not its generic. This is usually related to a financial arrangement between the insurance company and the pharmaceutical company that makes the name-brand product. Similarities between name-brand and generic medications According to the FDA, generic medications contain the same active ingredients as their name-brand counterparts, so theoretically, they should be equally effective, and in most cases they are. Here's how the two are similar: Same active ingredient(s): The vast majority of generic medications contain the same active chemical as in the name-brand version. Very similar bioequivalence: The generic version of the medication must be bioequivalent to the name brand. To be bioequivalent, the bioavailability of the generic must be very similar to that of the original medication. Bioavailability represents the amount of active chemical that gets into the system and the rate at which it does so. The bioavailability of the generic doesn't have to be identical to that of the original medication; it can be between 80 and 125 percent of the name brand. This may sound like a wide variation, but for most medications, in most people's bodies, the difference doesn't seriously affect how the generic works or the side effects it causes when compared to the name brand. Differences between name-brand and generic medications Although the generic is required by the FDA to deliver nearly the same amount of the same active ingredient(s) at about the same rate as the name-brand version, response to differences in the two can become more pronounced in the following areas: Individual response: How a person's body absorbs and then breaks down the medication can affect their response to a medication that's more or less bioavailable. If you change from a name brand to a generic, or vice versa, and you feel differently on it, let your doctor know. Medication class: Certain classes of medications have had some difficulties with these differences in bioavailability. For example, anticonvulsants (medicines for seizures, that are also often used to treat bipolar disorder) have a narrow therapeutic window, which means that getting control of seizures can require extremely tight management of doses and blood levels (within very narrow ranges). Studies have suggested that although patients who are started on a generic brand of an anticonvulsant may do well, changing from a previously well-managed dose of name brand to a similar dose of generic may cause reduced control of seizures. No specific studies show the same challenges with preventing mood cycles, but you and your doctor should consider and discuss the possibility. Extended-release versions: Long-acting versions of medications can be more difficult for generic companies to duplicate. In 2012, the FDA withdrew approval for a particular type and dose of a generic form of the long-acting antidepressant Wellbutrin XL. After patient and doctor complaints, the FDA tested and found that the generic version was only about 40 percent as bioavailable as the name brand. Other generic versions (by other manufacturers) were bioequivalent, but this one was withdrawn from the market. A similar incident happened recently with a generic version of the long-acting ADHD medication Concerta. Fillers: Medications include a variety of fillers and dyes that create the actual pill. Individuals may have more or less tolerance for these inactive ingredients (whether they're in the generic or name-brand version); they may even experience allergic reactions to them. Dealing with differences between generics of the same medication One downside to using a generic product is that a number of different manufacturers typically make the same product, and pharmacies may change suppliers to manage cost or supply levels. So, even though you may be stable on a generic version of your medicine, when you switch to a different generic, your response could change. With anti-seizure medications, this can be especially risky, but it could affect benefits or side effects in less dangerous but very important ways with other kinds of medicine, as well. Another concern is that the generic may look different depending on the manufacturer, which isn't usually a big problem, but it can cause challenges for certain populations, such as the elderly, who may experience confusion with that kind of change, or children, who may have difficulty swallowing a pill if it is much larger, for example.

Article / Updated 05-03-2023

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. Parents describe the child as being stubborn, strong-willed, or simply a pain in the neck. When this pattern creates significant problems in function — at school, at home, with friends, or during activities — a doctor or therapist may suggest a diagnosis of ODD, which is described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, as: "A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months . . . and is not exclusively directed at siblings." ODD's irritable mood and behavioral difficulties — not doing as one's told — can overlap with mania. Although this is often a confusing area, the child with ODD demonstrates these symptoms chronically and not episodically. Furthermore, ODD doesn't include other manic symptoms such as energy changes and grandiosity. ODD is a problematic diagnosis in many regards, because its core symptoms are nonspecific. Irritable mood and defiant behavior can be associated with a wide range of developmental and psychiatric conditions. Your child needs a careful medical and psychiatric evaluation to help understand the mechanisms underlying these difficult symptoms. Bipolar disorder/mania is one possible explanation, but others can include unipolar depression, attention deficit hyperactivity disorder, language disorders, autism spectrum disorder, and trauma, among others.

