Treatment for Bipolar Disorders in North Kingstown

Bipolar disorder, previously called manic-depression, is a mental disorder characterized by periods of elevated mood, fluctuating with periods of depressed mood. This is a rather simplistic explanation for a very complicated disorder that can have a variety of presentations.  We know of many celebrities who have talked openly about their struggles with this disease, including Ernest Hemingway, Jane Pauley, George Stephanopoulos, Selena Gomez, Catherine Zeta-Jones, and Carrie Fisher: in addition, many many artists have suffered from this disease (Touched with Fire by Kay Jamison is a wonderful book on this subject matter).

To be diagnosed as having bipolar disorder, all that is required is one manic episode, meaning one week of three or more of the following symptoms:

• Distractibility
• Irritability
• Grandiosity
• Fast speech
• Decreased need for sleep
• Increased in goal-directed activity
• Excessive involvement in activities that have a high potential for painful consequences (gambling, substance abuse, driving fast, promiscuity)
• Racing thoughts or flight of ideas
• Losing touch with reality may also be present

Most patients will proceed into having a depressive episode, which is five or more of the following for at least 2 weeks:

• Sad mood
• Lack of interest
• Guilt
• Low energy
• Poor concentration
• Changes in appetite
• Changes in sleep patterns
• Feelings of worthlessness
• Feeling slowed
• Suicidal thoughts
• Lack of libido

Patients with a variant called bipolar II disorder will have hypomanic episodes that do not experience the severe highs of Bipolar I disorder. Patients with cyclothymia will have periods of hypomania followed by periods of depression that do not meet full criteria for a depressive disorder. Patients with Bipolar disorder may also have mixed states, where periods of mania and depression are present at the same time. 

The typical presentation comes out when patients are in their teens or early 20’s though it can come out before or after. At times, someone who is predisposed to it may be started on an antidepressant, and this can trigger a manic or mixed state. There is a strong genetic component to it, as evidenced by the fact that it runs in families and identical twins have a higher rate of both having it than fraternal twins.

Like other disorders, treatment is composed of both medications and therapy.  The first line treatment is the use of mood stabilizers, which prevent both manic and depressive episodes. The first line treatment is Lithium, which is simply a salt that has been used since the 1870’s, but is a nearly miraculous medication that prevents these episodes (it even used to be in Seven Up, whose original name is  "Bib-Label Lithiated Lemon-Lime Soda".).  Other medications include Depakote, Tegretol, Lamictal and second generation antipsychotics such as Seroquel, Risperdal, Abilify, Zyprexa, Vraylar and Latuda. In severe, treatment-refractory cases, electroconvulsive therapy might be used (it’s very effective). Psychotherapy is also important; there are many things that patients can do to help manage their symptoms and prevent manic or depressive episodes from occurring (including use of blue-light blocking glasses and light boxes). We often try to involve someone in the patient’s life with whom they are close, because they can help the patient recognize when something is amiss, often earlier when the patient can.

This once debilitating illness can often be well managed now, and new treatments are being developed all the time.

The only way to know if you’re bipolar is to get a diagnosis from a licensed professional. In order to be diagnosed, you must have had at least one manic or hypomanic episode.

During a manic or hypomanic episode, you are likely to experience three or more of the following symptoms:

• Feeling unusually upbeat, jumpy, or wired
• Increased activity, energy, or agitation
• Exaggerated sense of well-being and self-confidence (euphoria)
• Decreased need for sleep
• More talkative than usual
• Racing thoughts
• Increased distractibility

Some people may suspect that they have bipolar disorder, but not everyone who has bipolar disorder knows they have it or is in a place where they can admit to themselves that they need to seek treatment.

Yes, it is possible that your bipolar disorder may worsen as you get older, particularly if the condition is left untreated. You may experience episodes that are either more severe or more frequent than when you first started having symptoms.

Some people with bipolar disorder experience psychotic symptoms, like hallucinations or delusions, during manic or depressive episodes, but this does not mean that you have schizophrenia.

Carrie Fisher, most famously known for her role as Princess Leia in the Star Wars movie franchise, was diagnosed with bipolar disorder at the age of 24. She wrote her acclaimed 1987 novel, Postcards From The Edge, while she was in rehab after a near-fatal drug overdose.

We know that bipolar disorder may be genetic, with about one in 10 children who have a parent with bipolar disorder developing the illness themselves.

Bipolar disorder can be diagnosed at any age, but it most often develops between the ages of 15 and 19, and rarely develops after the age of 40. Men and women of all ages, from all backgrounds are equally likely to have bipolar disorder.

Bipolar disorder is considered a disability under the American Disabilities Act, just like multiple sclerosis or blindness. If your symptoms prevent you from working, you may qualify for Social Security benefits.

Bipolar disorder is a serious mental illness, causing dramatic mood changes from happy and active to hopeless and inactive, then back again. Many people with bipolar disorder experience no other moods in between.