What are the signs of Bipolar Disorder and Treatment Options?

After learning I was bipolar I, a maniac-depressive disorder associated with severe mood swings, I tried to commit suicide. Subsequently I temporarily lost custody of my son. After consulting with my psychiatrist we decided that in addition to medication, I needed intensive outpatient therapy. For the next couple of months I was admitted as an outpatient in a treatment program where I would learn about my disorder and treatment options.

Bipolar Disorder is a complex illness marked by dramatic and unpredictable mood swings.

Mania symptoms include excessive happiness, excitement, irritability, restlessness, increased energy, less need for sleep, racing thoughts, high sex drive, and a tendency to make grand and unattainable plans.

Depression Symptoms include sadness, anxiety, irritability, loss of energy, uncontrollable crying, change in appetite, increased need for sleep, difficulty making decisions and thoughts of death or suicide.

Forms of therapy for Bipolar Disorder

Specific to bipolar, cognitive behavior therapy is individual therapy that focuses on identifying unhealthy, negative beliefs and behaviors and replacing these with healthy, positive ones. It can also help identify what triggers bipolar episodes and help the patient to learn effective strategies to manage stress and cope with upsetting situations, according to the Mayo Clinic. "A number of triggers can set off or worsen bipolar episodes," says Michael First, MD, a professor of clinical psychiatry at Columbia University and first attending psychiatrist at New York Presbyterian Hospital.

The most common triggers for bipolar mood swing are: stress, lack of sleep, erratic schedules, caffeine and alcohol, certain medications (such as antidepressants and corticosteroids), seasonal changes (for example: winter can worsen depression while summer can increase risk of mania), stopping bipolar medication(s), thyroid problems, and substance abuse, according to Everyday Health.

Psychoeducation is counseling to help the patient and their family and friends understand bipolar disorder. It is important for the patient, as well as family and friends to recognize the warning signs of mood swings. Family therapy involves visiting with a psychologist or other mental health provider along with the patient's family members. Family therapy can help identify and reduce stress within your family and help the patient's family learn how to communicate better, solve problems and manage conflicts, according to the Mayo Clinic.

Other forms of therapy include transcranial magnetic stimulation and Electroconvulsive therapy (ECT). The former treatment applies rapid pulses of a magnetic field to the head. However, according to the Mayo Clinic, not enough research has been performed on this treatment to provide clarity of its benefits and even how it helps.

ECT can be effective for those individuals who have episodes of severe depression or feel suicidal or those who have not seen improvements of symptoms despite treatment. With ECT, electrical currents are passed through the individual's brain. Although researchers do not fully understand how the process works, it is thought that the electric shock causes changes in brain chemistry that lead to improvements in mood.


Since the 2nd century, when the idea of the relationship between mania and melancholia was described by Soranus of Ephesus (98-177AD) as a distinct disease the medical industry has researched and provided bipolar patients with a vast array of medications to help with the symptoms. According to Bipolar 101 - A Practical Guide to Identifying Triggers, Managing Medications, Coping with Symptoms, and More, "bipolar disorder is a complex disease that requires medications that often are accompanied by close monitoring of blood levels. A successful medication regimen typically involves trial and error, and demands a close relationship with your medical doctor."

"After World War II, John Cade, an Australian psychiatrist, was investigating the effects of various compounds on veteran patients with manic depressive psychosis. In 1949, Cade discovered that lithium carbonate could be used as a successful treatment of manic depressive psychosis," according to Wikipedia. It was not until the 1950s, U.S. hospitals began experimenting with lithium on patients. By the mid-60s, reports started surfacing regarding lithium's effectiveness and by the 70s, the U.S. Food and Drug Administration had approved the drug.

Lithium carbonate is a chemical compound of lithium, carbon, and oxygen with the formula Li2CO3. This colorless salt is widely used in the processing of metal oxides, according to Wikipedia. The drug has been recognized as effective in stabilizing mood and preventing the extreme highs and lows of bipolar disorder. Periodic blood tests are required, since lithium can cause thyroid and kidney problems. Common side effects include restlessness, dry mouth, and digestive issues, according to the Mayo Clinic.

Anticonvulsants: "The mood stabilizing medications include valproic acid (Depakene, Stavzor), divalproex (Depakote) and lamotrigine (Lamictal)," according to the Mayo Clinic. The clinic also states that the medication asenapine (Saphris) may be helpful in treating mixed episodes. Common side effects include weight gain, dizziness and drowsiness.

Antipsychotics: For those who do not respond well to anticonvulsants, certain antipsychotic medications may fair better. These include, aripiprazole (Abilify), onlanzapine (Zyprexa), risperidone (Risperdal) and quetiapine (Seroquel). Although side effects depend on the medication the most common in this class of drugs include, weight gain, sleepiness, tremors, blurred vision and rapid heartbeat.

The first medication my psychiatrist and I agreed upon, mainly because I was highly against taking anything that may make me gain weight, was the anticonvulsant Trileptal (oxcarbazepine). I started at a low dose, and waited a couple weeks for the medication to control the racing thoughts and help me sleep but that miracle never did occur. Hence, my psychiatrist added abilify at the lowest dose and I almost immediately started feeling a lift in spirits.

I was still experiencing several episodes a week of highs and lows, so we gradually increased the dosage until I got to a dose that made me hallucinate. Yes, my first ever hallucination brought on by a legal substance. After the "episode" I called my pharmacist and she said that the dosage was probably too high for me and to cut back. Since completing intensive outpatient therapy and now back on a low dose of Abilify I have had no manic or depressive episodes, knock on wood.

Antidepressants: Although antidepressants can trigger manic episodes in bipolar patients, this class of drugs may be beneficial when taken along with a mood stabilizer. The most common antidepressant side effects include reduced sexual desire and problems reaching orgasm.

Benzodiazepines: These are in a class of drugs called anti-anxiety medications and can help to improve sleep. Examples according to the Mayo Clinic include clonazepam (Klonopin), lorazepam (Ativan), diazepam (Valium), chlordiazepoxide (Librium) and alprazolam (Niravam, Xanax). These are typically used only a short-term bases as they are potentially habit forming.

Written by : Kelly Adams Dennis, United States

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Edited by: Rajesh Bihani ( Find me on Google+ )

Disclaimer: The suggestions in the article(wherever applicable) are for informational purposes only. They are not intended as medical or any other type of advice