Bipolar Disorder (Manic Depression): Treatment and Therapy

Bipolar disorder is a mental health condition in which a person experiences highs and lows in mood. The lows are depression, and the highs are called mania. This is why, until the 1980s, the condition used to be called manic depression, and before then, someone with the condition was often referred to as manic depressive.

However, at that time, the complexities of the disorder were not fully known. As these came to be discovered and considered by clinicians, the name of the disorder began to change to reflect the different forms of bipolar disorder.

The term bipolar is often used in layman’s speech, but it is often used inaccurately. A person may think they have bipolar disorder when they actually mean that they experience a normal change in emotions throughout the day, such as going from happy to sad or from angry to happy.

On the other hand, bipolar disorder diagnoses do not consider emotion alone. Episodes of mania are not about emotion but, rather, heightened mood and energy that could lead to actions resulting in negative consequences.

Understanding the Types: Bipolar I vs II

Bipolar I disorder and bipolar II disorder differ in terms of the presence of depression and the duration and intensity of mania.

Bipolar I Disorder

Bipolar I disorder is characterized by the occurrence of at least one manic episode. The person may or may not have had a depressive episode. A manic episode is a period of at least one week during which most of the day, every day, the person experiences an extremely irritable mood and intensely high energy. This leads to impairment in work or relationships.

In addition, more than three of the following symptoms must be present during a manic episode:

Decreased need for sleep
Grandiose sense of self
Excessive engagement in high-risk behaviors that the person later regrets
Intense goal-directed activity or agitation (high activity with no purpose)
Racing thoughts
Significant increase in talkativeness
Easy distraction by unimportant things

Bipolar I disorder varies in severity. Clinicians may classify it as mild, moderate or severe. The greater the number of symptoms that are present, the higher the severity of the disorder.

An example of someone experiencing a manic episode would be that every day for one week, even after only two hours of sleep each night, they try to complete multiple projects, are very talkative, and go on expensive shopping sprees.

A severe example of bipolar I disorder would be a person who, for three weeks, on little sleep, believes themselves to be invincible, has unprotected sex with multiple partners, experiences racing thoughts, is very talkative, and requires hospitalization because of excessive alcohol consumption.

Bipolar II Disorder

Bipolar II disorder is defined by having had at least one hypomanic episode. A hypomanic episode has the same potential symptoms as those of a manic episode listed above. However, the duration is shorter—at least four consecutive days rather than seven consecutive days.

A diagnosis of bipolar II disorder also requires the person to have had one depressive episode. This is characterized by at least two weeks of five or more of the following symptoms most of the day nearly every day:

Depressed mood
Lack of interest or pleasure in most activities
Significant weight loss or gain, or significant increase or decrease in appetite
Sleeping too little or too much
Significant physical and emotional agitation, or lulling
Excessive feelings of worthlessness or inappropriate guilt
Fatigue
Problems with concentration or indecisiveness
Recurrent thoughts of death or suicidal ideation, having made a suicide attempt, or having a specific plan for suicide

Like bipolar I disorder, bipolar II disorder can be designated as mild, moderate, or severe. Unlike in bipolar I disorder, hypomanic symptoms do not cause occupational or social impairment.

In addition, psychotic symptoms—delusions or hallucinations—can be present in both bipolar I and II, but they are less frequent in bipolar II disorder. However, this does not mean that bipolar II disorder is milder than bipolar I disorder; depressive episodes can be severe enough to cause functional impairment.

One example of bipolar II disorder symptoms would be five consecutive days during which the person has racing thoughts, is easily distracted, and has an inflated sense of self. At the same time, the symptoms are not to the extent that they negatively affect their work or relationships.

This hypomanic episode is then followed by a depressive episode that can interfere with their work and relationships and can lead to thoughts of suicide.

It is important to note that many of the symptoms of mania/hypomania and depression can be observable to others. They do not have to be experienced solely internally by the person affected.

FAQs

What Does “Bipolar” Mean?

Bipolar is something that exists in opposite extremes. In the case of mental health, bipolar disorders are brain diseases in which mood fluctuates from one extreme (mania) to another (depression).