Article / Updated 04-27-2023

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. Here is some basic brain anatomy and physiology that helps explain the research. Dissecting the brain Looking at a whole human brain from the outside, as shown, you see the cerebral hemispheres (the large sections, not labeled in the figure, that comprise most of the brain), the cerebellum (the small ball toward the back of the hemispheres), and the brain stem (a long, thin structure leaving the brain and connecting it to the spinal cord). The cerebral hemispheres are divided into four sections that serve broadly different functions — the frontal lobe, the parietal lobe, the temporal lobe, and the occipital lobe. When you open the brain up, pulling the two hemispheres apart into two equal parts, and look inside, you see a number of brain structures within the hemispheres. Within the outer layer, researchers have identified a number of cell areas related to different functions. Several of these areas appear frequently in studies of bipolar, including the prefrontal cortex and the anterior cingulate cortex. Below the large outer layer are a number of structures, some of which are quite important in bipolar disorder research, including the thalamus, hypothalamus, hippocampus, and amygdala. Exploring the functions of different areas of the brain Now that you have a bird's-eye view of the brain, consider the functions of some of these areas: Cerebral hemispheres: The cerebral hemispheres include most of the thinking and planning parts of the brain as well as areas important to sensory input and learning and memory. The areas are as follows: The frontal lobe is the executive of the brain, serving to coordinate and manage the many functions within the body and brain. The parietal lobe is involved in managing sensory experiences, in addition to playing a role in many other functions. The temporal lobe is involved in smell and auditory sensory input, speech and language, and memory and learning. The occipital lobe is the center for processing visual stimuli. All of these areas perform many other functions, as well, and functions may overlap between areas. Cerebellum: The cerebellum appears to manage the fine-tuning of complex movements and also seems to be involved in regulating thought, language, and mood responses. Brain stem: The brain stem manages basic survival mechanisms, such as breathing and the heartbeat, and is involved in the management of consciousness, alertness, and sleep/wake cycles. Cerebral cortex: The cerebral cortex is the outer layer of brain cells in the hemispheres. It's considered to be the site of higher level thinking, coordinating incoming information and generating movement, actions, and thoughts. It's broken down into a number of smaller areas associated with specific types of function. Prefrontal cortex: The prefrontal cortex is a section of the cerebral cortex that is highly developed and is involved in regulating complex thinking and behavior; it's considered a center of judgment and planning. Hippocampus: The hippocampus is located in the cortex (subcortical) and is especially important in learning and memory. Thalamus: The thalamus is a structure that sits below the cortex (subcortical) that serves as a relay station for sensorimotor input, conveying it to areas of the cortex. It also regulates sleep, consciousness, and levels of alertness. Hypothalamus: The hypothalamus is also subcortical and regulates many survival mechanisms such as hunger/thirst and sleep/wake and energy cycles, all components of circadian rhythms — physical, mental, and behavioral patterns that occur in approximately 24-hour cycles. Amygdala: The amygdala, another subcortical area, is a major player in the brain's reaction to emotions. Limbic system: The term limbic system is used to describe a number of brain areas important to emotional function. The list of areas can be different in different textbooks but the hippocampus, thalamus, hypothalamus, and amygdala are considered main components of this system. Anterior cingulate cortex: The anterior cingulate cortex is a part of the cortex that has strong associations between the prefrontal cortex and the limbic system and is thought to play an important role in regulation of strong emotions. Viewing the brain under a microscope The brain has several layers. The outer layer of the brain is called the cortex, often referred to as the gray matter. The layer beneath the cortex is a network of fibers that connect different areas of the brain, often referred to as the white matter. The fibers are protected and insulated by a layer called the myelin sheath. Within the brain is a system of cavities, including spaces called the ventricles, that make, circulate, and then reabsorb cerebrospinal fluid. This fluid serves as a mechanical shock absorber to the brain but also brings nutrients from and filters waste back into the blood stream. Another important component of brain anatomy is comprised of cells that make up all of these structures. Brain cells include neurons and glia. Neurons form the telecommunications system in the brain and body, dictating body functions by generating, sending, and reacting to electrochemical signals. Glial cells, once thought to be just a support network for neurons, play a major role in brain