Doctor Q&A: Bipolar Disorder

Dr. Jerry Kennard, psychologist and Associate Fellow and Chartered member of the British Psychological Society, provides some expertise and insight into the diagnosis and treatment of Bipolar Disorder.

What causes bipolar disorder?

We don’t really know but current wisdom suggests interplay between physical and environmental factors. For example, although no single gene is responsible for bipolar there is evidence that it runs in families. Chemical imbalances in the brain are also influential. Too much or too little of certain brain chemicals (neurotransmitters) can result in either depression or mania.

What is the difference between Bipolar I and Bipolar II?

Symptoms are the key, although the distinction isn’t always that clear cut. The central feature of bipolar I is mania and this is usually severe enough to require hospitalization. People with bipolar I disorder have experienced at least one episode of mania and usually depression. Bipolar II may be diagnosed if the person experiences a less severe form of mania called hypomania. Again, hypomania and depression are the main characteristics and the intensity of the highs is not severe enough to lead to hospitalization. Sometimes the dividing line between care at home and hospitalization may be quite thin and may depend upon the level of support available.

Bipolar II is sometimes wrongly considered a milder form of bipolar disorder. An episode of bipolar is equally severe whether you are diagnosed as bipolar I or II. There is some evidence that suggests episodes of depression are more severe and more frequent in people with bipolar II.

What medications help treat bipolar disorder?

A variety of medications are available but it may take a little time before you settle on what’s best for you. Mood stabilizing medications are the cornerstone treatment but other medications can be used to help control psychotic symptoms and sometimes these are combined within a single tablet. Many people with bipolar disorder experience symptoms of anxiety so it is not unusual for the symptoms to be treated with medication. Antidepressant medication is usually avoided where possible as it may trigger manic episodes. Depending on your symptoms antidepressants may be recommended and carefully monitored.

What should I do if I have a manic episode?

This is often one of the most difficult areas for the patient and those around them. For the patient the question is why, when you’re feeling so good, so full of energy and great ideas would you need treatment? The answer is the effect this behavior has. Hypomania and mania are characterized by a lack of impulse control that can lead to destructive, disinhibited and high-risk behaviors.

Manic episodes can take months to develop or they can appear within just a couple of days. Your first ever episode may be extremely difficult to predict. You may be buzzing with optimism, sleep less and feel more impatient with the apparent slowness of things around you, but it’s really only with the benefit of hindsight that your emotional and behavioral changes start to mean something.

In order to head off potential problems at a future date it can help if you devise a plan with the support of loved ones and your doctor. Reflect on what happened during your first episode and take practical measures. For example, if you blew your savings and racked up credit, try to ensure this can’t happen again. If your thoughts were leading in a certain direction (big plans, radical lifestyle change etc.) try to monitor these. Perhaps you were expressing grandiose ideas that involved special abilities? Your plan might include such things being monitored and could also involve a loved-one contacting your dortor. Consider keeping a mood diary so you can predict change.

How can psychotherapy help with bipolar disorder?

Psychotherapy can be very useful. It can help to put your symptoms into context and help to define the parameters of the disorder. A therapist can work with you to devise methods for self-observation and will show you important self-help techniques for stress management and stress reduction. Accepting a diagnosis of bipolar disorder can be difficult. Some people resist, some become too accepting and feel disabled as a result. Psychotherapy can help you and sometimes a loved-one and other family members feel a sense of mastery over the situation rather than become victims of it.

How often should I see a therapist?

This is something to negotiate with your therapist(s). In the early stages following a diagnosis you may feel most benefit from regular weekly meetings, for example. These days it isn’t always necessary to meet face-to-face and a telephone or video communication may be acceptable. Different therapists offer different support so your family doctor may ask to see you less often than your counselor or psychologist.

Are there any programs or alternative options to help me manage bipolar disorder?

People who manage their bipolar disorder best will often point out that it’s a lifetime and lifestyle issue. Medication and therapy helps a lot but your own choices and behaviors can help lessen or possibly even prevent bipolar episodes from developing.

Our Western diet of red meats, fats, sugars and simple carbohydrates are not known to influence bipolar disorder directly but a more nutritious diet may help to reduce stress and improve overall health, thus reducing the risk of possible triggers. Fatty fish (mackerel, trout, salmon) a couple of times a week combined with complex carbohydrates (whole-grain breads, beans, vegetables) is far more beneficial for overall health. Avoiding alcohol, smoking, drugs, and even stimulants like coffee are important considerations.

A regular and predictable pattern is important if you are to reduce triggers. Sleep regularly, exercise regularly, eat well and keep stress levels down.
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