Bipolar Disorder Treatment

What is Bipolar Disorder?

Bipolar Disorder causes episodes of mood dysregulation that can lead to difficulty in school, at work, at home, and in all areas of life. In episodes of mania or hypomania, mood is euphoric and energy level is increased. During episodes of bipolar depression, mood is sad and low, and energy level is decreased. Bipolar Disorder increases risk for academic problems, unemployment, problems with friends and family, being the victim or perpetrator of crime or violence, financial problems, legal problems, incarceration, substance abuse, relationship problems, self-harm behaviors, and suicide. Bipolar Disorder also increases risk for physical health problems, particularly cardiovascular disease. Early diagnosis and treatment of Bipolar Disorder leads to better control of symptoms, reduces risks for adverse secondary effects, and improves overall prognosis.

Although Bipolar Disorder is a chronic condition, symptoms can be managed effectively with psychiatric treatment. With high quality treatment, people with Bipolar Disorder can live happy, healthy, satisfying lives. At Owl & Eagle Health and Wellness, our board-certified psychiatric nurse practitioners provide expert psychiatric care for Bipolar Disorder.

Symptoms of Bipolar Disorder

Bipolar Disorder causes rapid and dramatic shifts in mood, energy level, thinking, speech, behavior, appetite, and sleep. Anxiety is common in Bipolar Disorder as well. Bipolar Disorder most frequently presents in the teens to early 20s, but can occur at younger or older ages as well.

Adults and teens with Bipolar Disorder typically have episodes of depression that last weeks to months, and episodes of mania or hypomania typically lasting days to weeks. In some cases, Bipolar mood episodes can even last years. Bipolar Disorder in adults and teens shares symptoms with ADHD, PTSD, and Personality Disorders, and can be misdiagnosed as these disorders. Bipolar Disorder also can co-occur with these and other psychiatric disorders.

Bipolar disorder in children can present somewhat differently, with irritability, angry outbursts, impulsivity, aggressive behaviors, frequent mood swings, and feeling hot and sweaty in moderate or cool temperatures. Pediatric Bipolar Disorder is rare, and can be misdiagnosed as ADHD, PTSD, Oppositional Defiant Disorder, or Conduct Disorder, and can sometimes co-occur with these and other psychiatric disorders as well.

Mood Episodes in Bipolar Disorder

Bipolar Disorder can cause depressed episodes, manic episodes, hypomanic episodes, mixed episodes, and episodes with psychotic symptoms.

Bipolar Depression

During episodes of Bipolar Depression, people with Bipolar Disorder often feel sluggish, low energy, sad, apathetic, and unmotivated, and may have feelings of hopelessness or helplessness. They may also sleep or eat more than usual, and people often gain weight during depressive episodes. Thoughts of suicide can also occur during episodes of Bipolar Depression.

Depression is often the initial presentation in Bipolar Disorder, and most people have depressed episodes more frequently than manic or hypomanic episodes. Bipolar Depression is therefore frequently initially diagnosed as Major Depressive Disorder. Early diagnosis and treatment leads to a better prognosis in Bipolar Disorder, but on average, it takes 9 years for a person to be correctly diagnosed with Bipolar Disorder after their first episode.  

Bipolar Depression typically presents at earlier ages than Major Depressive Disorder, and is more likely to cause atypical symptoms. Bipolar Depression often doesn’t improve when treated with conventional antidepressants such as SSRIs, or may improve initially and then worsen again. Treatment with antidepressants can also sometimes trigger a switch from depression to mania or hypomania.

It is therefore important to seek care from a psychiatric provider who has experience and expertise in diagnosing and treating Bipolar Disorder when depression doesn’t respond well to standard treatment.

A person with Bipolar Depression can usually receive outpatient psychiatric treatment. However, in the event of serious suicidal ideation, they should call 988 or go to the ER for evaluation, and hospitalization may be needed.

Mania

During episodes of Mania, people with Bipolar Disorder experience elevated energy level, and they may feel extra cheerful and happy, or they may feel irritable and agitated. Sometimes they feel grandiose, like they could be or do anything if they tried. They might have racing thoughts, and may talk much faster than usual and jump from topic to topic. They may make a lot of new plans, start a lot of new projects, or get a lot more done than usual. They may find that they can sleep just a few hours per night without feeling tired. They may have increased interest in sex, or increased risky or thrill-seeking behavior, such as overspending, reckless driving, promiscuity, or use of drugs or alcohol.

People experiencing Mania may not realize that their behavior is abnormal, even when it puts them in danger, gets them in trouble with the police, or damages relationships, finances, or their career. During Manic episodes, inflammatory cytokines and stress hormones are released in the brain, causing a little bit of damage with each episode. If Bipolar Disorder goes untreated, this damage can lead to cognitive and memory problems. A person experiencing symptoms of Mania should call 988 or go to the ER for evaluation, and they will usually require hospitalization.