function and in the brain's communications and reaction systems. The gray matter of the cortex includes the cell bodies (central section) and dendrites (one of the connecting ends) of neurons, as well as glial cells. The white matter is made up of the axons (another type of connecting end) of neurons. Understanding how brain cells communicate Neurons communicate with one another in many different ways, but communication occurs primarily across the synapse — the space between neurons or between neurons and other cells, such as a gland or muscle cell. The most common type of communication occurs when one end of the neuron (often the axon, but not always) releases a chemical messenger into the synapse (as shown in the figure below). The next cell (often the dendrite of another neuron) receives the chemical messenger. Receptors on the outside of the second cell latch onto the chemical messenger. Cells have many different types of receptors for all of the chemical messengers; the type of receptor influences how the message is received and processed and how the instructions are transmitted to the second cell. After a chemical messenger occupies the receptor, it can generate many different responses in the receiving cell, depending on the chemical messenger and the receptor type. After the messenger has done its job, it's released from the receptor and then taken back into the first cell, a process called reuptake. In the brain, the chemical messengers are often referred to as neurotransmitters. Nervous system cells communicate in ways beyond the synapse. For example, chemicals called neuropeptides communicate between cells but not across synapses. Of great importance in the current research on bipolar disorder is the communication between glial cells and neurons. Disruptions in these communication systems may be at least as important as problems in neuron-to-neuron transmissions. Intracellular (within-cell) communication may also play a role.

Article / Updated 04-27-2023

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. Many of the suggestions are based on the few common principles covered here. With these in mind, you can begin to develop your own personal toolkit tailor-made for you and your loved one's needs. Don't take it personally. This principle is one of the hardest to put into action. Bipolar disorder symptoms include many behaviors that hurt your loved one and the people around him or her. It can seem clear to you that your loved one isn't trying hard enough or is just trying make things difficult. Don't give in to those thoughts. Blame the illness, not the person. What gets said or done to you isn't about you; it's about your loved one's distress and disrupted nervous system. Accept that you can't control your loved one or the illness. Your support is most effective when you let go of any ideas that you can force your loved one to do the things you think he or she needs to do. Empathizing rather than shaming, observing rather than criticizing, expressing feelings rather than demands, and trying to collaborate instead of control are some of the strategies that grow out of this principle. Keep cool. Bipolar disorder generates a lot of heat and high emotions. Responding with your own high emotions feeds the fire. Following this principle means figuring out how to refrain from yelling and screaming and how to walk away (disengage) from an interaction when necessary. You may want to explore ways to help you do this, such as mindfulness practices or regular exercise. Your lower tone can make a big difference for your loved one. Engage in discussion to create solutions. Effective communication is at the heart of helping your loved one. Listening attentively more than talking is one of your best tools in following this principle. Asking questions and really focusing on the answers opens up dialogue. Thoughts and feelings expressed clearly and compassionately are much more likely to yield positive outcomes than are blanket pronouncements and rambling lectures. Avoid the four big communication no-nos. Criticism, blame, judgment, and demand are likely to drive a wedge between you and your loved one. Work as a team to solve problems and address issues in ways that serve everyone's interests. Put safety first. Bipolar disorder can cause symptoms that are dangerous or even deadly. Being ready and able to call for help for your loved one is critical for everyone's safety and wellbeing. Your loved one may be unhappy, even angry, when you take action, but you can sort that out when they're feeling better. Planning ahead for crises — anticipating them, understanding that the risks are real, and being prepared to take action when needed — are strategies born out of this principle. Take care of yourself. You're in a better position to help others when you're physically and emotionally well. Discover how to leave a situation if you anticipate or observe danger. Care for your own health by paying attention to sleep, nutrition, and exercise, for example. This principle can feel hard to practice when you're exhausted by managing day-to-day crises, but caring for yourself alleviates the exhaustion and helps you maintain your role as a patient and effective caregiver.

Cheat Sheet / Updated 04-12-2023

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.