Bipolar depression refers to depressive episodes within bipolar disorder as opposed to unipolar depression, or major depressive disorder where the person does not experience mania or hypomania. Because of the extreme highs and lows of bipolar disorder, bipolar depression can feel especially low in contrast to the manic or hypomanic episode the person just had.

Can Bipolar Disorder Go Away Without Treatment?

No, bipolar disorder cannot go away on its own. Treatment is important to help the person feel better and includes medication and psychotherapy.

How is Bipolar Disorder Diagnosed?

Bipolar disorder is diagnosed by a health professional with training, certification, and competency in the American Psychiatric Association’s The Diagnostic and Statistical Manual of Mental Health Disorders. These include professionals with the credentials of a medical doctor (MD), Doctor of Philosophy in psychology (PhD), Doctor of Psychology (PsyD), and nurse practitioners (NPs).

What’s the Difference Between Bipolar I and Bipolar II?

Bipolar I disorder involves the presence of at least one manic episode, and the person may or may not have had a depressive episode. Mania tends to be more severe in bipolar I compared to bipolar II, and there is potential for high-risk activity that could necessitate hospitalization.

Bipolar II disorder requires the presence of at least one hypomanic episode and one depressive episode. Hypomania does not last as long as a manic episode in bipolar I disorder, and it also does not cause functional impairment. However, depressive episodes in bipolar II disorder can be debilitating.

Can Therapy Help with Bipolar Disorder Without Medication?

While therapy can help with strengthening coping skills like making and receiving interpersonal support, the first-line treatment for controlling symptoms of bipolar disorder is medication.

Are There Natural Treatments for Bipolar Disorder?

Alternative and complementary therapies do exist, but they are not approved by the U.S. Food and Drug Administration (FDA) to treat bipolar disorder. However, people may consider options like yoga, tai chi, and relaxation techniques to manage stress and foster overall wellness.

Common Bipolar Disorder Symptoms

Among those with bipolar disorder, the condition tends to initially present with a depressive episode. Further, people with the disorder spend more time in depression than they do in experiencing elevated or mixed symptoms.

Suicidal ideation and inability to experience pleasure are common depressive symptoms in bipolar disorder.In terms of manic symptoms, inflated self-esteem, irritability, impulsivity, and decreased need for sleep are most common.

Bipolar Disorder Medication and Treatment Options

Medication is the first-line treatment for bipolar disorder, and psychotherapy for bipolar disorder is most effective when combined with medication. Also, therapy and pharmacological treatment plans are individualized to meet a person’s unique needs.

Common bipolar disorder medications fall into these three types:

Mood stabilizers, like lithium, divalproex, and carbamazepine
Antipsychotics, such as clozapine, risperidone, and olanzapine
Antidepressants, like fluoxetine, sertraline, duloxetine, and amitriptyline

Find Therapy to Help Manage Bipolar Disorder

Psychotherapy can be important for helping those with bipolar disorder regulate emotions, use healthy coping skills, and increase their knowledge of the disorder and how they are impacted by it. Family therapy can also help family members better understand their loved one’s condition and how to support them.

A few different therapy strategies can be used in the treatment of bipolar disorder.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy (CBT) is based on the idea that a person’s thoughts, behaviors and emotions are interrelated. Thoughts, or core beliefs about self and the world, are often formed early in life.

CBT helps a person to reform those thoughts to engage in healthier behaviors and experience more positive emotions. CBT can help someone with bipolar disorder learn coping skills and realize that they no longer have to hold on to unhelpful beliefs they learned earlier in their life.

Interpersonal Therapy (IPT)

Interpersonal therapy (IPT) is based on the idea that a person’s difficulties are rooted in how they relate to others. IPT focuses on enhancing interpersonal connection and communication so that the person is able to experience a more enriching life through more fulfilling relationships.

Dialectical Behavior Therapy (DBT)

DBT is a structured and didactic form of therapy that is broken up into modules that focus on different skills. These modules include emotion regulation, mindfulness, interpersonal communication and distress tolerance.

Reach Out Today

Bipolar disorder can be difficult and distressing for the person experiencing it and for their loved ones. It is never too late to seek help. Treatment is available to manage symptoms, enhance quality of life, and maintain recovery.