Hypomania

During episodes of Hypomania, people have symptoms of Mania, but they are less severe and usually less damaging to their lives. Sometimes people feel like the life of the party when they are having Hypomanic episodes, and they can even excel in school or at work. Although the symptoms of Hypomania are less severe than symptoms of Mania, Hypomania still requires psychiatric treatment, because Hypomanic episodes still cause inflammation and damage to the brain that can lead to cognitive problems. Hypomania can usually be effectively treated as an outpatient, without the need for hospitalization.    

Bipolar Mixed Episode

In a Bipolar Mixed Episode, people with Bipolar Disorder have both Depression and Manic or Hypomanic symptoms at the same time. Bipolar Mixed Episodes can be some of the most distressing episodes for people with Bipolar Disorder, because people experiencing Bipolar Mixed Episodes can feel very sad and hopeless, and at the same time have increased energy, goal directed behavior, and impulsivity. Due to this dangerous combination of symptoms, Bipolar Mixed Episodes cause the highest associated risk of self-destructive behavior and suicide. People experiencing Mixed Episodes with Hypomania should receive prompt outpatient psychiatric treatment. A person experiencing a Mixed Episode with Mania or serious thoughts of suicide should call 988 or go to the ER for evaluation, and will often require hospitalization.  

Bipolar with Psychotic Features

Sometimes people with Bipolar Disorder have symptoms of psychosis during mood episodes, including hallucinations, paranoia, or delusions. This is called Bipolar with Psychotic Features, and people experiencing these episodes should also receive psychiatric evaluation and treatment as soon as possible. If safety cannot be maintained due to severe psychosis or suicidal ideation, 988 should be called or the person should be taken to the ER for evaluation and hospitalization.

Types of Bipolar Disorder

Subtypes of Bipolar Disorder include Bipolar 1, Bipolar 2, and Cyclothymia. Schizoaffective Disorder, Bipolar Type is a related condition. These subtypes present with different symptoms and severity, and each type requires individualized treatment.

The different types of Bipolar cause different types of mood episodes:

Bipolar 1 causes depressed episodes and episodes of mania, and sometimes causes mixed episodes or psychotic symptoms.

Bipolar 2 causes episodes of depression and episodes of hypomania.

Cyclothymia causes chronic milder episodes of depression and hypomania.

Schizoaffective Disorder, Bipolar Type is a related condition that causes episodes of depression, manic or hypomanic episodes, and symptoms of psychosis. It differs from Bipolar with Psychotic Features in that in Schizoaffective Disorder, Bipolar Type, psychotic symptoms occur during periods when the person’s mood is normal, whereas in Bipolar with Psychotic Features, psychosis only occurs during mood episodes. Schizoaffective Disorder is a serious chronic psychiatric disorder, and requires ongoing psychiatric care. In the event of Mania or serious suicidal ideation, 988 should be called or the person should be taken to the ER for evaluation, and they will usually require hospitalization.

The board-certified psychiatric nurse practitioners and psychotherapists at Owl & Eagle Health and Wellness bring knowledge, experience, and compassion to treatment of all types of Bipolar Disorder and Schizoaffective Disorder.

How common is Bipolar Disorder? 

Bipolar Disorder affects about 4-6% of adults and 3% of adolescents and children. Bipolar Disorder is a chronic condition that results in severe functional impairment in about 80-85% of affected people, and moderate impairment in the rest.

What causes Bipolar Disorder?

Three main factors contribute to the development of Bipolar Disorder:

1) Genetics. The heritability of Bipolar Disorder is approximately 77%. If someone in your family has Bipolar Disorder, you are more likely to develop Bipolar Disorder yourself. 

2) Trauma and psychological stressors. Adverse experiences such as poverty, violence, abuse, neglect, discrimination, and loss of important relationships increase risk for Bipolar Disorder.

3) Other health problems. Chronic neurological or autoimmune illness, hormone imbalances, substance abuse, and certain medications are associated with increased risk for Bipolar Disorder.

Bipolar and Suicide

People with Bipolar Disorder are at much higher risk for suicide than the general population. Suicidal Ideation can occur in Bipolar 1, Bipolar 2, Cyclothymia, and Schizoaffective Disorder, and during episodes of Bipolar Depression, Mania, Hypomania, or Mixed Episodes. People with Bipolar Disorder who are having serious thoughts of suicide should seek treatment immediately by calling 988 or going to the ER.

Bipolar and Self-Harm Behavior

People with Bipolar Disorder sometimes engage in Non-Suicidal Self-Harm Behavior, such as cutting, burning, scratching, or hitting themselves. These behaviors can result in injury, infection, or scarring. In some instances, these behaviors can accidentally lead to death.