Article / Updated 06-28-2021

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. The urge to stop taking bipolar meds is common and understandable, but it significantly increases the chances of a future mood episode, and every mood episode you have is likely to worsen the course of the illness. Identify your triggers. Certain situations, seasons, people, or activities may trigger mood instability. Try to identify patterns in your life that match up with your shifting moods. These patterns may help you pin down triggers and open your eyes to creative solutions for dealing with them. For example, some people who tend to have mood episodes around the holidays scale back their traditional holiday activities. Establish healthy routines. Many people with bipolar disorder discover that a well-regulated life helps to regulate their mood. Routines may cover sleep/wake times, meal times, a regular work schedule, and even social engagements. Monitor your moods. Keeping track of your ups and downs can help you identify what works to help you stay within a comfortable range and what doesn't. It can also reduce the chances that you'll experience a major mood episode. If you know you're starting to cycle into mania or depression, your doctor may be able to adjust your medications to help you avoid hospitalization. How to chart your moods, sleep, and energy levels 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. Print this version of the mood chart and make as many copies as you need — or feel free to make your own, if you're spreadsheet-savvy. In the column for each day, record the following: Mood level: Place a check mark in the box that represents your overall mood for that day, which ranges from –5 (Depressed) to +5 (Manic). Hours sleep: Record the total number of hours you slept. Assigning sleep hours for a day can get tricky, because you're likely to fall asleep late one day and wake up early the next day. Consider assigning sleep hours to the night before. For example, if you slept from 10 p.m. Sunday to 6 a.m. Monday, assign those hours to Sunday (add in any nap time from during the day on Sunday). Energy level: Write a number from 0 (no energy) to 5 (supercharged) in the Energy level box. You're already engaged in one of the most important self-help activities — psychoeducation. Finding out more about bipolar disorder and how to successfully live with it empowers you to make well-informed decisions about the various treatment options available. Psychoeducation also helps your friends and family develop the empathy they need to accept your illness and support you.

Article / Updated 06-22-2021

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. anticonvulsant: A class of medications developed primarily to prevent epileptic seizures. Many anticonvulsants, including valproate (Depakote) and carbamazepine (Tegretol), are also useful in treating mania. antidepressant: A class of medications effective in treating the symptoms of depression. antipsychotic: A class of medications originally developed to reduce the frequency and severity of psychotic episodes. The newer atypical or second-generation antipsychotics are now also used to treat bipolar disorder or more severe depression. Many people who take these medications don't have psychotic symptoms. bipolar disorder: A psychiatric condition characterized by extreme mood states of mania and depression. A person may have bipolar disorder even if they have experienced only one of the extreme mood states, making diagnosis very challenging. bipolar I: A type of bipolar disorder characterized by at least one full-blown manic episode that doctors can't attribute to another cause, such as a medication or substance abuse. A bipolar I diagnosis doesn't require an episode of major depression, although periods of mania often alternate with periods of depression. bipolar II: A type of bipolar disorder characterized by at least one major depressive episode that doctors can't attribute to another cause, along with one or more hypomanic episodes. The depression tends to be chronic and is usually more problematic than the hypomania. Some people with bipolar II develop a full manic episode, which changes the diagnosis to bipolar I. bipolar NOS (not otherwise specified): A type of bipolar disorder listed in the fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) that's characterized by hypomanic, manic, or depressive episodes that don't fit in any of the other bipolar categories and can't be ascribed to unipolar depression. See other specified bipolar and related disorders and unspecified bipolar and related disorders for the DSM-IV versions of this diagnosis. catatonia: A state of profound lack of movement and language, often including odd or unusual physical and verbal responses to stimuli. Sometimes alternates with periods of agitation and overexcitement. Can be associated with bipolar disorder, unipolar depression, schizophrenia, and other psychiatric and medical conditions. circadian rhythm: An individual's biological pattern of sleep, wakefulness, and energy that plays out through the course of a day. Some studies show that irregularities in a person's circadian rhythm can destabilize moods. cognitive behavioral therapy (CBT): A therapy that works at the intersection between thoughts, feelings, and behavior. It is an active process; the therapist teaches about concepts and strategies, and the patient practices new skills