Do you feel like your mood changes considerably?  Do you have a cycling of mood changes from extreme highs to extreme lows? If this is the case, you might have bipolar disorder. Bipolar disorder affects 2-7% of population. There are two types of bipolar disorder — bipolar disorder type I and bipolar disorder type II, the latter being less severe.  Bipolar I disorder was formerly known as manic-depressive illness, due to the presence of both mania as well as depression. Sometimes the mania and the depression alternate, but they may also occur simultaneously. Not everyone who is depressed or manic experiences every symptom.  Some people experience a few symptoms, some many. Severity of symptoms varies with individuals and also varies over time.

Bipolar I Disorder

Bipolar I Disorder requires the occurrence of at least one manic episode and at least one episode of major depression.

Mania : Irritability, impulsivity or insomnia: The highs are considered “mania” and include: 

• Abnormal or excessive elation
• Unusual irritability
• Decreased need for sleep
• Grandiose notions
• Increased or rapid talking and flight of ideas
• Racing thoughts
• Increased sexual desire
• Markedly increased energy
• Poor judgment
• Inappropriate social and sexual behavior 
• Impulsivity

Depression: Sadness, fatigue or low energy. The lows include symptoms of major depression, including:

• Persistent sad, anxious, or "empty" mood
• Feelings of hopelessness, pessimism 
• Feelings of guilt, worthlessness, helplessness
• Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
• Decreased energy, fatigue, being "slowed down"
• Difficulty concentrating, remembering, making decisions
• Insomnia, early-morning awakening, or oversleeping
• Appetite and/or weight loss or overeating and weight gain
• Thoughts of death or suicide; suicide attempts
• Restlessness, irritability
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain 

The mood changes are sometimes gradual, but can often be dramatic and rapid—a condition known as rapid cycling.  During a manic episode, you might feel extremely talkative with high energy, which can affect your judgment and behavior.  This can lead to negative and serious consequences, such as spending too much money, losing your entire life savings in a gambling spree, abusing substances, or engaging in risky behavior. In severe conditions, mania or depression can sometimes be accompanied by psychotic thinking.

Bipolar II Disorder 

Bipolar II disorder is considered to be milder than bipolar I disorder. Bipolar II disorder is characterized by at least one hypomanic episode and at least one episode of major depression. A hypomanic episode is similar to a manic episode but does not last as long and may have symptoms which are less severe.

Often neither the patient nor the therapist is aware of the presence of a bipolar disorder, especially if a manic episode has not yet occurred.  It is very common for one or more episodes of depression to occur prior to the occurrence of a manic episode. In fact, it may be years before a manic episode even occurs. As a result, many individuals who are diagnosed with depression will actually turn out to have bipolar disorder. It is important to arrive at the correct diagnosis since the two conditions are treated with different medications.   

What causes bipolar I and bipolar II disorder?

Your bipolar I or bipolar II disorder could be caused by several factors.  One thing to consider is your family history.  Has your mother, father, grandmother, grandfather, brother, sister, had mood swings or battled depression?  If anyone in your family has been affected by these conditions, you may be biologically predisposed to developing this illness.  Whether you have inherited bipolar disorder or not, mania and depression are often associated with changes in brain chemistry, and can be modified with treatment. 

If you have a pessimistic view of the world, are easily stressed, or have low self-esteem, you might be prone to depression.  These may be a personality characteristics or signs of an early form of depression. If you are impulsive, hyperactive and distractible, you may have ADHD.  ADHD is a learned behavior or a symptom of an underlying bipolar disorder. If these characteristics negatively affect your daily functioning and your interaction with others, you may have a form of bipolar disorder.  A licensed mental health professional can help you sort this out.

Treatment for Bipolar Disorder 

There are many new effective treatments for both bipolar I and bipolar II. Psychotherapy, in conjunction with medication, is very effective in treating both types of bipolar disorder.  It is important for an individual with symptoms of bipolar disorder to seek psychotherapy as soon as possible from a licensed psychologist, psychotherapist, psychiatric nurse practitioner or psychiatrist.  The sooner the issues are addressed, the sooner the individual can return to their former higher functioning level. In a confidential, supportive, non-judgmental atmosphere, psychotherapy or counseling can help the individual with bipolar disorder to gain awareness, achieve positive behavioral change, and improve functioning in academic settings, at work, and in relationships.

If you feel or suspect that you may have bipolar I disorder or bipolar II disorder, you should call a licensed mental health professional who can help you assess your symptoms and concerns.  You and your psychologist or psychotherapist can decide on the best course of treatment.  You might embark on a course of psychotherapy known as Cognitive Behavioral Therapy (CBT).  CBT can help you change your cognitions (patterns of thinking) so that your negative, depressing, or helpless thoughts will become more realistic, positive, and optimistic. Through the process of psychotherapy, your depressed feelings, symptoms, and behaviors will lessen and will be replaced by ones which are more functional, healthy, proactive, and optimistic. Other types of psychotherapy that help reduce the symptoms of bipolar disorder include interpersonal psychotherapy, family psychotherapy, and integrative psychotherapy. 

During the course of your psychotherapy or counseling, you and your therapist may decide that you should have a general physical and blood work to make certain you are in good health.  Bipolar patients usually benefit enormously from medication, because it helps to alleviate many of the bothersome symptoms associated mania and depression.  The medication prescribed for you is decided upon by you and your therapist.  Some individuals do not wish to take medication and pursue psychotherapy as their only form of treatment. Others want medication only.  However, most of the time patients with bipolar disorder benefit from a combination of medication and psychotherapy. For medication management, you may receive treatment from your therapist, or your therapist will recommend a psychiatric nurse practitioner or psychiatrist, who you will see monthly while you continue your weekly psychotherapy sessions.

Your specific treatment depends on your particular evaluation, diagnosis and preference. Mild bipolar II disorder may be able to be treated with psychotherapy alone, while moderate to severe bipolar disorder is usually treated with a combination of medication and psychotherapy. When psychotherapy is augmented with medication, the medication can often hasten remission of the symptoms of the bipolar disorder. Usually psychotherapy and medication work in conjunction to help the individual.

If the description above sounds like you or someone you know, and you would like more information about treatment for bipolar disorder, or if would like to make an appointment, call our office today to speak to someone. Our telephone number is 212-996-3939.