People with Bipolar also sometimes engage in Para-Suicidal Self-Harm Behavior, which is behavior that is not done with the clear intent to kill themselves, but which is known to be extremely dangerous and potentially deadly. For instance, a person might walk out into traffic, drive very recklessly, or use excessive quantities of drugs or alcohol. People engaging in Para-Suicidal Self-Harm Behavior may feel like it would be better to be dead, or that it wouldn’t matter if they were to die, and unfortunately, sometimes these behaviors do lead to severe injury or death.  

The pain, fear, and shock caused by Self-Harm Behaviors induces the release of dopamine, norepinephrine, and endorphins, which can provide slight temporary improvement in symptoms. However, the risk of injury and death far outweighs the benefits. With psychiatric treatment, symptoms can be better managed and more effective coping strategies can be learned. A combination of medication and Dialectical Behavioral Therapy can be very helpful in reducing Self-Harm Behavior. If it is not causing severe injury, Non-Suicidal Self Harm Behavior can often be managed as an outpatient. Due to high risk for severe injury and death, a person who demonstrates Para-Suicidal Self-Harm Behavior should always receive emergency treatment by calling 988 or going to the ER.

What is the best Bipolar Disorder Treatment?

Effective treatment for Bipolar Disorder requires specialized psychiatric training and expertise. Nutritional modifications, sleep hygiene, vitamins, supplements, exercise, yoga, and meditation can be helpful, but people with Bipolar Disorder will usually need to take medications and engage in psychotherapy on an ongoing basis to most effectively control their symptoms. Psychosocial support such as school and work accommodations, assistance with food and housing, or disability assistance is sometimes needed as well.

Our board-certified psychiatric nurse practitioners provide expert treatment for Bipolar Disorder, using a holistic approach combining medication, psychotherapy, TMS, Ketamine Therapy, and integrative treatments to maximize treatment efficacy. They will work with you to create a customized treatment plan to help manage your symptoms, provide psychosocial support as needed, and improve your overall health and wellness.

Bipolar Medication

The best medication for a person with Bipolar Disorder depends on the type of Bipolar Disorder and the type of mood episode the person is currently experiencing. Accurate diagnosis is essential to creating the most effective medication regimen. At Owl & Eagle Health and Wellness, our board-certified psychiatric nurse practitioners have extensive experience and expertise in diagnosing and treating all types of Bipolar Disorder.

Medications for Bipolar Disorder include mood stabilizers, antipsychotics, and sometimes antidepressants. Sleep medications and anxiolytics may also be included in a Bipolar medication regimen. Genetic testing can help us custom tailor your treatment plan, to select the medications with the best possible efficacy and tolerability for you.

Mood Stabilizers

Mood Stabilizers are typically the foundation of treatment for Bipolar Disorder. Mood Stabilizers are medications that reduce excessive mood fluctuations, helping to resolve episodes of Mania, Hypomania, and Depression and helping to prevent additional mood episodes from occurring in future. By helping to prevent the inflammatory damage that occurs during Bipolar mood episodes, Mood Stabilizers also help prevent cognitive problems from developing. Studies shows that Mood Stabilizers also reduce risk for suicide.

Mood Stabilizers that are commonly prescribed to treat Bipolar Disorder include lithium, valproic acid, divalproex sodium, carbamazepine, and lamotrigine. Some Mood Stabilizers are recommended for use in manic and hypomanic episodes, some for depressive episodes, and some for mixed episodes. Some Mood Stabilizers are more effective and tolerable for long-term maintenance once mood has stabilized.

Common side effects of Mood Stabilizers include dizziness, headaches, drowsiness, and increased appetite, but these side effects are usually manageable and improve over time. Mood Stabilizers can also cause rare but serious adverse effects, such as changes in levels of blood cells or electrolytes, kidney or liver problems, or hypersensitivity reactions. Some Mood Stabilizers can also cause birth defects, so they should not be used in a person who is pregnant, and should only be used in a person who could become pregnant if that person understands the risks and is using a highly effective method of birth control.

Due to these complexities, Mood Stabilizers should be prescribed by providers with expertise and experience in treating Bipolar Disorder. Thorough patient education, regular follow up appointments, and lab monitoring are essential for people taking Mood Stabilizers.

Antipsychotics for Bipolar

Antipsychotics are a class of medications that help resolve and prevent psychotic symptoms in Bipolar Disorder with Psychotic Features and Schizoaffective Disorder, but antipsychotics also help stabilize mood and can help resolve and prevent Depression, Mania, and Hypomania in any type of Bipolar Disorder. Antipsychotics frequently prescribed for Bipolar include quetiapine, olanzapine, cariprazine, aripiprazole, lurasidone, asenapine, and ziprasidone.