outside of the sessions. Many studies show that CBT is effective for treating depression, anxiety, obsessive compulsive disorder, insomnia, post-traumatic stress disorder (PTSD), and some pain syndromes. Researchers are studying its use in other conditions as well. comorbid: Any medical condition that presents along with and often independent from another condition. People who have bipolar disorder can have other comorbid conditions — such as attention deficit hyperactivity disorder (ADHD), alcoholism, or anxiety disorder — that complicate the diagnosis and treatment of bipolar disorder. cyclothymia: Sometimes referred to as bipolar lite, a muted form of bipolar that nevertheless interferes with a person's life. It involves multiple episodes of hypomania and depressive symptoms that don't meet the criteria for mania or major depression. Symptoms must last for at least two years, (one year in children and teens) during which time there are no more than two symptom-free months. decompensation: A relapse to the return of symptoms that had previously been under control. deep brain stimulation (DBS): Electronic stimulation of targeted areas of the brain that has been shown in some studies to reduce the symptoms of treatment resistant depression (TRD). Diagnostic and Statistical Manual of Mental Disorders (DSM): A book that describes the criteria for diagnosing various mental illnesses and related conditions and that psychiatrists in the United States refer to when developing a diagnosis. DSM is similar to the International Classification of Diseases (ICD) used in most countries outside the United States. differential diagnosis: The process of distinguishing between two or more diseases or conditions that feature identical or similar symptoms. A doctor commonly performs a differential diagnosis to rule out other possibilities. dopamine: Often described as a feel-good neurotransmitter, dopamine is linked to feelings of pleasure and reward. It modulates attention, focus, and muscle movements, is involved in addiction, and is related to psychosis. dysthymia: Chronic, low-level depression that's commonly characterized by irritability and an inability to feel pleasure or joy. In DSM-IV, it is now described as persistent depressive disorder. electroconvulsive therapy (ECT): A medical procedure in which a low-level electrical current is applied to the brain to induce a mild seizure in order to treat severe depression. ECT is often successful in treating depression that doesn't respond to medicine or therapy, or when patients have had intolerable side effects with medicines, or have medical conditions that prevent them from taking antidepressants. ECT can also be an effective treatment for mania and catatonia. epigenetics: The study of the changes that affect the expression of genes but don't change the genes themselves. essential fatty acid (EFA): A healthy fat that the body uses for tissue development and other purposes and that must be obtained through diet. Omega-3 is a source of several EFAs that may be valuable in treating many health problems, including mood disorders. euthymic: Moods considered to be in the normal range — not manic or depressive. executive function: The ability to organize, sort, and manage internal and external stimuli and generate adaptive and effective responses. Many psychiatric disorders weaken executive functioning, often leading to impaired judgment and uninhibited speech or behavior. expressed emotion: A term used by researchers to describe expressions of criticism or conflict that can have negative effects on people with mood disorders or other mental illness. gamma-aminobutyric acid (GABA): An amino acid neurotransmitter that works mostly as an inhibitor or calming-down agent in the brain. glutamate: A neurotransmitter that's involved in revving up the central nervous system. Glutamate circuits may play a significant role in the development of mania and depression. G-protein-linked receptors: These are also called metabotropic receptors, and are one of two main types of receptors found on cell surfaces. G-protein-linked receptors are part of a signal system that communicates between chemicals outside of the cell, including neurotransmitters, such as serotonin. These chemicals attach to the G-protein-linked receptors, triggering specific reactions inside the cell. These systems have been linked to the development of mood symptoms and to many of the medications used to treat bipolar disorder. hypersexual: Having an excessive interest or involvement in sexual activity. hyperthymic: A medical term for high energy, sometimes used to describe a personality profile that includes being highly extroverted, very active physically and mentally, highly confident, temperamental, stimulus seeking, and risk taking. hypomania: An elevated mood that doesn't qualify as full-blown mania but typically involves increased energy, less need for sleep, clarity of vision, and a strong creative drive. These changes are noticeable to others but don't significantly impair daily function. insight: A clear acceptance and understanding of a psychological disorder and the ability to objectively observe one's own behaviors and attitudes that are characteristic of the disorder. International Classification of Diseases (ICD): The diagnostic manual developed by the World Health Organization (WHO) and used in most countries outside the United States. The ICD includes a chapter on the