In some cases, Antipsychotics can be used as monotherapy for Bipolar Disorder, but will often work better in combination with a Mood Stabilizer. Some Antipsychotics are more effective than others for Mania or Hypomania, some work better for Bipolar Depression, some for Mixed Episodes, and some are more efficacious for episodes with Psychotic Features. Some are used primarily for Bipolar 1 and Schizoaffective Disorder, and others are more frequently used for Bipolar 2 and Cyclothymia.

Common side effects of Antipsychotics include drowsiness, weight gain, and constipation, but these side effects are usually manageable and improve over time. Antipsychotics can more rarely cause blood pressure to drop when going from sitting to standing, increases in blood sugar or lipids, or abnormal movements such as tremors or restless legs. Side effects of Antipsychotics that are intolerable or that do not improve with time can often be relieved by switching to a different Antipsychotic or a Mood Stabilizer, or with medication for the side effects.

Antipsychotics can also cause rare but more serious movement disorders including tardive dyskinesia or tardive dystonia. These disorders occur more frequently with the use of older antipsychotics that are not commonly used for Bipolar Disorder any longer, but they can still occur in rare instances with second-generation antipsychotics. Tardive dyskinesia or dystonia often improve after switching to a different Antipsychotic or a Mood Stabilizer, or with treatment with medication for the movement disorder. However, sometimes symptoms do not fully resolve.

Due to these complexities, Antipsychotics should only be prescribed for Bipolar by experienced psychiatric providers. Patients should be informed about the potential risks and benefits of Antipsychotics, and should have regular follow up appointments and lab monitoring.

Antidepressants for Bipolar

Antidepressants are not typically used as monotherapy for Bipolar Disorder, because they are often ineffective and may trigger manic or hypomanic episodes when used alone. However, Antidepressants can be used as adjunctive treatment for residual depressive symptoms when a person is already taking a Mood Stabilizer or Antipsychotic medication. Certain Antidepressants are preferred over others for use in Bipolar Depression because they are less likely to trigger mania or hypomania, and some are more effective when Anxiety, OCD, or PTSD co-occurs with Bipolar Disorder.  

Anxiolytics

When anxiety co-occurs with Bipolar Disorder, antianxiety medication is sometimes needed, especially when Bipolar medication is being changed or initiated. Buspirone, gabapentin, hydroxyzine, and propranolol are commonly used for anxiety in patients with Bipolar Disorder. Benzodiazepines may be used for severe anxiety or panic attacks that haven’t improved on other medications, but are used sparingly, due to their risks of dependence, memory problems, and behavioral disinhibition. Often, once mood has stabilized on Bipolar Medication, anxiety improves as well, and anxiolytics may be discontinued.

Sleep Medications

People with Bipolar Disorder often have difficulty sleeping, particularly during manic and hypomanic episodes. Sleep often improves when mood regulates due to treatment with Mood Stabilizers and Antipsychotics, but not always sufficiently. Insufficient sleep increases risk for additional mood episodes in Bipolar Disorder, so ongoing treatment with additional sleep medication is sometimes necessary. Gabapentin, hydroxyzine, and low dose quetiapine are often used for this purpose. Hypnotics such as eszopiclone may be used for severe insomnia that does not respond to other treatments, but are used sparingly due to the risk of dependence. Good sleep hygiene is also helpful.

Treatment Resistant Bipolar Disorder

Ketamine Assisted Therapy and TMS can be used as adjunctive treatments for treatment resistant depressive episodes in Bipolar Disorder.

Integrative Treatment for Bipolar Disorder

Psychotherapy, exercise, meditation, yoga, supplements, and vitamins can also be very helpful in managing Bipolar symptoms and improving overall wellness.

At Owl & Eagle Health and Wellness, our board-certified psychiatric nurse practitioners provide personalized holistic treatment for Bipolar Disorder that can effectively manage Bipolar symptoms and help people with Bipolar Disorder achieve optimal mental health, well-being, and quality of life.  

If you would like to learn more about psychiatric evaluation and holistic psychiatric treatment for Bipolar Disorder in children, teens, and adults at Owl & Eagle Health and Wellness, Contact Us with questions or Book Now  to request an intake appointment today. Appointments are available either in-person at our offices in Golden or Greenwood Village, Colorado, convenient to the Denver Metro area, or via telehealth anywhere in Colorado. We look forward to meeting you!

Sources

https://www.nami.org

https://www.nimh.nih.gov/

https://www.samhsa.gov/

https://www.mentalhealth.gov/basics/mental-health-myths-facts

https://mhanational.org/mentalhealthfacts

https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Bipolar-Disorder