Classification of Mental and Behavioral Disorders, which is similar to the Diagnostic and Statistical Manual of Mental Disorders (DSM) used in the United States. interpersonal and social rhythm therapy (IPSRT): A therapy developed to maintain mood stability through strict scheduling, learning about personal roles, coping with transitions, developing healthy routines, increasing social contact, and resolving and preventing interpersonal problems. maintenance dose: An amount of a prescription medication that's intended to prevent the onset of symptoms rather than treat existing symptoms. major depressive episode: An extreme low mood that lasts at least two weeks and is characterized by symptoms such as despair, fatigue, loss or increase in appetite, loss of interest in pleasurable activities, an increased need for sleep or inability to sleep, and thoughts of death or suicide. mania: An extremely elevated mood typically characterized by euphoria, excessive energy, impulsivity, nervousness, impaired judgment, irritability, and a decreased need for sleep. manic depression: Another name for bipolar disorder. manic episode: A period of elevated mood, either euphoric or irritable, typically characterized by impulsivity, nervousness, impaired judgment, irritability, and a decreased need for sleep. The period must last at least one week (or shorter if it leads to hospitalization). MAOI (monoamine oxidase inhibitor): A class of antidepressant medications that slow the action of monoamine oxidase, an enzyme responsible for breaking down dopamine, serotonin, and norepinephrine in the brain. Because of the strict diet changes needed when taking MAOIs, doctors typically prescribe them only if a person reacts poorly to other antidepressants. mechanism of action: The way a medication acts on the biology or physiology of the brain to produce the desired effect. mindfulness: A mental state of focusing on the present moment, creating active awareness of internal and external experiences, with full acceptance and without judgment. Mindfulness can be practiced in many ways, including particular types of meditation. Numerous scientific studies support the cognitive, emotional, and behavioral benefits of a variety of mindfulness strategies. mood chart: A graph that shows the rise and fall of mood levels over time. Mood charts are very useful in predicting the onset of mood episodes and documenting the response to medications. mood disorder: A psychiatric condition that results in persistently disrupted moods and/or mood regulation. mood stabilizer: Strictly speaking, a medication that reduces frequency and/or severity of episodes of depression and/or mania. The term has become commonly, if inaccurately, associated with any medications that have antimanic effects or that reduce agitation. neuroleptic: Another name for antipsychotics, neuroleptics led the charge in pharmacological treatment of mental illness in the 1950s and 1960s. neuroleptic malignant syndrome: A potentially fatal but very rare side effect of antipsychotic medications that results in high temperature, muscle rigidity, and altered consciousness. neurons: Cells that are part of the telecommunications network in the brain and other parts of the nervous system; they carry signals throughout the body. neuroplasticity: The ability of the nervous system to adapt in response to internal and external stimuli or events. Some treatments for bipolar disorder appear to affect the capacity for change and growth in the nervous system. neurotransmitter: A chemical that's part of the communication systems between cells within the nervous system and from the nervous system to other parts of the body. norepinephrine: Best known for its role in the fight-or-flight response, norepinephrine is a neurotransmitter that functions to regulate mood, anxiety, and memory. off-label: A legal and legitimate use of a prescription medication to treat symptoms that the Food and Drug Administration in the United States or comparable agencies in other countries didn't officially approve it to treat. omega-3: A source of several essential fatty acids that some experts believe are vital to the healthy development and function of the brain. Omega-3 is present in high concentration in cold-water ocean fish, including sardines, herring, and salmon, walnuts, flaxseed, and supplements. other specified bipolar and related disorders: One of the DSM-IV categories of bipolar disorder, replacing bipolar disorder NOS in the DSM-IV. This category relates to someone with most, but not all, of the symptoms of a specific type of bipolar; for example, all of the symptoms of hypomania but not lasting the necessary duration of four days, or lasting four days or more, but not having enough of the symptoms to meet full criteria. phase delayed: The condition of having your daily rhythm out of sync with the rising and setting of the sun. Night owls and typically developing adolescents are considered to be phase delayed. phototherapy: The use of light to stimulate mood changes. presenting symptoms: Signs of discomfort that prompt a visit to a doctor. pressured speech: Urgent, non-stop talking that's difficult to interrupt. Pressured speech is a characteristic of hypomania and mania. prodromal symptoms: Early signs that may indicate that a psychiatric disorder (including mania or depression) is developing. prophylaxis: A fancy word for prevention. Doctors commonly prescribe a maintenance dose of a medication to prevent the onset of symptoms. protein kinases: A group of secondary chemical messengers in the neurological system, including the brain, that trigger changes to proteins inside of cells. psychiatrist: A physician who specializes in the biology and physiology of the brain. A psychiatrist's role in treating bipolar includes diagnosis and medication prescription as well as patient education and psychotherapy. psychoeducation: A type of therapy that consists primarily of educating those affected about the condition, its causes, and its treatment so they can more effectively manage the condition. psychologist: A professional who specializes in brain development and function, thought processes, emotions, and behaviors. A psychologist can play a vital role in stabilizing moods by assessing brain functions and helping the sufferer adjust negative thoughts and thought processes, regulate emotional responses, and control self-destructive or otherwise maladaptive behaviors. psychopharmacology: The study of the effects of medications on the brain. psychosis: Brain malfunction that blurs the line between real and imaginary, often causing delusions, auditory hallucinations, and irrational fears. psychotropic substance: Any chemical substance (usually a medicine) that affects mental functioning, emotions, or behavior. rapid cycling: A state in which mood alternates between depression and mania more than four times in a year. repetitive transcranial magnetic stimulation (rTMS): The application of strong, quick-changing magnetic fields to the brain to produce electrical fields indirectly. Researchers are studying it for use in treatment-resistant depression and other disorders. schizoaffective disorder: A psychiatric disorder in which symptoms of bipolar disorder and schizophrenia are both present. schizophrenia: A psychiatric disorder in which thought becomes dissociated from sensory input and emotions and is accompanied by hallucinations and delusional thinking. Thinking or cognitive skills are also often affected and day-to-day function can be severely impaired. Bipolar is sometimes misdiagnosed as schizophrenia. seasonal affective disorder (SAD): A mood disorder that's strongly linked to the change of seasons. People who have SAD commonly experience major depressive episodes in the winter months. second messenger systems: Circuits that transmit signals within a brain cell rather than between brain cells. Selective serotonin and norepinephrine reuptake inhibitor (SNRI): A class of antidepressant medications that prevent the brain from absorbing and breaking down the neurotransmitters norepinephrine and serotonin after their use. Whether this is the primary mechanism for reducing symptoms of depression is unclear. Selective serotonin reuptake inhibitor (SSRI): A class of antidepressant medications that prevent the brain from absorbing and breaking down the neurotransmitter serotonin after its use. Whether this is the primary mechanism for reducing symptoms of depression is unclear. self-medicate: The attempt to stabilize moods by taking nonprescription chemical substances, including alcohol and marijuana, or by regulating doses of prescription medication without a doctor's assistance. serotonin: A neurotransmitter that's a major part of the cellular circuits that regulate mood, anxiety, fear, sleep, body temperature, the rate at which your body releases certain hormones, and many other body and brain processes. stigmatize: To brand someone as disgraceful or shameful. stressor: Anything that places demands on your brain and body. Stressors are often thought of as negative, but exciting and positive events can also be stressful. Day-to-day life is full of little and big stressors, which the body and brain respond to and then return to baseline. Stress is a necessary and normal part of human function, but certain stressors may contribute to mood instability depending on various other factors. support group: A group of patients and/or family members who meet to discuss and empower one another in the face of a common illness. tardive dyskinesia: A condition — sometimes caused by the long-term use of neuroleptics — that results in abnormal, uncontrollable muscle movements, often in the mouth and face. therapeutic level: The concentration of medicine in the bloodstream required for medication to be effective. thyroid: A gland situated below the Adam's apple that produces hormones that control growth, regulate many body functions, and influence moods. treatment-resistant depression (TRD): Depression that doesn't respond well to standard medical treatments, including medication. tricyclic antidepressant: A class of medications that treat depression and limit the reuptake of the neurotransmitters serotonin and norepinephrine. unipolar depression: A mood disorder characterized by episodes of major depression without symptoms of mania or hypomania. unspecified bipolar and related disorders: A type of bipolar disorder listed in the DSM-IV that's characterized by hypomanic, manic, or depressive symptoms that cause problems in function, don't fit into any of the other bipolar categories, and can't be attributed to unipolar depression. See other specified bipolar and related disorders. vagus nerve stimulation (VNS): Electronic brain stimulation through the vagus nerves in the neck that has some evidence of helping reduce the symptoms of treatment resistant depression (TRD).